Complex Posttraumatic Stress Disorder Symptom Profiles in Traumatized Refugees

Abstract

Although it is well documented that exposure to severe, cumulative trauma and postdisplacement stress increases the risk for posttraumatic stress symptom disorder (PTSD), less is known about the representation and predictors of complex PTSD (CPTSD) symptoms in refugee populations. We examined PTSD and CPTSD symptom profiles (co-occurring PTSD and disturbances in self-organization [DSO] symptoms) and their premigration, postmigration, and demographic predictors, using latent class analysis (LCA), in a cohort of 112 refugees resettled in Australia. The LCA identified a four-factor model as the best fit to the data, comprising classes categorized as: (a) CPTSD, exhibiting high levels of PTSD and DSO symptoms (29.5%); (b) PTSD only (23.5%); (c) high affective dysregulation (AD) symptoms (31.9%); and (d) low PTSD and DSO symptoms (15.1%). Membership in the CPTSD and PTSD classes was specifically associated with cumulative traumatization, CPTSD OR = 1.56, 95% CI [1.15, 2.12], and PTSD OR = 1.64, 95% CI [1.15, 2.34]; and female gender, CPTSD OR = 14.18, 95% CI [1. 66, 121.29], and PTSD OR = 16.84, 95% CI [1.78, 159.2], relative to the low-symptom class. Moreover, CPTSD and AD class membership was significantly predicted by insecure visa status, CPTSD OR = 7.53, 95% CI [1. 26, 45.08], and AD OR = 7.19, 95% CI [1.23, 42.05]. These findings are consistent with the ICD-11 model of CPTSD and highlight the contributions of cumulative trauma to CPTSD and PTSD profiles as well as of contextual stress from visa uncertainty to DSO symptom profiles in refugee cohorts, particularly those characterized by AD.

Introduction to the Special Section on Complex Posttraumatic Stress Disorder (CPTSD): The Evolution of a Disorder

“…Similar to Liddell et al. (; this issue), cumulative trauma was found to be a significant predictor of posttraumatic stress symptoms. However, although cumulative adulthood trauma was associated with both PTSD and CPTSD, cumulative childhood trauma was more strongly associated with CPTSD.…”

“…However, evidence indicates that although developmental trauma is a risk factor for CPTSD, it is not necessarily a requirement (Hyland et al., ). Indeed, empirical data demonstrate that other types of traumatic exposure in adulthood (e.g., torture; see Liddell et al., , current issue) can also lead to CPTSD.…”

“…Similarly, Liddell and colleagues (; current issue) examined the discriminant validity of CPTSD and PTSD using LCA techniques in a sample of 112 refugees residing in Australia. They found evidence of a four‐class solution that included PTSD, CPTSD, affective dysregulation, and low‐symptom classes.…”

New findings questioning the construct validity of complex posttraumatic stress disorder (cPTSD): let’s take a closer look

“…Using a factor mixture model with two latent dimensional variables representing distinct structures of interrelationships among symptoms, and four latent classes representing sub-groups with distinct symptom profiles, with civilian and military samples, Wolf et al (2015) found evidence that levels of symptom severity but not a differentiation of PTSD and cPTSD symptoms best accounted for derived sub-sets of both symptoms and individuals. More recently, with a sample of resettled adult refugees, subgroups were found with symptom profiles consistent with PTSD and with CPTSD, but also a subgroup with prominent affect dysregulation symptoms, as well as evidence of cumulative trauma exposure only for the PTSD and cPTSD classes (Liddell et al, 2019). In a United States adult community sample, cumulative trauma exposure in adulthood and specific adverse childhood events were associated with both PTSD and cPTSD, but cumulative childhood trauma exposure had a clear dose-response relationship with CPTSD but was associated with PTSD only at the highest cumulative exposure leveland to a much lesser degree than for CPTSD (i.e.…”

Commentary on the Special Section on Complex PTSD: Still Going Strong After All These Years

“…With a sample of resettled adult refugees, Liddell et al. () were able to identify subgroups with symptom profiles consistent with PTSD and with CPTSD as well as a subgroup with elevated affect dysregulation symptoms only. Cumulative trauma exposure was elevated in the PTSD and CPTSD classes, whereas resettlement insecurity was elevated for the affect dysregulation and CPTSD classes.…”