Complex PTSD among treatment-seeking veterans with PTSD

Abstract

Background: In the ICD-11 hierarchical classification structure, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) are separate and distinct but also 'sibling' disorders, meaning that the diagnoses follow from the parent category of traumatic stress disorders. Objective: The aim of this study was to examine the prevalence of CPTSD in treatmentseeking war veterans with PTSD more than 20 years after the exposure to cumulative warrelated trauma(s). The second aim was to examine if there was an association between demographic and psychosocial variables and CPTSD or PTSD. Method: A sample of 160 male war veterans with PTSD referred to the outpatient service of the PTSD Referral Centre at the Clinical Hospital Centre (CHC) Rijeka participated in a crosssectional study. Psychiatric comorbidity was assessed using the Mini-International Neuropsychiatric Interview (MINI) and participants completed validated self-report measures: The Life Events Checklist for DSM-5 (LEC-5), International Trauma Questionnaire (ITQ). Results: In total, 80.63% of the sample met criteria for a probable diagnosis of CPTSD. The study revealed that there was no significant difference in the length of deployment, in the intensity of the PTSD symptoms, types of trauma exposure and pharmacotherapeutic treatment between PTSD and CPTSD group. It was found that veterans with PTSD were more likely to be divorced and to participate in PTSD clubs. On the other hand, veterans with CPTSD were significantly more likely to have higher levels of functional impairment and comorbidity with general anxiety disorder (GAD) compared to the PTSD group. Conclusions: This study supports the proposition that a prolonged trauma of severe interpersonal intensity such as war is related to high rates of CPTSD among treatmentseeking veterans, years after the war. The distinction between PTSD and complex PTSD may help the selection of person-centred treatment interventions that would target specific mental health and functional problems in patients.

Rt-fMRI neurofeedback-guided cognitive reappraisal training modulates amygdala responsivity in posttraumatic stress disorder

“…This selection criterion was introduced to facilitate a homogenous sample based on observations of distinct profiles of PTSD and complex PTSD ( Karatzias et al, 2017 ). Patients with multiple and complex traumatization show increased rates of childhood traumatization, comorbid disorders as well as higher functional impairment ( Karatzias et al, 2017 , Letica-Crepulja et al, 2020 ). Accordingly, the inclusion of PTSD after the experience of a single traumatic event allowed for a disease-specific investigation of regulation mechanisms and associated deficits that is less distorted by complex comorbid symptom profiles.…”

The international trauma questionnaire (ITQ) measures reliable and clinically significant treatment-related change in PTSD and complex PTSD

“…One of the more widely used self-report questionnaires is the International Trauma Questionnaire (ITQ: Cloitre et al, 2018 ). Psychometric evaluations indicate that the PTSD and DSO items of the ITQ produce scores with satisfactory internal consistency, as measured by Cronbach’s alpha (α), across a range of study samples including epidemiological (Ben-Ezra et al, 2018 ; Cloitre et al, 2019 ), community (Ho et al, 2020 , 2019 ), and clinical (Hyland, Shevlin, Fyvie, & Karatzias, 2018 ; Kazlauskas, Gegieckaite, Hyland, Zelviene, & Cloitre, 2018 ) samples as well as among refugees (Hyland et al, 2018 ) and military personnel (Letica-Crepulja et al, 2020 ; Mordeno, Nalipay, & Mordeno, 2019 ; Murphy et al, 2020 ).…”

Posttraumatic stress disorder symptoms and coping with the lockdown among help-seeking veterans before and during the COVID-19 pandemic

“…The impact of PTSD treatment between two assessments certainly has to be discussed. Participants have been in treatment for their PTSD symptoms for 16 years on average, implying that they mostly suffer from chronic, usually treatment-resistant, PTSD symptoms with more severe posttraumatic symptoms (ie, complex PTSD) ( 23 ). Most of the participants continued to be treated as usual.…”

“…The same is true for PTSD patients treated in the Referral Center of the Ministry of Health of the Republic of Croatia (RCPTSD) at the Clinical Hospital Center (CHC) Rijeka. A recent study revealed high rates of overall symptoms and severe posttraumatic symptoms (ie, complex PTSD) in this population years after the war ended ( 23 ).…”