Journal articles: 'CPTSD'

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Padun, M. A. "Complex PTSD: Psychotherapy of Prolonged Traumatization." Консультативная психология и психотерапия 29, no. 3 (2021): 69–87. http://dx.doi.org/10.17759/cpp.2021290306.

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The article considers a new diagnostic category — complex post-traumatic stress disorder (CPTSD), introduced into the International Classification of Diseases (ICD-11). Differences in the mechanism of influence of situational and prolonged trauma are analyzed. CPTSD diagnostic criteria are compared to PTSD and BPD (borderline personality disorder) symptoms. The term “disturbances in self-organi¬zation” is analyzed, which explains the main mechanism of the impact of complex trauma and includes emotional dysregulation, disturbances in self-perception and relationships. Psychotherapeutic approaches developed for PTSD were shown to be insufficient for the treatment of CPTSD. The article reviews an approach to CPSTD therapy based on the consensus of experts in the field of post-traumatic stress and its possible limitations are discussed. “Component based psychotherapy” — another approach to CPTSD therapy — is described. Specific features of psychotherapy for complex trauma are discussed.

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Bukhbinder, Avram S., Austin C. Wang, Salah U. Qureshi, Garima Arora, Ali Jawaid, Yogeshwar V. Kalkonde, Nancy J. Petersen, et al. "Increased Vascular Pathology in Older Veterans With a Purple Heart Commendation or Chronic Post-Traumatic Stress Disorder." Journal of Geriatric Psychiatry and Neurology 33, no. 4 (August 19, 2019): 195–206. http://dx.doi.org/10.1177/0891988719868308.

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The goal of this retrospective cohort study was to determine whether stressors related to military service, determined by a diagnosis of chronic post-traumatic stress disorder (cPTSD) or receiving a Purple Heart (PH), are associated with an increased risk of vascular risk factors and disease, which are of great concern for veterans, who constitute a significant portion of the aging US population. The Veterans Integrated Service Network (VISN) 16 administrative database was searched for individuals 65 years or older between October 1, 1997 to September 30, 1999 who either received a PH but did not have cPTSD (PH+/cPTSD−; n = 1499), had cPTSD without a PH (PH−/cPTSD+; n = 3593), had neither (PH−/cPTSD−; n = 5010), or had both (PH+/cPTSD+; n = 153). In comparison to the control group (PH−/cPTSD−), the PH+/cPTSD− group had increased odds ratios for incidence and prevalence of diabetes mellitus, hypertension, and hyperlipidemia. The PH−/cPTSD+ group had increased odds ratios for prevalence of diabetes mellitus and for the incidence and prevalence of hyperlipidemia. The PH−/cPTSD+ and PH+/cPTSD− groups were associated with ischemic heart disease and cerebrovascular disease, but not independently of the other risk factors. The PH+/cPTSD+ group was associated only with an increase in the incidence and prevalence of hyperlipidemia, though this group’s much smaller sample size may limit the reliability of this finding. We conclude that certain physical and psychological stressors related to military service are associated with a greater incidence of several vascular risk factors in veterans aged 65 years or older, which in turn are associated with greater rates of ischemic heart disease and cerebrovascular disease.

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Silove, Derrick, Susan Rees, Mohammed Mohsin, Natalino Tam, Moses Kareth, and Alvin Kuowei Tay. "Differentiating ICD-11 complex post-traumatic stress disorder from other common mental disorders based on levels of exposure to childhood adversities, the traumas of persecution and postmigration living difficulties among refugees from West Papua." BJPsych Open 4, no. 5 (August 24, 2018): 361–67. http://dx.doi.org/10.1192/bjo.2018.49.

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BackgroundFollowing years of controversy, a category of complex post-traumatic stress disorder (CPTSD) will be included in the forthcoming ICD-11.AimsTo test whether refugees with CPTSD differ from those with other common mental disorders (CMDs) in the degree of exposure to childhood adversities, adult interpersonal trauma and post-traumatic hardship.MethodSurvey of 487 West Papuan refugees (response rate 85.5%) in Papua New Guinea.ResultsRefugees with CPTSD had higher exposure to childhood adversities (CPTSD: mean 2.6, 95% CI 2.5–2.7 versus CMD: mean 1.15, 95% CI 1.10–1.20), interpersonal trauma (CPTSD: mean 9, 95% CI 8.6–9.4 versus CMD: mean 5.4, 95% CI 5.4–5.5) and postmigration living difficulties (CPTSD: mean 2.3, 95% CI 2–2.5 versus CMD mean 1.85, 95% CI 1.84–1.86), compared with those with CMDs who in turn exceeded those with no mental disorder on all these indices.ConclusionsThe findings support the cross-cultural validity of CPTSD as a reaction to high levels of exposure to recurrent interpersonal trauma and associated adversities.Declaration of interestNone.

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Murphy, Dominic, Mark Shevlin, Emily Pearson, Neil Greenberg, Simon Wessely, Walter Busuttil, and Thanos Karatzias. "A validation study of the International Trauma Questionnaire to assess post-traumatic stress disorder in treatment-seeking veterans." British Journal of Psychiatry 216, no. 3 (February 28, 2020): 132–37. http://dx.doi.org/10.1192/bjp.2020.9.

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BackgroundVeterans with post-traumatic stress disorder (PTSD) typically report a poorer treatment response than those who have not served in the Armed Forces. A possible explanation is that veterans often present with complex symptoms of PTSD. ICD-11 PTSD and complex PTSD (CPTSD) have not previously been explored in a military sample.AimsThis study aimed to validate the only measure of ICD-11 PTSD and CPTSD, the International Trauma Questionnaire, and assess the rates of the disorder in a sample of treatment-seeking UK veterans.MethodA sample of help-seeking veterans (N = 177) was recruited from a national charity in the UK that provides clinical services to veterans. Participants completed measures of ICD-11 PTSD and CPTSD as well as childhood and adult traumatic life events. Confirmatory factor analysis was used to assess the latent structure of PTSD and CPTSD symptoms, and rates of the disorders were estimated.ResultsThe majority of the participants (70.7%) reported symptoms consistent with a diagnosis of either PTSD or CPTSD. Results indicated the presence of two separate disorders, with CPTSD being more frequently endorsed (56.7%) than PTSD (14.0%). CPTSD was more strongly associated with childhood trauma than PTSD.ConclusionsThe International Trauma Questionnaire can adequately distinguish between PTSD and CPTSD within clinical samples of veterans. There is a need to explore the effectiveness of existing and new treatments for CPTSD in military personnel.

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Hearns, Aisling, Philip Hyland, Carin Benninger-Budel, and Frederique Vallières. "ICD-11 PTSD and CPTSD: Implications for the rehabilitation of survivors of torture seeking international protection." Torture Journal 31, no. 3 (December 29, 2021): 96–112. http://dx.doi.org/10.7146/torture.v32i3.125780.

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Introduction: Rates of torture are especially high among those seeking asylum, with global estimates of forced migrants having experienced torture exceeding 50%. Torture is the strongest predictor of PTSD amongst refugee populations. This study assesses the construct validity and diagnostic rate of the ICD-11 PTSD and Complex PTSD (CPTSD) within a population of torture survivors seeking asylum in Ireland. It further explores whether this population were more likely to meet the diagnostic criteria for CPTSD than PTSD, and whether any sex differences existed in probable rates of PTSD and CPTSD. Methods: A secondary data analysis of 264 treatment-seeking asylum seekers and refugees who experienced torture or ill-treatment was conducted. Rates of PTSD and CPTSD were assessed using the International Trauma Questionnaire. Findings: A Confirmatory Factor Analysis supported a a six-factor correlated model consisting of re-experiencing (Re), avoidance (Av), threat (Th), affective dysregulation (AD), negative self-concept (NSC), and disturbed relationships (DR), consistent with ICD-11 PTSD and CPTSD. High rates of PTSD (32.4%) and CPTSD (39.6%) were found, with the experience of torture significantly associated to the development of PTSD. No significant difference was found between the sexes. Discussion: This is the first study to investigate the validity of ICD 11 PTSD and CPTSD among torture survivors actively seeking international protection in Europe. Given the high rates of PTSD and CPTSD found among torture survivors, rehabilitation centres for victims of torture should consider CPTSD as part of their assessment and treatment programmes.

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Vang, Maria Louison, Sabrina Brødsgaard Nielsen, Mikkel Auning-Hansen, and Ask Elklit. "Testing the validity of ICD-11 PTSD and CPTSD among refugees in treatment using latent class analysis." Torture Journal 29, no. 3 (January 20, 2020): 27–45. http://dx.doi.org/10.7146/torture.v29i3.115367.

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Introduction: The WHO has proposed posttraumatic stress (PTSD) and Complex PTSD (CPTSD) trauma-related ‘sibling’-disorders in ICD-11. The proposal has received support from research among clinical and community samples alike but only few studies have tested the validity of these disorders in a sample of refugees using the International Trauma Questionnaire especially designed for assessment of ICD-11 PTSD and CPTSD. Methods: Latent class analysis was used to test the validity of the ICD-11 PTSD and CPTSD distinction in a heterogeneous group of 284 highly symptomatic refugees registered for treatment at a Danish treatment-center. Results: A two-class solution fit the data best. One group reported elevated levels of PTSD-symptoms and symptoms of affective dysregulation, and one group reported elevated levels of symptoms corresponding to CPTSD. The CPTSD group was considerably larger than the PTSD-group. Discussion: The current study supports the ICD-11 distinction between PTSD and CPTSD in a sample of treatment-seeking refugees. The assistance of interpreters was needed for some of the participants which affected the reliability of the assessment. Conclusion: The ICD-11 proposal for PTSD and CPTSD is supported in a heterogenous sample of refugees using the ITQ.

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Ford, Julian D. "Progress and Limitations in the Treatment of Complex PTSD and Developmental Trauma Disorder." Current Treatment Options in Psychiatry 8, no. 1 (February 9, 2021): 1–17. http://dx.doi.org/10.1007/s40501-020-00236-6.

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Abstract Purpose of review This review describes treatments that have been developed (or adapted from treatment models for posttraumatic stress disorder [PTSD]) for Complex PTSD (cPTSD) in adulthood and developmental trauma disorder (DTD) in childhood. The nascent research evidence-base is reviewed and future directions are discussed. Recent findings Numerous psychotherapy treatments are in the early stages of clinical testing and dissemination for symptoms of cPTSD (emotion dysregulation, interpersonal detachment, altered self-perception) and the additional symptoms of DTD (interpersonal, somatic, and behavioral dysregulation and dissociation). There is indirect evidence, primarily based on reductions in depression and anxiety symptoms (but not cPTSD or DTD symptoms specifically), of efficacy for varied approaches to trauma-focused cognitive behavior therapy (CBT) in randomized controlled trials with adults and children with histories of developmentally adverse traumatic childhood experiences (e.g., abuse, violence). No approaches to pharmacotherapy have been systematically developed or tested for adult cPTSD or childhood DTD. Summary Despite a rapidly growing array of promising approaches to psychotherapy for cPTSD and DTD, the absence of formal diagnostic criteria for cPTSD and DTD has limited efforts to conduct scientific evaluations of the efficacy of these treatments. As treatment models continue to be created, refined, and disseminated, the recent development and validation of psychometric assessment measures for cPTSD (the International Trauma Questionnaire; ITQ) and DTD (the Developmental Trauma Disorder Semi-structured Interview; DTD-SI) is a crucial catalyst for rigorous outcome research that can lead to a robust cPTSD and DTD treatment outcome evidence-base and a precision health approach to treatment.

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Longo, L., T. Jannini, M. Merlo, V. Cecora, M. Gagliano, B. D’Imperia, A. Daverio, et al. "Suicidality in post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD)." European Psychiatry 64, S1 (April 2021): S142. http://dx.doi.org/10.1192/j.eurpsy.2021.390.

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IntroductionInternational Classification of Diseases 11th Revision (ICD-11) has inserted complex post-traumatic stress disorder (cPTSD) as a clinically distinct disorder, different from PTSD. The diagnosis of cPTSD has the same requirements for the one of PTSD, in addition to disturbances of self-organization (DSO – e.g., disturbances in relationships, affect dysregulation, and negative self-concept).ObjectivesThis study aimed to explore suicidality in PTSD and cPTSD. We examined also the association between clinical dimensions of hopelessness (feelings, loss of motivation, future expectations) and other symptomatologic variables.MethodsThe sample, recruited at the Fondazione Policlinico Tor Vergata, Rome, Italy, consisted of 189 subjects, 132 diagnosed with PTSD, and 57 with cPTSD, according to the ICD-11 criteria. Participants underwent the following clinical assessments: Clinician-Administered PTSD Scale (CAPS), Impact of Event Scale-Revised (IES), Beck Depression Inventory (BDI), Symptom Checklist-90-Revised (SCL-90), Dissociative Experience Scale (DES), Beck Hopelessness Scale (BHS).ResultscPTSD showed significantly higher BHS-total (p = 0.01) and BHS-loss of motivation subscale (p <0.001) scores than PTSD. Besides, cPTSD showed significantly higher scores in all clinical variables except for the IES-intrusive subscale. By controlling for the confounding factor “depression”, suicidality in cPTSD (and in particular the BHS-total) appears to be correlated with IES-total score (p = 0.042) and with DES-Absorption (p = 0.02). Differently, no such correlations are found in PTSD.ConclusionsOur study shows significant symptomatologic differences between PTSD and cPTSD, including suicidality. Indeed, suicidality in cPTSD appears to be correlated with the “loss of motivation” dimension, which fits well within the ICD-11 criteria of DSO.DisclosureNo significant relationships.

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Koch, Lynn C., Stephanie L. Lusk, and Andrea Hampton Hall. "Complex Posttraumatic Stress Disorder and Rehabilitation Counseling." Rehabilitation Research, Policy, and Education 35, no. 3 (September 1, 2021): 185–200. http://dx.doi.org/10.1891/re-21-01.

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PurposeComplex posttraumatic stress disorder (CPTSD) is a multifaceted disorder, and the specific diagnostic criteria developed by the World Health Organization (WHO), which highlight symptoms of CPTSD (i.e., affect dysregulation, negative self-concept, disturbed relationships), that occur along with PTSD symptoms speak to this. Understanding the disorder itself and its ramifications is essential as our society is exposed to seemingly more and more traumatic and long-lasting events, all of which may lead to an increase in the number of overall cases. CPTSD is characterized by changes in three primary areas of the brain – hippocampus, amygdala, and medial prefrontal cortex (mPFC)– which are usually smaller in individuals with CPTSD, and there are certain subsets of individuals who have an increased likelihood of developing this disorder (e.g., individuals with physical and psychiatric disabilities, children exposed to long-term trauma).MethodThe authors conducted a scoping literature review on CPTSD, treatment approaches for individuals with CPTSD, and rehabilitation implications.ResultsTreatment for CPTSD is generally more extensive than treatment for PTSD and should be made available for those in need. There is a dearth of research on this topic in the rehabilitation literature; however, disability research has consistently shown that employment plays a huge role in successful recovery among individuals with psychiatric disabilities, which includes CPTSD.ConclusionIn order to ensure client success, rehabilitation counselors, educators, and researchers must understand the complexities associated with CPTSD and then how to best go about incorporating this information into individual plans for employment and our classrooms as well as making research in this area a priority for the field.

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Biggs, C., N. Tehrani, and J. Billings. "Brief trauma therapy for occupational trauma-related PTSD/CPTSD in UK police." Occupational Medicine 71, no. 4-5 (June 1, 2021): 180–88. http://dx.doi.org/10.1093/occmed/kqab075.

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Abstract Background Police are frequently exposed to occupational trauma, making them vulnerable to post-traumatic stress disorder (PTSD) and other mental health conditions. Through personal and occupational trauma police are also at risk of developing Complex PTSD (CPTSD), associated with prolonged and repetitive trauma. Police Occupational Health Services require effective interventions to treat officers experiencing mental health conditions, including CPTSD. However, there is a lack of guidance for the treatment of occupational trauma. Aims To explore differences in demographics and trauma exposure between police with CPTSD and PTSD and compare the effectiveness of brief trauma-focused therapy between these diagnostic groups. Methods Observational cohort study using clinical data from the Trauma Support Service, providing brief trauma-focused therapy for PTSD (cognitive behavioural therapy/eye movement desensitization and reprocessing) to UK police officers. Demographics, trauma exposure, baseline symptom severity and treatment effectiveness were compared between police with PTSD and CPTSD. Changes in PTSD, depression and anxiety symptoms were used to measure treatment effectiveness. Results Brief trauma therapy reduced symptoms of PTSD, depression and anxiety. Treatment effectiveness did not differ between CPTSD and PTSD groups. Police with CPTSD exposed to both primary and secondary occupational trauma had poorer treatment outcomes than those exposed to a single occupational trauma type. Conclusions Brief trauma-focused interventions are potentially effective in reducing symptoms of PTSD, depression and anxiety in police with CPTSD and PTSD. Further research is needed to establish whether additional CPTSD symptoms (affect dysregulation, self-perception and relational difficulties) are also reduced.

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Morris, Deborah, Elanor Lucy Webb, Jessica Holmes, Katharine Reynolds, Michele Head, Amy Lunn, Rachel Canterbury, Peter McAllister, Karolos Dionelis, and Sanjith Kamath. "Examining the prevalence of complex PTSD in an inpatient DBT service for females with a primary diagnosis of EUPD." Abuse: An International Impact Journal 2, no. 1 (April 6, 2021): 79–95. http://dx.doi.org/10.37576/abuse.2021.020.

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In response to differential clinical presentations of survivors of multiple or chronic exposure to trauma, complex post-traumatic stress disorder (CPTSD) has been included in the 11th revision of the International Classification of Diseases (ICD-11). A growing body of research has explored the prevalence of CPTSD in a range of populations, yet its prevalence in adults diagnosed with Emotionally Unstable Personality Disorder (EUPD) has been subject to limited evaluation, including in individuals requiring specialist inpatient care. The International Trauma Questionnaire (ITQ) was administered to 42 females with primary diagnoses of EUPD admitted to a specialist DBT service. Twenty-eight (66.8%) participants met full diagnostic criteria for either PTSD (11.9%, n=5) or CPTSD (54.8%, n=23). Additionally, PTSD and CPTSD symptomatology were highly prevalent in participants who did not meet the functional impairment criteria. Significant differences in the prevalence of CPTSD were found, dependent on whether a measure of functional impairment was included. This is the first study to explore the prevalence of CPTSD in an inpatient EUPD sample, using diagnostic thresholds. The findings highlight the importance of attending to trauma as well as EUPD-related needs. Theoretical, clinical and future research implications are discussed.

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Marques Feixa, L., S. Romero, J. Moya-Higueras, P. Santamarina-Pérez, J. March-Llanes, M. J. Muñoz, I. Zorrilla, et al. "Reinforcing the new diagnosis of Complex Post-Traumatic Stress disorder (CPTSD) of ICD-11: exploring the clinical outcomes in youth exposed to complex trauma." European Psychiatry 65, S1 (June 2022): S448—S449. http://dx.doi.org/10.1192/j.eurpsy.2022.1139.

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Introduction Youth exposed to complex trauma (CT) show an increased risk of psychiatric morbidity, including a wide range of psychiatric disorders. However, to date, there is no specific diagnosis in the DSM-5 that capture the clinical complexity of these patients. Properly, the last version of the ICD-11 includes a diagnosis termed Complex Post-Traumatic Stress Disorder (CPTSD), which considers the pattern of post-traumatic stress symptoms, plus life-impairing disturbances in self-organization (emotion dysregulation, negative self-concept and interpersonal problems). Clinical research about CPTSD, especially in younger population, is still limited. Objectives To explore the symptomatology of CPTSD in a sample of youth exposed to CT and its association with worse clinical outcomes. Methods 187 youth aged 7 to 17 years participated in the EPI_young_stress_project (116 with current psychiatric disorder and 71 healthy controls). CT was evaluated following the TASSCV criteria. To identify CPTSD symptomatology, we performed an exploratory factor analysis including CBCL and TEIQue items. The global level of functioning was measured by CGAS. Results Preliminary results pointed that youth exposed to CT showed greater internalizing (p<.001) and externalizing (p<.001) symptomatology. Regardless of their current primary diagnosis based on DSM-5, youth exposed to CT reported more CPTSD symptomatology (p<.001). Moreover, youth with CPTSD showed greater use of psychotropic drugs (p<.001), higher and longer hospitalizations (p=.002) and worse overall functioning (p<.001). Conclusions The inclusion of the CPTSD in future versions of mental disorders manuals should increase the implementation of early specific trauma interventions, which may improve victims’ lives and reduce the risk of worse clinical outcomes. Disclosure No significant relationships.

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Karatzias, Thanos, Philip Hyland, Aoife Bradley, Claire Fyvie, Katharine Logan, Paula Easton, Jackie Thomas, et al. "Is Self-Compassion a Worthwhile Therapeutic Target for ICD-11 Complex PTSD (CPTSD)?" Behavioural and Cognitive Psychotherapy 47, no. 3 (October 2, 2018): 257–69. http://dx.doi.org/10.1017/s1352465818000577.

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Background:Two ‘sibling’ disorders have been proposed for the fourthcoming 11th version of theInternational Classification of Diseases(ICD-11): post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). Examining psychological factors that may be associated with CPTSD, such as self-compassion, is an important first step in its treatment that can inform consideration of which problems are most salient and what interventions are most relevant.Aims:We set out to investigate the association between self-compassion and the two factors of CPTSD: the PTSD factor (re-experiencing, avoidance, sense of threat) and the Disturbances in Self-Organization (DSO) factor (affect dysregulation, negative self-concept and disturbances in relationships). We hypothesized that self-compassion subscales would be negatively associated with both PTSD and DSO symptom clusters.Method:A predominantly female, clinical sample (n= 106) completed self-report scales to measure traumatic life events, ICD-11 CPTSD and self-compassion.Results:Significant negative associations were found between the CPTSD DSO clusters of symptoms and self-compassion subscales, but not for the PTSD ones. Specifically it was also found that self-judgement and common humanity significantly predicted hypoactive affect dysregulation whereas self-judgement and isolation significantly predicted negative self-concept.Conclusions:Our results indicate that self-compassion may be a useful treatment target for ICD-11 CPTSD, particularly for symptoms of negative self-concept and affect dysregulation. Future research is required to investigate the efficacy and acceptability of interventions that have implicit foundations on compassion.

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de Jongh, Ad, Iva Bicanic, Suzy Matthijssen, Benedikt L. Amann, Arne Hofmann, Derek Farrell, Christopher W. Lee, and Louise Maxfield. "The Current Status of EMDR Therapy Involving the Treatment of Complex Posttraumatic Stress Disorder." Journal of EMDR Practice and Research 13, no. 4 (November 1, 2019): 284–90. http://dx.doi.org/10.1891/1933-3196.13.4.284.

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Complex posttraumatic stress disorder (CPTSD) is a diagnostic entity that will be included in the forthcoming edition of the International Classification of Diseases, 11th Revision (ICD-11). It denotes a severe form of PTSD, comprising not only the symptom clusters of PTSD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV-TR]), but also clusters reflecting difficulties in regulating emotions, disturbances in relational capacities, and adversely affected belief systems about oneself, others, or the world. Evidence is mounting suggesting that first-line trauma-focused treatments, including eye movement desensitization and reprocessing (EMDR) therapy, are effective not only for the treatment of PTSD, but also for the treatment of patients with a history of early childhood interpersonal trauma who are suffering from symptoms characteristic of CPTSD. However, controversy exists as to when EMDR therapy should be offered to people with CPTSD. This article reviews the evidence in support of EMDR therapy as a first-line treatment for CPTSD and addresses the fact that there appears to be little empirical evidence supporting the view that there should be a stabilization phase prior to trauma processing in working with CPTSD.

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Knefel, Matthias, Thanos Karatzias, Menachem Ben-Ezra, Marylene Cloitre, Brigitte Lueger-Schuster, and Andreas Maercker. "The replicability of ICD-11 complex post-traumatic stress disorder symptom networks in adults." British Journal of Psychiatry 214, no. 06 (January 9, 2019): 361–68. http://dx.doi.org/10.1192/bjp.2018.286.

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BackgroundThe ICD-11 includes a new disorder, complex post-traumatic stress disorder (CPTSD). A network approach to CPTSD will enable investigation of the structure of the disorder at the symptom level, which may inform the development of treatments that target specific symptoms to accelerate clinical outcomes.AimsWe aimed to test whether similar networks of ICD-11 CPTSD replicate across culturally different samples and to investigate possible differences, using a network analysis.MethodWe investigated the network models of four nationally representative, community-based cross-sectional samples drawn from Germany, Israel, the UK, and the USA (total N = 6417). CPTSD symptoms were assessed with the International Trauma Questionnaire in all samples. Only those participants who reported significant functional impairment by CPTSD symptoms were included (N = 1591 included in analysis; mean age 43.55 years, s.d. 15.10, range 14–99, 67.7% women). Regularised partial correlation networks were estimated for each sample and the resulting networks were compared.ResultsDespite differences in traumatic experiences, symptom severity and symptom profiles, the networks were very similar across the four countries. The symptoms within dimensions were strongly associated with each other in all networks, except for the two symptom indicators assessing aspects of affective dysregulation. The most central symptoms were ‘feelings of worthlessness’ and ‘exaggerated startle response’.ConclusionsThe structure of CPTSD symptoms appears very similar across countries. Addressing symptoms with the strongest associations in the network, such as negative self-worth and startle reactivity, will likely result in rapid treatment response.Declaration of interestA.M. and M.C. were members of the World Health Organization (WHO) ICD-11 Working Group on the Classification of Disorders Specifically Associated with Stress, reporting to the WHO International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders. The views expressed in this article are those of the authors and do not represent the official policies or positions of the International Advisory Group or the WHO.

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Nurahman, Dwi, and Dina Haryati Sukardi. "Kebijakan Model Crime Prevention Through Social Development Dalam Penanggulangan Tindak Pidana Terorisme." Ganaya : Jurnal Ilmu Sosial dan Humaniora 4, no. 2 (September 10, 2021): 520–30. http://dx.doi.org/10.37329/ganaya.v4i2.1330.

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The problem in this study is how the implementation of the conception of Crime Prevention Through Social Development (CPTSD) by Bhabinkamtibmas in combating criminal acts of terrorism and why there are obstacles to the implementation of the conception of CPTSD by Bhabinkamtibmas in combating criminal acts of terrorism. The research method specifically uses this type of qualitative research with a normative juridical approach to the problem and an empirical approach. The types of data used are primary data and secondary data. Primary data were obtained from interviews with resource persons and secondary data from literature studies. The results of the study indicate that the CPTSD model policy by Bhabinkamtibmas in overcoming criminal acts of terrorism is carried out through preventive, preemptive, and repressive efforts. Preventive efforts are supervision of chemicals that can be processed into explosives. Preemptive efforts are holding tabligh akbar and re-instilling Pancasila values in society. The repressive effort is the establishment of the Anti-Terror Task Force. The obstacle in implementing the CPTSD model policy by Bhabinkamtibmas in overcoming criminal acts of terrorism is that Bhabinkamtibmas still lacks resources both in terms of quantity of members and in the field of facilities and infrastructure which includes the number of vehicles and task tools used to carry out Anjau Glare and binluh to the community. The Binmas Pioneer program through the CPTSD by Bhabinkamtibmas has not yet reached the target, so it has not been maximal in raising public awareness and preventing crime.

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Padun, M. A., N. N. Kazymova, and Yu Ccentsova-Dutton. "Russian Version of the International Trauma Questionnaire: Adaptation and Validation in a Non-Clinical Sample." Консультативная психология и психотерапия 30, no. 3 (2022): 42–67. http://dx.doi.org/10.17759/cpp.2022300304.

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Purpose. The article presents the results of adaptation and validation of the International Trauma Questionnaire (ITQ) on a Russian sample. The questionnaire measures the symptoms of complex post-traumatic stress disorder (CPTSD), which can develop as a result of exposure to prolonged, repetitive traumatic experiences in the interpersonal sphere. Method. The study was carried out on a non-clinical sample, which included 429 participants who were 18 to 68 years old and who experienced at least one traumatic event in their lives. International Trauma Questionnaire (ITQ), LEC-5 (Life events checklist-5), author’s questionnaire “Emotional abuse”, Symptom Checklist (SCL-90-R) were used in the study. Results. The structure of the questionnaire in the Russian-speaking sample confirmed the two-factor model of complex PTSD, which combines the symptoms of PTSD («Re-experiencing», «Avoidance», «Sense of Threat») and disturbances of Self-organization («Affective Dysregulation», «Negative Self-concept», «Disturbances in Relationships»). Internal consistency of the scale was in the acceptable range. Among those who have experienced at least one traumatic event, 20% met criteria for PTSD (11%) or CPTSD (9%). These data show that respondents with CPTSD have more intense psychopathological symptoms than respondents with PTSD; women show more intense symptoms of CPTSD than men.

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Brewin, Chris R. "Complex post-traumatic stress disorder: a new diagnosis in ICD-11." BJPsych Advances 26, no. 3 (August 8, 2019): 145–52. http://dx.doi.org/10.1192/bja.2019.48.

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SUMMARYThe World Health Organization's proposals in ICD-11, released for comment by member states in 2018, introduce for the first time in a major diagnostic system a distinction between post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD). This article sets the new diagnosis of CPTSD within the context of previous similar formulations, describes its definition and requirements, and reviews the evidence concerning its epidemiology, differential diagnosis, assessment and treatment.

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Karabekiroglu, Koray, Seher Akbas, Gokce Nur Tasdemir, and Melih Nuri Karakurt. "Post-Traumatic Stress Symptoms in Adolescents after Two Murders in a School: A Controlled Follow-up Study." International Journal of Psychiatry in Medicine 38, no. 4 (December 2008): 407–24. http://dx.doi.org/10.2190/pm.38.4.b.

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Objectives: Two students were murdered by gunshot by another student. Among the classmates and the students in another school, we aimed to investigate the factors on the fifth day of trauma to be predictive of higher post-traumatic stress symptoms (PTSS) scores five months later. Methods: The adolescents attending the school (School A: acute phase n:41; second phase n:57; follow-up group n:35) where the event had occurred, and the adolescents attending a school (School B: acute phase n:98; second phase n:57) of similar statue were included. They had completed “Trauma Questionnaire” (TQ), “Childhood Post Traumatic Stress Disorder-Reaction Index” (CPTSD-RI), “Beck Depression Inventory” (BDI), and “State-Trait Anxiety Inventory” (STAI) both 5 days and 5 months after the event. Results: Both 5 days and 5 months after the trauma, students in school A, and the girls in both schools had significantly higher CPTSD-RI scores. Nine students (25.7%) in the follow-up group were found to have CPTSD-RI scores higher than 39, indicating severe PTSD symptoms. The CPTSD-RI scores of this group 5 months after the trauma were significantly correlated with the several scores of the acute term (CPTSD-RI [ r: .76, p < .001]; BDI [ r: .56, p: .001]; STAI-state [ r:. 49, p: .004]). Conclusion: Results reveal that a murder of a peer triggers post-traumatic stress symptoms in a vast majority of the 16-year-old adolescents even without directly witnessing the event. The severity of PTSS significantly increases as the adolescent is in closer relationship with the victim. The concomitant depression and/or anxiety with acute stress symptoms 5 days after the trauma, female gender, and worse school performance were found to be significantly related to the development of more severe PTSS 5 months later.

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García, C. Álvarez, L. Nocete Navarro, M. D. C. Molina Lietor, I. Cuevas Iñiguez, and A. Sanz Giancola. "The overlap between complex posttraumatic stress disorder and borderline personality disorder." European Psychiatry 64, S1 (April 2021): S754. http://dx.doi.org/10.1192/j.eurpsy.2021.1997.

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IntroductionResearch has shown the relationship between borderline personality disorder (BPD) and complex posttraumatic stress disorder (cPTSD), pointing out the overlapping nature and expression of both conditions. In order to understand their differences and similarities, we present a case of a 22-years-old patient with a history of repeated sexual trauma throughout all her adolescence, whose diagnose was changed from BPD to cPTSD after she was admitted in an acute inpatient mental health unit.ObjectivesTo gather the similarities between borderline personality disorder and complex posttraumatic stress disorder.MethodsA narrative review of the literature through the presentation of a case. Articles were chosen based on its clinical relevance.ResultscPTSD merges the clinical features and symptoms of PTSD with affect dysregulation, negative self-perception, unstable relationships and somatization, also present in BPD. Furthermore, BPD is known to frequently have a traumatic etiology.ConclusionsIt is not always simple to draw a clear line between cPTSD and BPD conditions. However, each diagnosis may have a different impact on patient understanding and treatment.DisclosureNo significant relationships.

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Karatzias, Thanos, Philip Murphy, Marylene Cloitre, Jonathan Bisson, Neil Roberts, Mark Shevlin, Philip Hyland, et al. "Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis." Psychological Medicine 49, no. 11 (March 12, 2019): 1761–75. http://dx.doi.org/10.1017/s0033291719000436.

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AbstractBackgroundThe 11th revision to the WHO International Classification of Diseases (ICD-11) identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions.MethodsWe conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality.ResultsFifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = −0.90 (CBT; k = 27, 95% CI −1.11 to −0.68; moderate quality) to g = −1.26 (EMDR; k = 4, 95% CI −2.01 to −0.51; low quality). CBT and EA each had moderate–large or large effects on negative self-concept, but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or moderate–large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared with non-specific interventions (e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome.ConclusionsThe development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.

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Jovarauskaite, Lina, Dominic Murphy, Inga Truskauskaite-Kuneviciene, Austeja Dumarkaite, Gerhard Andersson, and Evaldas Kazlauskas. "Associations between moral injury and ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD among help-seeking nurses: a cross-sectional study." BMJ Open 12, no. 5 (May 2022): e056289. http://dx.doi.org/10.1136/bmjopen-2021-056289.

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Objectives This study aimed to evaluate how moral injury (MI), traumatic experiences and daily stressors were related to the symptoms of post-traumatic stress disorder (PTSD) and International Classification of Diseases 11th revision specific complex PTSD (CPTSD) symptoms of disturbances in self-organisation (DSO) in a treatment-seeking sample of nurses. Design A cross-sectional study. Setting Nurses from all regions of Lithuania participated in the study. The data were collected between April and May 2021. Participants A total of 206 nurses, mean age 42.34 years (SD=11.68), 97.1% women and with 65% >10 years of work experience. Results The prevalence of PTSD and CPTSD in the treatment-seeking sample of nurses was 9.2% and 10.2%, respectively. The results of structural equation modelling indicated an acceptable model fit for the model regarding the links between trauma exposure, daily stressors, MI, PTSD and DSO symptoms, (χ2 (df)=219.718 (123), p<0.001, Comparative Fit Index/Tucker-Lewis Index=0.937/0.922, root mean square error of approximation (90% CI)=0.062 (0.048 to 0.075), standardised root mean square residual=0.049). MI had a large effect on DSO symptoms, β=0.667, p<0.001, and a medium effect on PTSD symptoms, β=0.394, p<0.001. Daily stress but not trauma exposure was significantly related to MI, β=0.618, p<0.001. Conclusions The prevalence of PTSD and CPTSD in a treatment-seeking sample of nurses inform healthcare administrators, policymakers and medical staff about the demand for psychosocial interventions for healthcare workers focused on stress management to address their daily stressors and mitigate effects on MI or trauma-focused treatments for PTSD/CPTSD. Trial registration number NCT04817995; Pre-results.

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Purnell, Lucy R., Alicia C. J. Graham, Michael A. P. Bloomfield, and Jo Billings. "Reintegration interventions for CPTSD: a systematic review." European Journal of Psychotraumatology 12, no. 1 (January 1, 2021): 1934789. http://dx.doi.org/10.1080/20008198.2021.1934789.

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Langtry, John, Marcin Owczarek, Donal McAteer, Laurence Taggart, Christina Gleeson, Catherine Walshe, and Mark Shevlin. "Predictors of PTSD and CPTSD in UK firefighters." European Journal of Psychotraumatology 12, no. 1 (January 1, 2021): 1849524. http://dx.doi.org/10.1080/20008198.2020.1849524.

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Lehrner, Amy, and Rachel Yehuda. "PTSD diagnoses and treatments: closing the gap between ICD-11 and DSM-5." BJPsych Advances 26, no. 3 (April 23, 2020): 153–55. http://dx.doi.org/10.1192/bja.2020.10.

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SUMMARYThe diagnostic status of ‘complex’ post-traumatic stress disorder (PTSD) remains controversial. The revisions to PTSD diagnostic criteria in ICD-11 and DSM-5 take opposing positions on how best to conceptualise post-traumatic presentations that include affect dysregulation, interpersonal difficulties and negative self-concept. ICD-11 carved out a separate category of complex PTSD (CPTSD) that is distinct from PTSD, whereas DSM-5 expanded PTSD to encompass such symptoms. Each approach carries problematic implications for clinical care. ICD-11 creates a dichotomy but the criteria themselves suggest a difference in severity rather than category. Furthermore, separating CPTSD perpetuates expectations that a ‘simple’ PTSD can be easily treated with brief trauma-focused therapy. DSM-5 complicates the PTSD diagnosis, but does not revise treatment recommendations. Both ICD and DSM need to recognise that most patients with PTSD do not reflect the clinical trial samples and do not fully recover with brief manualised therapies. Treatment guidelines should be developed that address the multiple needs and challenges of all patients with PTSD.

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Pynoos, Robert S., Armen Goenjian, Madeline Tashjian, Meline Karakashian, Raffi Manjikian, Gagik Manoukian, Alan M. Steinberg, and Lynn A. Fairbanks. "Post-traumatic Stress Reactions in Children After the 1988 Armenian Earthquake." British Journal of Psychiatry 163, no. 2 (August 1993): 239–47. http://dx.doi.org/10.1192/bjp.163.2.239.

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One and a half years after the devastating earthquake in Armenia in 1988, 231 children from three cities at increasing distances from the epicentre were randomly screened in their schools to determine the frequency and severity of post-traumatic stress reactions, using the Children's Post-traumatic Stress Disorder Reaction Index (CPTSD-RI). A systematic clinical assessment of PTSD based on DSM-III-R criteria was also conducted on approximately half of this sample. A high CPTSD-RI score was strongly correlated with a clinical diagnosis of PTSD. A strong positive correlation was found between proximity to the epicentre and overall severity of post-traumatic stress reaction, as well as severity of core component symptoms of PTSD. High rates of chronic, severe post-traumatic stress reactions were found among children in the two most damaged cities, Spitak and Gumri. Analyses controlling for exposure revealed that girls reported more persistent fears than boys. These findings indicate that after catastrophic natural disaster, post-traumatic reactions in children may reach epidemic proportions, remain high for a prolonged period, and jeopardise the well-being of the child population of a large region. Systematic screening of children for PTSD can provide critical information for a rational public mental health programme after such a disaster.

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Lechner-Meichsner, Franziska, and Regina Steil. "A clinician rating to diagnose CPTSD according to ICD-11 and to evaluate CPTSD symptom severity: Complex PTSD Item Set additional to the CAPS (COPISAC)." European Journal of Psychotraumatology 12, no. 1 (January 1, 2021): 1891726. http://dx.doi.org/10.1080/20008198.2021.1891726.

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Ormerod, Jennie, and Ashleigh McLellan. "Working with dissociation and complex trauma in military veterans." Clinical Psychology Forum 1, no. 314 (February 2019): 34–38. http://dx.doi.org/10.53841/bpscpf.2019.1.314.34.

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In this article we will outline some of the special considerations when working with a military population who have a presentation of complex post traumatic stress disorder (CPTSD) and where dissociation may be a feature. We discuss the historical context of the military, the impact of military training and whether dissociation is an adaptive strategy for military personnel, or if it increases the likelihood of later difficulties. We conclude with the treatment implications for working with this client group.

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Herman, Judith. "CPTSD is a distinct entity: Comment on Resick et al. (2012)." Journal of Traumatic Stress 25, no. 3 (June 2012): 256–57. http://dx.doi.org/10.1002/jts.21697.

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Zerach, Gadi, Mark Shevlin, Marylene Cloitre, and Zahava Solomon. "Complex posttraumatic stress disorder (CPTSD) following captivity: a 24-year longitudinal study." European Journal of Psychotraumatology 10, no. 1 (May 28, 2019): 1616488. http://dx.doi.org/10.1080/20008198.2019.1616488.

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DeJong, Margaret, and Simon Wilkinson. "Assessment of mental health problems in children following early maltreatment: What will the new diagnosis of complex PTSD add?" Developmental Child Welfare 1, no. 4 (December 2019): 360–73. http://dx.doi.org/10.1177/2516103219892636.

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Complex post-traumatic stress disorder (CPTSD) is a new diagnosis which has been developed for the forthcoming International Classification of Diseases 11th Revision criteria. This is in recognition of the impact of repeated, interpersonal trauma and an emerging evidence base supporting a distinction between PTSD and CPTSD, with its disturbances in self-organization in addition to the core features of reexperiencing, avoidance, and hypervigilance. The new diagnosis is discussed in the context of assessing children who have experienced maltreatment, many of whom will have affect dysregulation, interpersonal difficulties, and negative thoughts about themselves. However, not all maltreated children will have the core features of PTSD, and they may be affected in various other ways, which are discussed in the experience of a specialist clinic taking referrals for children who have been abused or neglected. The assessments recognize that maltreated children are typically exposed to multiple genetic and environmental risk factors. Traumatic symptoms are seen an adaptation to chronic threat, and close attention is also paid to systemic factors such as family relationships. Young children with PTSD will require developmentally sensitive assessment. Maltreated children are at high risk of mental health and neurodevelopmental problems but may present with symptoms in various domains which cumulatively are very impairing without always meeting diagnostic thresholds. Children may frequently be referred with possible autistic traits or symptoms of attention-deficit hyperactivity disorder, which need to be assessed in the light of their traumatic backgrounds. Assessing the role attachment in the development of children who have been abused or neglected is also considered.

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Frost, Rachel, Philip Hyland, Angela McCarthy, Rory Halpin, Mark Shevlin, and Jamie Murphy. "The complexity of trauma exposure and response: Profiling PTSD and CPTSD among a refugee sample." Psychological Trauma: Theory, Research, Practice, and Policy 11, no. 2 (February 2019): 165–75. http://dx.doi.org/10.1037/tra0000408.

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Simon, Natalie, Neil P. Roberts, Catrin E. Lewis, Marieke J. van Gelderen, and Jonathan I. Bisson. "Associations between perceived social support, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD): implications for treatment." European Journal of Psychotraumatology 10, no. 1 (February 13, 2019): 1573129. http://dx.doi.org/10.1080/20008198.2019.1573129.

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Karatzias, Thanos, and Alytia A. Levendosky. "Introduction to the Special Section on Complex Posttraumatic Stress Disorder (CPTSD): The Evolution of a Disorder." Journal of Traumatic Stress 32, no. 6 (December 2019): 817–21. http://dx.doi.org/10.1002/jts.22476.

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Frühe, Barbara, Hans-Joachim Röthlein, and Rita Rosner. "Vorhersagbarkeit posttraumatischer Belastung bei Kindern und Jugendlichen nach traumatischen Ereignissen in der Schule." Kindheit und Entwicklung 17, no. 4 (October 2008): 219–23. http://dx.doi.org/10.1026/0942-5403.17.4.219.

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Traumatische Ereignisse im schulischen Kontext treten vergleichsweise häufig auf. So ist die Bestimmung von Kindern und Jugendlichen, die aktuell und auch zu einem späteren Zeitpunkt einer psychologischen Betreuung bedürfen, im Rahmen der Fürsorgepflicht notwendig. 48 Jugendliche zwischen 12 und 17 Jahren wurden in der Schule zu zwei Messzeitpunkten zur akuten und posttraumatischen Symptomatik sowie zu verschiedenen Risikofaktoren befragt. Verwendet wurde die neu entwickelte Checkliste zur Akuten Belastung (CAB) und die deutsche Version des University of Los Angeles at California Posttraumatic Stress Disorder Reaction Index (UCLA CPTSD-RI). Eine Woche nach dem Ereignis betrug der Anteil klinisch bedeutsamer Belastung 21 % und nach 10 – 15 Wochen 10 %. Ein mittlerer Zusammenhang zwischen akuter und posttraumatischer Belastung konnte nachgewiesen werden. Als bedeutsame Risikofaktoren für die Entwicklung einer posttraumatischen Belastung stellten sich der Konfrontationsgrad, peritraumatisch erlebte Angst sowie akute Beeinträchtigung heraus. Im Kontext der Betreuung betroffener Jugendlicher nach traumatischen Ereignissen sollte den Risikofaktoren mehr Beachtung geschenkt werden.

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Currier, Joseph M., Joshua D. Foster, Thanos Karatzias, and Dominic Murphy. "Moral injury and ICD-11 complex PTSD (CPTSD) symptoms among treatment-seeking veterans in the United Kingdom." Psychological Trauma: Theory, Research, Practice, and Policy 13, no. 4 (May 2021): 417–21. http://dx.doi.org/10.1037/tra0000921.

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McQuillan, Katie, Philip Hyland, and Frédérique Vallières. "Prevalence, correlates, and the mitigation of ICD-11 CPTSD among homeless adults: The role of self-compassion." Child Abuse & Neglect 127 (May 2022): 105569. http://dx.doi.org/10.1016/j.chiabu.2022.105569.

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Ford, Julian D. "New findings questioning the construct validity of complex posttraumatic stress disorder (cPTSD): let’s take a closer look." European Journal of Psychotraumatology 11, no. 1 (January 21, 2020): 1708145. http://dx.doi.org/10.1080/20008198.2019.1708145.

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Gilbar, Ohad. "Examining the boundaries between ICD-11 PTSD/CPTSD and depression and anxiety symptoms: A network analysis perspective." Journal of Affective Disorders 262 (February 2020): 429–39. http://dx.doi.org/10.1016/j.jad.2019.11.060.

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Martin, Caroline J. Hollins, Jenny Patterson, Charlotte Paterson, Nicola Welsh, Nadine Dougall, Thanos Karatzias, and Brian Williams. "ICD-11 complex Post Traumatic Stress Disorder (CPTSD) in parents with perinatal bereavement: Implications for treatment and care." Midwifery 96 (May 2021): 102947. http://dx.doi.org/10.1016/j.midw.2021.102947.

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Salter, Michael, and Heather Hall. "Reducing Shame, Promoting Dignity: A Model for the Primary Prevention of Complex Post-Traumatic Stress Disorder." Trauma, Violence, & Abuse, December 20, 2020, 152483802097966. http://dx.doi.org/10.1177/1524838020979667.

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Complex post-traumatic stress disorder (CPTSD) refers to the complex psychological and psychosocial sequelae caused by prolonged interpersonal abuse. Contemporary approaches to CPTSD are dominated by individualized psychological interventions that are long term and costly. However, accumulating evidence indicates that CPTSD is a high prevalence mental illness implicated in significant social problems, with a pattern of lateral and intergenerational transmission that impacts on already disadvantaged communities. Consequently, there have been calls for a public health model for the prevention of CPSTD; however, there has been a lack of clarity as to what this should entail. This article argues that empirical and conceptual shifts framing CPTSD as a shame disorder offers new preventative opportunities. The article presents a series of interconnected literature reviews including a review of available prevalence data on CPTSD, the public health implications of CPTSD, the role of shame and humiliation in CPTSD, and current scholarship on dignity in public policy and professional practice. Drawing on these reviews, this article develops a social ecological model of primary prevention to CPTSD with a focus on the reduction of shame and the promotion of dignity at the relational, community, institutional, and macrolevel. A broad overview of this model is provided with examples of preventative programs and interventions. While the epidemiology of CPTSD is still emerging, this article argues that this model provides the conceptual foundations necessary for the coordination of preventative interventions necessary to reduce to the risk and prevalence of CPSTD.

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Fung, Hong Wang, Wai Tong Chien, Stanley Kam Ki Lam, and Colin A. Ross. "The Relationship Between Dissociation and Complex Post-Traumatic Stress Disorder: A Scoping Review." Trauma, Violence, & Abuse, September 5, 2022, 152483802211208. http://dx.doi.org/10.1177/15248380221120835.

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Complex post-traumatic stress disorder (CPTSD) has recently been recognized as an official psychiatric diagnosis in ICD-11, after years of research and advocacy in the field. It has been suggested that dissociative symptoms are a major feature of CPTSD. This scoping review aimed to summarize the existing knowledge base on the relationship between dissociation and CPTSD, and to identify relevant research gaps. We searched the two largest and most widely used academic databases (i.e., the Web of Science and Scopus databases) and the ProQuest database and identified original studies published in English relevant to our research questions, namely: (1) Would CPTSD be associated with dissociative symptoms? 2) How common are dissociative symptoms among people with CPTSD? (3) What are the correlates of dissociative symptoms among people with CPTSD? In all, 26 studies were included. We found 10 studies which reported that people with CPTSD scored significantly higher on a dissociation measure than those without CPTSD, and 11 studies reported a positive correlation between CPTSD symptoms and psychoform/somatoform dissociation scores. While very few studies reported the prevalence and correlates of dissociative symptoms among people with CPTSD, there may be a considerable subgroup of people with CPTSD who have clinically significant levels of dissociative symptoms (e.g., 28.6–76.9%). Dissociation may also be associated with other comorbidities (e.g., DSM-IV Axis II features, shame, somatic symptoms) in people with CPTSD. We recommend that more studies are needed to investigate the prevalence of dissociative symptoms among people with CPTSD and examine how these symptoms are associated with other comorbid conditions and clinical needs in this vulnerable group.

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Tian, Yuxin, Wenqi Li, Xinchun Wu, and Xiaochun Cheng. "Complex PTSD in Chinese Adolescents Exposed to Childhood Trauma: A Latent Profile Analysis." Journal of Interpersonal Violence, November 13, 2021, 088626052110501. http://dx.doi.org/10.1177/08862605211050111.

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Although numerous studies have supported the idea that complex posttraumatic stress disorder (CPTSD) is a distinct disorder from posttraumatic stress disorder (PTSD) and demonstrated that childhood interpersonal trauma is an important risk factor for CPTSD, few studies have examined the validity of CPTSD in adolescents, especially in non-Western contexts. Moreover, the question of which form of child maltreatment plays the most important role in predicting CPTSD, and how CPTSD is associated with psychological health, physical health, and social function among adolescents, is not clear. The present study used a Chinese high school student sample with childhood trauma experiences ( N = 395) to address these questions. Latent profile analysis indicated that there were four subgroups in our sample: Low symptoms (54.43%), Disturbance of self-organization (DSO, 18.99%), PTSD (15.95%), and CPTSD (10.63%). Further analysis revealed that emotional abuse was an important risk factor for CPTSD. In addition, the CPTSD class showed the highest levels of depression, anxiety, and stress, as well as the lowest levels of life satisfaction and physical health. This study revealed that CPTSD is a distinct disorder from PTSD in Chinese adolescents exposed to childhood trauma. It provides evidence that emotional abuse might be an important risk factor for CPTSD, and demonstrates that CPTSD is accompanied by serious psychological and physical consequences in adolescents. We suggest that parents and educators should focus more on adolescents’ emotional needs, avoid using negative ways such as verbal violence to express love, and pay more attention to adolescents’ DSO symptoms in parenting, teaching practices and clinical interventions.

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Rossi, Rodolfo, Valentina Socci, Francesca Pacitti, Claudia Carmassi, Alessandro Rossi, Giorgio Di Lorenzo, and Philip Hyland. "The Italian Version of the International Trauma Questionnaire: Symptom and Network Structure of Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder in a Sample of Late Adolescents Exposed to a Natural Disaster." Frontiers in Psychiatry 13 (May 25, 2022). http://dx.doi.org/10.3389/fpsyt.2022.859877.

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The 11th revision of the International Classification of Diseases has endorsed substantial changes in Post-Traumatic Stress Disorder (PTSD) and has introduced Complex PTSD (cPTSD). The objective of this study was to assess the symptom and network structure of PTSD and cPTSD using the International Trauma Questionnaire- Italian version (ITQ) and the prevalence of PTSD and cPTSD in a community sample of late adolescents enriched with exposure to a destructive earthquake. A 1,010 high school students participated to the study. Confirmatory Factor Analysis supports that a six first-order correlated factors was the best fitting model of ICD-11 PTSD/cPTSD. The network analysis supports a clear separation between core PTSD symptoms and disturbances in self-organization (DSO) symptoms, avoidance, and negative self-concept were the most central items. The prevalence of PTSD and cPTSD was 9.11 and 4.06%, respectively. Female participants reported higher rates of both PTSD and cPTSD. This is the first study to report on ICD-11 PTSD and cPTSD rates on an Italian adolescence community sample. Consistent with other community samples, we found higher rates of PTSD compared to cPTSD. The results confirmed the factorial validity of the ITQ. The network structure highlights the importance of negative self-concept in cPTSD and avoidance in PTSD.

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Kvedaraite, Monika, Odeta Gelezelyte, Agniete Kairyte, Neil P. Roberts, and Evaldas Kazlauskas. "Trauma exposure and factors associated with ICD-11 PTSD and complex PTSD in the Lithuanian general population." International Journal of Social Psychiatry, November 18, 2021, 002076402110577. http://dx.doi.org/10.1177/00207640211057720.

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Background: After the inclusion of a novel diagnosis of Complex Posttraumatic Stress Disorder (CPTSD) in the 11th edition of the International Classification of Diseases (ICD-11), there is a growing need for research focused on not only studying the underlying risk factors of this disorder but also differentiating the risk factors of Posttraumatic Stress Disorder (PTSD) and CPTSD to understand better the factors leading to CPTSD onset and symptom maintenance. Aims: This study aimed to explore the prevalence of traumatic experiences, trauma-related disorders and risk factors associated with ICD-11 PTSD and CPTSD in a population-based Lithuanian sample using the International Trauma Questionnaire (ITQ). Methods: The study sample included 885 participants (age M[ SD] = 37.96 [14.67], 63.4% female). The Life Events Checklist was used to measure trauma exposure, PTSD and CPTSD symptoms were measured by the Lithuanian ITQ version. The Disclosure of Trauma Questionnaire (DTQ) was used to measure the urge or reluctance to talk about trauma. Results: The prevalence of at least one traumatic experience in the study sample was 81.4%. The prevalence of PTSD and CPTSD among the general population in Lithuania was 5.8% and 1.8%, respectively. Accumulative lifetime trauma exposure, sexual assault and assault with a weapon were significant predictors for both PTSD and CPTSD. Participants from the CPTSD group reported greater reluctance to disclose trauma and stronger emotional reactions than no diagnosis and PTSD groups. Results also indicate that the Lithuanian ITQ version is a valid measure for screening PTSD and CPTSD in the general population. Conclusion: Previous history of trauma and interpersonal trauma were associated with posttraumatic stress disorders but did not differentiate between PTSD and CPTSD in our study. However, social trauma-related factors, such as trauma disclosure, were associated with stronger CPTSD symptoms.

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Gelezelyte, Odeta, Monika Kvedaraite, Agniete Kairyte, Neil P. Roberts, Jonathan I. Bisson, and Evaldas Kazlauskas. "The mediating role of complex posttraumatic stress and borderline pattern symptoms on the association between sexual abuse and suicide risk." Borderline Personality Disorder and Emotion Dysregulation 9, no. 1 (April 12, 2022). http://dx.doi.org/10.1186/s40479-022-00183-z.

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Abstract Background The 11th revision of the International Classification of Diseases (ICD-11) includes a new diagnosis of complex posttraumatic stress disorder (CPTSD). There has been very little research investigating associations between CPTSD symptoms and suicide risk following sexual abuse. This and questions concerning similarities and differences between CPTSD and borderline personality disorder (BPD), led to the current study that aimed to explore indirect associations between sexual abuse and suicide risk through the symptoms of CPTSD and borderline traits. Methods The study sample comprised 103 adults with a history of traumatic experiences (Mage = 32.64, SDage = 9.36; 83.5% female). In total, 26.3% of the participants reported experiencing sexual abuse during their lifetime. The clinician-administered International Trauma Interview (ITI) was used for the assessment of ICD-11 CPTSD symptoms. Self-report measures were used for the evaluation of borderline pattern (BP) symptoms and suicide risk. Mediation analyses were performed to evaluate the mediating effects of CPTSD and BP symptoms for the association between sexual trauma and suicide risk. Results In a parallel mediation model, CPTSD and BP symptoms mediated the association between sexual abuse and suicide risk, following adjustment for the covariates of age, gender, and whether the traumatic experience occurred in childhood or adulthood. Around 73% of participants who met diagnostic criteria for CPTSD reported previous suicide attempt(s). Conclusions Suicide risk assessment and intervention should be an important part of the management of victims of sexual abuse with CPTSD and BP symptoms.

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Bryant, Richard A., Kim L. Felmingham, Gin Malhi, Elpiniki Andrew, and Mayuresh S. Korgaonkar. "The distinctive neural circuitry of complex posttraumatic stress disorder during threat processing." Psychological Medicine, January 8, 2020, 1–8. http://dx.doi.org/10.1017/s0033291719003921.

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Abstract Background There is controversy over the extent to which the new International Classification of Diseases (ICD-11) diagnosis of complex posttraumatic stress disorder (CPTSD) is distinct from posttraumatic stress disorder (PTSD). This study aimed to conduct the first investigation of distinctive neural processes during threat processing in CPTSD relative to PTSD. Method This cross-sectional functional magnetic resonance study included 99 participants who met criteria for PTSD (PTSD = 32, CPTSD = 28) and 39 trauma-exposed controls. PTSD was assessed with the Clinician-Administered PTSD Scale (CAPS). CPTSD was assessed with an adapted version of the International Trauma Questionnaire. Neural responses were measured across the brain while threat or neutral faces were presented at both supraliminal and subliminal levels. Results During supraliminal presentations of threat stimuli, there was greater bilateral insula and right amygdala activation in CPTSD participants relative to PTSD. Reduced supraliminal right dorsolateral prefrontal cortex activation and increased subliminal amygdala and insula activation were observed as common dysfunction for both CPTSD and PTSD groups relative to trauma controls. There were no significant differences in terms of subliminal presentations and no differences in functional connectivity. Dissociative responses were positively associated with right insula activation (r = 0.347, p < 0.01). Conclusions These results provide the first evidence of distinct neural profiles of CPTSD and PTSD during threat processing. The observation of increased insula and right amygdala activation in CPTSD accords with the proposal that CPTSD is distinguished from PTSD by disturbances in emotion regulation and self-concept.

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Brewin, Chris R., Jessica K. Miller, Magdalena Soffia, Alexandra Peart, and Brendan Burchell. "Posttraumatic stress disorder and complex posttraumatic stress disorder in UK police officers." Psychological Medicine, September 7, 2020, 1–9. http://dx.doi.org/10.1017/s0033291720003025.

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Abstract Background We investigated work-related exposure to stressful and traumatic events in police officers, including repeated exposure to traumatic materials, and predicted that ICD-11 complex PTSD (CPTSD) would be more prevalent than posttraumatic stress disorder (PTSD). The effects of demographic variables on exposure and PTSD were examined, along with whether specific types of exposure were uniquely associated with PTSD or CPTSD. Methods An online survey covering issues about trauma management, wellbeing and working conditions was disseminated via social media and official policing channels throughout the UK. In total, 10 401 serving police officers self-identified as having been exposed to traumatic events. Measurement of PTSD and CPTSD utilised the International Trauma Questionnaire. Results The prevalence of PTSD was 8.0% and of CPTSD was 12.6%. All exposures were associated with PTSD and CPTSD in bivariate analyses. Logistic regression indicated that both disorders were more common in male officers, and were associated independently with frequent exposure to traumatic incidents and traumatic visual material, and with exposure to humiliating behaviours and sexual harassment, but not to verbal abuse, threats or physical violence. Compared to PTSD, CPTSD was associated with exposure to humiliating behaviours and sexual harassment, and also with lower rank and more years of service. Conclusions CPTSD was more common than PTSD in police officers, and the data supported a cumulative burden model of CPTSD. The inclusion in DSM-5 Criterion A of work-related exposure to traumatic materials was validated for the first time. Levels of PTSD and CPTSD mandate enhanced occupational mental health services.

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Hyland, P., R. Ceannt, F. Daccache, R. Abou Daher, J. Sleiman, B. Gilmore, S. Byrne, M. Shevlin, J. Murphy, and F. Vallières. "Are posttraumatic stress disorder (PTSD) and complex-PTSD distinguishable within a treatment-seeking sample of Syrian refugees living in Lebanon?" Global Mental Health 5 (2018). http://dx.doi.org/10.1017/gmh.2018.2.

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BackgroundThe World Health Organization will publish its 11th revision of the International Classification of Diseases (ICD-11) in 2018. The ICD-11 will include a refined model of posttraumatic stress disorder (PTSD) and a new diagnosis of complex PTSD (CPTSD). Whereas emerging data supports the validity of these proposals, the discriminant validity of PTSD and CPTSD have yet to be tested amongst a sample of refugees.MethodsTreatment-seeking Syrian refugees (N = 110) living in Lebanon completed an Arabic version of the International Trauma Questionnaire; a measure specifically designed to capture the symptom content of ICD-11 PTSD and CPTSD.ResultsIn total, 62.6% of the sample met the diagnostic criteria for PTSD or CPTSD. More refugees met the criteria for CPTSD (36.1%) than PTSD (25.2%) and no gender differences were observed. Latent class analysis results identified three distinct groups: (1) a PTSD class, (2) a CPTSD class and (3) a low symptom class. Class membership was significantly predicted by levels of functional impairment.ConclusionSupport for the discriminant validity of ICD-11 PTSD and CPTSD was observed for the first time within a sample of refugees. In support of the cross-cultural validity of the ICD-11 proposals, the prevalence of PTSD and CPTSD were similar to those observed in culturally distinct contexts.

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Jowett, Sally, Angeliki Argyriou, Odile Scherrer, Thanos Karatzias, and Cornelius Katona. "Complex post-traumatic stress disorder in asylum seekers and victims of trafficking: treatment considerations." BJPsych Open 7, no. 6 (October 1, 2021). http://dx.doi.org/10.1192/bjo.2021.1007.

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Asylum-seekers experience high levels of traumatic events pre-, post- and during migration. Poly-traumatisation is associated with complex post-traumatic stress disorder (CPTSD), which has not yet been extensively explored in this population. CPTSD is a prevalent and highly disabling disorder in the present population requiring culturally sensitive diagnostic and treatment approaches. In this service evaluation, we evidence the high prevalence of CPTSD in an asylum-seeking sample and its association with greater distress compared with PTSD. We outline the treatment needs of asylum seekers with CPTSD.

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Journal articles on the topic 'CPTSD'

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