Posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as per ICD-11 proposals: A population study in Israel

Ben–Ezra, Menachem; Karatzias, Thanos; Hyland, Philip; Brewin, Chris R.; Cloitre, Marylène; Bisson, Jonathan I.; Roberts, Neil P.; Lueger‐Schuster, Brigitte; Shevlin, Mark

doi:10.1002/da.22723

Cited by 174 publications

(195 citation statements)

References 53 publications

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“…However, an important difference between these studies and the current study is that the AD factor was estimated as a unidimensional construct and the study conducted by Silove and colleagues did not estimate a correlated first-order model. The current results supporting that affect dysregulation is better represented as two correlated but distinct factors ( r = 0.66) are consistent with a study conducted on a community sample of Israelis, which found that a correlated first-order seven-factor model with hyper- and hypo-activation modelled as correlated but distinct constructs was the best fitting model (Ben-Ezra et al, 2018). …”

Section: Discussionsupporting

confidence: 91%

“…This finding is considerably higher than reported by Silove et al (2017) and Ben-Ezra et al (2018), with CPTSD prevalence estimates of 3% and 2.6%, respectively, but lower than a multicultural refugee sample of whom 32.8% met the CPTSD criteria (Nickerson et al, 2016). However, given the context of the traumatic exposure that these individuals faced during their childhood, this finding is not surprising.…”

Section: Discussioncontrasting

confidence: 57%

“…To overcome this limitation, the International Trauma Questionnaire (ITQ) was developed in line with the proposed diagnostic criteria of PTSD and CPTSD (Cloitre, Roberts, Bisson, & Brewin, 2015). Although this measure is still in the development stages in terms of refining the symptom content and factor structure, a few studies using clinical and non-clinical samples have assessed the distinctiveness of PTSD and CPTSD using this instrument (Ben-Ezra et al, 2018; Hyland et al, 2017; Karatzias et al, 2016). …”

Section: Introductionmentioning

confidence: 99%

“…The factor structure of the ITQ has been tested using a nationally representative sample of Israeli adults (Ben-Ezra et al, 2018). This study, however, tested the dimensionality of the affective dysregulation domain as distinct factors representing hyper-activation and hypo-activation.…”

Section: Introductionmentioning

confidence: 99%

“…First, it was hypothesized that factorial models of the ITQ which discriminate between PTSD and DSO symptoms would produce good model fit (Hyland et al, 2017; Karatzias et al, 2016; Shevlin et al, 2017). Secondly, based on findings from Ben-Ezra et al (2018), it was hypothesized that modelling the AD dimension of hyper-activation and hypo-activation as correlated but distinct constructs would provide a better fit than models estimating AD as a unitary construct. Thirdly, consistent with previous evidence demonstrating that CPTSD is associated with greater psychopathology (Elklit, Hyland, & Shevlin, 2014; Perkonigg et al, 2016), it was hypothesized that CPTSD would be associated with higher levels of psychological problems than those with PTSD only and no diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Testing competing factor models of the latent structure of post-traumatic stress disorder and complex post-traumatic stress disorder according to ICD-11

Murphy

Elklit

Dokkedahl

et al. 2018

European Journal of Psychotraumatology

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With the publication of the International Statistical Classification of Diseases and Related Health Problems, 11th edition (ICD-11) due for release in 2018, a number of studies have assessed the factorial validity of the proposed post-traumatic stress disorder (PTSD) and complex (CPTSD) diagnostic criteria and whether the disorders are correlated but distinct constructs. As the specific nature of CPTSD symptoms has yet to be firmly established, this study aimed to examine the dimension of affect dysregulation as two separate constructs representing hyper-activation and hypo-activation. Seven alternative models were estimated within a confirmatory factor analytic framework using the International Trauma Questionnaire (ITQ). Data were analysed from a young adult sample from northern Uganda (n = 314), of which 51% were female and aged 18–25 years. Forty per cent of the participants were former child soldiers (n = 124) while the remainder were civilians (n = 190). The prevalence of CPTSD was 20.8% and PTSD was 13.1%. The results indicated that all models that estimated affective dysregulation as distinct but correlated constructs (i.e. hyper-activation and hypo-activation) provided satisfactory model fit, with statistical superiority for a seven-factor first-order correlated model. Furthermore, individuals who met the criteria for CPTSD reported higher levels of war experiences, symptoms of anxiety and depression, and somatic problems than those with PTSD only and no diagnosis. There was also a much larger proportion of former child soldiers that met the criteria for a CPTSD diagnosis. In conclusion, these results partly support the factorial validity of the ICD-11 proposals for PTSD and CPTSD in a non-Western culture exposed to mass violence. These findings highlight that more research is required across different cultural backgrounds before firm conclusions can be made regarding the factor structure of CPTSD using the ITQ.

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Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Testing competing factor models of the latent structure of post-traumatic stress disorder and complex post-traumatic stress disorder according to ICD-11

Murphy

Elklit

Dokkedahl

et al. 2018

European Journal of Psychotraumatology

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Validation of the International Adjustment Disorder Questionnaire in Israel and Switzerland

Levin

Bachem

Hyland

et al. 2022

Clin Psychology and Psychoth

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The ICD‐11 has introduced a new conceptualization of adjustment disorder (AjD) as a stress response syndrome with core symptoms of preoccupations and failure to adapt to the stressor. The current study aimed to assess the reliability and validity of the International Adjustment Disorder Questionnaire (IADQ) in two culturally distinct samples from Israel and Switzerland. Two samples were recruited in Israel (N = 1142) and Switzerland (N = 699) during the initial stages of the COVID‐19 pandemic. Confirmatory factor analysis indicated that a correlated two‐factor model provided an excellent fit to the Israeli and Swiss sample data. The IADQ scores correlated strongly with another measure of AjD symptoms and with symptoms of depression, anxiety, acute stress and negative emotions, whereas correlations with posttraumatic stress disorder, complex posttraumatic stress disorder and positive emotions were weaker. In the Swiss sample, 18.8% met diagnostic criteria for probable AjD and 10.2% in the Israeli sample. The current study provides the first evidence of the validity of the German and Hebrew versions of the IADQ and can be used for the screening of this debilitating condition.

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Risk factors and comorbidity of ICD‐11 PTSD and complex PTSD: Findings from a trauma‐exposed population based sample of adults in the United Kingdom

et al. 2019

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Background Following the recently published 11th version of the WHO International Classification of Diseases (ICD‐11), we sought to examine the risk factors and comorbidities associated with posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). Method Cross‐sectional and retrospective design. The sample consisted of 1,051 trauma‐exposed participants from a nationally representative panel of the UK adult population. Results A total of 5.3% (95% confidence interval [CI] = 4.0–6.7%) met the diagnostic criteria for PTSD and 12.9% (95% CI = 10.9–15.0%) for CPTSD. Diagnosis of PTSD was independently associated with being female, being in a relationship, and the recency of traumatic exposure. CPTSD was independently associated with younger age, interpersonal trauma in childhood, and interpersonal trauma in adulthood. Growing up in an urban environment was associated with the diagnosis of PTSD and CPTSD. High rates of physical and mental health comorbidity were observed for PTSD and CPTSD. Those with CPTSD were more likely to endorse symptoms reflecting major depressive disorder (odds ratio [OR] = 21.85, 95 CI = 12.51–38.04) and generalized anxiety disorder (OR = 24.63, 95 CI = 14.77–41.07). Presence of PTSD (OR = 3.13, 95 CI = 1.81–5.41) and CPTSD (OR = 3.43, 95 CI = 2.37–4.70) increased the likelihood of suicidality by more than three times. Nearly half the participants with PTSD and CPTSD reported the presence of a chronic illness. Conclusions CPTSD is a more common, comorbid, debilitating condition compared to PTSD. Further research is now required to identify effective interventions for its treatment.

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Posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as per ICD-11 proposals: A population study in Israel

Cited by 174 publications

References 53 publications

Testing competing factor models of the latent structure of post-traumatic stress disorder and complex post-traumatic stress disorder according to ICD-11

Testing competing factor models of the latent structure of post-traumatic stress disorder and complex post-traumatic stress disorder according to ICD-11

Validation of the International Adjustment Disorder Questionnaire in Israel and Switzerland

Risk factors and comorbidity of ICD‐11 PTSD and complex PTSD: Findings from a trauma‐exposed population based sample of adults in the United Kingdom

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