Update to an evaluation of ICD-11 PTSD and complex PTSD criteria in a sample of adult survivors of childhood institutional abuse by Knefel & Lueger-Schuster (2013): a latent profile analysis

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Abstract

Background

The World Health Organization (WHO) International Classification of Diseases, 11th version (ICD-11), has proposed a trauma-related diagnosis of complex posttraumatic stress disorder (CPTSD) separate and distinct from posttraumatic stress disorder (PTSD).

Objective

To determine whether the symptoms endorsed by individuals who had experienced childhood institutional abuse form classes that are consistent with diagnostic criteria for ICD-11 CPTSD as distinct from PTSD.

Methods

A latent profile analysis (LPA) was conducted on 229 adult survivors of institutional abuse using the Brief Symptom Inventory and the PTSD Checklist—Civilian Version to assess current psychopathological symptoms.

Results

The LPA revealed four classes of individuals: (1) a class with elevated symptoms of CPTSD (PTSD symptoms and disturbances in self-organization); (2) a class with elevated symptoms of PTSD and low disturbances in self-organization; (3) a class with elevated disturbances in self-organization symptoms and some elevated PTSD symptoms; and (4) a class with low symptoms.

Conclusions

The results support the existence of a distinct group in our sample, that could be described by the proposed diagnostic category termed CPTSD more precisely than by normal PTSD. In addition, there seems to be a group of persons that do not fulfill the criteria for a trauma-related disorder but yet suffer from psychopathological symptoms.

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Most cited references 13

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Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research.

David F Tolin, Edna B. Foa (2006)

Meta-analyses of studies yielding sex-specific risk of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) indicated that female participants were more likely than male participants to meet criteria for PTSD, although they were less likely to experience PTEs. Female participants were more likely than male participants to experience sexual assault and child sexual abuse, but less likely to experience accidents, nonsexual assaults, witnessing death or injury, disaster or fire, and combat or war. Among victims of specific PTEs (excluding sexual assault or abuse), female participants exhibited greater PTSD. Thus, sex differences in risk of exposure to particular types of PTE can only partially account for the differential PTSD risk in male and female participants. (c) 2006 APA, All Rights Reserved.

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Patterns of lifetime PTSD comorbidity: a latent class analysis.

Charles Marmar, Elad Levy, Brett T Litz … (2013)

Posttraumatic stress disorder (PTSD) is associated with high rates of psychiatric comorbidity, most notably substance use disorders, major depression, and other anxiety disorders. However, little is known about how these disorders cluster together among people with PTSD, if disorder clusters have distinct etiologies in terms of trauma type, and if they confer greater burden over and above PTSD alone. Utilizing Latent Class Analysis, we tested for discrete patterns of lifetime comorbidity with PTSD following trauma exposure (n = 409). Diagnoses were based on the Structured Clinical Interview for DSM-IV (SCID). Next, we examined if gender, trauma type, symptom frequency, severity, and interference with everyday life were associated with the latent classes. Three patterns of lifetime comorbidity with PTSD emerged: a class characterized by predominantly comorbid mood and anxiety disorders; a class characterized by predominantly comorbid mood, anxiety, and substance dependence; and a relatively pure low-comorbidity PTSD class. Individuals in both high comorbid classes had nearly two and a half times the rates of suicidal ideation, endorsed more PTSD symptom severity, and demonstrated a greater likelihood of intimate partner abuse compared to the low comorbidity class. Men were most likely to fall into the substance dependent class. PTSD comorbidity clusters into a small number of common patterns. These patterns may represent an important area of study, as they confer distinct differences in risk and possibly etiology. Implications for research and treatment are discussed. © 2012 Wiley Periodicals, Inc.

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Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with borderline personality disorder and healthy controls.

Borwin Bandelow, Göran Hajak, Andreas Broocks … (2005)

Patients with borderline personality disorder (BPD) were compared with a healthy control group with regard to traumatic life events during childhood. The patients (n=66) and controls (n=109) were investigated using a comprehensive retrospective interview with 203 questions about childhood traumatic life events, parental attitudes, family history of psychiatric disorders and birth risk factors. The frequency of reports of traumatic childhood experiences was significantly higher in patients than in controls, including sexual abuse, violence, separation from parents, childhood illness, and other factors. On a 0- to 10-point "severe trauma scale," patients had significantly more severe traumatic events (mean score=3.86, SD=1.77) than control subjects (0.61, SD=0.93). Only four (6.1%) of the BPD patients, but 67 (61.5%) of the controls did not report any severe traumatic events at all. Compared with controls, patients described the attitude of their parents as significantly more unfavorable in all aspects. Patients reported significantly higher rates of psychiatric disorders in their families in general, especially anxiety disorders, depression, and suicidality. Among birth risk factors, premature birth was reported more often in BPD subjects. In a logistic regression model of all possible etiological factors examined, the following factors showed a significant influence: familial neurotic spectrum disorders, childhood sexual abuse, separation from parents and unfavorable parental rearing styles. The present data support the hypothesis that the etiology of BPD is multifactorial and that familial psychiatric disorders and sexual abuse are contributing factors.

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Author and article information

Journal

Journal ID (nlm-ta): Eur J Psychotraumatol

Journal ID (iso-abbrev): Eur J Psychotraumatol

Journal ID (publisher-id): EJPT

Title: European Journal of Psychotraumatology

Publisher: Co-Action Publishing

ISSN (Print): 2000-8198

ISSN (Electronic): 2000-8066

Publication date (Electronic): 02 January 2015

Publication date Collection: 2015

Volume: 6

Electronic Location Identifier: 10.3402/ejpt.v6.25290

Affiliations

[1 ]Faculty of Psychology, University of Vienna, Vienna, Austria

[2 ]National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA

[3 ]Department of Psychiatry and Child and Adolescent Psychiatry, Langone Medical Center, New York University, New York, NY, USA

Author notes

[* ]Correspondence to: Matthias Knefel, Faculty of Psychology, University of Vienna, Liebiggasse 5, A-1010 Vienna, Austria, Email: Matthias.Knefel@ 123456univie.ac.at

Responsible Editor: Julian D. Ford, University of Connecticut Health Center, USA.

Article

Publisher ID: 25290

DOI: 10.3402/ejpt.v6.25290

PMC ID: 4283031

PubMed ID: 25557561

SO-VID: 44bb0e32-bc0e-4f80-b788-f4c592b08469

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 25 June 2014

Date revision received : 29 October 2014

Date accepted : 31 October 2014

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Update to an evaluation of ICD-11 PTSD and complex PTSD criteria in a sample of adult survivors of childhood institutional abuse by Knefel & Lueger-Schuster (2013): a latent profile analysis

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Abstract

Background

Objective

Methods

Results

Conclusions

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Most cited references 13

Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research.

Patterns of lifetime PTSD comorbidity: a latent class analysis.

Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with borderline personality disorder and healthy controls.

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Cited by 39

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