Abstract
Posttraumatic stress disorder (PTSD) is highly prevalent within prison settings, yet is often unidentified and undertreated. Complex PTSD (CPTSD) has been recently formally recognised in the International Classification of Diseases 11th revision (ICD-11) diagnostic framework but has never been explored in prison settings. We aimed to establish the prevalence of ICD-11 PTSD and CPTSD in a UK prison sample using a validated instrument (the International Trauma Questionnaire). We also explored the associations of these two diagnoses with their traumatic antecedents and psychiatric comorbidities. Randomly selected male, sentenced prisoners in a large medium-security prison in south London (N = 221) took part in a clinical interview which assessed PTSD, CPTSD, trauma histories, and comorbid disorders. Multinomial logistic regression was performed to examine differences between those with PTSD or CPTSD, and those without symptoms. A total of 7.7% (95% CI 4.5-12) of the male sentenced prisoners met diagnostic criteria for ICD-11 PTSD and 16.7% (95% CI 12.1-22.3) for CPTSD. A diagnosis of PTSD was associated with more recent traumatic exposure, comorbid generalised anxiety disorder, alcohol dependence, and Cluster B personality disorder. A diagnosis of CPTSD was associated with complex trauma exposure antecedents (developmental, interpersonal, repeated, or multiple forms), and comorbid with anxiety, depression, substance misuse, psychosis, and ADHD. This study confirms that CPTSD is a very common and comorbid condition in male prisoners. There is an urgent need to develop trauma-informed care in prisons.
Highlights
Posttraumatic stress disorder (PTSD) is more prevalent in prison than in community samples (Baranyi, Cassidy, Fazel, Priebe, & Mundt, 2018)
Complex PTSD (CPTSD) has been recently introduced into the International Classification of Diseases 11th revision (ICD-11) diagnostic framework and is a disorder characterised by PTSD symptomatology as well as additional difficulties in emotional regulation, negative alterations in the perception of self, and relationship disturbances (Brewin et al, 2017)
Substantial evidence suggests that men and women in prison experience high rates of the types of complex developmental traumas which have been shown to increase the risk of developing CPTSD (Howard, Karatzias, Power, & Mahoney, 2017; Karatzias et al, 2018; Wolff, Huening, Shi, & Frueh, 2014)
Summary
Posttraumatic stress disorder (PTSD) is more prevalent in prison than in community samples (Baranyi, Cassidy, Fazel, Priebe, & Mundt, 2018). A small number of studies in the UK have sought to establish the prevalence of PTSD in prisoners, with estimates ranging widely from 1.7 to 13.9% (Bebbington et al, 2017; Brooke, Taylor, Gunn, & Maden, 1996; Tyler et al, 2019) These previous studies have not considered trauma aetiology, nor have they distinguished between PTSD and complex PTSD (CPTSD). No study to date has explored the prevalence and traumatic antecedents of these two sibling disorders using validated instruments in a prison sample or examined the psychiatric comorbidity of both conditions (Facer-Irwin et al, 2019). There is an urgent need to develop trauma-informed care in prisons
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