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      Are posttraumatic stress disorder (PTSD) and complex-PTSD distinguishable within a treatment-seeking sample of Syrian refugees living in Lebanon?

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          Abstract

          Background

          The World Health Organization will publish its 11 th 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.

          Methods

          Treatment-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.

          Results

          In 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.

          Conclusion

          Support 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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          Most cited references6

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          Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse.

          Fifty-eight women with posttraumatic stress disorder (PTSD) related to childhood abuse were randomly assigned to a 2-phase cognitive-behavioral treatment or a minimal attention wait list. Phase 1 of treatment included 8 weekly sessions of skills training in affect and interpersonal regulation; Phase 2 included 8 sessions of modified prolonged exposure. Compared with those on wait list, participants in active treatment showed significant improvement in affect regulation problems, interpersonal skills deficits, and PTSD symptoms. Gains were maintained at 3- and 9-month follow-up. Phase 1 therapeutic alliance and negative mood regulation skills predicted Phase 2 exposure success in reducing PTSD, suggesting the value of establishing a strong therapeutic relationship and emotion regulation skills before exposure work among chronic PTSD populations.
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            ICD-11 Complex PTSD in US National and Veteran Samples: Prevalence and Structural Associations with PTSD.

            The eleventh edition of the International Classification of Diseases (ICD-11) is under development and current proposals include major changes to trauma-related psychiatric diagnoses, including a heavily restricted definition of posttraumatic stress disorder (PTSD) and the addition of complex PTSD (CPTSD). We aimed to test the postulates of CPTSD in samples of 2695 community participants and 323 trauma-exposed military veterans. CPTSD prevalence estimates were 0.6% and 13% in the community and veteran samples, respectively; one-quarter to one-half of those with PTSD met criteria for CPTSD. There were no differences in trauma exposure across diagnoses. A factor mixture model with two latent dimensional variables and four latent classes provided the best fit in both samples: classes differed by their level of symptom severity but did not differ as a function of the proposed PTSD versus CPTSD diagnoses. These findings should raise concerns about the distinctions between CPTSD and PTSD proposed for ICD-11.
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              What do we know about child abuse and neglect patterns of co-occurrence? A systematic review of profiling studies and recommendations for future research.

              Latent class (LCA) and latent profile (LPA) analysis represent methodological approaches to identify subgroups of maltreated individuals. Although research examining child abuse and neglect (CAN) profiles is still rare, the application of person-centered techniques to clarify CAN types co-occurrence has substantially increased in recent years. Therefore, the aim of the present study was to provide a summary and critical evaluation of the findings of LCA/LPA child maltreatment research to: (a) systemize the current understanding of patterns of maltreatment across populations and (b) elucidate interactive effects of CAN types on psychosocial functioning. A search in PsychInfo, Eric, PubMed, Scopus, and Science Direct, and Google Scholar was performed. Sixteen studies examining the co-occurrence between child physical abuse, emotional abuse, sexual abuse, neglect, and/or exposure to domestic violence were identified. A critical review of the studies revealed inconsistent findings as to the number of CAN classes, but most research uncovered a poly-victimized and a low abuse group. Further, multiple victimization was associated with most adverse internalizing and externalizing outcomes, especially when sexual abuse was present. Exposure to physical and emotional abuse was frequently reported to lead to behavioural problems. Based on the present study results, we provide a set of recommendations for surpassing the current methodological and conceptual limitations in future research.
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                Author and article information

                Journal
                Glob Ment Health (Camb)
                Glob Ment Health (Camb)
                GMH
                Global Mental Health
                Cambridge University Press (Cambridge, UK )
                2054-4251
                2018
                16 April 2018
                : 5
                : e14
                Affiliations
                [1 ]Centre for Global Health, University of Dublin , Trinity College, 7-9 South Leinster Street, Dublin 2, Ireland
                [2 ]School of Business, National College of Ireland , International Financial Services Centre, Mayor Street, Dublin 1, Ireland
                [3 ]International Medical Corps Lebanon , Beirut, Lebanon
                [4 ]School of Psychology, University of Dublin , Trinity College, Ireland
                [5 ]Psychology Research Institute, Ulster University , Londonderry, Northern Ireland
                Author notes
                [* ]Address for correspondence: Philip Hyland, Centre for Global Health, University of Dublin , Trinity College, 7–9 South Leinster Street, Dublin 2, Ireland (Email: philip.hyland@ 123456ncirl.ie )
                Article
                S205442511800002X 00002
                10.1017/gmh.2018.2
                5981765
                29868234
                218fefc1-7b06-42e5-ab7a-75f6902738b8
                © The Author(s) 2018

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 24 June 2017
                : 03 November 2017
                : 21 December 2017
                Page count
                Figures: 1, Tables: 3, References: 32, Pages: 9
                Categories
                Other
                Displacement and Mental Health
                Original Research Paper

                complex posttraumatic stress disorder (cptsd),icd-11,refugees,posttraumatic stress disorder (ptsd)

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