ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) in treatment seeking veterans: risk factors and comorbidity

Abstract

Purpose Emerging evidence suggests that ICD-11 CPTSD is a more common condition than PTSD in treatment seeking samples although no study has explored risk factors and comorbidities of PTSD and CPTSD in veteran populations. In this study, risk factors and comorbidity between veterans meeting criteria for PTSD or CPTSD using the ICD-11 International Trauma Questionnaire (ITQ) were explored. Methods A sample of help-seeking veterans who had been diagnosed with a mental health difficulty (n = 177) was recruited. Participants completed a range of mental health and functioning measures. Multinomial logistic regression analysis was conducted to explore differences in the above factors between participants meeting case criteria for PTSD, CPTSD or another mental health disorder. Results Those with CPTSD appeared to have taken longer to seek help, reported higher rates of childhood adversity and more experiences of emotional or physical bullying during their military careers. Further, participants with CPTSD reported a greater burden of comorbid mental health difficulties including high levels of dissociation, anger, difficulties related to moral injury and common mental health difficulties and greater degree of impairment including social isolation, sleep difficulties and impaired functioning. Conclusions Considering that CPTSD is a more debilitating condition than PTSD, there is now an urgent need to test the effectiveness of new and existing interventions in veterans with CPTSD.

Moral injury and ICD-11 complex PTSD (CPTSD) symptoms among treatment-seeking veterans in the United Kingdom.

“…The purpose of this brief report was to examine associations between ICD-11 PTSD, CPTSD, and MI related to self and others in a sample of treatment-seeking veterans from the United Kingdom. In keeping with Murphy, Karatzias, et al’s (2020; Murphy, Shevlin, et al, 2020) reports, roughly two thirds of this sample possibly met criteria for ICD-11 PTSD or CPTSD. When compared to counterparts with or without PTSD, veterans who satisfied Cloitre et al’s (2018) criteria for CPTSD reported greater MI related to both perpetration- and betrayal-based events.…”

“…Participants were recruited from a national charity in the United Kingdom that offers mental health services to veterans (for more details of the larger study, see Murphy, Karatzias, et al, 2020; Murphy, Shevlin, et al, 2020). In addition to serving with the British military, veterans needed to have a clinical diagnosis of a mental health condition and reside in the United Kingdom.…”

“…The purpose of this brief report was to enhance knowledge regarding associations between MI and ICD-11 CPTSD symptoms. Building on Murphy, Karatzias, et al’s (2020; Murphy, Shevlin, et al, 2020) work, the first aim was to conduct a more granular test of differences in outcomes across perpetration- and betrayal-based forms of MI for veterans with probable CPTSD and PTSD. Second, we sought to clarify the most prominent profiles of MI, PTSD, and DSO symptoms.…”

Risk factors for complex posttraumatic stress disorder in UK police

“…The risk of C-PTSD in police officers with heightened anxiety and depression is consistent with evidence that anxiety and depression are commonly observed in those with C-PTSD [ 7 ]. Moreover, the relationship between fewer hours of sleep and C-PTSD is supported by evidence that poor sleep could be a risk factor for C-PTSD [ 8 ], although poorer sleep may also be a consequence of C-PTSD. However, the risk of PTSD and C-PTSD did not differ by the total frequency of traumatic events experienced personally and at work, inconsistent with evidence that chronic trauma is a significant risk factor for C-PTSD [ 2–4 ].…”

“…This may be relevant in police populations where high workload and unsociable working hours are common. Moreover, a cross-sectional study of the UK population established that alcohol abuse doubled the odds of C-PTSD [ 7 ], and in a study of military veterans those with C-PTSD reported poorer sleep quality compared with those with PTSD [ 8 ]. With 5% of police officers reporting increased alcohol consumption following a work trauma [ 9 ], and meta-analyses demonstrating that 51% of police officers have below average sleep [ 10 ], alcohol intake and sleep quality may be crucial risk factors for C-PTSD in police officers.…”