Complex trauma, PTSD and complex PTSD in African refugees

Abstract

Background: The introduction of the diagnosis of complex posttraumatic stress disorder (CPTSD) by ICD-11 is a turning point in the field of traumatic stress studies. It's therefore important to examine the validity of CPTSD in refugee groups exposed to complex trauma (CT) defined as a repeated, prolonged, interpersonal traumatic event. Objective: The objective of this study was to compare DSM-5 and ICD-11 post-traumatic stress disorder diagnoses and to evaluate the discriminant validity of ICD-11 PTSD and CPTSD constructs in a sample of treatment-seeking refugees living in Italy. Method: The study sample included 120 treatment-seeking African refugees living in Italy. All participants were survivors of at least one CT. PTSD and CPTSD diagnoses were assessed according to both DSM-5 and ICD-11 criteria. Results: Findings revealed that 79% of the participants met the DSM-5 criteria for PTSD, 38% for ICD-11 PTSD and 30% for ICD-11 CPTSD. Generally, ICD-11 CPTSD items evidenced strong sensitivity and negative predictive power, low specificity and positive predictive power. Latent class analysis results identified two distinct groups: (1) a PTSD class, (2) a CPTSD class. None of the demographic and trauma-related variables analysed was significantly associated with diagnostic group. On the other hand, the months spent in Italy were significantly associated with PCL-5 score. Conclusions: Findings extend the current evidence base to support the discriminant validity of PTSD and CPTSD amongst refugees exposed to torture and other gross violations of human rights. The results suggest also that, in the post-traumatic phase, the time spent in a 'safe place' condition contributes to improve the severity of post-traumatic symptomatology, but neither this variable nor other socio-demographic factors seem to contribute to the emergence of complex PTSD. Further investigations are needed to clarify which specific vulnerability factors influence the development of PTSD or CPTSD in refugees exposed to complex trauma.

Evidence of distinct profiles of ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD in a South African sample

“…Our findings contrast with research showing that differences between PTSD and CPTSD are related to symptom severity only, with CPTSD representing a more severe form of PTSD (Wolf et al, 2015). These findings are also consistent with those of several previous studies (Barbieri et al, 2019;Hyland et al, 2018;Karatzias et al, 2017;Kazlauskas et al, 2020;Murphy et al, 2016).…”

“…Surprisingly, our data supported the emergence of another distinct class, namely a DSO class. Most previous studies have not found evidence of this class (Barbieri et al, 2019;Hyland et al, 2018;Jowett et al, 2019;Karatzias et al, 2017;Kazlauskas et al, 2018;Murphy et al, 2016). However, Kazlauskas et al (2020) also reported a DSO class in their study examining the validity of PTSD and CPTSD in adolescents, albeit with an adapted version of the ITQ best suited to their sample.…”

“…Although the validity of CPTSD as a clinical syndrome has been questioned (Herman, 2012 ; Resick et al, 2012 ), primarily owing to overlapping symptomology with other trauma-related disorders (Wolf et al, 2015 ), there is now a significant body of literature that supports the hierarchical structure presented in the ICD-11. This includes a notable systematic review (Brewin et al, 2017 ) and a variety of validation studies: latent class analyses (Barbieri et al, 2019 ; Ho et al, 2020 ; Hyland et al, 2018 ; Jowett, Karatzias, Shevlin, & Albert, 2019 ; Karatzias et al, 2017 ), confirmatory factor analyses (Hyland et al, 2017 ; Karatzias et al, 2016 ; Kazlauskas, Gegieckaite, Hyland, Zelviene, & Cloitre, 2018 ; Murphy et al, 2020 ; Owczarek et al, 2020 ), and network analyses (Gilbar, 2020 ; Knefel et al, 2019 , 2020 ; Knefel, Tran, & Lueger-Schuster, 2016 ; McElroy et al, 2019 ). These studies have used the only standardized self-report measure for symptoms of ICD-11 PTSD and CPTSD, the International Trauma Questionnaire (ITQ; Cloitre et al, 2018 ).…”

Patterns and predictors of PTSD in treatment-seeking African refugees and asylum seekers: A latent class analysis

“…According to the DSM-5 criteria the rate of probable PTSD (79.5%) was high in the current sample but consistent with findings of other previous studies investigating samples of treatment-seeking refugees resettled in Europe which reported DSM-IV PTSD rates of 82% (Teodorescu et al, 2012) and 94% (Teegen & Vogt, 2002). In a slightly different sample to the one of the current study, the reported DSM-5 PTSD rate was 79.0% (Barbieri et al, 2019). Meta-analytic findings have suggested that the prevalence of PTSD in refugee groups was approximately 30% (Steel et al, 2009).…”

Relational Spirituality and Transgenerational Obligations: The Role of Family in Lay Explanatory Models of Post-traumatic Stress Disorder in Male Cameroonian Asylum Seekers and Undocumented Migrants in Europe

“…According to the World Health Organization (18), PTSD is defined by the core symptoms of intrusiveness or re-experiencing the trauma (nightmares, flashbacks, and recurring memories), hyperarousal (difficulty sleeping, irritability, and hypervigilance), and avoidance (reminders of events and dissociation) (17). Past research in asylum-seeking and refugee populations from Africa found PTSD rates of up to 79% (19)(20)(21). Individuals without secure residency status-be it pending cases (22,23), rejected asylum seekers (24,25), or undocumented migrants (26)-appear to be at a particularly high risk for ongoing mental health problems and post-migration stress (25,27).…”