Revealing what is distinct by recognising what is common: distinguishing between complex PTSD and Borderline Personality Disorder symptoms using bifactor modelling

Frost, Rachel; Murphy, Jamie; Shevlin, Mark; Ben–Ezra, Menachem; Hansen, Maj; Armour, Chérie; McCarthy, Angela; Cunningham, Twylla; McDonagh, Tracey

doi:10.1080/20008198.2020.1836864

Cited by 19 publications

(31 citation statements)

References 36 publications

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“…This difference was present when the baseline class was used as the reference category and when the Moderate Symptomatic class was the reference, though the likelihood was not as high. These results are consistent with previous findings (Frost et al, 2020 ; Mur-Crepulja et al, 2020 ) and with the suggestion of an increased psychological encumbrance due to CPTSD including high rates of comorbidity with anxiety, depression, and self-injurious/suicidal ideation due to a hypothesised general ‘internalizing’ factor of psychological distress (Hyland et al, 2018 ). Depression was the most comorbid in both classes ( OR = .06 for Probable CPTSD, OR = .28 for Moderate Symptomatic), followed by anxiety ( OR = .05 for Probable CPTSD, OR = .77 for Moderate Symptomatic), and while suicidal ideation was comorbid in both classes, a suicide attempt was only so for the Probable CPTSD class.…”

Section: Discussionsupporting

confidence: 93%

“…Individuals with CPTSD are more likely to report experiencing higher levels of anxiety and depression (Karatzias et al, 2019 ; Mur-Crepulja et al, 2020 ; Murphy, Karatzias, Busuttil, Greenberg, & Shevlin, 2021 ), suicidality (Hyland, Shevlin, Fyvie, & Karatzias, 2018 ; Karatzias et al, 2019 ), moral injury (Mur-Crepulja et al, 2020 ; Murphy et al, 2021 ), substance misuse and psychosis (Facer-Irwin, Karatzias, Bird, Blackwood, & MacManus, 2021 ), and alcohol misuse (Hitch, Toner, & Armour, 2020 ). The DSO elements of CPTSD overlap with symptomology of borderline personality disorder (BPD), which is also associated with trauma (Herman, Perry, & Van der Kolk, 1989 ), though recent studies have shown a clear delineation between the two in trauma exposed populations (Cloitre, Garvert, Weiss, Carlson, & Bryant, 2014 ; Frost et al, 2020 ; Frost, Hyland, Shevlin, & Murphy, 2020 ; Murphy et al, 2021 ), with the association being one of comorbidity.…”

Section: Introductionmentioning

confidence: 99%

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Exploring complex-PTSD comorbidity in trauma-exposed Northern Ireland veterans

Spikol

Robinson

McGlinchey

et al. 2022

European Journal of Psychotraumatology

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Background Complex posttraumatic stress disorder (CPTSD) describes the results of complex, prolonged, and/or inescapable trauma, and is typified by avoidance, re-experiencing, sense of threat, affect dysregulation, negative self-concept, and interpersonal disturbances. Additionally, CPTSD is highly comorbid with other common psychopathologies. Objectives A study was conducted in a trauma-exposed UK Armed Forces Veteran population resident in Northern Ireland ( N = 638, NI) to determine the prevalence of CPTSD and comorbid associations. Methods Data from the Northern Ireland Veterans Health and Wellbeing Study (NIVHWS), including self-report data describing traumatic stress, depression, anxiety, and suicidality, were used in a latent class analysis to identify distinct profiles of symptomology in the sample, and in a multinomial logistic regression to identify comorbidities associated with class membership. Results Three distinct classes emerged: a low endorsement ‘baseline’ class (36%), a ‘Moderate Symptomatic’ class (27%), and a high endorsement ‘Probable CPTSD’ class (37%). Both the Moderate Symptomatic and CPTSD classes were predicted by cumulative trauma exposure. Depression was highly comorbid ( OR = .06 in CPTSD), as was anxiety ( OR = .05 in CPTSD) and suicidal ideation ( OR = .32 in CPTSD), with suicidal attempt associated with the CPTSD class ( OR = .51). Conclusions Cases of probable CPTSD were more prevalent than cases of probable posttraumatic stress disorder (PTSD) without Difficulties in Self-Organisation (DSO) symptoms in a UK Armed Forces veteran sample, were associated with repeated/cumulative trauma, and were highly comorbid across a range of psychopathologies. Findings validate previous literature on CPTSD and indicate considerable distress and thus need for support in UK Armed Forces veterans resident in NI.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Exploring complex-PTSD comorbidity in trauma-exposed Northern Ireland veterans

Spikol

Robinson

McGlinchey

et al. 2022

European Journal of Psychotraumatology

Self Cite

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“…Here, most studies find clear commonalities between CPTSD and BPD (Ford, 2019 ; Frost, Hyland, Shevlin, & Murphy, 2020 ; Frost et al, 2020 ; Giourou et al, 2018 ; Hyland, Karatzias, Shevlin, & Cloitre, 2019 ; Jowett, Karatzias, & Albert, 2020 ; Jowett, Karatzias, Shevlin, & Albert, 2020 ; Saraiya et al, 2021 ; van Dijke, Hopman, & Ford, 2018 ), specifically regarding affective dysregulation, which is attributed to transdiagnostic risk factors. Several of these studies have used latent class analyses (Frost et al, 2020 ; Jowett et al, 2020 ; Saraiya et al, 2021 ), but also extended analyses such as structure equation modelling have been used (Frost et al, 2020 ; Hyland et al, 2019 ; van Dijke et al, 2018 ) to address limitations in factor analytical methods for discriminative purposes, as BPD and CPTSD have conceptual similarities (Achterhof et al, 2019 ; Ford, 2020 ; Hyland et al, 2019 ). Despite these identified similarities, CPTSD is distinguishable from BPD in these studies, except for one (Saraiya et al, 2021 ), thus also confirming findings from previous studies (Cloitre et al, 2014 ; Ford & Courtois, 2014 ).…”

Section: Differential Diagnosticsmentioning

confidence: 91%

“…Despite these identified similarities, CPTSD is distinguishable from BPD in these studies, except for one (Saraiya et al, 2021 ), thus also confirming findings from previous studies (Cloitre et al, 2014 ; Ford & Courtois, 2014 ). The differences are seen primarily in the phenomenological expression of the disorders; BPD marked by an unstable self-concept, and CPTSD by a more persistent negative self-concept (Frost et al, 2020 ; Jowett et al, 2020 ). Mood fluctuations are generally more prominent in BPD and are expressed, among other things, through unstable social connections, separation anxiety, and emotional reactivity such as self-harming behaviour (Hyland et al, 2019 ).…”

Section: Differential Diagnosticsmentioning

confidence: 99%

“…Mood fluctuations are generally more prominent in BPD and are expressed, among other things, through unstable social connections, separation anxiety, and emotional reactivity such as self-harming behaviour (Hyland et al, 2019 ). Contrary to this, CPTSD is characterized by emotional numbing and withdrawal from social relationships (Frost et al, 2020 ; Hyland et al, 2019 ). The latter can be considered as a post-traumatic symptom of avoidance, as social interactions can trigger trauma responses.…”

Section: Differential Diagnosticsmentioning

confidence: 99%

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Complex PTSD: what is the clinical utility of the diagnosis?

Rød

Schmidt

2021

European Journal of Psychotraumatology

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Background The diagnosis of complex posttraumatic stress disorder (CPTSD) was included in the 11th revised edition of the International Classification of Diseases (ICD-11). CPTSD shares trauma-specific symptoms with its sibling disorder PTSD but is additionally characterized by disturbances of the individual’s self-organization (DSO). The clinical utility of the CPTSD diagnosis has yet to be thoroughly investigated. Objective The current study aimed to examine the clinical utility of the CPTSD diagnosis, considering the upcoming implementation of ICD-11 in clinical practice. Method International field studies, construct- and validity analyses leading up to the inclusion in ICD-11 are reviewed, and the diagnostic measures; International Trauma Questionnaire (ITQ) and International Trauma Interview (ITI) are presented. Also, the relationship between CPTSD and borderline personality disorder (BPD) is elaborated in an independent analysis, to clarify their differences in clinical relevance to treatment. Treatment implications for CPTSD are discussed with reference to existing guidelines and clinical needs. Results The validation of ITQ and ITI contributes to the cementation of CPTSD in further clinical practice, providing qualified assessment of the construct, with intended informative value for both clinical communication and facilitation of treatment. CPTSD is found distinguishable from both PTSD and BPD in empirical studies, while the possibility of comorbid BPD/PTSD cases being better described as CPTSD is acknowledged. Practitioners need to employ well-established methods developed for PTSD, while considering additional DSO-symptoms in treatment of CPTSD. Conclusions The inclusion of CPTSD in ICD-11 may potentially facilitate access to more tailored treatment interventions, as well as contribute to increased research focus on disorders specifically associated with stress. The clinical utility value of this additional diagnosis is expected to reveal itself further after ICD-11 is implemented in clinical practice in 2022 and onwards. Yet, CPTSD’s diagnostic inclusion gives future optimism to assessing and treating complex posttraumatic stress symptoms.

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Emerging experience with selected new categories in the ICD‐11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder

et al. 2022

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Among the important changes in the ICD-11 is the addition of 21 new mental disorders. New categories are typically proposed to: a) improve the usefulness of morbidity statistics; b) facilitate recognition of a clinically important but poorly classified mental disorder in order to provide appropriate management; and c) stimulate research into more effective treatments. Given the major implications for the field and for World Health Organization (WHO) member states, it is important to examine the impact of these new categories during the early phase of the ICD-11 implementation. This paper focuses on four disorders: complex post-traumatic stress disorder, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. These categories were selected because they have been the focus of considerable activity and/or controversy and because their inclusion in the ICD-11 represents a different decision than was made for the DSM-5. The lead authors invited experts on each of these disorders to provide insight into why it was considered important to add it to the ICD-11, implications for care of not having that diagnostic category, important controversies about adding the disorder, and a review of the evidence generated and other developments related to the category since the WHO signaled its intention to include it in the ICD-11. Each of the four diagnostic categories appears to describe a population with clinically important and distinctive features that had previously gone unrecognized as well as specific treatment needs that would otherwise likely go unmet. The introduction of these categories in the ICD-11 has been followed by a substantial expansion of research in each area, which has generally supported their validity and utility, and by a significant increase in the availability of appropriate services.

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Revealing what is distinct by recognising what is common: distinguishing between complex PTSD and Borderline Personality Disorder symptoms using bifactor modelling

Cited by 19 publications

References 36 publications

Exploring complex-PTSD comorbidity in trauma-exposed Northern Ireland veterans

Exploring complex-PTSD comorbidity in trauma-exposed Northern Ireland veterans

Complex PTSD: what is the clinical utility of the diagnosis?

Emerging experience with selected new categories in the ICD‐11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder

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