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      ICD-11 PTSD and complex PTSD in treatment-seeking Danish veterans: a latent profile analysis Translated title: El TEPT y el TEPT-Complejo de la CIE-11 en veteranos daneses en busca tratamiento: Un análisis de perfil latente Translated title: 寻求治疗的丹麦退伍军人中ICD-11标准下 PTSD和复杂性PTSD:一项潜在剖面分析

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      a , b , a , c , a , d , e , a , f

      European Journal of Psychotraumatology

      Taylor & Francis

      ICD-11, posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD), military veterans, treatment-seeking persons, latent profile analysis, CIE-11, Trastorno de Estrés Postraumático (TEPT) y Trastorno de Estrés Postraumático Complejo (TEPT-C) , veteranos militares, personas en busca de tratamiento, análisis de perfil latente, ICD-11, 创伤后应激障碍(PTSD)和复杂性创伤后应激障碍(CPTSD), 退伍军人, 寻求治疗者, 潜在剖面分析, • The present study evaluated the ICD-11 model of PTSD and CPTSD in a sample of treatment-seeking military veterans. • Latent profile analysis revealed a CPTSD-class, a PTSD-class, a High DSO-class, a Hyperarousal-class, a Moderate DSO-class, and a Low Symptoms-class. • CPTSD is a more debilitating condition than PTSD. • Compared to the PTSD-class, membership of the CPTSD-class was predicted by increased exposure to childhood traumatic experiences.

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          ABSTRACT

          Background: The WHO International Classification of Diseases, 11th version (ICD-11), includes a trauma-related diagnosis of complex posttraumatic stress disorder (CPTSD) distinct from posttraumatic stress disorder (PTSD). Results from previous studies support the validity of this distinction. However, no studies to date have evaluated the ICD-11 model of PTSD and CPTSD in treatment-seeking military veterans.

          Objective: To determine if the distribution of symptoms in treatment-seeking Danish veterans was consistent with the ICD-11 PTSD and CPTSD symptom profiles. Based on previous studies, we hypothesized that separate classes representing PTSD and CPTSD would be found that membership of a potential CPTSD-class would be predicted by a larger number of childhood traumas, and that a potential distinction between PTSD and CPTSD would be supported by differences in sociodemographic and functional outcomes.

          Method: Participants (N = 1,541) were formerly deployed Danish soldiers who completed proxy measures of ICD-11 PTSD and disturbances in self-organization (DSO) symptoms, along with self-report measures of traumatic life events, prior to starting treatment at the Military Psychology Department of the Danish Defence.

          Results: All hypotheses were supported. Latent profile analysis (LPA) revealed separate classes representing PTSD and CPTSD. In comparison to the PTSD-class, membership of the CPTSD-class was predicted by more childhood traumatic experiences, and members of this class were more likely being single/divorced/widowed and more likely to use psychotropic medication. Besides a PTSD-class and a CPTSD-class, LPA revealed a Low Symptoms-class, a Moderate DSO-class, a Hyperarousal-class, and a High DSO-class, with clear differences in functional outcomes between classes.

          Conclusion: Findings replicate previous studies supporting the distinction between ICD-11 PTSD and CPTSD. In addition, there seem to be groups of treatment-seeking military veterans that do not fulfil full criteria for a trauma-related disorder. Further research should explore subsyndromal PTSD and CPTSD profiles in veterans and other populations.

          Antecedentes: La Clasificación Internacional de Enfermedades de la OMS, 11ª versión (CIE-11), incluye un diagnóstico relacionado con el trauma para el trastorno de estrés postraumático complejo (TEPT-C) distinto del trastorno de estrés postraumático (TEPT). Los resultados de los estudios anteriores respaldan la validez de esta distinción. Sin embargo, ningún estudio hasta la fecha ha evaluado el modelo CIE-11 del TEPT y TEPT-C en veteranos militares en busca de tratamiento.

          Objetivo: Determinar si la distribución de los síntomas en los veteranos daneses en busca tratamiento fue consistente con los perfiles de los síntomas del TEPT y TEPT-C de la CIE-11. Basados en estudios previos, planteamos la hipótesis de que se encontrarían clases separadas que representan el TEPT y TEPT-C, que la pertenencia a la clase potencial del TEPT-C sería predicha por un mayor número de traumas infantiles, y que una posible distinción entre el TEPT y TEPT-C sería apoyada por las diferencias en los resultados sociodemográficos y funcionales.

          Método: Los participantes (N = 1,541) fueron soldados daneses desplegados anteriormente, que completaron medidas indirectas del TEPT CIE-11 y la alteración en los síntomas de autoorganización (DSO en su sigla en inglés), junto con medidas de autoinforme de los eventos traumáticos de la vida, antes de comenzar el tratamiento en el Departamento de Psicología Militar de la Defensa Danesa.

          Resultados: Todas las hipótesis fueron sustentadas. El análisis de perfil latente (APL) reveló clases separadas que representan el TEPT y TEPT-C. En comparación con la clase del TEPT, la pertenencia a la clase del TEPT-C fue predicha por más experiencias traumáticas infantiles, y los miembros de esta clase eran más propensos a ser solteros/divorciados/viudos y más propensos a usar medicamentos psicotrópicos. Además de una clase del TEPT y una clase del TEPT-C, el APL reveló una clase de Síntomas Bajos, una clase de DSO Moderado, una clase de Hiperactivación y una clase de DSO Alto, con claras diferencias en los resultados funcionales entre las clases.

          Conclusión: Los resultados replican los estudios previos que respaldan la distinción entre el TEPT y TEPT-C del CIE-11. Adicionalmente, parece haber grupos de veteranos militares en busca de tratamiento que no cumplen con los criterios completos para un trastorno relacionado con el trauma. Los estudios futuros deben explorar los perfiles del TEPT y TEPT-C sub-sindrómico en veteranos y otras poblaciones.

          背景:世界卫生组织《国际疾病分类》(第11版)(ICD-11)包括一项创伤相关并有别于创伤后应激障碍(PTSD)的复杂创伤后应激障碍(CPTSD)的诊断。前人研究结果支持这种区分的有效性。但是,至今尚无研究在寻求治疗的退伍军人中评估PTSD和CPTSD的ICD-11模型。

          目的:确定寻求治疗的丹麦退伍军人中的症状分布是否与ICD-11 PTSD和CPTSD症状剖面一致。基于前人的研究,我们假设可以找到分别代表PTSD和CPTSD的类别,可以通过更多的童年期创伤来预测潜在CPTSD类的成员,并且可以在社会人口学和功能性的结果差异上支持PTSD和CPTSD间的潜在区别。

          方法: 1541名参与者曾是丹麦部署士兵,他们在开始丹麦国防部军事心理学部门的治疗之前,完成了ICD-11 标准下PTSD和自我组织障碍(DSO)症状的间接测量,及针对创伤性生活事件的自我报告式测量。

          结果:所有假设均得到支持。潜在剖面分析(LPA)结果呈现了分别代表PTSD和CPTSD的类别。相较于PTSD类,属于CPTSD类可由更多的童年期创伤经历预测,且此类人群更可能是单身/离婚/丧偶的,并且更可能服用精神药物。除PTSD类和CPTSD类外,LPA结果还包括低症状类, 中度DSO类, 高唤起类和高DSO类,且各类间的功能性结果存在明显差异。

          结论:研究结果重复了前人的研究,支持了ICD-11 中PTSD和CPTSD间的区别。此外,似乎有一些寻求治疗的退伍军人不完全满足创伤相关疾病的标准。进一步的研究应探究退伍军人和其他人群中的亚综合征性PTSD和CPTSD剖面。

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          Most cited references 20

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          Latent Class Modeling with Covariates: Two Improved Three-Step Approaches

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            Development and preliminary validation of a brief broad-spectrum measure of trauma exposure: the Traumatic Life Events Questionnaire.

            This article describes the development and preliminary validation of a brief questionnaire that assesses exposure to a broad range of potentially traumatic events. Items were generated from multiple sources of information. Events were described in behaviorally descriptive terms, consistent with Diagnostic and Statistical Manual of Mental Disorders IV posttraumatic stress disorder stressor criterion A1. When events were endorsed, respondents were asked if they experienced intense fear, helplessness, or horror (stressor criterion A2). In separate studies with college students, Vietnam veterans, battered women, and residents of a substance abuse program, most items possessed adequate to excellent temporal stability. In a study comparing questionnaire and structured-interview inquiries of trauma history, the 2 formats yielded similar rates of disclosure. Preliminary data on positive predictive power are also presented.
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              Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma.

              Children and adults exposed to chronic interpersonal trauma consistently demonstrate psychological disturbances that are not captured in the posttraumatic stress disorder (PTSD) diagnosis. The DSM-IV (American Psychiatric Association, 1994) Field Trial studied 400 treatment-seeking traumatized individuals and 128 community residents and found that victims of prolonged interpersonal trauma, particularly trauma early in the life cycle, had a high incidence of problems with (a) regulation of affect and impulses, (b) memory and attention, (c) self-perception, (d) interpersonal relations, (e) somatization, and (f) systems of meaning. This raises important issues about the categorical versus the dimensional nature of posttraumatic stress, as well as the issue of comorbidity in PTSD. These data invite further exploration of what constitutes effective treatment of the full spectrum of posttraumatic psychopathology.
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                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                ZEPT
                zept20
                European Journal of Psychotraumatology
                Taylor & Francis
                2000-8066
                2019
                11 November 2019
                : 10
                : 1
                Affiliations
                [a ]Research and Knowledge Centre, the Danish Veterans Centre , Ringsted, Denmark
                [b ]Department of Military Psychology, the Danish Veterans Centre , Copenhagen, Denmark
                [c ]The Research Unit and Section of General Practice, Institute of Public Health, University of Copenhagen , Copenhagen, Denmark
                [d ]School of Health and Social Care, Napier University , Edinburgh, UK
                [e ]Rivers Centre for Traumatic Stress, NHS, Lothian , Edinburgh, UK
                [f ]Department of Psychology, University of Copenhagen , Copenhagen, Denmark
                Author notes
                CONTACT Sofie Folke vetc-mpa43@ 123456mil.dk ; sofiefolke@ 123456gmail.com Department of Military Psychology, Danish Veterans Centre, Danish Defence , Ryvangs Allé 1-3, Copenhagen 2100, Denmark
                Article
                1686806
                10.1080/20008198.2019.1686806
                6853202
                © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

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

                Page count
                Figures: 2, Tables: 3, References: 40, Pages: 11
                Product
                Categories
                Clinical Research Article

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