Abstract
ObjectiveComplex post‐traumatic stress disorder (CPTSD) will be introduced in ICD‐11 and comprises symptoms of PTSD and disturbances in self‐organisation (DSO). The association of trauma with PTSD and DSO is not yet fully understood. We investigated the path from child maltreatment to PTSD and DSO and examined the mediating role of emotion regulation (ER) and adult interpersonal re‐victimisation.MethodAdult patients (N = 193) from a Scottish National Health Service clinic participated in the project. Participants completed measures of life events, ICD‐11 PTSD and CPTSD, and ER. Path analysis was used to assess possible direct and indirect effects from childhood trauma on current post‐traumatic psychopathology.ResultsOverall results indicate that the path from child maltreatment to PTSD is a direct one, while the path to DSO is indirectly mediated by ER.ConclusionsFuture research should address the potentially beneficial effect of treatment protocols for CPTSD explicitly aiming at reducing ER difficulties.
Highlights
The ICD-11 workgroup on the classification of disorders associated with stress (Maercker et al, 2013) proposed a new diagnosis, complex post-traumatic stress disorder (CPTSD)
CPTSD is associated with prolonged interpersonal trauma such as child maltreatment or torture (e.g. Karatzias et al, 2017), the ICD-11 proposal does not specify a certain type of trauma as prerequisite (Maercker et al, 2013)
We aimed to investigate the path from child maltreatment to ICD-11 CPTSD and examine the mediating role of different aspects of emotion regulation (ER) and adult re-victimisation in this relationship
Summary
The ICD-11 workgroup on the classification of disorders associated with stress (Maercker et al, 2013) proposed a new diagnosis, complex post-traumatic stress disorder (CPTSD). The concept of CPTSD has long been subject to clinical and scientific debate This is rooted in the observation that certain types of traumatic experiences that occur repeatedly and cumulatively, usually over a period of time and within specific relationships and contexts (complex trauma) are associated with other but the typical PTSD symptoms (Herman, 1992). CPTSD as proposed for ICD-11 included symptoms of PTSD and DSO and has been shown to capture the symptom presentation of survivors of more complex interpersonal trauma, such as child maltreatment (Cloitre, Garvert, Brewin, Bryant, & Maercker, 2013). Neglected children seem to have more difficulties discriminating emotions than abused children and tend to react hopeless in stressful situations, while abused children tend to be more angry (Hildyard & Wolfe, 2002) These different aspects of ER predicted different facets of adult maladaptation in terms of psychopathology and interpersonal problems (Berzenski, 2018). We hypothesised that PTSD symptoms would be more directly predicted by child maltreatment and re-victimisation, while DSO would be more mediated by ER
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