Diagnosis Of Complex Posttraumatic Stress Disorder Research Articles

Can the PCL-5 be used as a potential indicator of probable Complex PTSD?

PurposeAlongside the recognition of the ICD-11 Complex Posttraumatic Stress Disorder (CPTSD), research has been underway to develop effective assessment measures to identify CPTSD. Given the novelty of the CPTSD diagnosis and associated assessment methods, many services have exhibited caution in incorporating such methods. Yet, there remains a clinical need to identify individuals experiencing CPTSD-like difficulties as it may hold important treatment considerations. This study aims to identify a score on the commonly administered Posttraumatic Stress Disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) (PCL-5) that may be suggestive of CPTSD-like difficulties. MethodsUsing cross-sectional data from a clinical veteran sample (N = 227), a Receiver Operating Characteristics (ROC) analysis using CPTSD criteria as a benchmark was conducted to identify an PCL-5 cut-off score. ResultsThis study suggests a PCL-5 cut-off score of 51, which had a sensitivity of 78.8 % and a specificity of 77.8 %. ConclusionThe potential utility of this score is discussed in terms of suitability as an indicator of potential CPTSD-like difficulties as well as potential service implications. Further research is required to further investigate the feasibility of a PCL-5 score to screen for CPTSD.

Evaluación pericial psicológico-forense del trastorno por estrés postraumático complejo en víctimas de violencia de género

Given the inclusion of the Complex Post-Traumatic Stress Disorder (C-PTSD) in the International Classification of Diseases 11th edition, this article analyses the C-PTSD as a possible new diagnosis in women victims of gender-based violence to explain a wide range of symptoms resulting from interpersonal, persistent, continuous, severe and uncontrollable traumas that may occur in this context. Thus, it describes the psychological impact and the psychopathological consequences it produces on the victims, which are most serious when the violence suffered has occurred repeatedly and over time. In addition, it delves into the differential diagnosis of C-PTSD with other psychopathologies. Finally, a protocol for forensic psychological assessment is proposed based on C-PTSD as a clinical disorder, which explains the serious psychological impact on the evaluation of women victims of gender-based violence, considering this disorder as an alternative diagnostic hypothesis in the forensic psychological assessment of the psychological injury.

Personalized psychotherapy of posttraumatic stress disorder : Overview on the selection of treatment methods and techniques using statistical procedures

Arelevant heterogeneity of treatment effects in posttraumatic stress disorder (PTSD) is discussed with respect to the debate about the necessity of phase-based treatment and in light of the new diagnosis of complex PTSD and has recently been proven; however, there has been little personalization in the treatment of PTSD. This article presents the current state of research on the personalized selection of specific psychotherapeutic methods for the treatment of PTSD based on patient characteristics using statistical methods. Asystematic literature search was conducted in the PubMed (including Medline), Embase, Web of Science Core Collection, Google Scholar, PsycINFO and PSYNDEX databases to identify clinical trials and reviews examining personalized treatment for PTSD. A total of 13relevant publications were identified, of which 5articles were predictor analyses in samples without control conditions and 7articles showed analyses of randomized controlled trials (RCT) with apost hoc comparison of treatment effects in optimally and nonoptimally assigned patients. In addition, one article was asystematic review on the treatment of patients with comorbid borderline personality order and PTSD. The available manuscripts indicate the importance and benefits of personalized treatment in PTSD. The relevant predictor variables identified for personalization should be used as asuggestion to investigate them in future prospective studies.

Against an insufficient intervention for patients with alcoholism or PTSD: An activity report on a psychiatric clinic after the 2011 complex disaster in Fukushima, Japan

Despite numerous studies using questionnaires to assess mental health problems among disaster victims following a disaster, only a few have examined actual medical treatment situations. Surveys of residents in disaster-affected areas following the Great East Japan Earthquake and Fukushima nuclear power plant disaster also indicate deteriorated mental health among survivors; however, concrete evidence of increased individuals seeking treatment at psychiatric institutions is still scarce.Using medical records of a psychiatric clinic in an affected area during the chronic phase after a disaster, this study investigated the status of interventions for patients with alcoholism, post-traumatic stress disorder (PTSD), and others, including whether violence occurred during treatment.We found that 730 patients visited the clinic for a year, but a few with alcoholism received treatment. Patients who experienced traumatic stress during the disaster had a higher treatment discontinuation rate, though it is not correlated with their involvement in violence. However, a diagnosis of complex PTSD was correlated with involvement in violence during the treatment.The psychiatric clinic providing care during the chronic phase of the post-disaster period did not provide sufficient treatment for alcoholism, where therapeutic interpersonal interaction is emphasized, or for PTSD, where trauma-focused psychotherapy is the standard of care. It is difficult to ensure the availability of highly specialized resources and the establishment of comprehensive ties with the local people in affected areas, however, such a situation poses a challenge.

Complex post-traumatic stress disorder (CPTSD) of ICD-11 in youths with childhood maltreatment: Associations with age of exposure and clinical outcomes

BackgroundExposure to childhood maltreatment (CM) increases the risk of psychiatric morbidity in youths. The new Complex Post-Traumatic Stress Disorder (CPTSD) diagnosis captures the heterogeneity and complexity of clinical outcomes observed in youths exposed to CM. This study explores CPTSD symptomatology and its association with clinical outcomes, considering the impact of CM subtypes and age of exposure. MethodsExposure to CM and clinical outcomes were evaluated in 187 youths aged 7–17 (116 with psychiatric disorder; 71 healthy controls) following the Tools for Assessing the Severity of Situations in which Children are Vulnerable (TASSCV) structured interview criteria. CPTSD symptomatology was explored by confirmatory factor analysis, considering four subdomains: post-traumatic stress symptoms, emotion dysregulation, negative self-concept and interpersonal problems. ResultsYouths exposed to CM (with or without psychiatric disorders) showed greater internalizing, externalizing and other symptomatology, worse premorbid adjustment and poorer overall functioning. Youth with psychiatric disorder and exposed to CM reported more CPTSD symptomatology, psychiatric comorbidity and polypharmacy and earlier onset of cannabis use. Different subtypes of CM and the developmental stage of exposure differentially impact CPTSD subdomains. LimitationsSmall percentage of resilient youths was studied. It was not possible to explore specific interactions between diagnostic categories and CM. Direct inference cannot be assumed. ConclusionsGathering information on type and age of exposure to CM is clinically useful to understand the complexity of psychiatric symptoms observed in youths. Inclusion of the CPTSD diagnosis should increase the implementation of early specific interventions, improving youths' functioning and reducing the severity of clinical outcomes.

Evaluation of an adapted version of the International Trauma Questionnaire for use by people with intellectual disabilities.

The International Trauma Questionnaire (ITQ) is a novel assessment instrument that is aligned to the ICD-11 diagnoses of post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). The purpose of this study was to develop and evaluate an adapted version of the ITQ suitable for use by people with intellectual disabilities. The ITQ-ID follows the original ITQ, using wording developed in collaboration with a focus group of people with intellectual disabilities The ITQ-ID was administered to 40 people with intellectual disabilities recruited from learning disability forensic and community settings, alongside a Trauma Information Form and the Impact of Event Scale-Intellectual Disabilities (IES-IDs). Most participants reported multiple traumatizing events. Around half of the participants met strict criteria for a diagnosis of PTSD, and around three quarters met looser criteria. Depending on definitions, between 66% and 93% of those who met criteria for PTSD also met criteria for a diagnosis of CPTSD. The ITQ-ID showed a single-component structure, with very good-to-excellent internal consistency, excellent test-retest reliability, and evidence of concurrent, discriminant, and content validity. The results support the potential of the ITQ-ID for assessment of PTSD and CPTSD in people with intellectual disabilities in both clinical and research contexts and highlight the need for further validation work.

Psychometric Properties of The Turkish Version of The International Trauma Questionnaire

ABSTRACT In clinical practice, there is a need for a measurement tool that can support the diagnosis of posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). The present study investigates the psychometric properties of the Turkish Version of the International Trauma Questionnaire (ITQ), the first scale developed for PTSD and CPTSD diagnosis purposes. The sample for this study comprised 395 participants recruited from the clinical sample (n = 112) and community (n = 283). After identifying the best fitting model, correlations between factors and criterion variables were calculated to examine the concurrent and convergent validity of ITQ scales. Criterion variables to examine concurrent validity comprised PTSD symptoms as assessed by the Impact of Event Scale-Revised (IES-R), Sheehan Disability Scale (SDS), The Core Self-Evaluations Scale (CSES), Relationship Assessment Scale (RAS), and Emotion Regulation Questionnaire (ERQ). Participants were primarily female (61.0%, n = 241) with a mean age of 32.43 years (SD = 10.14). Confirmatory factor analysis (CFA) findings of our study indicated that Two-Factor Second-Order Model, Each Measured by Three First-Order Factors (Six first-order and two second-order factors), is congruent with previous studies. Cronbach’s alpha was satisfactory for both PTSD (α = .910) and Disturbances in Self-Organization (α = .867) scales. The correlations between ITQ and the IES-R, RAS, ERQ, CSES, and SDS supported the concurrent and convergent validity of the scale. The study results demonstrated that the Turkish version of the scale is valid and reliable and can be used in research and clinical practice.

Cross-cultural validity and psychometric properties of the International Trauma Questionnaire in a clinical refugee sample

ABSTRACT Background: The ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD diagnoses have been examined in several studies using the International Trauma Questionnaire (ITQ). The cross-cultural validity of the ITQ has not previously been studied using item responses theory methods focused on the issue of equal item functioning and thus comparability of scores across language groups. Objective: To investigate the cross-cultural validity of the ITQ scales considering specifically local independence of items and differential item functioning (DIF) in a cross-cultural sample of refugees. Method: Data from 490 treatment-seeking refugees were included, covering Danish, Arabic, and Bosnian languages and different levels of interpreter-assisted administration. Rasch and graphical log-linear Rasch models were used. Results: There was strong local dependence among items from the same symptom clusters in the PTSD and disorders in self-organization (DSO) scales, except between affective dysregulation items. Weak local dependence was discovered between an item from the affective dysregulation cluster and an item from the disturbed relationship cluster. There was no evidence of DIF related to language or interpreter assistance. There was evidence of DIF for two PTSD items relative to gender and time since the traumatic event. The targeting of the scales to the study population was not optimal. Reliability varied from 0.55 to 0.78 for subgroups. Conclusions: The PTSD and the DSO scales have stable psychometric properties across the Danish, Arabic, and Bosnian language versions and different levels of assisted administration. Scores are comparable across these groups. However, DIF relative to gender and time since trauma introduces considerable measurement bias. DIF-adjusted summed scale scores or estimated person parameters should be used to avoid measurement bias. Future research should investigate whether scales including more and/or alternative items that require higher levels of PTSD and DSO to be endorsed will improve targeting and measurement precision for refugee populations.

Skills Training in Affective and Interpersonal Regulation Narrative Therapy for women with ICD-11 complex PTSD related to childhood abuse in Japan: a pilot study

ABSTRACT Background: Skills Training in Affective and Interpersonal Regulation (STAIR) Narrative Therapy (SNT) has shown efficacy in alleviating symptoms of posttraumatic stress disorder (PTSD) and improving emotion regulation and interpersonal skills among individuals with complex trauma, such as childhood abuse. Although this therapy is expected to be effective for patients with complex PTSD (CPTSD), no study has directly assessed diagnostic and symptom outcomes. Moreover, the potential of therapy to achieve good outcomes in non-Western countries remains unclear. Objective: This pilot study examined the feasibility, safety, and outcomes of SNT for CPTSD among women with a history of childhood abuse in a Japanese clinical setting. Methods: Ten women aged 21–54 years (M = 29.1 years) with childhood-abuse-related ICD-11 CPTSD were enrolled in this study. The International Trauma Interview and International Trauma Questionnaire were administered to diagnose CPTSD and assess its severity. Symptoms of dissociation and depression, difficulties in emotion regulation and interpersonal relationships, quality of life, and negative cognitions were assessed pretreatment, midtreatment (after the STAIR phase), and immediately posttreatment (after the Narrative Therapy phase), in addition to 3 months after treatment. Results: Seven of the 10 participants completed the treatment. The therapists’ adherence to the therapy protocol was 96.4%, ranging from 93.6% to 100% across therapists. Serious adverse events were not observed. Among the seven completers, six at posttreatment and all at follow-up no longer met CPTSD diagnosis. Exploratory analyses using the linear mixed-effects model showed significant improvements at posttreatment and follow-up for almost all the variables. Conclusions: The results provide preliminary evidence for the feasibility and safety of SNT for CPTSD in a Japanese clinical setting. This study is the first to report the use of SNT for individuals diagnosed with ICD-11 CPTSD using reliable clinician and self-report measures. HIGHLIGHTS This study examined the feasibility and safety of STAIR Narrative Therapy for women with ICD-11 CPTSD related to childhood abuse in a Japanese clinical setting. High therapy adherence was observed. No serious adverse events occurred.

A Sequenced, Relationship-Based Approach to the Treatment of Complex Posttraumatic Stress Disorder (CPTSD): The Hybrid Case Study of "Chloe"

Chronic and repeated exposure to relational and developmental trauma can result in a presentation that differs from posttraumatic stress disorder (PTSD), with a unique cluster of complicated symptoms, and has thus been labeled as complex PTSD (CPTSD). Many such individuals meet criteria for PTSD while also exhibiting additional symptomology not accounted for in a traditional PTSD diagnosis. This case study provides an overview of the differences between PTSD and CPTSD, using empirical evidence to illustrate the necessity of distinguishing between these two differing diagnoses and subsequently the need for differing treatment approaches. The purpose of this case study is to examine the benefits of using a three-phase, integrative model for an individual with CPTSD. Specifically, it explores the delivery of Courtois and Ford’s (2013) sequenced, relationship-based approach to the treatment of complex trauma. This model was chosen due to the emphasis on attachment and because it allows for clinicians to tailor interventions to the unique individual while also providing an overarching structure to treatment. This treatment analysis is demonstrated via the hybrid case of "Chloe,” who serves as a meaningful representation of a psychotherapy patient with a history of chronic relational and developmental trauma who presents to treatment with symptoms concurrent with a CPTSD diagnosis. Chloe’s composite case example is based on the author’s actual, de-identified psychotherapy cases in addition to clinical examples in the relevant literature. Using the format of a pragmatic case study (Fishman, 1999, 2013), Chloe’s case is analyzed through qualitative processes and quantitative measures. An in-depth illustration of this hybrid patient’s course of treatment provides an avenue for describing key clinical issues related to the treatment of CPTSD and the utility of an integrative treatment approach. Chloe’s case study is intended to be a resource for clinicians seeking more knowledge and understanding of the impact of chronic developmental and relational trauma and the implications this has for effective treatment.

Local understandings of PTSD and complex PTSD among health professionals working with adolescents in violent neighbourhoods of S\xe3o Paulo city, Brazil

BackgroundAdolescents in low-resource urban settings in Brazil are often exposed to high levels of trauma that can result in post-traumatic stress disorder (PTSD). However, preliminary evidence indicates that PTSD tends to be under-reported in Brazilian health services, despite the high prevalence of trauma. Additionally, little is known about the perceived applicability among clinicians of the new ICD-11 diagnosis of complex PTSD (CPTSD), despite its potential relevance for contexts of chronic trauma. The current study investigated local understandings of PTSD and CPTSD among health professionals working with adolescents in violent neighbourhoods of São Paulo city.MethodsSemi-structured interviews were conducted with 58 health professionals working at both the primary care and specialized mental health levels in two areas of São Paulo city with high levels of community violence.ResultsMost participants knew about PTSD, but most did not know about CPTSD. There were mixed views concerning the commonality of PTSD among adolescents exposed to community violence. Many participants reported having no experience working with patients with the PTSD diagnosis. According to some, community violence was normalized by adolescents and health professionals, and did not result in PTSD. Others highlighted how they did not use psychiatric diagnoses in their practice, had critical perspectives towards psychiatric diagnoses and/or PTSD, or simply knew little about PTSD. Furthermore, many highlighted how the chronic nature of multiple traumas experienced by adolescents often resulted in complex clinical presentations characterised by many symptoms beyond PTSD. The diagnosis of CPTSD was considered appropriate to the context by many participants as it captured the complex traumatic histories and symptom presentations of adolescents exposed to community violence in Brazil.ConclusionsThese findings have important implications for the assessment and treatment of mental health among adolescents exposed to community violence in Brazil.

Complex PTSD and personality disorder in ICD-11: when to assign one or two diagnoses?

To outline overlap and boundaries between ICD-11 definitions of complex post-traumatic stress disorder (C-PTSD) and personality disorder (PD) and propose guiding principles that may assist practitioners in assigning one or both of the two diagnoses. The ICD-11 definitions for C-PTSD and PD are substantially comparable in terms of self- and interpersonal problems, and childhood trauma may be at the root of both disorders. The ICD-11 formally recognizes this overlap and allows the assignment of both diagnoses at the same time. The C-PTSD diagnosis essentially differs from a PD diagnosis by requiring a history of trauma and PTSD symptoms. Moreover, C-PTSD typically involves stable and persistent patterns of negative self-perception while emphasizing avoidant interpersonal patterns. In comparison, the PD diagnosis may differ from C-PTSD by allowing an unstable or internally contradictory sense of self, which may involve both overly negative and overly positive self-views. When the diagnostic requirements for both C-PTSD and PD are met, only the C-PTSD diagnosis should be assigned, unless the PD diagnosis may contribute with clinically useful information that is not sufficiently covered by the C-PTSD diagnosis. The outlined similarities and boundaries must be further corroborated by future empirical studies.

Does complex PTSD predict or moderate treatment outcomes of three variants of exposure therapy?

BackgroundOne reason for the inclusion of Complex Posttraumatic Stress Disorder (CPTSD) in the 11th revision of the International Classification of Diseases (ICD-11) was its suspected relevance for treatment indications. We investigated whether CPTSD predicted and moderated treatment outcomes of Prolonged Exposure (PE), intensified PE (iPE) and Skills Training in Affective and Interpersonal Regulation followed by PE (STAIR + PE). We expected that CPTSD would predict worse treatment outcomes across treatments. Secondly, we expected that CPTSD would lead to better treatment effect in STAIR + PE compared to PE and iPE. MethodsWe analyzed 149 patients with childhood-abuse related PTSD from a randomized clinical trial. CPTSD diagnosis and symptom severity were measured with the International Trauma Questionnaire. The main outcome was change in clinician-assessed PTSD symptoms. Assessments took place at baseline, week 4, week 8, week 16 (post-treatment) and at a 6-and 12-month follow-up. Analyses were based on an intention-to-treat sample using mixed effect models. ResultsMore than half (54 %) of the patients met criteria for CPTSD at baseline. CPTSD was related to more severe PTSD symptoms and higher comorbidity at baseline. CPTSD neither predicted nor moderated treatment outcome. LimitationsInclusion was limited to patients with PTSD related to childhood abuse. Replication is needed in different samples. ConclusionsCPTSD is associated with more severe PTSD and with higher comorbidity. CPTSD did not predict treatment outcome and did not indicate differential treatment outcome of STAIR + PE compared to PE and iPE.

ICD-11 complex Post Traumatic Stress Disorder (CPTSD) in parents with perinatal bereavement: Implications for treatment and care

IntroductionThe 11th revision of the WHO International Classification of Diseases (ICD-11) has identified Complex PTSD (CPTSD) as a new condition. AimTo explore whether the new diagnosis of CPTSD (ICD11) is relevant to women who have experienced perinatal bereavement and to advance knowledge about the acceptability, feasibility and perceived impact of delivering an innovative flexible Compassionate Focused Therapy (CFT) informed treatment package to alleviate symptoms of this condition. MethodsA mixed methods study using survey and interviews was conducted. Participants first completed the International Trauma Questionnaire (ITQ) to assess if they met the criteria for PTSD or CPTSD (n=72), and subsequent semi-structured interviews (n=12) identified participants’ views about different treatment approaches. ParticipantsA convenience sample of women who had experienced perinatal bereavement were recruited from one geographical region in Scotland. Data collectionInformation was gathered about trauma experiences related to perinatal bereavement; participants’ levels of PTSD or CPTSD using the ITQ; and views regarding the features of treatment options. In-depth interviews with women (n=12) and a focus group with staff (n=5) were also conducted. FindingsOf 74 participants (n=74) who fully completed the ITQ, 10.8% (n=8) met the criteria for PTSD and 29.7% (n=22) for CPTSD, equating to a total of 40.5% of participants experiencing traumatic stress. Results suggest that CPTSD is a more common condition than PTSD in people with perinatal bereavement, with qualitative data suggesting that CFT and EMDR can be useful and acceptable interventions for this population group. ConclusionA feasibility study is recommended next to evaluate acceptability of trial processes in preparation for a definitive randomised controlled trial of a new flexible CFT informed treatment package to address PTSD and CPTSD in people with perinatal bereavement. Recommendations for practiceRoutine assessment of ICD-11 CPTSD is recommended in this population group.

Fatalism and ICD-11 CPTSD and PTSD diagnoses: results from Nigeria, Kenya & Ghana

ABSTRACT Background: Existing research on post-traumatic sequelae suggests a positive association between fatalism and symptoms of post-traumatic stress disorder (PTSD). However, the associations between fatalism and the new ICD-11 diagnosis of complex PTSD (CPTSD) have never been explored before. Objective: The current study explored the association between fatalism and PTSD and CPTSD in samples from three African countries. Methods: A total of 2,524 participants from Nigeria (n = 1018), Kenya (n = 1006), and Ghana (n = 500) completed measures of fatalism (non-judgemental fatalism, current fatalism, pessimistic fatalism, prospective fatalism) and the International Trauma Questionnaire (ITQ). A combination of a multinomial regression and path analysis was used to identify fatalism predictors of PTSD and CPTSD versus no diagnosis, and CPTSD versus PTSD, adjusted for demographic variables and trauma exposure. Results: While PTSD was not predicted by any of the fatalism types, compared to no diagnosis, CPTSD was significantly predicted by pessimistic, non-judgemental and current fatalism, both compared to no diagnosis and PTSD. Conclusions: The results broaden the knowledge on potential correlates of the new diagnosis of CPTSD. Addressing fatalistic beliefs by empowering people to think that they can choose their fate should be further explored as a possible target for intervention in the treatment of CPTSD.

Prevalence and treatment implications of ICD-11 complex PTSD in Australian treatment-seeking current and ex-serving military members

ABSTRACT Background: Despite growing support for the distinction between posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as separate diagnoses within the ICD-11 psychiatric taxonomy, the prevalence and treatment implications of CPTSD among current and ex-serving military members have not been established. Objective: The study aims were to a) establish the prevalence of provisional ICD-11 CPTSD diagnosis relative to PTSD in an Australian sample of treatment-seeking current and ex-serving military members, and b) examine the implications of CPTSD diagnosis for intake profile and treatment response. Methods: The study analysed data collected routinely from Australian-accredited treatment programmes for military-related PTSD. Participants were 480 current and ex-serving military members in this programmes who received a provisional ICD-11 diagnosis of PTSD or CPTSD at intake using proxy measures. Measures of PTSD symptoms, disturbances in self-organisation, psychological distress, mental health and social relationships were considered at treatment intake, discharge, and 3-month follow-up. Results: Among participants with a provisional ICD-11 diagnosis, 78.2% were classified as having CPTSD, while 21.8% were classified as having PTSD. When compared to ICD-11 PTSD, participants with CPTSD reported greater symptom severity and psychological distress at intake, and lower scores on relationship and mental health dimensions of the quality of life measure. These relative differences persisted at each post-treatment assessment. Decreases in PTSD symptoms between intake and discharge were similar across PTSD (d RM = −0.81) and CPTSD (d RM = −0.76) groups, and there were no significant post-treatment differences between groups when controlling for initial scores. Conclusions: CPTSD is common among treatment-seeking current and ex-serving military members, and is associated with initially higher levels of psychiatric severity, which persist over time. Participants with CPTSD were equally responsive to PTSD treatment; however, the tendency for those with CPTSD to remain highly symptomatic post-treatment suggests additional treatment components should be considered.

Using Latent Class Analysis to Support the ICD-11 Complex Posttraumatic Stress Disorder Diagnosis in a Sample of Homeless Adults.

The 11th revision of the International Classification of Diseases (ICD-11), ratified at the World Health Assembly in May 2019, introduced revised diagnostic guidelines for posttraumatic stress disorder (PTSD) as well as a separate diagnosis of complex PTSD (CPTSD). We aimed to test the new ICD-11 symptom structure for PTSD and CPTSD in a sample of individuals who have experienced homelessness. Experiences of trauma exposure and the associated mental health outcomes have been underresearched in this population. A sample of adults experiencing homelessness (N = 206) completed structured and semi-structured interviews that collected information about trauma exposure and symptoms of PTSD and CPTSD. We conducted a latent class analysis (LCA) using six symptom clusters (three PTSD symptom clusters that are components of CPTSD and three CPTSD symptom clusters). All participants reported trauma exposure, with 88.6% having experienced at least one event before 16 years of age. Four distinct classes of participants emerged in relation to the potential to meet the diagnosis: LCA CPTSD (n = 122, 59.8%), LCA no diagnosis (n = 27: 13.2%), LCA PTSD (n = 33; 16.2%), and LCA disturbance in self-organization (DSO; n = 22; 10.8%). Of note, participants with an ICD-11 CPTSD as well as those with an ICD-11 PTSD diagnosis fell into the LCA CPTSD class. Our findings provide some support for the distinction between CPTSD and PTSD within this population specifically but potentially have broader implications. Clear diagnoses will allow targeted PTSD and CPTSD treatment development.

Prevalence and predictive value of ICD-11 post-traumatic stress disorder and Complex PTSD diagnoses in children and adolescents exposed to a single-event trauma.

BackgroundThe 11th edition of the International Classification of Diseases (ICD‐11) made a number of significant changes to the diagnostic criteria for post‐traumatic stress disorder (PTSD). We sought to determine the prevalence and 3‐month predictive values of the new ICD‐11 PTSD criteria relative to ICD‐10 PTSD, in children and adolescents following a single traumatic event. ICD‐11 also introduced a diagnosis of Complex PTSD (CPTSD), proposed to typically result from prolonged, chronic exposure to traumatic experiences, although the CPTSD diagnostic criteria do not require a repeated experience of trauma. We therefore explored whether children and adolescents demonstrate ICD‐11 CPTSD features following exposure to a single‐incident trauma.MethodData were analysed from a prospective cohort study of youth aged 8–17 years who had attended an emergency department following a single trauma. Assessments of PTSD, CPTSD, depressive and anxiety symptoms were performed at two to four weeks (n = 226) and nine weeks (n = 208) post‐trauma, allowing us to calculate and compare the prevalence and predictive value of ICD‐10 and ICD‐11 PTSD criteria, along with CPTSD. Predictive abilities of different diagnostic thresholds were undertaken using positive/negative predictive values, sensitivity/specificity statistics and logistic regressions.ResultsAt Week 9, 15 participants (7%) were identified as experiencing ICD‐11 PTSD, compared to 23 (11%) experiencing ICD‐10 PTSD. There was no significant difference in comorbidity rates between ICD‐10 and ICD‐11 PTSD diagnoses. Ninety per cent of participants with ICD‐11 PTSD also met criteria for at least one CPTSD feature. Five participants met full CPTSD criteria.ConclusionsReduced prevalence of PTSD associated with the use of ICD‐11 criteria is likely to reduce identification of PTSD relative to using ICD‐10 criteria but not relative to DSM‐4 and DSM‐5 criteria. Diagnosis of CPTSD is likely to be infrequent following single‐incident trauma.

Building 'a compassionate armour': The journey to develop strength and self-compassion in a group treatment for complex post-traumatic stress disorder.

Complex post-traumatic stress disorder (PTSD) is associated with severe difficulties in emotional regulation, interpersonal relationships, and shame. For individuals with these difficulties, exposure-based treatment for PTSD symptoms is less effective and can even be harmful. This study aimed to investigate the mechanisms of change at an individual and group level for individuals completing treatment for complex PTSD. Constructivist grounded theory was used to develop an explanatory theoretical model of the change process. Semi-structured interviews were conducted with 11 women with a diagnosis of complex PTSD who had completed the group treatment. The theoretical model captured change as an ongoing journey, which continued after treatment finished. Participants identified three essential aspects of the group that brought about change. The first was the group itself, in which valued relationships were formed. Additionally, participants described two key mechanisms - developing a comprehensive understanding of themselves and their difficulties, and experiencing their emotions and compassion from others. The key mechanisms of change were the relationships formed within the group and the need for a deeper understanding of the self in order to reduce shame and prepare for exposure-based treatment. Further support is provided for a phase-based approach to complex PTSD treatment. Psychoeducation alone, however, was not sufficient, and it was also crucial that participants could safely access their emotions and experience compassion from others in order for change to come about. Important aspects of treatment for complex PTSD are emphasised to inform professional practice. In particular, the role of relationships is altering self-perceptions through group therapy. Other key elements included participants building an understanding of themselves and their difficulties through psychoeducation, developing compassion for others and themselves, and safely accessing their emotions. This study also builds upon the body of evidence for the benefits of phase-based treatment which addresses shame and emotional regulation prior to exposure therapy.

Complex PTSD among treatment-seeking veterans with PTSD

ABSTRACT Background: In the ICD-11 hierarchical classification structure, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) are separate and distinct but also ‘sibling’ disorders, meaning that the diagnoses follow from the parent category of traumatic stress disorders. Objective: The aim of this study was to examine the prevalence of CPTSD in treatment-seeking war veterans with PTSD more than 20 years after the exposure to cumulative war-related trauma(s). The second aim was to examine if there was an association between demographic and psychosocial variables and CPTSD or PTSD. Method: A sample of 160 male war veterans with PTSD referred to the outpatient service of the PTSD Referral Centre at the Clinical Hospital Centre (CHC) Rijeka participated in a cross-sectional study. Psychiatric comorbidity was assessed using the Mini-International Neuropsychiatric Interview (MINI) and participants completed validated self-report measures: The Life Events Checklist for DSM-5 (LEC-5), International Trauma Questionnaire (ITQ). Results: In total, 80.63% of the sample met criteria for a probable diagnosis of CPTSD. The study revealed that there was no significant difference in the length of deployment, in the intensity of the PTSD symptoms, types of trauma exposure and pharmacotherapeutic treatment between PTSD and CPTSD group. It was found that veterans with PTSD were more likely to be divorced and to participate in PTSD clubs. On the other hand, veterans with CPTSD were significantly more likely to have higher levels of functional impairment and comorbidity with general anxiety disorder (GAD) compared to the PTSD group. Conclusions: This study supports the proposition that a prolonged trauma of severe interpersonal intensity such as war is related to high rates of CPTSD among treatment-seeking veterans, years after the war. The distinction between PTSD and complex PTSD may help the selection of person-centred treatment interventions that would target specific mental health and functional problems in patients.