Maj Hansen

Less is more? Assessing the validity of the ICD-11 model of PTSD across multiple trauma samples

Background In the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the symptom profile of posttraumatic stress disorder (PTSD) was expanded to include 20 symptoms. An alternative model of PTSD is outlined in the proposed 11th edition of the International Classification of Diseases (ICD-11) that includes just six symptoms. Objectives and method The objectives of the current study are: 1) to independently investigate the fit of the ICD-11 model of PTSD, and three DSM-5-based models of PTSD, across seven different trauma samples (N=3,746) using confirmatory factor analysis; 2) to assess the concurrent validity of the ICD-11 model of PTSD; and 3) to determine if there are significant differences in diagnostic rates between the ICD-11 guidelines and the DSM-5 criteria. Results The ICD-11 model of PTSD was found to provide excellent model fit in six of the seven trauma samples, and tests of factorial invariance showed that the model performs equally well for males and females. DSM-5 models provided poor fit of the data. Concurrent validity was established as the ICD-11 PTSD factors were all moderately to strongly correlated with scores of depression, anxiety, dissociation, and aggression. Levels of association were similar for ICD-11 and DSM-5 suggesting that explanatory power is not affected due to the limited number of items included in the ICD-11 model. Diagnostic rates were significantly lower according to ICD-11 guidelines compared to the DSM-5 criteria. Conclusions The proposed factor structure of the ICD-11 model of PTSD appears valid across multiple trauma types, possesses good concurrent validity, and is more stringent in terms of diagnosis compared to the DSM-5 criteria.

Evidence of the dissociative PTSD subtype: A systematic literature review of latent class and profile analytic studies of PTSD

BACKGROUNDnThe dissociative PTSD (D-PTSD) subtype was first introduced into the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. Prior to this, studies using latent profile analysis (LPA) or latent class analysis (LCA), began to provide support for the D-PTSD construct and associated risk factors. This research is important, because dissociative symptoms in the context of PTSD may potentially interfere with treatment course or outcome. The aims of the present study were twofold: to systematically review the LCA and LPA studies investigating support for the D-PTSD construct; and to review the associated research on the risk factors or covariates of D-PTSD in the identified studies.nnnMETHODnSix databases (PubMed, Web of Science, Scopus, PILOTS, PsychInfo, and Embase) were systematically searched for relevant papers.nnnRESULTSnEleven studies were included in the present review. The majority of the studies were supportive of the D-PTSD subtype; primarily characterized by depersonalization and derealization. Several covariates of the D-PTSD subtype have been investigated with mixed results.nnnLIMITATIONSnMany limitations relate to the state of the current literature, including a small number of studies, the use of self-report measurements of PTSD, and heterogeneity across the samples in investigated covariates.nnnCONCLUSIONnThe results were overall supportive of the D-PTSD construct. Future research on D-PTSD and associated risk factors is needed to shed light on the possibilities of facilitating preventive actions, screening, and implications on treatment effects.

Validation of the PTSD-8 scale in chronic pain patients

ObjectivesnThe aim was to validate the short PTSD-8 scale against the Structured Clinical Interview (SCID-1) for post-traumatic stress disorder and to test the latent structure of post-traumatic stress disorder in chronic pain patients.nnnMethodsnA total of 51 chronic nonmalignant pain patients exposed to a traumatic event were consecutively recruited from a multidisciplinary pain center. All participants answered a baseline questionnaire followed by the PTSD-8 and the diagnostic interview for PTSD. Finally, the latent structure of PTSD-8 was tested in a large cohort of 419 patients with chronic nonmalignant pain using confirmatory factor analysis (CFA).nnnResultsnIn total, 33.3% had a diagnosis of PTSD. A good overall accuracy was found validating the PTSD-8 against the diagnostic interview. Convergent validity was indicated as the PTSD-8 correlated strongly with scores of depression and anxiety. The results of the CFA for the PTSD-8 three-factor structure provided excellent fit for the eight post-traumatic stress disorder symptoms.nnnConclusionsnOverall, the results showed that the PTSD-8 is a valid short screening tool to assess possible post-traumatic stress disorder among patients with chronic pain. In addition, the PTSD-8 scale comprises all of the upcoming ICD-11 post-traumatic stress disorder symptoms within its eight items. Thus, the PTSD-8 is likely also to measure the proposed ICD-11 post-traumatic stress disorder.

Are rape cases closed because of rape stereotypes? Results from a Danish police district

Abstract Research shows that the majority of reported rapes is never continued for prosecution but is closed during the police investigation. Studies suggest that rape assaults corresponding to stereotypes about “the real rape” and “the good victim” have a higher likelihood of continuing for prosecution. The aim of the present study was to investigate, if selected characteristics of rape stereotypes influenced investigational outcomes within a Danish police district participating in a multidisciplinary rape response team. The study was based on all reported rapes or rape attempts within a Danish police district over a three-year period (n = 248). Logistic regression analysis was used to investigate, if selected assault and victim characteristics influenced the likelihood of case continuing for prosecution. The following four prominent characteristics of rape stereotypes were selected for investigation: stranger perpetrator, no victim intoxication during the assault, presence of victim resistance and victim physical injuries, respectively. Results indicated that prominent characteristics of rape stereotypes significantly influenced whether the case was continued for prosecution. However, the independent effects of the investigated characteristics were not distinctively supportive of an investigative bias toward rape stereotypes. Even so, no victim intoxication during the assault and more physical injuries were found to increase the likelihood of case continuing for prosecution in this sample of reported rapes. Results are discussed in relation to the possible influence of a coordinated multidisciplinary rape response approach that characterized this sample.

Alternative models of DSM-5 PTSD: Examining diagnostic implications

The factor structure of DSM-5 posttraumatic stress disorder (PTSD) has been extensively debated with evidence supporting the recently proposed seven-factor Hybrid model. However, despite myriad studies examining PTSD symptom structure few have assessed the diagnostic implications of these proposed models. This study aimed to generate PTSD prevalence estimates derived from the 7 alternative factor models and assess whether pre-established risk factors associated with PTSD (e.g., transportation accidents and sexual victimisation) produce consistent risk estimates. Seven alternative models were estimated within a confirmatory factor analytic framework using the PTSD Checklist for DSM-5 (PCL-5). Data were analysed from a Malaysian adolescent community sample (n = 481) of which 61.7% were female, with a mean age of 17.03 years. The results indicated that all models provided satisfactory model fit with statistical superiority for the Externalising Behaviours and seven-factor Hybrid models. The PTSD prevalence estimates varied substantially ranging from 21.8% for the DSM-5 model to 10.0% for the Hybrid model. Estimates of risk associated with PTSD were inconsistent across the alternative models, with substantial variation emerging for sexual victimisation. These findings have important implications for research and practice and highlight that more research attention is needed to examine the diagnostic implications emerging from the alternative models of PTSD.

Training the next generation of psychotraumatologists: COllaborative Network for Training and EXcellence in psychoTraumatology (CONTEXT)

ABSTRACT In this paper we present a description of the Horizon2020, Marie Skłodowska-Curie Action funded, research and training programme CONTEXT: COllaborative Network for Training and EXcellence in psychoTraumatology. The three objectives of the programme are put forward, each of which refers to a key component of the CONTEXT programme. First, we summarize the 12 individual research projects that will take place across three priority populations: (i) refugees and asylum seekers, (ii) first responders, and (iii) perpetrators and survivors of childhood and gender-based violence. Second, we detail the mentoring and training programme central to CONTEXT. Finally, we describe how the research, together with the training, will contribute towards better policy, guidelines, and practice within the field of psychotraumatology.

Rape Crimes: Are Victims’ Acute Psychological Distress and Perceived Social Support Associated With Police Case Decision and Victim Willingness to Participate in the Investigation?:

This study examined level of acute psychological distress and perceived social support in 64 victims of rape and the association with police case decisions and victims’ willingness to participate in the investigation. The results of independent-sample t tests revealed that victims’ unwillingness to participate in the investigation was significantly associated with a higher level of psychological distress in the acute phase following the assault. The results suggest that victims of rape who disengage with the police investigation may do so because of a high level of acute psychological distress. Clinical implications are discussed.

Do post-traumatic pain and post-traumatic stress symptomatology mutually maintain each other? A systematic review of cross-lagged studies

Abstract After traumatic exposure, individuals are at risk of developing symptoms of both pain and post-traumatic stress disorder (PTSD). Theory and research suggest a complex and potentially mutually maintaining relationship between these symptomatologies. However, findings are inconsistent and the applied methods are not always well suited for testing mutual maintenance. Cross-lagged designs can provide valuable insights into such temporal associations, but there is a need for a systematic review to assist clinicians and researchers in understanding the nature of the relationship. Thus, the aim of this systematic review was to identify, critically appraise, and synthesize results from cross-lagged studies on pain and PTSD symptomatology to assess the evidence for longitudinal reciprocity and potential mediators. Systematic searches resulted in 7 eligible studies that were deemed of acceptable quality with moderate risk of bias using the cohort study checklist from Scottish Intercollegiate Guidelines Network. Furthermore, synthesis of significant pathways in the cross-lagged models showed inconsistent evidence of both bidirectional and unidirectional interaction patterns between pain and PTSD symptomatology across time, hence not uniformly supporting the theoretical framework of mutual maintenance. In addition, the synthesis suggested that hyperarousal and intrusion symptoms may be of particular importance in these cross-lagged relationships, while there was inconclusive evidence of catastrophizing as a mediator. In conclusion, the findings suggest an entangled, but not necessarily mutually maintaining relationship between pain and PTSD symptomatology. However, major variations in findings and methodologies complicated synthesis, prompting careful interpretation and heightening the likelihood that future high-quality studies will change these conclusions.

Assessing the existence of dissociative PTSD in sub-acute patients of whiplash

ABSTRACT Numerous studies investigating dissociative posttraumatic stress disorder (D-PTSD) have emerged. However, there is a lack of studies investigating D-PTSD following a wider range of traumatic exposure. Thus, the present study investigates D-PTSD using latent class analysis (LCA) in sub-acute patients of whiplash and associated risk factors. The results of LCA showed a three-class solution primarily distributed according to posttraumatic stress disorder (PTSD) symptom severity and thus no indication of D-PTSD. Dissociative symptoms, psychological distress (i.e. anxiety/depression), and pain severity significantly predicted PTSD severity. Combined, the results support the component model of dissociation and PTSD, while still stressing the importance of dissociative symptoms when planning treatment for PTSD.

Child maltreatment across the lifespan

ABSTRACT The present editorial introduces selected research for a special issue covering the 15th Annual Meeting of the European Society for Traumatic Stress Studies (ESTSS) 2017, ‘Child Maltreatment across the Lifespan’. Unfortunately, childhood maltreatment is highly prevalent around the world. Exposure to child maltreatment is associated with a considerable risk of developing a wide range of psychopathologies. Thus, preventing child maltreatment and offering early treatment to victims is an important and promising area in reducing the risk of psychopathology. The 10 articles included in the special issue focus on different important areas related to the topic of child maltreatment. These include a biological and systemic understanding of maltreatment, a globalization perspective, and contributions on diagnosis and treatment, with implications for clinical practice. Furthermore, the special issue includes an update on ICD-11 and implications associated with the implementation of ICD-11. Future research recommendations are provided to underline the enduring need to promote and undertake research into all aspects of child maltreatment.