Abstract
Traumatic experiences and post-traumatic stress are highly prevalent in people with psychosis, increasing symptom burden, decreasing quality of life and moderating treatment response. A range of post-traumatic sequelae have been found to mediate the relationship between trauma and psychotic experiences, including the “traditional” symptoms of post-traumatic stress disorder (PTSD). The International Classification of Diseases-11th Edition recognizes a more complex post-traumatic presentation, complex PTSD (cPTSD), which captures both the characteristic symptoms of PTSD alongside more pervasive post-traumatic sequelae known as ‘disturbances in self-organization’ (DSOs). The prevalence and impact of cPTSD and DSOs in psychosis remains to be explored. In the first study of this kind, 144 participants with psychosis recruited from North West United Kingdom mental health services completed measures assessing trauma, PTSD and cPTSD symptoms and symptoms of psychosis. Forty-percent of the sample met criteria for cPTSD, compared to 10% who met diagnostic criteria for PTSD. PTSD and DSOs mediated the relationship between trauma and positive symptoms, controlling for dataset membership. Both PTSD and DSOs mediated the relationship between trauma and affective symptoms but did not explain a significant proportion of variance in negative symptoms. Cognitive and excitative symptoms of psychosis did not correlate with trauma, PTSD or DSO scores. These findings indicate the possible value of adjunct therapies to manage cPTSD symptoms in people with psychosis, pending replication in larger epidemiological samples and longitudinal studies.
Highlights
Traumatic life events and adverse childhood experiences may lead to various psychosocial difficulties
Prior studies indicate that core Post-Traumatic Stress Disorder (PTSD) symptoms may be more severe in people with complex PTSD (cPTSD) (Wolf et al, 2015; Murphy et al, 2016), that cPTSD is associated with increased burden (Cloitre et al, 2020), and requires disparate treatment approaches to PTSD (UK Psychological Trauma Society, 2017)
The International Trauma Questionnaire (ITQ) diagnostic algorithm was applied to ITQ scores of the sample to delineate groups of participants meeting ICD-11 criteria for PTSD and cPTSD
Summary
Traumatic life events and adverse childhood experiences may lead to various psychosocial difficulties. Following a body of empirical research demonstrating a quantitative (Hyland et al, 2017) and qualitative (Stadtmann et al, 2018) distinction between PTSD and cPTSD, the most recent International Classification of Diseases (11th Edition; ICD-11, World Health Organisation, 2019) has recognized cPTSD as a separate, sibling diagnosis to PTSD (Karatzias et al, 2017). This includes the symptoms of PTSD as above, alongside other symptoms collectively referred to as ‘disturbances of self-organization’ (DSOs), including negative self-concept, emotional dysregulation and interpersonal difficulties. Prior studies indicate that core PTSD symptoms may be more severe in people with cPTSD (Wolf et al, 2015; Murphy et al, 2016), that cPTSD is associated with increased burden (Cloitre et al, 2020), and requires disparate treatment approaches to PTSD (UK Psychological Trauma Society, 2017)
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