Complex posttraumatic stress disorder symptoms and anorexia nervosa manifestations. Dissociative symptoms and emotion dysregulation as explanatory mechanisms

The diagnosis of complex posttraumatic stress disorder (CPTSD) was included in the ICD-11 in 2018. Debates are still ongoing in the scientific community regarding the conceptual distinction between CPTSD symptoms and those of comorbid PTSD and borderline personality disorder (BPD). The present study aimed to determine whether (a) patterns of symptoms reported by women in a community sample would reveal a CPTSD profile distinct from PTSD and BPD profiles and (b) the resulting profiles could be compared on measures of cumulative childhood trauma exposure, dissociation, and life satisfaction. Women who reported at least one potentially traumatic experience (N = 438) completed questionnaires assessing PTSD, CPTSD, and BPD symptoms. We performed latent profile analyses testing seven models, with the five-profile model emerging as the most appropriate solution. The profiles were characterized as "high PTSD symptoms" (12.0%), "high CPTSD symptoms" (7.6%), "high BPD symptoms" (9.9%), "high CPTSD and BPD symptoms" (3.8%), and "low symptoms" (66.7%). Group comparisons revealed that the profiles characterized by high CPTSD symptoms, high BPD symptoms, and high CPTSD and BPD symptoms tended to include participants with higher levels of cumulative childhood trauma exposure and symptoms of dissociation and lower ratings of life satisfaction compared to the profiles characterized by high PTSD symptoms and low symptoms, ds = 0.55-1.06. These findings support the distinction between ICD-11 CPTSD symptoms and those of PTSD and BPD, promoting an integrative approach to understanding trauma sequelae, diagnosis, and treatment.

Although there has been significant work on the association between posttraumatic stress disorder (PTSD) and attachment orientation, this is less the case for complex PTSD (CPTSD). The primary aim of this paper was to assess the strength of the association between the four adult attachment styles (i.e., secure, dismissing, preoccupied, and fearful) and severity of CPTSD symptoms (i.e., symptoms of PTSD and disturbances in self-organization [DSO]). We hypothesized that attachment orientation would be more strongly associated with DSO symptoms compared to PTSD symptoms. A trauma exposed clinical sample (N = 331) completed self-report measures of traumatic life events, CPTSD symptoms, and attachment orientation. It was found that secure attachment and fearful attachment were significantly associated with DSO symptoms but not with PTSD symptoms. Dismissing attachment style was significantly associated with PTSD and DSO symptoms. Preoccupied attachment was not significantly associated with CPTSD symptoms. Treatment implications for CPTSD using an attachment framework are discussed.

Background There is very little work on the role of positive or benevolent childhood experiences and how such events might offer protection from the insidious effects of adverse experiences in childhood or later in life. Objectives We set out to test, using latent variable modelling, whether adverse and benevolent childhood experiences could be best described as a single continuum or two correlated constructs. We also modelled the relationship between adverse and benevolent childhood experiences and ICD-11 PTSD and Complex PTSD (CPTSD) symptoms and explored if these associations were indirect via psychological trauma. Methods Data were collected from a trauma-exposed sample (N = 275) attending a specialist trauma care centre in the UK. Participants completed measures of childhood adverse and benevolent experiences, traumatic exposure, and PTSD and CPTSD symptoms. Results Findings suggested that adverse childhood experiences operate only indirectly on PTSD and CPTSD symptoms through lifetime trauma exposure, and with a stronger effect for PTSD. Benevolent childhood experiences directly predicted only CPTSD symptoms. Conclusions Benevolent and traumatic experiences seem to form unique associations with PTSD and CPTSD symptoms. Future research is needed to explore how benevolent experiences can be integrated within existing psychological interventions to maximise recovery from traumatic stress.

Background: Although trauma-related symptoms (e.g. complex PTSD and dissociative symptoms) and psychotic symptoms often co-occur, little is known about the complex relationships among these symptoms over time. Objective: This study examined the bidirectional relationships among complex PTSD symptoms, dissociative symptoms, and positive symptoms of psychosis. Methods: This study analyzed available longitudinal data from two convenience samples (Sample 1: N = 214, Chinese-speaking adults; Sample 2: N = 301, English-speaking adults). Participants in both samples completed validated measures of ICD-11 complex PTSD (that included measurement of ‘classical’ PTSD), dissociation, and positive symptoms of psychosis at baseline and follow-up, six months (Sample 1) or 12 months (Sample 2) apart. A cross-lagged panel model was used to examine the longitudinal relationship between trauma-related symptoms and psychotic symptoms in each sample. Results: In Sample 1, baseline dissociative symptoms significantly predicted positive symptoms of psychosis at follow-up. In Sample 2, no significant longitudinal relationships between trauma-related and psychotic symptoms were observed. In both samples, baseline disturbances in self-organization (DSO) symptoms predicted ‘classical’ PTSD symptoms at follow-up. Conclusion: This study made the first attempt to examine the longitudinal relationships among ICD-11 complex PTSD symptoms, dissociative symptoms, and psychotic symptoms. The inconsistent findings point to the importance of further research on the longitudinal relationships between trauma-related and psychotic symptoms. Moreover, our results indicate that addressing DSO symptoms may be important in the prevention and treatment of PTSD symptoms.

Adverse childhood experiences (ACEs) and exposure to potentially traumatic events (PTEs) during military service are associated with mental health problems. However, knowledge about relative contributions of these factors to non-U.S. women combat veterans' posttraumatic sequelae is sparse. This study examines associations between ACEs, combat exposure (CES), military sexual trauma (MST), potentially morally injurious events (PMIEs), posttraumatic stress disorder (PTSD), and complex PTSD (CPTSD) symptoms among women veterans. A volunteer sample of Israeli women combat veterans (n = 885) and noncombat veterans (n = 728) responded to self-report questionnaires in a cross-sectional design study. Combat veterans reported higher total average ACEs and were more likely to experience three or more ACEs and specific ACEs of physical abuse and emotional neglect, as compared to noncombat veterans. Combat veterans also reported higher levels of CES, PMIEs, higher prevalence of MST, and higher levels of PTSD symptoms, but not CPTSD symptoms, as compared to noncombat veterans. Importantly, ACEs, CES, MST-assault, and PMIEs of betrayal predicted PTSD symptoms, while only ACEs and PMIEs of betrayal predicted CPTSD symptoms. This study emphasized the relatively high exposure to PTEs and PTSD symptoms of women combat veterans as compared to noncombat veterans. Our findings also confirm prior studies demonstrating associations between ACEs, CES, MST, and mental health problems. Importantly, we demonstrated the unique contribution of betrayal-based PMIEs and the differential associations of PTEs with PTSD and CPTSD symptoms among combat veterans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Background: Despite concerns of conceptual similarity, increasing evidence supports the discriminant validity of Complex Posttraumatic Stress Disorder (CPTSD) and Borderline Personality Disorder (BPD). However, all studies to date have assumed a categorical model of psychopathology. In contrast, dimensional models of psychopathology, such as the Hierarchical Taxonomy of Psychopathology model (i.e. HiTOP model), recognise shared vulnerability across supposedly discrete disorders. Accounting for shared vulnerability between CPTSD and BPD symptoms may help to better reveal what is unique about these constructs. Objective: To identify the distinct and shared features of CPTSD and BPD via the application of dimensional modelling procedures. Method: Confirmatory bifactor and confirmatory factor analysis were employed to identify the optimal latent structure of CPTSD and BPD symptoms amongst a convenience sample of Israeli adults (N = 617). Additionally, structural equation modelling was used to identify risk factors associated with these constructs. Results: The latent structure of CPTSD and BPD symptoms was best explained by a bifactor model including one ‘general’ factor (i.e. vulnerability to all symptoms) and three ‘specific’ correlated factors (i.e. vulnerability to PTSD, DSO, and BPD symptoms, respectively). CPTSD symptoms were more readily distinguished from the general factor whereas BPD symptoms were not as easily distinguished from the general factor. CPTSD symptoms reflecting a negative self-concept and BPD symptoms reflecting an alternating self-concept were the most distinctive features of CPTSD and BPD relative to the general factor, respectively. Most of the risk factors were associated with the general vulnerability factor, consistent with the predictions of dimensional models of psychopathology regarding shared risk across supposedly distinct psychiatric constructs. Conclusion: Consistent with a dimensional model of psychopathology, CPTSD and BPD shared a common latent structure but were still distinguishable. CPTSD and BPD symptoms may be most effectively distinguished based on the phenomenology of self-concept symptoms.

Disturbance of self-organization (DSO) is defined by affective dysregulation, negative self-concept, and disturbances in relationships. Along with post-traumatic stress disorder (PTSD), DSO is a part of complex post-traumatic stress disorder (CPTSD), which often results from childhood trauma and has life-long consequences. We investigated the association between CPTSD, PTSD, DSO, childhood adversity, and irritable bowel syndrome (IBS). Individuals with IBS exhibited markedly higher prevalences of DSO, CPTSD, and PTSD symptoms and higher trauma scores compared with healthy individuals. The odds of having IBS were 3.718 and 1.924 times greater for those with DSO symptoms (p < .001) and CPTSD symptoms (p = .005), respectively. IBS severity was highest in the DSO group, followed by the CPTSD, PTSD, and non-DSO/CPTSD/PTSD groups. DSO symptoms mediate the impact of childhood adversity on IBS symptoms, explaining half of this effect, whereas PTSD symptoms do not. These findings suggest a significant role of DSO in the development of IBS.

Background and Objectives: Young adults with a history of adverse childhood experiences (ACEs) may exhibit varying trajectories of complex post-traumatic stress disorder (CPTSD) symptoms over time. Unraveling the patterns of interactions between CPTSD symptoms across distinct trajectories is crucial. This study aimed to investigate the longitudinal relationships, changes, and central symptoms in CPTSD networks over time across distinct CPTSD trajectory groups.Methods: This longitudinal study followed 1277 university students (47.5% male) who reported ACEs from China through three waves of surveys. ACEs were assessed at baseline, while symptoms of CPTSD were measured at all three time points. Growth mixture modeling (GMM) was used to identify CPTSD symptom trajectories, and cross-lagged panel network (CLPN) analysis estimated the longitudinal relationships among CPTSD symptoms within these trajectories.Results: Two distinct and consistent CPTSD symptom trajectories were identified: a high-risk group and a resistance group. In the high-risk group, “disturbed relationships” (DRs) and “negative self-concept” (NSC) emerged as the strongest predictors of other symptoms at various time points. In the resilient group, the predictive influence of DR and NSC on other symptoms was attenuated. Instead, “affective dysregulation” (AD) emerged as the central symptom, demonstrating the strong predictive associations with other symptom domains.Conclusions: These findings reveal directional relationships among symptoms in young adults. Symptoms related to disturbances in self-organization (DSO), identified through centrality indices, are key drivers of symptom network development in different CPTSD trajectories. Targeting these symptoms in interventions for young adults with ACEs may help prevent or reduce CPTSD progression.

PurposeThis study aims to develop and test multivariable psychosocial prediction models of perceived post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD) symptoms development among trauma-exposed Ukrainian adults (n = 761) after 1.5 years of the 2022 Russian invasion of Ukraine.Design/methodology/approachThis research was designed as a survey in line with the methodology of “Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis” checklist. The survey included a questionnaire on sociodemographic characteristics and specifics of trauma exposure, as well as validated self-reported inventories: The International Trauma Questionnaire, Acceptance and Action Questionnaire – version 2, Connor–Davidson Resilience Scale-10 and the Modified BBC Subjective Well-being Scale.FindingsRegression analysis revealed different prediction models for PTSD and CPTSD symptoms, explaining 18.4% and 41.4% of their variance with five and eight predictors, respectively. Four variables were similar in predicting PTSD and CPTSD: war-relatedness of trauma, living with a friend, perceived physical health and regret for the past. War-relatedness of trauma the respondents were exposed to was among the strongest predictors for PTSD and CPTSD severity. However, living with a friend was almost equally strong in mitigating these mental consequences. Regret for past and lowly rated physical health were assessed as relatively weaker but statistically significant predictors in this study.Originality/valueUpon the original theoretical framework, two psychosocial prediction models were developed for PTSD and CPTSD symptoms in a non-clinical sample of trauma-exposed Ukrainian adults.

Background:After the inclusion of a novel diagnosis of Complex Posttraumatic Stress Disorder (CPTSD) in the 11th edition of the International Classification of Diseases (ICD-11), there is a growing need for research focused on not only studying the underlying risk factors of this disorder but also differentiating the risk factors of Posttraumatic Stress Disorder (PTSD) and CPTSD to understand better the factors leading to CPTSD onset and symptom maintenance.Aims:This study aimed to explore the prevalence of traumatic experiences, trauma-related disorders and risk factors associated with ICD-11 PTSD and CPTSD in a population-based Lithuanian sample using the International Trauma Questionnaire (ITQ).Methods:The study sample included 885 participants (age M[SD] = 37.96 [14.67], 63.4% female). The Life Events Checklist was used to measure trauma exposure, PTSD and CPTSD symptoms were measured by the Lithuanian ITQ version. The Disclosure of Trauma Questionnaire (DTQ) was used to measure the urge or reluctance to talk about trauma.Results:The prevalence of at least one traumatic experience in the study sample was 81.4%. The prevalence of PTSD and CPTSD among the general population in Lithuania was 5.8% and 1.8%, respectively. Accumulative lifetime trauma exposure, sexual assault and assault with a weapon were significant predictors for both PTSD and CPTSD. Participants from the CPTSD group reported greater reluctance to disclose trauma and stronger emotional reactions than no diagnosis and PTSD groups. Results also indicate that the Lithuanian ITQ version is a valid measure for screening PTSD and CPTSD in the general population.Conclusion:Previous history of trauma and interpersonal trauma were associated with posttraumatic stress disorders but did not differentiate between PTSD and CPTSD in our study. However, social trauma-related factors, such as trauma disclosure, were associated with stronger CPTSD symptoms.

Complex posttraumatic stress disorder (CPTSD) has been included as a diagnostic category in the International Classification of Diseases, 11th Edition, consisting of six symptom clusters: the three PTSD criteria of reexperiencing, avoidance, and hypervigilance, in addition to three disturbances of self-organization (DSO) symptoms defined as emotional dysregulation, interpersonal difficulties, and negative self-concept. As borderline personality disorder (BPD) shares similar features to DSO presentations and is commonly associated with PTSD, there is debate as to whether and how CPTSD is distinct from PTSD comorbid with BPD. This article aimed to identify groups with distinct profiles of self-reported CPTSD and BPD symptoms and associated trauma history characteristics. A latent class analysis (LCA) using CPTSD and BPD symptom variables was conducted on a sample of 195 treatment-seeking adults at a specialist trauma service. The classes were then compared on demographic and clinical characteristics using a series of analysis of variance and χ2 tests. The latent class analysis determined three distinct classes: a CPTSD/High BPD class characterized by high symptom endorsement across both conditions, a CPTSD/Moderate BPD class characterized by high PTSD and DSO symptom endorsement and moderate BPD, and a PTSD/Low BPD class characterized by PTSD symptoms and low DSO and BPD symptom endorsement. The two CPTSD classes were associated with greater exposure to multiple, interpersonal traumas earlier in life and exhibited higher functional impairment. Findings support the construct of a CPTSD diagnosis as a separate entity although BPD features seem to overlap greatly with CPTSD symptoms in this highly traumatized clinical sample. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The phenomenology of nightmares in post-traumatic stress disorder and complex post-traumatic stress disorder

This study is aimed to test the symptoms network of International Classification of Diseases, 11th Revision (ICD-11) complex posttraumatic stress disorder (CPTSD) symptoms, using data collected from Ukrainian civilians during the 2022 Russia-Ukraine war. Findings can inform our understanding of the stress response in individuals exposed to continuous trauma and give insight into the nature of CPTSD during the war. A network analysis was conducted on CPTSD symptoms as assessed by the International Trauma Questionnaire using data from a nationally representative sample of 2,000 Ukrainians. While PTSD and disturbances in self-organization clusters did not enmesh, several communities within these clusters were merged. Results highlight that in terms of strength centrality, emotional dysregulation (emotional numbing) and a heightened sense of threat (SoT) were most prominent. The results confirm the ICD-11 structure of CPTSD but suggest that continuous traumatic stress manifests in more condensed associations between CPTSD symptoms and that emotional regulation may play a vital role in activating the CPTSD network. War-exposed populations could be provided with scalable, brief self-help materials focused on fostering emotion regulation and an SoT. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

We aimed to investigate the relationship between complex posttraumatic stress disorder (CPTSD) symptoms and posttraumatic growth (PTG) among adolescents and emerging adults with adverse childhood experiences. A total of 4,581 adolescents and 4,335 emerging adults with adverse childhood experiences completed questionnaires. Network analysis was used to investigate the relationship between CPTSD symptoms and PTG from a variable-centered perspective. Latent profile analysis was used to investigate this relationship from a person-centered perspective. Positive and negative correlations between various dimensions of CPTSD symptoms (especially disturbances in self-organization symptoms) and PTG were found by network analysis. The correlations between posttraumatic stress disorder/disturbances in self-organization symptoms and PTG differed in the two samples. PTG2 (spiritual-existential change) had the highest bridge expected influence value among the two samples. PTG1 (appreciation of life) and PTG4 (relation to others) had the lowest bridge expected influence among adolescents and emerging adults, respectively. By latent profile analysis, five subgroups of CPTSD symptoms and PTG (low reaction group, low disorder-moderate growth group, low disorder-high growth group, coexistence group, and high disorder-low growth group) were identified in the two samples, with different proportions. There were negative and positive correlations between various dimensions of CPTSD symptoms and PTG, which might reflect the constructive (appreciation of life among adolescents; relation to others among emerging adults) and illusory (spiritual-existential change) components of PTG. CPTSD symptoms and PTG exhibited heterogeneous characteristics. The relationship between CPTSD symptoms and PTG differed between adolescents and emerging adults with adverse childhood experiences. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

ObjectivesMindfulness-based interventions have recently been shown to be a promising option for treating posttraumatic stress. The current study aimed to investigate the effects of an online mindfulness-based intervention on ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) symptoms at a 3-month follow-up.MethodsAn RCT design with three measurement points (pre-intervention, post-intervention, and 3-month follow-up) was used to investigate the effects of an 8-week online mindfulness intervention. In total, 53 traumatized young adults (Mage = 23.21, SDage = 2.81; 84.9% female) participated in the study: 17 in the intervention group and 36 in the waiting list control group.ResultsIntervention group and waiting list control group comparison revealed that the intervention was effective for reducing CPTSD disturbances in self-organization symptoms (d = −0.84 [−1.44; −0.24]), specifically, negative self-concept (d = −0.66 [−1.25; −0.07]) and disturbances in relationships (d = −0.87 [−1.47; −0.27]), at 3-month follow-up. There were no between-group effects for PTSD symptoms from pre-test to follow-up.ConclusionThis is one of the first RCT studies to report follow-up effects of an online mindfulness-based intervention for ICD-11 PTSD or CPTSD symptoms. Our study yielded that the effects of mindfulness-based internet intervention on CPTSD symptoms tend to retain over time.Trial RegistrationThis study was registered with ClinicalTrials.gov (NCT number: NCT04333667; https://clinicaltrials.gov/ct2/show/NCT04333667). Registered April 3, 2020.