The complexity of trauma exposure and response: Profiling PTSD and CPTSD among a refugee sample.

Abstract

Objective: This study investigated the latent dimensional and categorical structure of ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) within a refugee sample. Method: A subsample that identified as refugee (n = 308) was selected from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC-II). Factor Mixture Modelling (FMM) was employed to establish the dimensional structure of CPTSD symptomology and the categorical distribution of these dimensions. It was then evaluated whether trauma history could differentiate between the distribution of trauma response profiles. Results: A correlated six-factor model with five latent classes was the best fitting model. Two classes were characterised by symptom profiles that were consistent with ICD-11 CPTSD and PTSD formulations. The remaining classes were characterised by non-specific variation across dimensions. CPTSD class membership was predicted by traumas that were predominantly interpersonal in nature (serious neglect, physical assault and sexual assault) while PTSD class membership was predicted by situational traumatic experiences (unarmed civilian in a conflict environment and a serious accident). A distinct dose response effect was evident between cumulative traumatic exposure and CPTSD class membership. Conclusion: FMM class profiles distinguished between PTSD and CPTSD symptom formulations. Moreover, class membership was determined by specific trauma exposure histories.

Complex trauma, PTSD and complex PTSD in African refugees

“…Indeed, the results of this study are consistent with most of the investigations on clinical samples, which have identified only 2 or 3 classes (on the contrary, four or more classes have been identified in larger community samples), which typically represented a PTSD profile, a CPTSD profile, and, in some cases, a third profile low on all symptoms, describing what might be viewed as a resilient group (Brewin et al, 2017). Moreover, also the other two studies with refugee samples evidenced two classes characterized by symptom profiles that were consistent with ICD-11 CPTSD and PTSD formulations (Frost et al, 2019;Hyland et al, 2018). Therefore, the findings of the present studythe first on a sample of African refugees living in a western countryadd to a large and growing empirical literature supporting the discriminant validity of PTSD and CPTSD amongst multiple samples taken from culturally and trauma diverse backgrounds (see references in the introduction).…”

“…institutional child abuse, sexual assault, bereavement, child soldiering, war prisoners). Of these sixteen studies, thirteen offer support for qualitatively distinct classes where symptom profiles are consistent with the distinction between ICD-11 PTSD and CPTSD (Ben-Ezra et al, 2018;Böttche et al, 2018;Cloitre, Garvert, Brewin, Bryant, & Maercker, 2013;Cloitre, Garvert, Weiss, Carlson, & Bryant, 2014;Elklit, Hyland, & Shevlin, 2014;Frost et al, 2019;Karatzias et al, 2017;Knefel, Garvert, Cloitre, & Lueger-Schuster, 2015;Murphy, Elklit, Dokkedahl, & Shevlin, 2016;Palic et al, 2016;Perkonigg et al, 2016;Sachser, Keller, & Goldbeck, 2017;Zerach, Shevlin, Cloitre, & Solomon, 2019). In contrast, the remaining three studies (Eidhof et al, 2019;Glück, Knefel, Tran, & Lueger-Schuster, 2016;Wolf et al, 2015) observed classes that differed quantitatively rather than qualitatively suggesting that CPTSD is not distinguishable from PTSD and that differences in classes are best explained varying degrees of symptom severity on a single, underlying, condition (i.e.…”

“…PTSD). To date, only two investigations evaluated the discriminant validity of ICD-11 PTSD and CPTSD amongst refugees; one study involved 110 Syrian refugees in Lebanon (Hyland et al, 2018) and the other a subsample of refugees (n = 308) selected from the National Epidemiological Survey on Alcohol and Related Conditions in Ireland (Frost et al, 2019). Both studies supported for two distinct trauma-based disorders, as put forward in the ICD-11.…”

Resting State Functional Connectivity of the Thalamus in North Korean Refugees with and without Posttraumatic Stress Disorder

“…The likelihood of developing PTSD depends on the interaction between individual risk factors (i.e. genetic or epigenetic risks, psychological resiliency) and traumatic load 21 , whereas cumulative trauma exposures have a clear dose-effect relationship with the symptoms of PTSD in a population with high levels of traumatic events [22][23][24] . However, TEC group showed the stronger thalamo-postcentral negative connectivity than PTSD group even after controlling for traumatic load.…”

Modeling Patterns of Polyvictimization and Their Associations with Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in the Israeli Population

“…Indeed, mounting evidence supports the proposition that CPTSD develops after continuous, severe interpersonal trauma exposure, and, expressly, with trauma occurring during childhood (Ben‐Ezra et al., ; Cloitre et al., ; Frost et al., ; Frost, Hyland, Shevlin, & Murphy, ; Hyland et al., ; Palic et al., ; Shevlin et al., ). Research by Hyland, Murphy, and colleagues () suggests that there might be specificity in the associations among trauma exposure, PTSD, and CPTSD: They found that some trauma types were uniquely associated with PTSD (robbery), some uniquely associated with CPTSD (childhood physical abuse), and some were associated with both disorders (childhood sexual abuse).…”