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      Evidence for the coherence and integrity of the complex PTSD (CPTSD) diagnosis: response to Achterhof et al., (2019) and Ford (2020) Translated title: Carta al editor: Respuesta a Achterhof y cols., (2019) y Ford (2020): Evidencia para la coherencia eintegridad del diagnóstico de tept complejo (TEPT-C) Translated title: 致信编辑:回应Achterhof等(2019)和Ford(2020):复杂型PTSD(CPTSD)诊断的连贯性和完整性的证据

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          ABSTRACT

          This letter to the editor responds to a recent EJPT editorial and following commentary which express concerns about the validity of the ICD-11 complex PTSD (CPTSD) diagnosis. Achterhof and colleagues caution that latent profile analyses and latent class analyses, which have been frequently used to demonstrate the discriminative validity of the ICD-11 PTSD and CPTSD constructs, have limitations and cannot be relied on to definitively determine the validity of the diagnosis. Ford takes a broader perspective and introduces the concept of ‘cPTSD’ which describes a wide ranging set of symptoms identified from studies related to DSM-IV, DSM-V and ICD-11 and proposes that the validity of the ICD-11 CPTSD is in question as it does not address the multiple symptoms identified from previous trauma-related disorders. We argue that ICD-11 CPTSD is a theory-driven, empirically supported construct that has internal consistency and conceptual coherence and that it need not explain nor resolve the inconsistencies of past formulations to demonstrate its validity. We do agree with Ford and with Achterhof and colleagues that no one single statistical process can definitively answer the question of whether CPTSD is a valid construct. We reference several studies utilizing many different statistical approaches implemented across several countries, the overwhelming majority of which have supported the validity of ICD-11 as a unique construct. We conclude with our own cautions about ICD-11 CPTSD research to date and identify important next steps.

           

          Un reciente artículo de la EJPT comentario editorial y siguiente han manifestado preocupaciones acerca de la validez del diagnóstico de TEPT complejo (TEPT-C) de la CIE-11. Achterhof y colegas argumentan que la validez del TEPT-C requiere más evidencia de la que puede ser otorgada por el análisis de clase latente (ACL) y análisis de perfil latente (APL). Ford toma una visión más amplia proponiendo que la actual conceptualización de TEPT-C no capta el rango completo de síntomas asociados o los individuos que sufren los efectos del trauma y concluye que la actual definición de TEPT-C requiere de una revisión para poder representar un constructo distinto, cohesivo y válido. En esta carta resumimos los datos sustantivos que en total, apoyan la validez del constructo del diagnóstico de TEPT-C e indican la coherencia conceptual y la integridad del TEPT-C como es presentado en la CIE-11. Estamos de acuerdo tanto con Ford como con Achterhof y colegas que la validez para el constructo de TEPT-C debería estar construido sobre la evidencia de distintas metodologías, cuidadosa revisión de cómo el TEPT-C es lo mismo versus diferente de otros trastornos, y evaluación de su valour en la comprensión y tratamiento de los individuos que han experimentado trauma. Concluimos, basados en la evidencia actual de los estudios epidemiológicos, clínicos y de neurociencia que el diagnóstico de TEPT-C de la CIE-11 provee un fundamento científicamente sólido para investigaciones futuras acerca del TEPT complejo.

           

          Achterhof和同事(2019)最近发表在EJPT的社论,和随后Ford(2020)发表的评论,表达了对ICD-11复合型PTSD(CPTSD)诊断效度的担忧。Achterhof及其同事认为,CPTSD的效度需要比潜在类别分析(LCA)和潜在剖面分析(LPA)提供的证据更多。Ford则提出了一个更宽泛的观点,即当前CPTSD的概念并未涵盖遭受创伤影响后的全部症状,并总结CPTSD的当前定义需要修订以代表一个独特的、连贯的和有效的结构。在这封信中,我们总结了实证数据,这些数据总体上支持CPTSD诊断的结构效度,并指出了ICD-11中提出的CPTSD概念上的连贯性和完整性。我们同意Ford 和 Achterhof及其同事的观点,即CPTSD的结构效度应建立在不同方法学的证据之上,仔细审查CPTSD与其他疾病的区别与区别,以及评估其在理解和治疗创伤暴露个体中的价值。基于流行病学、临床和神经科学研究的最新证据,我们得出结论:ICD-11中CPTSD诊断为未来有关复杂型PTSD的研究提供了科学的基础。

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          Most cited references23

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          Complex PTSD in victims exposed to sexual and physical abuse: results from the DSM-IV Field Trial for Posttraumatic Stress Disorder.

          Two hundred thirty four participants in the DSM-IV Posttraumatic Stress Disorder (PTSD) Field Trial who reported sexual and/or physical abuse were evaluated. Participants were categorized according to type of abuse (physical, sexual, both), duration of abuse (acute versus chronic), and onset of abuse (early versus late). Separate logistic regression analyses examined the relationship between age of onset, duration, abuse type, and the complex PTSD (CP) lifetime diagnosis for women and men. Sexually abused women, especially those who also experienced physical abuse, had a higher risk of developing CP, although CP symptoms occurred at a high base rate among physically abused women. The theoretical implications and incremental clinical usefulness of targeting CP symptoms with abused populations are discussed.
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            The limits of resilience: distress following chronic political violence among Palestinians.

            We examined posttraumatic stress disorder (PTSD) and depression symptom trajectories during ongoing exposure to political violence, seeking to identify psychologically resilient individuals and the factors that predict resilience. Face-to-face interviews were conducted with a random sample of 1196 Palestinian adult residents of the West Bank, Gaza, and East Jerusalem across three occasions, six months apart (September 2007-November 2008). Latent growth mixture modeling identified PTSD, and depression symptom trajectories. Results identified three PTSD trajectories: moderate-improving (73% moderate symptoms at baseline, improving over time), severe-chronic (23.2% severe and elevated symptoms over the entire year); and severe-improving (3.5% severe symptoms at baseline and marked improvement over time). Depression trajectories were moderate-improving (61.5%); severe-chronic (24.4%); severe-improving (14.4%). Predictors of relatively less severe initial symptom severity, and improvement over time for PTSD were less political violence exposure and less resource loss; and for depression were younger age, less political violence exposure, lower resource loss, and greater social support. Loss of psychosocial and material resources was associated with the level of distress experienced by participants at each time period, suggesting that resource-based interventions that target personal, social, and financial resources could benefit people exposed to chronic trauma. Copyright © 2011 Elsevier Ltd. All rights reserved.
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              Validation of ICD ‐11 PTSD and complex PTSD in foster children using the International Trauma Questionnaire

              Objective ICD‐11 introduces post‐traumatic stress disorder (PTSD) and complex PTSD (CPTSD) as two distinct trauma‐related disorders. Using the International Trauma Questionnaire (ITQ) as disorder‐specific measure, this study is the first to examine the factorial and construct validity of ICD‐11 PTSD, CPTSD and the ITQs’ applicability in children. Methods Two hundred and eight Austrian foster children completed a set of standardized measures. Excluding participants who reported not having experienced any kind of trauma, a final sample of 136 children completed the ITQ. Factorial and construct validity of ICD‐11 CPTSD and psychometric properties of ITQ scales were assessed by factor analysis and latent class analysis. Results Confirmatory factor analysis supported the two‐factor higher‐order model of ICD‐11 CPTSD in children by high factor loadings and excellent model fit. Reliability and regression analysis evidenced psychometric adequacy and discriminant validity of ITQ scales. Latent class analysis substantiated construct validity of ICD‐11 CPTSD, identifying a CPTSD (22.8%), PTSD (31.6%) and low symptoms class (45.6%). The CPTSD class showed highest rates of childhood trauma, comorbid psychopathology and functional impairment. Conclusion Factorial and construct validity of ICD‐11 CPTSD was evidenced in children for the first time using precise descriptions of ICD‐11 symptom content, supporting the reliability and validity of the ITQ in children.
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                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                ZEPT
                zept20
                European Journal of Psychotraumatology
                Taylor & Francis
                2000-8198
                2000-8066
                2020
                03 April 2020
                : 11
                : 1
                : 1739873
                Affiliations
                [a ]National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System , Palo Alto, CA, USA
                [b ]Department of Psychiatry and Behavioural Sciences, Stanford University , Stanford, CA, USA
                [c ]Clinical Educational & Health Psychology, University College London , London, UK
                [d ]School of Medicine, Cardiff University , Cardiff, UK
                [e ]Department of Psychology, Maynooth University , Kildare, Ireland
                [f ]Centre for Global Health, Trinity College Dublin , Dublin, Ireland
                [g ]NHS Lothian, Rivers Centre for Traumatic Stress , Edinburgh, UK
                [h ]School of Health & Social Care, Edinburgh Napier University , Edinburgh, UK
                [i ]Unit of Psychotraumatology, Faculty of Psychology, University of Vienna , Vienna, Austria
                [j ]Division of Psychopathology and Clinical Intervention Zurich, University of Zurich , Switzerland
                [k ]Psychology and Psychological Therapies Directorate, Cardiff & Vale University Health Board , Cardiff, UK
                [l ]Division of Psychological Medicine & Clinical Neurosciences, Cardiff University , Cardiff, UK
                [m ]School of Psychology, Ulster University , Derry, Northern Ireland
                Author notes
                CONTACT Marylène Cloitre Marylene.Cloitre@ 123456va.gov National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Department of Psychiatry and Behavioural Sciences, Stanford University , CA 94025, USA
                Author information
                http://orcid.org/0000-0001-8029-1570
                http://orcid.org/0000-0001-5170-1243
                http://orcid.org/0000-0002-9574-7128
                http://orcid.org/0000-0002-3002-0630
                http://orcid.org/0000-0001-6925-3266
                http://orcid.org/0000-0002-6277-0102
                http://orcid.org/0000-0001-6262-5223
                Article
                1739873
                10.1080/20008198.2020.1739873
                7170304
                32341764
                d6a68322-3d82-4197-98bd-5f5e28aaf767
                © 2020 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.

                History
                : 03 February 2020
                : 21 February 2020
                : 21 February 2020
                Page count
                References: 36, Pages: 8
                Categories
                Editorial

                Clinical Psychology & Psychiatry
                icd-11,complex ptsd,cptsd,tept complejo,trauma complejo,cie-11,复杂型ptsd,复杂型创伤

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