The association of posttraumatic stress disorder, complex posttraumatic stress disorder, and borderline personality disorder from a network analytical perspective

Knefel, Matthias; Tran, Ulrich S.; Lueger‐Schuster, Brigitte

doi:10.1016/j.janxdis.2016.09.002

Cited by 122 publications

(136 citation statements)

References 31 publications

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“…The main findings have consistently been that some symptoms cluster together (e.g., symptoms of depression) [78], but are also connected by bridging symptoms. For example, “internal avoidance” and “identity disturbance” are related in comorbid PTSD and BPD [79], while “drinking to cope” and “subjective stress” could explain comorbid Alcohol Use Disorder and anxiety and depression [80]. These results may be important in terms of identifying individuals at risk to develop two or more disorders and also to be used in treatment to reduce current and future comorbidities.…”

Section: Resultsmentioning

confidence: 99%

The Study of Psychopathology from the Network Analysis Perspective: A Systematic Review

Contreras

Nieto

Valiente

et al. 2019

Psychother Psychosom

304

214

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Background: Network analysis (NA) is an analytical tool that allows one to explore the map of connections and eventual dynamic influences among symptoms and other elements of mental disorders. In recent years, the use of NA in psychopathology has rapidly grown, which calls for a systematic and critical analysis of its clinical utility. Methods: Following PRISMA guidelines, a systematic review of published empirical studies applying NA in psychopathology, between 2010 and 2017, was conducted. We included the literature published in PubMed and PsycINFO using as keywords any combination of “network analysis” with the terms “anxiety,” “affective disorders,” “depression,” “schizophrenia,” “psychosis,” “personality disorders,” “substance abuse” and “psychopathology.” Results: The review showed that NA has been applied in a plethora of mental disorders in adults (i.e., 13 studies on anxiety disorders; 19 on mood disorders; 7 on psychosis; 1 on substance abuse; 1 on borderline personality disorder; 18 on the association of symptoms between disorders), and 6 on childhood and adolescence. Conclusions: A critical examination of the results of each study suggests that NA helps to identify, in an innovative way, important aspects of psychopathology like the centrality of the symptoms in a given disorder as well as the mutual dynamics among symptoms. Yet, despite these promising results, the clinical utility of NA is still uncertain as there are important limitations on the analytic procedures (e.g., reliability of indices), the type of data included (e.g., typically restricted to secondary analysis of already published data), and ultimately, the psychometric and clinical validity of the results.

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Section: Resultsmentioning

confidence: 99%

The Study of Psychopathology from the Network Analysis Perspective: A Systematic Review

Contreras

Nieto

Valiente

et al. 2019

Psychother Psychosom

304

214

View full text Add to dashboard Cite

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“…Network models were implemented only recently in the field of PTSD research (McNally et al, 2015), and have been used in at least 11 papers since (Afzali et al, 2016(Afzali et al, , 2017Armour et al, 2016;Birkeland & Heir, 2017;Bryant et al, 2016;Frewen, Schmittmann, Bringmann, & Borsboom, 2013;Knefel, Tran, & Lueger-Schuster, 2016;Mitchell et al, 2017;Spiller et al, 2017;Sullivan, Smith, Lewis, & Jones, 2016). Overall, we identify three specific challenges in the prior literature of PTSD symptom networks that we aim to address in the present paper.…”

Section: Introductionmentioning

confidence: 99%

“…This apparent lack of consistent results strongly warrants replicability investigations. Second, only few PTSD network papers featured large samples (Bryant et al, 2016;Mitchell et al, 2017)-most publications are based on comparably small populations with only about 200 subjects (Armour et al, 2016;Birkeland & Heir, 2017;Knefel et al, 2016;Spiller et al, 2017). Given that network models require the estimation of many parameters and that these models need considerable power to reliably detect small coefficients , this calls for investigations in larger datasets.…”

Section: Introductionmentioning

confidence: 99%

“…(Afzali et al, 2016(Afzali et al, , 2017Sullivan et al, 2016)) or subclinical/mixed samples (e.g. (Armour et al, 2016;Bryant et al, 2016;Knefel et al, 2016;McNally et al, 2015;Mitchell et al, 2017)). The network structure in clinical samples-arguably the most relevant level of observation if we take network theory seriously-is presently unknown.…”

Section: Introductionmentioning

confidence: 99%

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Replicability and generalizability of PTSD networks: A cross-cultural multisite study of PTSD symptoms in four trauma patient samples

Fried¹

2017

Preprint

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The growing literature conceptualizing mental disorders like Posttraumatic Stress Disorder (PTSD) as networks of interacting symptoms faces three key challenges. Prior studies predominantly used (a) small samples with low power for precise network estimation, (b) non-clinical samples, and (c) single samples. This renders network structures in clinical data, and the extent to which networks replicate across datasets, unknown. To overcome these limitations, the present cross-cultural multisite study estimated regularized partial correlation networks of 16 PTSD symptoms across four datasets of traumatized patients receiving treatment for PTSD (total N=2,782), and compared resulting networks.Despite differences in culture, trauma-type and severity of the samples, considerable similarities emerged, with moderate to high correlations between symptom profiles (0.43 to 0.82), network structures (0.62 to 0.74), and centrality estimates (0.63 to 0.75). We discuss the importance of future replicability efforts to improve clinical psychological science, and provide code, model output, and correlation matrices to make the results of this paper fully reproducible.

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“…They were recruited for the Vienna Institutional Abuse Study, which aimed to investigate the long-term correlates of IA and current health in adult survivors. Only adult survivors who disclosed their experiences to a victims’ protection commission were invited to participate in the study, and data on 220 people were included (see Knefel, Tran, & Lueger-Schuster, 2016, for a detailed description of recruitment). The study was approved by the Institutional Review Board of the University of Vienna (ref.…”

Section: Methodsmentioning

confidence: 99%

A network analysis of anger, shame, proposed ICD-11 post-traumatic stress disorder, and different types of childhood trauma in foster care settings in a sample of adult survivors

Glück

Knefel

2017

European Journal of Psychotraumatology

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Background: Anger and shame are aspects that are specifically associated with psychopathology and maladaptation after childhood abuse and neglect. They are known to influence symptom maintenance and exacerbation; however, their interaction is not fully understood. Objective: To explore with network analysis the association and interaction of prolonged, complex interpersonal childhood abuse and neglect in institutional foster care settings [institutional abuse (IA)] with anger, shame, and the proposed 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) post-traumatic stress disorder (PTSD) symptoms in adult survivors. Method: Adult survivors of IA (N = 220, mean age = 57.95 years) participated in the study and were interviewed using the Childhood Trauma Questionnaire, the International Trauma Questionnaire, the State–Trait Anger Expression Inventory, the Displaced Aggression Questionnaire, and shame-related items. To identify the most central aspects, we used a staged network analysis and centrality analysis approach: (1) on the scale level; (2) on the item/symptom level; and (3) with modularity analysis to find communities within the item-level network. Results: Trait anger, anger rumination, emotional abuse, and PTSD re-experiencing symptoms played the most important roles on a scale level and were then further analyzed on the item/symptom level. The most central symptom on the item level was anger rumination related to meaningful past events. The modularity analysis supported discriminant validity of the included scales. Conclusions: Anger is an important factor in the psychopathological processes following childhood abuse. Anger rumination is closely related to PTSD symptoms; however, anger is not a part of the proposed ICD-11 PTSD in the present study.

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The association of posttraumatic stress disorder, complex posttraumatic stress disorder, and borderline personality disorder from a network analytical perspective

Cited by 122 publications

References 31 publications

The Study of Psychopathology from the Network Analysis Perspective: A Systematic Review

The Study of Psychopathology from the Network Analysis Perspective: A Systematic Review

Replicability and generalizability of PTSD networks: A cross-cultural multisite study of PTSD symptoms in four trauma patient samples

A network analysis of anger, shame, proposed ICD-11 post-traumatic stress disorder, and different types of childhood trauma in foster care settings in a sample of adult survivors

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