Exploring complex PTSD in patients visiting a psychiatric outpatient clinic in Kathmandu, Nepal

Rishav Koirala,Erik Ganesh Iyer Søegaard,Zhanna Kan,Saroj Prasad Ojha,Edvard Hauff,Suraj Bahadur Thapa

doi:10.1016/j.jpsychires.2021.08.030

Abstract

Decades of research on trauma patients have shown that a post-traumatic stress disorder (PTSD) diagnosis does not always cover the full spectrum of symptoms after severe trauma. Complex PTSD (CPTSD) was recently introduced in the International Classification of Diseases 11th Revision. There have been no published studies on CPTSD in the South Asian region to date. The objective of this study was to evaluate CPTSD in a sample of trauma patients in Nepal. We also examined quality of life (QOL) and mental health comorbidities and their association with CPTSD caseness. One hundred patients with a history of trauma who visited the outpatient psychiatry clinic at a hospital in Kathmandu from 2017 to 2018 were assessed. The Composite International Diagnostic Interview Version 2.1 was used to evaluate PTSD, major depressive disorder, and generalized anxiety disorder (GAD). Disturbance of self-organization symptoms from the Structured Interview for Disorders of Extreme Stress (SIDES) together with the PTSD diagnosis was used to confirm CPTSD caseness. The World Health Organization (WHO) QOL Scale Brief Version (WHOQOL-BREF) was used to assess QOL in four domains. Among the 83 patients who had PTSD, 42 also had CPTSD. CPTSD was significantly associated with major depressive disorder, GAD, female gender, and lower QOL in all four domains. CPTSD was prevalent among these patients. Having CPTSD was significantly associated with worse outcomes in terms of QOL and comorbid mental disorders, even with similar trauma. There is a need to explore CPTSD symptoms and to address trauma patients with CPTSD in this region.

Highlights

The experience of serious trauma can cause several forms of mental illness such as post-traumatic stress disorder (PTSD), adjustment disor der, anxiety, and depression (Lazar, 2014; Pietrzak et al, 2012)
Among the 83 patients suffering from lifetime PTSD, 42 had lifetime complex PTSD (CPTSD) caseness (50.6%)
We found that the quality of life (QOL) of patients with CPTSD caseness was significantly lower in all four domains: physical, psycho logical, social, and environmental

Summary

Introduction

The experience of serious trauma can cause several forms of mental illness such as post-traumatic stress disorder (PTSD), adjustment disor der, anxiety, and depression (Lazar, 2014; Pietrzak et al, 2012). The Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) included the category “associated features of PTSD”: “Disorders of Extreme Stress Not Otherwise Specified” (DESNOS). This symptom constellation and diagnostic category mirrored Herman’s description but was not a recognized diagnosis. Due to controversies and lack of adequate evidence, the working group of the DSM-5 (APA, 2013) found that CPTSD lacked a distinct identity. Both DESNOS and CPTSD were excluded from the DSM-5. After long and rigorous discussions and with emerging evidence (Brewin et al, 2017; Cloitre et al, 2013; Karatzias et al, 2017; Maercker et al, 2013) the CPTSD diagnosis was accepted and included in the 11th Edition of the World Health Organization (WHO) Interna tional Classification of Diseases (ICD-11)

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