1
|
Grinsill R, Kolandaisamy M, Kerr K, Varker T, Khoo A. Prevalence of Complex Post-Traumatic Stress Disorder in Serving Military and Veteran Populations: A Systematic Review. Trauma Violence Abuse 2024:15248380241246996. [PMID: 38651819 DOI: 10.1177/15248380241246996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Serving military personnel and veterans are known to be at elevated risk of post-traumatic stress disorder (PTSD), and some veterans have been shown to respond poorly to current standard treatments. Evidence so far suggests that according to the 11th edition of the International Classification of Diseases and Related Health Problems guidelines, complex PTSD (CPTSD) may be of higher prevalence in the general population than PTSD. The aim of the study was to investigate the prevalence of CPTSD compared to PTSD in serving and ex-serving military populations. A systematic review was conducted with the search criteria set to peer-reviewed English language journal articles, focusing on serving military or veteran populations, reporting on the prevalence of CPTSD, not restricted by year. Four comprehensive databases (Psycinfo, Pubmed, CINAHL, and Embase) were searched. Of the 297 identified articles, 16 primary studies were eligible for inclusion. The review was registered in the PROSPERO database (CRD42023416458), and results were reported based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of the 16 studies, 13 demonstrated higher prevalence of CPTSD than PTSD. Studies were predominantly veteran focused. Prevalence of CPTSD ranged from 5% to 80.63%, while prevalence of PTSD ranged from 3.8% to 42.37%. There was high heterogeneity in study populations, preventing meta-analysis. This is the first systematic review to assess the prevalence of CPTSD in serving military and veteran populations, with the findings demonstrating a higher rate of CPTSD compared to PTSD. It is hoped that the review will assist clinicians and military and veteran health services with appropriate assessment, diagnosis, and intervention for those affected by CPTSD, as well as PTSD.
Collapse
Affiliation(s)
| | | | - Katelyn Kerr
- Toowong Private Hospital, QLD, Australia
- Australian Institute for Suicide Research and Prevention, Griffith University, Mt Gravatt, QLD, Australia
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, QLD, Australia
- Savoir Rooms Specialist Medial Practice, Milton, QLD, Australia
| | - Tracey Varker
- Phoenix Australia-Centre for Posttraumatic Mental Health, University of Melbourne, Carlton, VIC, Australia
| | | |
Collapse
|
2
|
De Jongh A, Hafkemeijer LCS. Trauma-focused treatment of a client with Complex PTSD and comorbid pathology using EMDR therapy. J Clin Psychol 2024; 80:824-835. [PMID: 37058521 DOI: 10.1002/jclp.23521] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/20/2023] [Accepted: 03/25/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVE Complex post-traumatic stress disorder (CPTSD) is a classification within the International Classification of Diseases, 11th Revision (ICD-11) that, besides the DSM-5 symptom clusters of post-post-traumatic stress disorder (PTSD), includes the presence of negative self-concept, difficulties in regulating emotions and relationship skills. The purpose of the present study was to provide guidance on how to deliver Eye Movement Desensitization and Reprocessing (EMDR) therapy in the context of CPTSD, based on current clinical knowledge and the latest scientific research findings. METHOD This paper describes the treatment of a 52-year-old woman with CPTSD and borderline personality disorder for which immediate trauma-focused EMDR therapy was used. RESULTS First, a description of what EMDR therapy entails and some important treatment strategies that the therapist may employ to assist in trauma-focused treatment of clients with CPTSD using EMDR therapy are outlined. CONCLUSION The treatment results are in line with mounting evidence supporting the notion that EMDR therapy is a safe and potentially effective treatment alternative for individuals with CPTSD or personality problems.
Collapse
Affiliation(s)
- A De Jongh
- Psychotrauma Expertise Centre (PSYTREC), Bilthoven, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
- Research Department PSYTREC, Bilthoven, The Netherlands
- School of Health Sciences, Salford University, Manchester, UK
- Institute of Health and Society, University of Worcester, Worcester, UK
- School of Psychology, Queen's University, Belfast, Northern Ireland
| | | |
Collapse
|
3
|
Rusmir M, Rohner SL, Maercker A, Salas Castillo AN, Thoma MV. Predictors and (in-)stability of ICD-11 complex posttraumatic stress disorder in older adults: findings from a longitudinal study in Switzerland. Eur J Psychotraumatol 2024; 15:2299618. [PMID: 38258813 PMCID: PMC10810634 DOI: 10.1080/20008066.2023.2299618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Objective: There is a lack of research on complex post-traumatic stress disorder (CPTSD) in older individuals, with little known about the temporal course of CPTSD. Therefore, this study assessed and compared the demographic characteristics, adverse childhood experiences (ACE), and well-being of Swiss older adults with and without probable CPTSD. The (in-)stability of probable CPTSD was also examined in relation to the predictive value of various emotion-related factors.Methods: A longitudinal study was conducted in Switzerland with N = 213 participants (Mage = 69.98 years, SD = 10.61; 45.5% female). Data was collected via face-to-face assessments at baseline and follow-up, 21 months apart. The German version of the International Trauma Questionnaire was used to screen for (C)PTSD. Standardized instruments were used to assess ACE as well as the predictors anger, embitterment, emotion regulation, and meaning in life.Results: From the total sample, n = 16 participants (7.5%) were identified as having probable CPTSD, with only five of these (31.25%) having probable CPTSD at both baseline and follow-up. Individuals with and without probable CPTSD differed significantly regarding age and employment status. Significant predictors of probable CPTSD were anger (β = 0.16), embitterment (β = 0.06), cognitive reappraisal (β = -0.41), and the presence of meaning in life (β = -0.10).Conclusions: Probable CPTSD appears to be relatively unstable over the course of a 21-month period in older individuals. The links between CPTSD and emotion-related predictors highlight potential targets for intervention.
Collapse
Affiliation(s)
- Milan Rusmir
- Psychopathology and Clinical Intervention, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Shauna L. Rohner
- Competence Centre for Mental Health, Department of Health, OST – University of Applied Sciences of Eastern Switzerland, St. Gallen, Switzerland
- University Research Priority Program ‘Dynamics of Healthy Aging’, University of Zurich, Zurich, Switzerland
| | - Andreas Maercker
- Psychopathology and Clinical Intervention, Institute of Psychology, University of Zurich, Zurich, Switzerland
- University Research Priority Program ‘Dynamics of Healthy Aging’, University of Zurich, Zurich, Switzerland
| | - Aileen N. Salas Castillo
- Psychopathology and Clinical Intervention, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Myriam V. Thoma
- Psychopathology and Clinical Intervention, Institute of Psychology, University of Zurich, Zurich, Switzerland
- University Research Priority Program ‘Dynamics of Healthy Aging’, University of Zurich, Zurich, Switzerland
| |
Collapse
|
4
|
Pinho M, Martins DO, Santos MF, Coutinho F. When Addressing Trauma Makes a Difference: A Case Report of Undiagnosed Complex Post-traumatic Stress Disorder. Cureus 2024; 16:e51640. [PMID: 38313901 PMCID: PMC10837782 DOI: 10.7759/cureus.51640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
Complex post-traumatic stress disorder (C-PTSD) is an emergent diagnosis, which acknowledges the impact of prolonged interpersonal abuse on affect regulation, interpersonal functioning, and self-concept. We present the case of a 59-year-old woman who remained undiagnosed and untreated for this condition for three decades while under follow-up in mental health services for the diagnosis of personality disorder and bipolar disorder. The patient suffered repeated sexual abuse in her childhood, resulting in intrusive traumatic memories she emotionally and cognitively avoided, dissociative amnesia, a persistent inability to experience positive emotions, a persistent sense of guilt, re-experiencing phenomena, and hypervigilance toward others and their intentions to harm her. She persistently believed herself to be worthless, defective, inferior, and lacking value; had a history of affective dysregulation resulting in suspicion of bipolar disorder; and displayed a pattern of relationship avoidance. Addressing chronic trauma and assessing its impact offered deeper contextualization of the patient's symptoms and proved pivotal in redefining her diagnosis and providing access to trauma-focused psychotherapy, which is the mainstay of treatment for C-PTSD.
Collapse
Affiliation(s)
- Mauro Pinho
- Acute Psychiatry Service Unit, Centro Hospitalar Universitário de Santo António - Hospital de Magalhães Lemos, Porto, PRT
| | - Daniela O Martins
- Acute Psychiatry Service Unit, Centro Hospitalar Universitário de Santo António - Hospital de Magalhães Lemos, Porto, PRT
| | - Mónica F Santos
- Acute Psychiatry Service Unit, Centro Hospitalar Universitário de Santo António - Hospital de Magalhães Lemos, Porto, PRT
| | - Francisco Coutinho
- Acute Psychiatry Service Unit, Centro Hospitalar Universitário de Santo António - Hospital de Magalhães Lemos, Porto, PRT
| |
Collapse
|
5
|
Fung HW, Chien WT, Lam SKK, Ross CA. The Relationship Between Dissociation and Complex Post-Traumatic Stress Disorder: A Scoping Review. Trauma Violence Abuse 2023; 24:2966-2982. [PMID: 36062904 DOI: 10.1177/15248380221120835] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Complex post-traumatic stress disorder (CPTSD) has recently been recognized as an official psychiatric diagnosis in ICD-11, after years of research and advocacy in the field. It has been suggested that dissociative symptoms are a major feature of CPTSD. This scoping review aimed to summarize the existing knowledge base on the relationship between dissociation and CPTSD, and to identify relevant research gaps. We searched the two largest and most widely used academic databases (i.e., the Web of Science and Scopus databases) and the ProQuest database and identified original studies published in English relevant to our research questions, namely: (1) Would CPTSD be associated with dissociative symptoms? 2) How common are dissociative symptoms among people with CPTSD? (3) What are the correlates of dissociative symptoms among people with CPTSD? In all, 26 studies were included. We found 10 studies which reported that people with CPTSD scored significantly higher on a dissociation measure than those without CPTSD, and 11 studies reported a positive correlation between CPTSD symptoms and psychoform/somatoform dissociation scores. While very few studies reported the prevalence and correlates of dissociative symptoms among people with CPTSD, there may be a considerable subgroup of people with CPTSD who have clinically significant levels of dissociative symptoms (e.g., 28.6-76.9%). Dissociation may also be associated with other comorbidities (e.g., DSM-IV Axis II features, shame, somatic symptoms) in people with CPTSD. We recommend that more studies are needed to investigate the prevalence of dissociative symptoms among people with CPTSD and examine how these symptoms are associated with other comorbid conditions and clinical needs in this vulnerable group.
Collapse
Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Hong Kong
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Stanley Kam Ki Lam
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Colin A Ross
- The Colin A. Ross Institute for Psychological Trauma, Richardson, Texas, USA
| |
Collapse
|
6
|
Carbone EA, Menculini G, de Filippis R, D’Angelo M, Zebi L, Steardo L. Sleep Disturbances in Panic Disorder with Comorbid Complex PTSD: A Possible Relationship and Different Psychopathology? Life (Basel) 2023; 13:1636. [PMID: 37629493 PMCID: PMC10455867 DOI: 10.3390/life13081636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/13/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Several studies have shown the possible link between trauma and sleep disturbances, particularly in anxiety disorders. This issue could be because sympathetic hyperarousal is central to both disorders, probably caused by a dysregulation of the noradrenergic system. This study aimed to establish if the comorbidity with complex post-traumatic stress disorder (cPTSD) is associated with sleep disturbances in panic disorder (PD) and if the presence of poor sleep quality is associated with a higher psychopathological burden. METHODS Participants (N = 211) with PD completed the International Trauma Questionnaire concerning their most troubling experience, the Hamilton Anxiety Rating Scale (HAM-A), and the Pittsburgh Sleep Quality Index (PSQI) to assess anxiety symptoms and sleep disturbances, respectively. RESULTS The sample was divided into two subgroups based on the presence of cPTSD. No significant differences emerged in the bivariate analyses for what concerns sociodemographic features. As for the scores of the psychopathological scales, the analysis highlighted statistically significant differences between the subgroups. Subjects with cPTSD reported significantly higher HAM-A total scores. As for the disturbances in self-organization (DSO) and PSQI scores, these were all significantly higher in the cPTSD subsample. At the logistic regression, the presence of cPTSD was inserted as the dependent variable, while the PSQI scores of the subscales evaluating subjective sleep quality, sleep duration, sleep efficacy, and the use of hypnotics were used as independent variables. The presence of cPTSD was significantly associated with the PSQI subscores for subjective sleep quality and use of hypnotics. CONCLUSIONS Patients with PD exhibit more severe sleep disturbances and a higher anxiety burden when experiencing prolonged trauma. Therapeutic advances are needed in this field to target these symptomatologic domains.
Collapse
Affiliation(s)
- Elvira Anna Carbone
- Department of Medical and Surgical Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy;
| | - Giulia Menculini
- Department of Psychiatry, University of Perugia, Piazzale Lucio Severi, 1, 06132 Perugia, Italy; (G.M.); (L.Z.)
| | - Renato de Filippis
- Department of Health Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy; (R.d.F.); (M.D.)
| | - Martina D’Angelo
- Department of Health Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy; (R.d.F.); (M.D.)
| | - Leonardo Zebi
- Department of Psychiatry, University of Perugia, Piazzale Lucio Severi, 1, 06132 Perugia, Italy; (G.M.); (L.Z.)
| | - Luca Steardo
- Department of Health Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy; (R.d.F.); (M.D.)
| |
Collapse
|
7
|
Salome G, Vignaud P, Galia P, Prieto N, Chauliac N. Determinants of Care Pathways for C-PTSD Patients in French Psychotrauma Centers: A Qualitative Study. Int J Environ Res Public Health 2023; 20:6278. [PMID: 37444125 PMCID: PMC10341220 DOI: 10.3390/ijerph20136278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/05/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
In 2018, the International Classification of Diseases (ICD-11) established a novel nosographic category within the stress-specific disorders known as complex post-traumatic stress disorder (C-PTSD). Characterized by distinctive clinical attributes and a limited response to conventional PTSD treatments, C-PTSD has prompted the reconsideration of care methods. Our study's purpose was to explore the intricate factors shaping the care pathways for individuals suffering from C-PTSD. We used a grounded theorization technique involving professionals across a range of specialized French psychotraumatology institutions. The resulting comprehensive theoretical model offers valuable insights into the constitution mechanisms of these pathways, helping elucidate the varying care options. Interestingly, we found that differences in clinical perspectives were determined by the care provider's viewpoint on clinical guidelines, screening tools, and treatment options, but also by structural and organizational factors. The distinctive dynamics and interrelationships identified in our research reveal potential areas of focus for incorporating C-PTSD care more effectively into specialized French trauma centers. This investigation offers a path toward improved understanding and management of C-PTSD, ultimately advancing patient outcomes.
Collapse
Affiliation(s)
- Germain Salome
- Centre Régional du Psychotraumatisme Auvergne-Rhône-Alpes, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Philippe Vignaud
- Centre Régional du Psychotraumatisme Auvergne-Rhône-Alpes, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-69003 Lyon, France
- Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, F-69008 Lyon, France
| | - Perrine Galia
- Centre Régional du Psychotraumatisme Auvergne-Rhône-Alpes, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Nathalie Prieto
- Centre Régional du Psychotraumatisme Auvergne-Rhône-Alpes, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Nicolas Chauliac
- Centre Régional du Psychotraumatisme Auvergne-Rhône-Alpes, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-69003 Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290 & Université Claude Bernard Lyon 1, Domaine Rockefeller, F-69008 Lyon, France
| |
Collapse
|
8
|
Greenblatt-Kimron L, Karatzias T, Yonatan M, Shoham A, Hyland P, Ben-Ezra M, Shevlin M. Early maladaptive schemas and ICD-11 CPTSD symptoms: Treatment considerations. Psychol Psychother 2023; 96:117-128. [PMID: 36253922 DOI: 10.1111/papt.12429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/19/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Early maladaptive schemas (EMS) can result from adverse interpersonal traumatic experiences. The ICD-11 updated the concept of disorders following traumatic experiences with the new disorder of complex post-traumatic stress disorder (CPTSD). There is now a need to develop and test interventions for CPTSD. An essential step in identifying interventions that are particularly relevant to the treatment of CPTSD is to explore psychological constructs associated more closely with CPTSD compared to PTSD. The current study explored the associations of EMS with PTSD and CPTSD. DESIGN The sample consisted of 603 adults (mean age = 41.65, SD = 13.8), recruited through social media and e-mails, and who responded to an online questionnaire. METHODS Participants completed measures of demographic, traumatic life events, EMS, PTSD and CPTSD symptoms. RESULTS Overall, results suggest that participants with CPTSD present with higher schema elevations across all schemas compared to those with PTSD or no diagnosis. Secondly, the schemas of emotional deprivation, abandonment/instability, social isolation/alienation, defectiveness/shame, enmeshment/undeveloped self, subjugation, emotional inhibition and insufficient self-control/self-discipline were significantly associated with the symptom clusters of CPTSD. Finally, results indicate that different schemas form significant associations with the individual symptom clusters of CPTSD. CONCLUSIONS Although results require replication in clinical samples, initial findings suggest that specific EMS may be important psychological correlates of CPTSD symptoms. Wider treatment considerations of these findings are discussed.
Collapse
Affiliation(s)
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK.,Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | - Maya Yonatan
- School of Social Work, Ariel University, Ariel, Israel
| | - Adi Shoham
- School of Social Work, Ariel University, Ariel, Israel
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland.,Trinity Centre for Global Health, University of Dublin, Trinity College, Dublin, Ireland
| | | | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, UK
| |
Collapse
|
9
|
Bally K. [Trauma Disorders - A Relevant Health Problem]. Praxis (Bern 1994) 2023; 112:87-91. [PMID: 36722115 DOI: 10.1024/1661-8157/a004000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Trauma Disorders - A Relevant Health Problem Abstract. In medical practice traumatic stress disorders are underdiagnosed. Post-traumatic stress disorder (PTSD) must be considered in case of pronounced need for control, severe anxiety and restlessness, jumpiness, mental torpor, dissociative disorders, social withdrawal, distrust or vegetative over-arousal. Simple screening instruments such as the "Primary Care PTSD Screen" are suitable for an initial assessment. As long as symptoms are not serious and long-lasting and there are no risk factors for the development of severe PTSD, it is a matter of creating external and internal security, informing about possible support, acknowledging the suffering and establishing secure interpersonal relationships. In the case of a pronounced PTSD with considerable psychological strain, a referral for further psychiatric or psychotherapeutic clarification and treatment is appropriate.
Collapse
Affiliation(s)
- Klaus Bally
- Universitäres Zentrum für Hausarztmedizin beider Basel/uniham-bb, Kantonsspital Baselland, Liestal, Schweiz
| |
Collapse
|
10
|
Dokkedahl S, Kristensen TR, Elklit A. Can Women Shelters Help Reduce Symptoms of PTSD and C-PTSD? Trajectories of PTSD Symptom Development Following Partner- and Family-Related Violence. J Interpers Violence 2022; 37:NP22026-NP22046. [PMID: 34986313 DOI: 10.1177/08862605211066568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND To protect women from Intimate partner violence (IPV), women's shelters should not only provide emergency safety from IPV exposure, but also prolonged support that empowers women to build a life free from violence. The present study aims to investigate individual symptom development in association with residency at a women's shelter. METHOD Data were collected at four different timepoints, that is, enrolment (T1, N = 150), 3-months residency (T2, = 110), 6-months residency (T3, N = 68) and after relocation (T4, N = 63). Women were included from four Danish women's shelters. The International Trauma Questionnaire (ITQ) was applied to test for post-traumatic stress disorder (PTSD) and Complex-PTSD (C-PTSD) at all timepoints. A paired sample t-test was used to test the mean symptom development, and a Latent Class Growth Analysis (LCGA) was applied to test for different classes of PTSD-trajectories. Logistic regression was applied to predict class membership from shelter-related variables and symptom severity, that is, length of residency, psychological counselling, revictimization and key symptoms of C-PTSD. RESULTS The prevalence of PTSD (31%) and C-PTSD (37.9%) was high at enrolment. Although t-tests suggested a significant decline in symptoms at follow-up, the LCGA revealed different classes of symptom development. The two-class model was found to be the best representation of data with low-symptom- and high-symptom profiles, respectively. Overall, the largest decline in symptoms occurred within the first 3 months of residency. Revictimization was high and was further found to predict class membership. However, when included in a multiple regression only symptom severity predicted the high-symptoms profile class. DISCUSSION Psychological treatment focussing on PTSD and C-PTSD is important for the women's future well-being and safety. Reports on revictimization was alarmingly high, which emphasises a continuing need to protect women from psychological violence within the shelters. These findings should be replicated in larger samples before we can draw any conclusion.
Collapse
Affiliation(s)
- Sarah Dokkedahl
- Danish National Center of Psychotraumatology, Odense, Denmark
- 6174University of Southern Denmark, Odense, Denmark
- Dannercenterfonden
| | - Trine Rønde Kristensen
- Centre for Persons Subjected to Violence, Center of Social Medicine, Copenhagen University Hospital, 53146Bispebjerg and Frederiksberg Hospital, Kobenhavn, Denmark
| | - Ask Elklit
- Danish National Center of Psychotraumatology, Odense, Denmark
- 6174University of Southern Denmark, Odense, Denmark
| |
Collapse
|
11
|
Reed GM, First MB, Billieux J, Cloitre M, Briken P, Achab S, Brewin CR, King DL, Kraus SW, Bryant RA. Emerging experience with selected new categories in the ICD-11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. World Psychiatry 2022; 21:189-213. [PMID: 35524599 PMCID: PMC9077619 DOI: 10.1002/wps.20960] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Among the important changes in the ICD-11 is the addition of 21 new mental disorders. New categories are typically proposed to: a) improve the usefulness of morbidity statistics; b) facilitate recognition of a clinically important but poorly classified mental disorder in order to provide appropriate management; and c) stimulate research into more effective treatments. Given the major implications for the field and for World Health Organization (WHO) member states, it is important to examine the impact of these new categories during the early phase of the ICD-11 implementation. This paper focuses on four disorders: complex post-traumatic stress disorder, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. These categories were selected because they have been the focus of considerable activity and/or controversy and because their inclusion in the ICD-11 represents a different decision than was made for the DSM-5. The lead authors invited experts on each of these disorders to provide insight into why it was considered important to add it to the ICD-11, implications for care of not having that diagnostic category, important controversies about adding the disorder, and a review of the evidence generated and other developments related to the category since the WHO signaled its intention to include it in the ICD-11. Each of the four diagnostic categories appears to describe a population with clinically important and distinctive features that had previously gone unrecognized as well as specific treatment needs that would otherwise likely go unmet. The introduction of these categories in the ICD-11 has been followed by a substantial expansion of research in each area, which has generally supported their validity and utility, and by a significant increase in the availability of appropriate services.
Collapse
Affiliation(s)
- Geoffrey M Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Michael B First
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Joël Billieux
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals, Lausanne, Switzerland
| | - Marylene Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sophia Achab
- Outpatient Treatment Unit for Addictive Behaviors ReConnecte, Geneva University Hospitals, Geneva, Switzerland
- Psychological and Sociological Research and Training Unit, Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Daniel L King
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
| | - Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
12
|
Crole-Rees C, Forrester A. Developing a clinical pathway for traumatic stress in prisons. Med Sci Law 2022; 62:4-7. [PMID: 35006013 DOI: 10.1177/00258024211072770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Clare Crole-Rees
- Cardiff University and Cwm Taf Morgannwg University Health Board, Pontypridd, UK
| | - Andrew Forrester
- Forensic Psychiatry, Department of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|
13
|
Spikol E, Robinson M, McGlinchey E, Ross J, Armour C. Exploring complex-PTSD comorbidity in trauma-exposed Northern Ireland veterans. Eur J Psychotraumatol 2022; 13:2046953. [PMID: 35386731 PMCID: PMC8979541 DOI: 10.1080/20008198.2022.2046953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Complex posttraumatic stress disorder (CPTSD) describes the results of complex, prolonged, and/or inescapable trauma, and is typified by avoidance, re-experiencing, sense of threat, affect dysregulation, negative self-concept, and interpersonal disturbances. Additionally, CPTSD is highly comorbid with other common psychopathologies. OBJECTIVES A study was conducted in a trauma-exposed UK Armed Forces Veteran population resident in Northern Ireland (N = 638, NI) to determine the prevalence of CPTSD and comorbid associations. METHODS Data from the Northern Ireland Veterans Health and Wellbeing Study (NIVHWS), including self-report data describing traumatic stress, depression, anxiety, and suicidality, were used in a latent class analysis to identify distinct profiles of symptomology in the sample, and in a multinomial logistic regression to identify comorbidities associated with class membership. RESULTS Three distinct classes emerged: a low endorsement 'baseline' class (36%), a 'Moderate Symptomatic' class (27%), and a high endorsement 'Probable CPTSD' class (37%). Both the Moderate Symptomatic and CPTSD classes were predicted by cumulative trauma exposure. Depression was highly comorbid (OR = 23.06 in CPTSD), as was anxiety (OR = 22.05 in CPTSD) and suicidal ideation (OR = 4.32 in CPTSD), with suicidal attempt associated with the CPTSD class (OR = 2.51). CONCLUSIONS Cases of probable CPTSD were more prevalent than cases of probable posttraumatic stress disorder (PTSD) without Difficulties in Self-Organisation (DSO) symptoms in a UK Armed Forces veteran sample, were associated with repeated/cumulative trauma, and were highly comorbid across a range of psychopathologies. Findings validate previous literature on CPTSD and indicate considerable distress and thus need for support in UK Armed Forces veterans resident in NI.
Collapse
Affiliation(s)
- Eric Spikol
- Stress Trauma and Related Conditions (STARC) Research Centre, School of Psychology, Queen's University Belfast, Belfast, UK
| | - Martin Robinson
- Stress Trauma and Related Conditions (STARC) Research Centre, School of Psychology, Queen's University Belfast, Belfast, UK
| | - Emily McGlinchey
- Stress Trauma and Related Conditions (STARC) Research Centre, School of Psychology, Queen's University Belfast, Belfast, UK
| | - Jana Ross
- Stress Trauma and Related Conditions (STARC) Research Centre, School of Psychology, Queen's University Belfast, Belfast, UK
| | - Cherie Armour
- Stress Trauma and Related Conditions (STARC) Research Centre, School of Psychology, Queen's University Belfast, Belfast, UK
| |
Collapse
|
14
|
Levin Y, Bachem R, Palgi Y, Hyland P, Karatzias T, Shevlin M, Ben-Ezra M, Maercker A. Fatalism and ICD-11 CPTSD and PTSD diagnoses: results from Nigeria, Kenya & Ghana. Eur J Psychotraumatol 2021; 12:1988452. [PMID: 34777713 PMCID: PMC8583916 DOI: 10.1080/20008198.2021.1988452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/26/2021] [Accepted: 09/21/2021] [Indexed: 11/11/2022] Open
Abstract
Background Existing research on post-traumatic sequelae suggests a positive association between fatalism and symptoms of post-traumatic stress disorder (PTSD). However, the associations between fatalism and the new ICD-11 diagnosis of complex PTSD (CPTSD) have never been explored before. Objective The current study explored the association between fatalism and PTSD and CPTSD in samples from three African countries. Methods A total of 2,524 participants from Nigeria (n = 1018), Kenya (n = 1006), and Ghana (n = 500) completed measures of fatalism (non-judgemental fatalism, current fatalism, pessimistic fatalism, prospective fatalism) and the International Trauma Questionnaire (ITQ). A combination of a multinomial regression and path analysis was used to identify fatalism predictors of PTSD and CPTSD versus no diagnosis, and CPTSD versus PTSD, adjusted for demographic variables and trauma exposure. Results While PTSD was not predicted by any of the fatalism types, compared to no diagnosis, CPTSD was significantly predicted by pessimistic, non-judgemental and current fatalism, both compared to no diagnosis and PTSD. Conclusions The results broaden the knowledge on potential correlates of the new diagnosis of CPTSD. Addressing fatalistic beliefs by empowering people to think that they can choose their fate should be further explored as a possible target for intervention in the treatment of CPTSD.
Collapse
Affiliation(s)
- Yafit Levin
- Department of Education, Ariel University, Ariel, Israel
| | - Rahel Bachem
- Department of Psychology, Psychopathology and Clinical Intervention, University of Zürich, Zurich, Switzerland
| | - Yuval Palgi
- Department of Gerontology, University of Haifa, Haifa, Israel
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Thanos Karatzias
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland, UK
- Nhs Lothian, Rivers Centre for Traumatic Stress, Edinburgh, Scotland, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | | | - Andreas Maercker
- Department of Psychology, Psychopathology and Clinical Intervention, University of Zürich, Zurich, Switzerland
| |
Collapse
|
15
|
Matheson C, Weightman E. Research and recovery: Can patient participation in research promote recovery for people with complex post-traumatic stress disorder, CPTSD? Health Expect 2021; 24 Suppl 1:62-69. [PMID: 31868308 PMCID: PMC8137490 DOI: 10.1111/hex.13014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 11/09/2019] [Accepted: 12/01/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A new diagnosis of complex post-traumatic stress disorder, CPTSD, has been agreed by the World Health Organization, WHO, and evidence is needed for what psychological treatment might be effective, particularly from those with experience of the disorder. We used a novel participatory approach to explore patient views and simultaneously studied the impact on the patient researchers of the research process itself. In this paper, we report on the latter section of the study how the involvement in research of patients with CPTSD affected their mental health. Symptoms of CPTSD may include emotional dysregulation, feelings of self-worthlessness and difficulties in relationships. OBJECTIVE The aim of this study section was to explore whether patients' mental health could be promoted through empowering them to participate in research on CPTSD. DESIGN The study had a qualitative, participatory design. The clinician who led the research (first author) held group meetings with patient researchers to explore the impact of the research process. The clinician also kept notes on the process in a reflective log. SETTING AND PARTICIPANTS Six patient researchers participated in research with other patients with lived experience of CPTSD in an NHS outpatient unit in a London hospital. INTERVENTION STUDIED The research process itself was analysed in group meetings with researchers which the clinician recorded and transcribed. FINDINGS Participation in research may promote increased self-confidence and social inclusion for those with CPTSD. CONCLUSION Involvement in research may be seen as an empowering intervention because patients felt it contributed to recovery.
Collapse
Affiliation(s)
- Catherine Matheson
- Senior PsychotherapistSouth London and Maudsley NHS Mental Health TrustLondonUK
| | | |
Collapse
|
16
|
Shin YJ, Kim SM, Hong JS, Han DH. Correlations Between Cognitive Functions and Clinical Symptoms in Adolescents With Complex Post-traumatic Stress Disorder. Front Public Health 2021; 9:586389. [PMID: 33996705 PMCID: PMC8113386 DOI: 10.3389/fpubh.2021.586389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 03/31/2021] [Indexed: 01/07/2023] Open
Abstract
Introduction: Complex post-traumatic stress disorder (C-PTSD) is characterized by the typical symptoms of PTSD, in addition to affective dysregulation, negative self-concept, and disturbances in interpersonal relationships. Children and adolescents with C-PTSD have been reported to have deficits in emotional and cognitive functions. We hypothesized that the following are associated with the severity of C-PTSD symptoms: (1) adolescents with C-PTSD who show deficits in emotional perception and cognitive functions, including executive function and attention; and (2) deficits in neurocognitive functions. Methods: Information on 69 adolescents with PTSD, aged 10-19 years, was gathered from seven shelters. All participants were assessed using complete clinical scales, including the C-PTSD Interview and Depression, Anxiety, and Stress Scales, and neurocognitive function tests, including the emotional perception, mental rotation, and modified Tower of London tests. Results: Adolescents with C-PTSD were more likely to have a history of sexual assault, dissociation, and self-harm than those with PTSD. The total and subscale scores of the C-PTSD Interview Scale in adolescents with C-PTSD were higher than that in adolescents with PTSD. In addition, neurocognitive functions, including emotional perception, attention, and working memory, were correlated with the severity of C-PTSD symptoms. Discussion: Adolescents with C-PTSD experienced more serious clinical symptoms and showed more deficits in neurocognitive functions than adolescents with PTSD. Clinicians should pay careful attention toward the emotional and neurocognitive functions when assessing and treating patients with C-PTSD.
Collapse
Affiliation(s)
- Yee Jin Shin
- Department of Psychiatry, Yeonsei University Hospital, Seoul, South Korea
| | - Sun Mi Kim
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, South Korea
| | - Ji Sun Hong
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, South Korea
| | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, South Korea
| |
Collapse
|
17
|
Møller L, Augsburger M, Elklit A, Søgaard U, Simonsen E. Traumatic experiences, ICD-11 PTSD, ICD-11 complex PTSD, and the overlap with ICD-10 diagnoses. Acta Psychiatr Scand 2020; 141:421-431. [PMID: 32049369 PMCID: PMC7317379 DOI: 10.1111/acps.13161] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study investigated the frequency of traumatic experiences, prevalence rates of ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD), and overlap with ICD-10 classified disorders in outpatient psychiatry. METHOD Overall, 165 Danish psychiatric outpatients answered the International Trauma Questionnaire, the Life Event Checklist, and the World Health Organization Well-being Index. ICD-10 diagnoses were extracted from the hospital record. Chi-square analysis, t-tests, and conditional probability analysis were used for statistical analysis. RESULTS Nearly, all patients (94%) had experienced at least one traumatic event. CPTSD (36%) was more common than PTSD (8%) and had considerable overlap with ICD-10 affective, anxiety, PTSD, personality, adjustment and stress-reaction disorders, and behavioural and emotional disorders with onset usually occurring in childhood and adolescence. ICD-11 PTSD overlapped with ICD-10 anxiety, PTSD, adjustment and stress-reaction disorders, and behavioural and emotional disorders with onset usually occurring in childhood and adolescence. A subgroup of patients with ICD-10 PTSD (23%) did not meet criteria for ICD-11 PTSD or CPTSD. CONCLUSION Traumatic experiences are common. ICD-11 CPTSD is a highly prevalent disorder in psychiatric outpatients. One quarter with ICD-10 PTSD did not meet criteria for either ICD-11 PTSD or CPTSD. PTSD and CPTSD had considerable overlap with ICD-10 disorders.
Collapse
Affiliation(s)
- L. Møller
- Psychiatric Research Unit, Region ZealandSlagelseDenmark,Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark,Clinic for Traumatized Refugees, Region ZealandSlagelseDenmark
| | - M. Augsburger
- Division of PsychopathologyDepartment of PsychologyUniversity of ZurichZurichSwitzerland
| | - A. Elklit
- Department of PsychologyNational Centre of PsychotraumatologyUniversity of Southern DenmarkOdenseDenmark
| | - U. Søgaard
- Psychiatric Research Unit, Region ZealandSlagelseDenmark,Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - E. Simonsen
- Psychiatric Research Unit, Region ZealandSlagelseDenmark,Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| |
Collapse
|
18
|
Hyland P, Shevlin M, Brewin CR, Cloitre M, Downes AJ, Jumbe S, Karatzias T, Bisson JI, Roberts NP. Validation of post-traumatic stress disorder (PTSD) and complex PTSD using the International Trauma Questionnaire. Acta Psychiatr Scand 2017; 136:313-322. [PMID: 28696531 DOI: 10.1111/acps.12771] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The 11th version of the International Classification of Diseases (ICD-11) has proposed two related trauma diagnoses: Post-traumatic stress disorder (PTSD) and Complex PTSD (CPTSD). Using a newly developed, disorder-specific measure of PTSD and CPTSD called the International Trauma Questionnaire (ITQ) the current study will (i) assess the factorial validity of ICD-11 PTSD and CPTSD; (ii) provide the first test of the discriminant validity of these constructs; and (iii) provide the first comparison of ICD-11, and Diagnostic and Statistical Manual, Fifth Edition (DSM-5), PTSD diagnostic rates using disorder-specific measures. METHOD ICD-11 and DSM-5 PTSD-specific measures were completed by a British clinical sample of trauma-exposed patients (N = 171). The structure and validity of ICD-11 PTSD and CPTSD were assessed by means of factor analysis and assessing relationships with criterion variables. RESULTS Diagnostic rates under ICD-11 were significantly lower than those under DSM-5. A two-factor second-order model reflecting the distinction between PTSD and CPTSD best represented the data from the ITQ; and the PTSD and CPTSD factors differentially predicted multiple psychological variables. CONCLUSION The factorial and discriminant validity of ICD-11 PTSD and CPTSD was supported, and ICD-11 produces fewer diagnostic cases than DSM-5.
Collapse
Affiliation(s)
- P Hyland
- National College of Ireland, Dublin, Ireland.,Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - M Shevlin
- School of Psychology, Ulster University, Derry, UK
| | - C R Brewin
- Clinical Educational & Health Psychology, University College London, London, UK
| | - M Cloitre
- School of Medicine, New York University, New York, NY, USA.,National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - A J Downes
- St Mark's Dee View Surgery, Betsi Cadwaldr Health Board, Connah's Quay, UK
| | - S Jumbe
- Centre for Primary Care and Public Health, Queen Mary University of London, Research Design Service London, London, UK
| | - T Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK.,Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | - J I Bisson
- School of Medicine, Cardiff University, Cardiff, UK
| | - N P Roberts
- Cardiff & Vale University Health Board, Cardiff, UK
| |
Collapse
|
19
|
Shevlin M, Hyland P, Karatzias T, Fyvie C, Roberts N, Bisson JI, Brewin CR, Cloitre M. Alternative models of disorders of traumatic stress based on the new ICD-11 proposals. Acta Psychiatr Scand 2017; 135:419-428. [PMID: 28134442 DOI: 10.1111/acps.12695] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Although there is emerging evidence for the factorial validity of the distinction between post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) proposed in ICD-11, such evidence has been predominantly based on using selected items from individual scales that describe these factors. We have attempted to address this gap in the literature by testing a range of alternative models of disorders of traumatic stress using a broader range of symptoms and standardized measures. METHOD Participants in this cross-sectional study were a sample of individuals who were referred for psychological therapy to a National Health Service (NHS) trauma centre in Scotland (N = 195). Participants were recruited over a period of 18 months and completed measures of stressful life events, DSM-5 PTSD, emotion dysregulation, self-esteem and interpersonal difficulties. RESULTS Overall, results indicate that a structural model incorporating six first-order factors (re-experiencing, avoidance of traumatic reminders, sense of threat, affective dysregulation, negative self-concept and disturbances in relationships) and two second-order factors (PTSD and disturbances in self-organization [DSO]) was the best fitting. The model presented with good concurrent validity. Childhood trauma was found to be more strongly associated with DSO than with PTSD. CONCLUSION Our results are in support of the ICD-11 proposals for PTSD and CPTSD.
Collapse
Affiliation(s)
- M Shevlin
- School of Psychology, Ulster University, Derry, UK
| | - P Hyland
- School of Business, National College of Ireland, Dublin, Ireland
| | - T Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK.,Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | - C Fyvie
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | - N Roberts
- Psychology and Counselling Directorate, Cardiff and Vale University Health Board, Cardiff, UK
| | - J I Bisson
- School of Medicine, Cardiff University, Cardiff, UK
| | - C R Brewin
- Clinical, Education & Health Psychology, University College London, London, UK
| | - M Cloitre
- School of Medicine, New York University, New York, NY, USA.,National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| |
Collapse
|
20
|
Silove D, Tay AK, Kareth M, Rees S. The Relationship of Complex Post-traumatic Stress Disorder and Post-traumatic Stress Disorder in a Culturally Distinct, Conflict-Affected Population: A Study among West Papuan Refugees Displaced to Papua New Guinea. Front Psychiatry 2017; 8:73. [PMID: 28620322 PMCID: PMC5449451 DOI: 10.3389/fpsyt.2017.00073] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 04/13/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Controversy continues about the validity of the construct of complex post-traumatic stress disorder (C-PTSD). In particular, questions remain whether C-PTSD can be differentiated from post-traumatic stress disorder (PTSD) and, secondarily, other common mental disorders. The examination of these issues needs to be expanded to populations of diverse cultural backgrounds exposed to prolonged persecution. We undertake such an inquiry among a community sample of West Papuan refugees exposed to extensive persecution and trauma. METHODS We interviewed over 300 West Papuan refugees using the Refugee-Mental Health Assessment Package to record symptoms of PTSD, C-PTSD, major depressive disorder (MDD), and complex grief (CG). We used first- and second-order confirmatory factor analysis (CFA) to test aspects of the convergent and discriminant validity of C-PTSD. RESULTS The CFA analysis supported both a one-factor and two-factor model of PTSD and C-PTSD. Nested model comparison tests provide support for the parsimonious one-factor model solution. A second-order CFA model of PTSD and C-PTSD produced a poor fit. The modified three-factor multi-disorder solution combining a traumatic stress (TS) factor (amalgamating PTSD and C-PTSD), MDD, and CG yielded a good fit only after removing three CG domains (estrangement, yearning, and behavioral change), a model that produced large standardized residuals (>0.20). CONCLUSION The most parsimonious model yielded a single TS factor combining symptom domains of C-PTSD and PTSD in this culturally distinct community exposed to extensive persecution and conflict-related trauma. There may be grounds for expanding the scope of psychological treatments for refugees to encompass this wider TS response. Our findings are consistent with theoretical frameworks focusing on the wider TS reaction of refugees exposed to human rights-related traumas of mass conflict, persecution, and displacement.
Collapse
Affiliation(s)
- Derrick Silove
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Alvin Kuowei Tay
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Moses Kareth
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Susan Rees
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
21
|
Taycan O, Yildirim A. An Alternative Approach to the Effects of Multiple Traumas: Complex Post-Traumatic Stress Disorder. Noro Psikiyatr Ars 2015; 52:312-314. [PMID: 28360730 DOI: 10.5152/npa.2015.7573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 04/16/2014] [Indexed: 11/22/2022] Open
Abstract
Exposure to multiple traumatic events, particularly in childhood, has been shown to result in more complex symptoms than those seen after exposure to a single traumatic event. In case of overlooking the link between trauma and psychopathology, patients with multiple traumatic experiences receive a variety of different diagnoses that are unable to completely cover the clinical picture. Misdiagnoses of genuine cases inevitably lead to mistreatment. A diagnosis of complex post-traumatic stress disorder has been proposed to cover the emerging psychopathology in survivors of multiple traumas. This present report aimed to discuss the construct and to increase the awareness of complex post-traumatic stress disorder diagnosis among mental health professionals.
Collapse
Affiliation(s)
- Okan Taycan
- Clinic of Psychiatry, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Yildirim
- Clinic of Neurology, İstanbul Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
22
|
Thomaes K, Dorrepaal E, Draijer N, de Ruiter MB, Elzinga BM, Sjoerds Z, van Balkom AJ, Smit JH, Veltman DJ. Increased anterior cingulate cortex and hippocampus activation in Complex PTSD during encoding of negative words. Soc Cogn Affect Neurosci 2013; 8:190-200. [PMID: 22156722 PMCID: PMC3575721 DOI: 10.1093/scan/nsr084] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 11/01/2011] [Indexed: 12/15/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is associated with impaired memory performance coupled with functional changes in brain areas involved in declarative memory and emotion regulation. It is not yet clear how symptom severity and comorbidity affect neurocognitive functioning in PTSD. We performed a functional magnetic resonance imaging (fMRI) study with an emotional declarative memory task in 28 Complex PTSD patients with comorbid depressive and personality disorders, and 21 healthy non-trauma-exposed controls. In Complex PTSD patients--compared to controls--encoding of later remembered negative words vs baseline was associated with increased blood oxygenation level dependent (BOLD) response in the left ventral anterior cingulate cortex (ACC) and dorsal ACC extending to the dorsomedial prefrontal cortex (dmPFC) together with a trend for increased left hippocampus activation. Patients tended to commit more False Alarms to negative words compared to controls, which was associated with enhanced left ventrolateral prefrontal and orbitofrontal cortex (vlPFC/OFC) responses. Severity of child abuse was positively correlated with left ventral ACC activity and severity of depression with (para) hippocampal and ventral ACC activity. Presented results demonstrate functional abnormalities in Complex PTSD in the frontolimbic brain circuit also implicated in fear conditioning models, but generally in the opposite direction, which may be explained by severity of the trauma and severity of comorbid depression in Complex PTSD.
Collapse
Affiliation(s)
- Kathleen Thomaes
- Department of Psychiatry, GGZ InGeest/VU University Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|