Structured Interview For Disorders Of Extreme Stress Research Articles

The Self-Administered Version of the Structured Interview for Disorders of Extreme Stress (SIDES-SR) in a Clinical and Non-Clinical Portuguese Sample.

Disorders of Extreme Stress Not Otherwise Specified (DESNOS) refers to a constellation of symptoms deriving from chronic interpersonal trauma, inflicted by caregivers or in the context of intimate relationships. The Structured Interview for Disorders of Extreme Stress-Self-Report (SIDES-SR) was designed for the assessment of DESNOS. This study aimed to validate the Portuguese version of the SIDES-SR in the community (N = 814; Mage = 40.09, SD = 14.25, 39.2% male, 60.8% female) and clinical (N = 310; Mage = 42.49, SD = 12.47, 57.7% male, 42.3% female) samples. It had three objectives: (1) to validate the SIDES-SR rationally derived domains in the community sample; (2) to characterise the reliability of the SIDES-SR scales in both samples; and (3) to explore mean differences in the SIDES-SR results in both samples. The Portuguese SIDES-SR confirmed the six clinical domains of DESNOS and demonstrated acceptable internal consistency levels, similar to those obtained in prior research. Highly significant differences and large and very large effect sizes between the community and clinical samples were found for all the SIDES-SR domains. DESNOS symptomatology was shown to be more frequent in females and the clinical sample reported a higher frequency of traumatic events in life, specifically interpersonal trauma. The results support the relevance of the SIDES-SR for clinical practice in the assessment of the DESNOS diagnosis.

Psychometric Properties of Difficulties in Emotion Regulation Scale (DERS) on Young Nigerian People

A cross-sectional survey design was adopted to validate the Difficulties in Emotion Regulation Scale (DERS) on Nigerian university undergraduates. A multistage sampling technique was used to purposively select 1338 (mean age ± SD 19.86 ± 2.95) participants made up of 512 (38.3%) male, and 826 (61.7%) were female. Participants were drawn from four selected universities in Osun state, southwestern Nigeria. Participants responded to the Difficulties in Emotion Regulation Scale, and the Structured Interview for Disorders of Extreme Stress (SIDES) Affect Dysregulation Scale. Observed internal consistency of DERS showed a Cronbach’s alpha coefficient of .90, a Spearman-Brown coefficient of .80 and Guttman Split-Half coefficient of .80. The items that measure awareness of emotion had a weak corrected item-total correlation and did not discriminate well. A significant positive correlation was observed between DERS and SIDES, revealing a correlation coefficient validity score of (r = .622, p = .000). The DERS has acceptable psychometric properties for the Nigerian population. Observed gender-based norms were ≥113.15 and ≥114.07 for male and female respectively. DERS is found to be gender-sensitive. A re-work or expunging of the items measuring awareness to fit with the construct of emotional regulation was recommended.

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

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.

Chronic pain in multi-traumatized outpatients with a refugee background resettled in Norway: a cross-sectional study.

BackgroundTraumatized refugees often report significant levels of chronic pain in addition to posttraumatic stress disorder symptoms, and more information is needed to understand pain in refugees exposed to traumatic events. This study aimed to assess the frequency of chronic pain among refugee psychiatric outpatients, and to compare outpatients with and without chronic pain on trauma exposure, psychiatric morbidity, and psychiatric symptom severity.MethodsWe conducted a cross-sectional study of sixty-one psychiatric outpatients with a refugee background using structured clinical diagnostic interviews to assess for traumatic events [Life Events Checklist (LEC)], PTSD (Posttraumatic Stress Disorder) and complex PTSD [Structured Clinical Interview for DSM-IV PTSD Module (SCID-PTSD) and Structured Interview for Disorders of Extreme Stress (SIDES)], chronic pain (SIDES Scale VI) and psychiatric symptoms [M.I.N.I. International Neuropsychiatric Interview (M.I.N.I.)]. Self-report measures were used to assess symptoms of posttraumatic stress [Impact of Event Scale-revised (IES-R)], depression and anxiety [Hopkins Symptom Checklist (HSCL-25)] and several markers of acculturation in Norway.ResultsOf the 61 outpatients included, all but one reported at least one chronic pain location, with a mean of 4.6 locations per patient. Chronic pain at clinical levels was present in 66% of the whole sample of outpatients, and in 88% of the outpatients with current PTSD diagnosis. The most prevalent chronic pain locations were head (80%), chest (74%), arms/legs (66%) and back (62%). Women had significantly more chronic pain locations than men. Comorbid PTSD and chronic pain were found in 57% of the outpatients. Significant differences were found between outpatients with and without chronic pain on posttraumatic stress, psychological distress, and DESNOS severity.ConclusionsChronic pains are common in multi-traumatized refugees in outpatient clinics in Norway, and are positively related to symptomatology and severity of psychiatric morbidity. The presence of chronic pain, as well as comorbid chronic pain and PTSD, in psychiatric outpatients with a refugee background call for an integrated assessment and treatment for both conditions.

Complex posttraumatic stress disorder in traumatised asylum seekers: a pilot study

Complex posttraumatic stress disorder (cPTSD), a construct associated with early onset and repeated interpersonal trauma, has not previously been assessed in asylum seekers who have experienced major human rights violations. The aim of this pilot study was to describe the cPTSD symptom profile in asylum seekers, and to compare this profile between three groups of people who have experienced: human trafficking, domestic violence and/or torture. Methods: Over a period of eight weeks, clinicians working at the Helen Bamber Foundation charity invited 48 patients currently receiving psychotherapy to take part in the study, of whom 30 (62.5%) agreed. The structured interview for disorders of extreme stress (SIDES) was used to assess cPTSD in 29 asylum seekers, as one patient withdrew during the interview. Results: Participants originated from 18 countries, 72.4% were female, the median age at trauma onset was 17 years and the duration of trauma was ten years. Eight (27.6%) participants were found to have cPTSD, defined as having all six symptom clusters, and 15 (51.7%) had five or more cPTSD symptom clusters. Age at trauma onset, duration of trauma, last trauma experience, gender and trauma type were not found to be associated with cPTSD presence. Conclusions: Extensive cPTSD symptoms were common in all participants, regardless of the nature of the trauma experienced. Future research is needed to enable generalisability of cPTSD symptom profile in asylum seekers.

Concurrent validity of the Structured Interview for Disorders of Extreme Stress (SIDES-SR) in a non-clinical sample of South African adolescents

The concurrent criterion-related validity of the Structured Interview for Disorders of Extreme Stress (SIDES-SR) was examined in a cross-sectional study of 719 secondary school students attending a high school in Durban, South Africa. For purposes of analysis, exposure to complex developmental trauma was defined as exposure to either chronic (>1 month) and/or multiple incidents (5+ types) of interpersonal victimisation prior to the age of 18 years. A series of discriminant analyses indicated that 12 of the 45 items on the SIDES-SR (27%) did not significantly discriminate individuals who had been exposed to complex developmental trauma from those who had not, with the removal of these 12 items from the scale having no significant impact on estimates of the concurrent validity, sensitivity, or specificity of the SIDES-SR. These findings suggest that the SIDES-SR may be characterised by some degree of construct over-representation when applied to South African samples, with further research being indicated in order to not only replicate the present findings but also address the issue of construct under-representation in the South African context.

Stabilizing Group Treatment for Complex Posttraumatic Stress Disorder Related to Child Abuse Based on Psychoeducation and Cognitive Behavioural Therapy: A Multisite Randomized Controlled Trial

Background: Evidence-based treatments for complex posttraumatic stress disorder (PTSD) related to childhood abuse are scarce. This is the first randomized controlled trial to test the efficacy of psycho-educational and cognitive behavioural stabilizing group treatment in terms of both PTSD and complex PTSD symptom severity. Methods: Seventy-one patients with complex PTSD and severe comorbidity (e.g. 74% axis II comorbidity) were randomly assigned to either a 20-week group treatment in addition to treatment as usual or to treatment as usual only. Primary outcome measures were the Davidson Trauma Scale (DTS) for PTSD and the Structured Interview for Disorders of Extreme Stress (SIDES) for complex PTSD symptoms. Statistical analysis was conducted in the intention-to-treat (ITT) and in the completer sample. Subjects were considered responders when scoring at 20 weeks at least 1 standard deviation below pretest findings. Results: The 16% attrition was relatively low. After 20 weeks, the experimental condition (large effect sizes) and control condition (medium effect sizes) both showed significant decreases on the DTS and SIDES, but differences between the conditions were not significant. The secondary responder analysis (ITT) revealed significantly more responders on the DTS (45 vs. 21%), but not on the SIDES (61 vs. 42%). Conclusions: Adding psycho-educational and cognitive behavioural stabilizing group treatment for complex PTSD related to child abuse to treatment as usual showed an equivocal outcome. Patients in both conditions improved substantially during stabilizing treatment, and while significant superiority on change scores was absent, responder analysis suggested clinical meaningfulness of adding group treatment.

A Controlled Pilot-Outcome Study of Sensory Integration (SI) in the Treatment of Complex Adaptation to Traumatic Stress

This study tested whether sensory integration (SI) treatment combined with psychotherapy would improve symptom outcome over psychotherapy alone in the treatment of complex posttraumatic stress, as measured by the Disorders of Extreme Stress Not Otherwise Specified (DESNOS) clinical construct in a group of 10 adult patients with histories of childhood abuse. DESNOS symptoms were assessed at three time periods (T1, baseline; T2, after experimental group SI treatment; and T3, after wait-list control group SI treatment) using the Structured Interview for Disorders of Extreme Stress (SIDES). The Sensory Learning Program™ (SLP), developed by the Sensory Learning Institute of Boulder, Colorado, was used as the SI treatment modality. Results indicated significant differential improvement for the group treated with SLP in SIDES Total Score (T1/T2 and T2/T3), Self Perception (T1/T2 and T2/T3), Affect Regulation (T2/T3), and Alterations in Meaning (T1/T2).

Komplexe Traumatisierung als Folge ziviler Kriegserlebnisse. Eine Kurzmitteilung

The concept of disorders of extreme stress not otherwise specified (DESNOS) was designed to encompass the psychopathological consequences of interpersonal and ongoing traumatic experiences. This study examined the prevalence rate of DESNOS among students who reported having gone through war experiences. The sample consisted of 55 Kosovar students who had been exposed to war-related events. The various variables were recorded with the Structured Interview for Disorders of Extreme Stress (SIDES), the Impact of Event Scale-Revised (IES-R), and the Brief Symptom Inventory (BSI). 16.4% of the participants met the criteria for posttraumatic stress disorder but none of them could be diagnosed as suffering from DESNOS. However, the symptoms somatization, altered relationships, and altered systems of meaning were reported by 21-37% of the participants. The DESNOS total score was found to be a better predictor of psychiatric distress than posttraumatic stress symptoms. The results argue against the validity of DESNOS as a diagnostic construct for evaluating the effects of war traumatisation. Further study is necessary to determine whether changes in the individual subscales are relevant to the assessment of psychological aftereffects of war.

Ergebnisse zur internen und externen Validität des Interviews zur komplexen Posttraumatischen Belastungsstörung (I-kPTBS)

The diagnostic construct of complex posttraumatic stress disorder (complex PTSD) describes the consequences of early onset and long-term persisting psychological traumatizations. The interview for complex PTSD (I-kPTBS) - is the German adaptation of the structured interview for disorders of extreme stress (SIDES). The present study reports first data regarding the internal validity of the I-kPTBS as well as on the external validity of the diagnosis of complex PTSD. The I-kPTBS was applied in 72 consecutive patients of a specialized outpatient clinic. 31 patients fulfilled the criteria of the diagnosis complex PTSD. 25 suffered from a PTSD but did not fulfil the diagnostic criteria of complex PTSD. Both groups where compared regarding their symptoms, resources and reports of childhood events. Internal consistence of the I-kPTBS regarding the sample was good to excellent (alpha = 0.88). As expected, patients with the diagnosis of complex PTSD showed more severe dissociative, depressive and general anxiety symptoms than patients with PTSD alone. Patients fulfilling the criteria of complex PTSD reported a lower age at their first traumatic event, more multiple traumatizations and more often a dissociative disorder as comorbid diagnosis. Patients with complex PTSD show a higher traumaload in childhood and a lower level of compensatory resources. The interview for complex PTSD (I-kPTBS) describes a consistent diagnostic construct. The results demonstrate that the diagnosis of complex PTSD selects a specific group of patients with early childhood trauma and high symptom level. Specific criteria can differentiate this patient group well from patients that suffer from PTSD alone.

Complex posttraumatic stress disorder and child maltreatment in forensic inpatients

There is converging evidence that forensic inpatients represent a severely traumatized population, particularly with respect to child maltreatment including sexual, physical, and emotional abuse as well as emotional and physical neglect. One of their possible aftermaths is captured by the syndrome of complex posttraumatic stress disorder (PTSD). This study investigated the prevalence of child maltreatment and complex PTSD in forensic patients. A total of 32 patients (28 men, 4 women) with a mean age of 36.9 years (SD = 11.8) were studied with the Structured Interview for Disorders of Extreme Stress (SIDES) and the Childhood Trauma Questionnaire (CTQ). The majority had experienced emotional abuse (75%), neglect (59%), and physical abuse (52%). The three-month prevalence of complex PTSD was 28% and the lifetime prevalence was 44%. Subjects with complex PTSD had significantly more physical abuse than those without complex PTSD, but did not differ in the other types of trauma. In line with previous research our results indicate that (a) a substantial proportion of forensic patients has been severely victimized in childhood and (b) nearly half meet diagnostic criteria for complex PTSD. These findings have important implications for the treatment process.

Dissociative Symptomatology in Posttraumatic Stress Disorder and Disorders of Extreme Stress

ABSTRACT The present study was designed to assess differences in dissociative symptoms in adults with Posttraumatic Stress Disorder (PTSD) vs. PTSD plus Disorders of Extreme Stress Not Otherwise Specified (DESNOS). This study was done for two reasons: (1) to better understand the clinical profile of DESNOS clients in order to inform more effective treatment, and (2) to further empirical research on the validity of the DESNOS construct. To assess severity of dissociative symptoms, the authors administered the Dissociative Experiences Scale (DES) to 155 participants with PTSD. Using the Structured Interview for Disorders of Extreme Stress (SIDES), participants were divided into two groups: those who also met criteria for DESNOS and those who did not. DES means are provided for the two groups. Participants with PTSD plus DESNOS scored higher than participants with only PTSD on the measure of dissociative symptomatology, particularly on the DES scales that tap absorption/fantasy and depersonalization/derealization. The two groups did not differ on the amnesia subscale of the DES. Findings support the construct validity of the DESNOS concept and further delineate the clinical profiles of community-based PTSD with and without DESNOS, thus contributing to the knowledge base on the assessment of complex adaptations to trauma.

DESNOS in three postconflict settings: Assessing cross-cultural construct equivalence

This study examined the cross-cultural construct equivalence of the Structured Interview for Disorders of Extreme Stress (SIDES), an instrument designed to assess symptoms of Disorders of Extreme Stress Not Otherwise Specified (DESNOS). Participants completed the SIDES as a part of an epidemiological survey conducted between 1997 and 1999 among survivors of war or mass violence in Algeria (n = 652), Ethiopia (n = 1,200), and Gaza (n = 585). Findings indicated that the factor structure of the SIDES across samples was not stable; thus construct equivalence was not shown. A multistep interdisciplinary method is proposed to improve the cross-cultural construct validity of a psychiatric concept. This method accommodates universal chronic sequelae of extreme stress and accommodates culture-specific symptoms across a variety of cultures.

Validation of the structured interview for disorders of extreme stress

There is a dearth of valid instruments to evaluate the primary sequelae of sexual abuse. The present study examined the construct validity of the subscales of the Structured Interview for Disorders of Extreme Stress (SIDES), a measure of the associated features of posttraumatic stress disorder (PTSD). Using a clinical sample of 74 survivors of childhood sexual abuse with PTSD, this study demonstrated that the subscales of the SIDES (alterations in regulation of affect and impulses, alterations in attention or consciousness, alterations in self-perception, and somatization) correlated highly with instruments hypothesized to measure similar constructs. Divergent validity was established for each of four subscales of the SIDES. Findings from this study and other research on the psychometrics of the SIDES indicate that it is a valid measure of the associated features of PTSD in survivors of childhood sexual abuse.

Development of a criteria set and a structured interview for disorders of extreme stress (SIDES)

AbstractData regarding the development of a structured interview measuring alterations that may accompany extreme stress are presented. A list of 27 criteria often seen in response to extreme trauma and not addressed by DSM‐IV criteria for posttraumatic stress disorder (PTSD) were generated based on a systematic review of the literature and a survey of 50 experts. A structured interview for disorders of extreme stress (SIDES) measuring the presence of these criteria was administered to 520 subjects as part of the DSM‐IV PTSD field trials. Inter‐rater reliability as measured by Kappa coefficients for lifetime Disorders of Extreme Stress was .81. Internal consistency using coefficient alpha ranged from .53 to .96. Results indicate that the SIDES is a useful tool for investigation of response to extremes stress.