Philip Hyland

Evidence of symptom profiles consistent with posttraumatic stress disorder and complex posttraumatic stress disorder in different trauma samples

Background The International Classification of Diseases, 11th version (ICD-11), proposes two related stress and trauma-related disorders, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). A diagnosis of CPTSD requires that in addition to the PTSD symptoms, an individual must also endorse symptoms in three major domains: (1) affective dysregulation, (2) negative self-concepts, and (3) interpersonal problems. This study aimed to determine if the naturally occurring distribution of symptoms in three groups of traumatised individuals (bereavement, sexual victimisation, and physical assault) were consistent with the ICD-11, PTSD, and CPTSD specification. The study also investigated whether these groups differed on a range of other psychological problems. Methods and Results Participants completed self-report measures of each symptom group and latent class analyses consistently found that a three class solution was best. The classes were “PTSD only,” “CPTSD,” and “low PTSD/CPTSD.” These classes differed significantly on measures of depression, anxiety, dissociation, sleep disturbances, somatisation, interpersonal sensitivity, and aggression. The “CPTSD” class in the three samples scored highest on all the variables, with the “PTSD only” class scoring lower and the “low PTSD/CPTSD” class the lowest. Conclusion This study provides evidence to support the diagnostic structure of CPTSD and indicted that CPTSD is associated with a broad range of other psychological problems.

Evidence of distinct profiles of Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) based on the new ICD-11 Trauma Questionnaire (ICD-TQ)

BACKGROUND The WHO International Classification of Diseases, 11th version (ICD-11), has proposed two related diagnoses following exposure to traumatic events; Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). We set out to explore whether the newly developed ICD-11 Trauma Questionnaire (ICD-TQ) can distinguish between classes of individuals according to the PTSD and CPTSD symptom profiles as per ICD-11 proposals based on latent class analysis. We also hypothesized that the CPTSD class would report more frequent and a greater number of different types of childhood trauma as well as higher levels of functional impairment. Methods Participants in this study were a sample of individuals who were referred for psychological therapy to a National Health Service (NHS) trauma centre in Scotland (N=193). Participants completed the ICD-TQ as well as measures of life events and functioning. RESULTS Overall, results indicate that using the newly developed ICD-TQ, two subgroups of treatment-seeking individuals could be empirically distinguished based on different patterns of symptom endorsement; a small group high in PTSD symptoms only and a larger group high in CPTSD symptoms. In addition, CPTSD was more strongly associated with more frequent and a greater accumulation of different types of childhood traumatic experiences and poorer functional impairment. LIMITATIONS Sample predominantly consisted of people who had experienced childhood psychological trauma or been multiply traumatised in childhood and adulthood. CONCLUSIONS CPTSD is highly prevalent in treatment seeking populations who have been multiply traumatised in childhood and adulthood and appropriate interventions should now be developed to aid recovery from this debilitating condition.

An initial psychometric assessment of an ICD-11 based measure of PTSD and complex PTSD (ICD-TQ): Evidence of construct validity

Among the conditions following exposure to traumatic life events proposed by ICD-11 are Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). The primary aim of this study was to provide an assessment of the reliability and validity of a newly developed self-report measure of ICD-11 PTSD and CPTSD: the ICD-11 Trauma Questionnaire (ICD-TQ). Participants in this study were a sample of individuals who were referred for psychological therapy to a National Health Service (NHS) trauma centre in Scotland (N=193). Participants completed the ICD-TQ and measures of traumatic life events, DSM-5 PTSD, emotion dysregulation, self-esteem, and interpersonal difficulties. Confirmatory factor analysis results supported the factorial validity of the ICD-TQ with results in line with ICD-11 proposals. The ICD-TQ demonstrated satisfactory internal reliability, and correlation results indicated that the scale exhibited convergent and discriminant validity. Current results provide initial support for the psychometric properties of this initial version of the ICD-TQ. Future theoretical and empirical work will be required to generate a final version of the ICD-TQ that will match the diagnostic structure of PTSD and CPTSD when ICD-11 is published.

A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD

The World Health Organizations proposals for posttraumatic stress disorder (PTSD) in the 11th edition of the International Classification of Diseases, scheduled for release in 2018, involve a very brief set of symptoms and a distinction between two sibling disorders, PTSD and Complex PTSD. This review of studies conducted to test the validity and implications of the diagnostic proposals generally supports the proposed 3-factor structure of PTSD symptoms, the 6-factor structure of Complex PTSD symptoms, and the distinction between PTSD and Complex PTSD. Estimates derived from DSM-based items suggest the likely prevalence of ICD-11 PTSD in adults is lower than ICD-10 PTSD and lower than DSM-IV or DSM-5 PTSD, but this may change with the development of items that directly measure the ICD-11 re-experiencing requirement. Preliminary evidence suggests the prevalence of ICD-11 PTSD in community samples of children and adolescents is similar to DSM-IV and DSM-5. ICD-11 PTSD detects some individuals with significant impairment who would not receive a diagnosis under DSM-IV or DSM-5. ICD-11 CPTSD identifies a distinct group who have more often experienced multiple and sustained traumas and have greater functional impairment than those with PTSD.

An Assessment of the Construct Validity of the ICD-11 proposals for Complex Posttraumatic Stress Disorder

Background: A new diagnosis, complex posttraumatic stress disorder (CPTSD), is set to be introduced in the 11th revision to the International Classification of Diseases (ICD-11). Studies have supported a unique group of trauma-exposed individuals who exhibit symptoms consistent with CPTSD proposals. No studies have yet tested the proposed latent symptom structure of CPTSD proposed for ICD-11. This study tests the factorial validity of CPTSD and assesses the role of a range of risk factors to predict CPTSD. Method: A large sample (N = 453) of treatment-seeking adult victims of childhood sexual abuse completed self-report measures of CPTSD. Confirmatory factor analysis (CFA) was used to compare a set of alternative factor models of CPTSD. Results: Just less than half of the sample met the diagnostic criteria for CPTSD (42.8%). CFA results supported the factorial validity of the ICD-11 proposals for CPTSD. Being female and experiencing a greater number of sexual abuse acts during childhood were more strongly associated with PTSD than CPTSD symptoms. Regarding symptoms, anxiety was more strongly associated with PTSD than CPTSD, whereas higher levels of dysthymia were more strongly associated with CPTSD than PTSD symptoms. Conclusions: Results provide initial evidence regarding the factorial validity of the proposed ICD-11 model of CPTSD. In addition, current results support the proposals of the ICD-11 that exposure to abuse during early development is associated with a greater likelihood of CPTSD than PTSD. The study contributes to a growing body of empirical data supporting the construct validity of CPTSD as a unique diagnostic entity.

The Role of Criminal Social Identity in the Relationship between Criminal Friends and Criminal Thinking Style within a Sample of Recidivistic Prisoners

Previous research suggests a direct relationship between criminal friends and criminal thinking style; however, social identity theory proposes that identity mediates the impact of social group members on development of thinking styles. This research project is the first attempt to empirically test the mediating role of criminal social identity in the development of criminal thinking styles within a recidivistic prison sample (N = 312). The structural equation model of criminal thinking style presented and tested in this study supports the central predictions of social identity theory, with findings demonstrating an indirect effect of antisocial friend associations on criminal thinking through in-group affect and in-group ties with criminal in-group members that reflect two of three dimensions of the measure of criminal social identity applied in the current study. Further implications in relation to theory and previous studies are discussed.

Development and Validation of a Measure of Criminal Social Identity within a sample of Polish Recidivistic Prisoners

BACKGROUND Social identity is a well-established theoretical concept within psychological research; however, the role of criminal social identity has received far less research attention. One salient reason for the limited research relating to the concept of criminal social identity is the absence of a specific measure. AIM To develop and test the construct validity of a new measure of criminal social identity (MCSI) and to provide additional evidence relating to Camerons three-factor conceptualisation of social identity. METHOD The eight-item MCSI was used to collect data from recidivists incarcerated in high-security prison (N=312) to assess criminal social identification. These data were subjected to confirmatory factor analysis. RESULTS Three alternative models of criminal social identity were specified and tested in Mplus 6, and results revealed that the data were best explained by a three-factor model of criminal social identity (cognitive centrality, in-group affect and in-group ties). CONCLUSION The current study is important in terms of future research in criminology and psychology because the MCSI provides the first reliable MCSI, which was developed and validated on a relatively large recidivistic prison sample.

Variation in post-traumatic response: the role of trauma type in predicting ICD-11 PTSD and CPTSD symptoms

PurposeThe World Health Organization’s 11th revision to the International Classification of Diseases manual (ICD-11) will differentiate between two stress-related disorders: PTSD and Complex PTSD (CPTSD). ICD-11 proposals suggest that trauma exposure which is prolonged and/or repeated, or consists of multiple forms, that also occurs under circumstances where escape from the trauma is difficult or impossible (e.g., childhood abuse) will confer greater risk for CPTSD as compared to PTSD. The primary objective of the current study was to provide an empirical assessment of this proposal.MethodsA stratified, random probability sample of a Danish birth cohort (aged 24) was interviewed by the Danish National Centre for Social Research (N = 2980) in 2008–2009. Data from this interview were used to generate an ICD-11 symptom-based classification of PTSD and CPTSD.ResultsThe majority of the sample (87.1%) experienced at least one of eight traumatic events spanning childhood and early adulthood. There was some indication that being female increased the risk for both PTSD and CPTSD classification. Multinomial logistic regression results found that childhood sexual abuse (OR = 4.98) and unemployment status (OR = 4.20) significantly increased risk of CPTSD classification as compared to PTSD. A dose–response relationship was observed between exposure to multiple forms of childhood interpersonal trauma and risk of CPTSD classification, as compared to PTSD.ConclusionsResults provide empirical support for the ICD-11 proposals that childhood interpersonal traumatic exposure increases risk of CPTSD symptom development.

Dimensionality and construct validity of the Rosenberg self-esteem scale within a sample of recidivistic prisoners

Purpose – This study aims to examine the construct validity and factor structure of the Rosenberg self-esteem scale (RSES) using a sample (n ¼ 312) of Polish prisoners incarcerated in Nowogard High Security Prison. Design/methodology/approach – The number of confirmatory factor analysis (CFA) models under investigation was limited to two by virtue of employing a much stricter and more rigorously sound methodological procedure in which item errors were prevented from correlating, as suggested by Brown. Findings – Confirmatory factor analyses indicated that the two-factor (positive and negative self-esteem) model provided a better fit for the RSES items than did the one-factor model. Originality/value – The results provide some initial support for the two-dimensional model that could possibly be measuring substantively separate factors within a prison sample, thus calling into question the one-factor solution of the RSES.

Validation of post-traumatic stress disorder (PTSD) and complex PTSD using the International Trauma Questionnaire

The 11th version of the International Classification of Diseases (ICD‐11) has proposed two related trauma diagnoses: Post‐traumatic stress disorder (PTSD) and Complex PTSD (CPTSD). Using a newly developed, disorder‐specific measure of PTSD and CPTSD called the International Trauma Questionnaire (ITQ) the current study will (i) assess the factorial validity of ICD‐11 PTSD and CPTSD; (ii) provide the first test of the discriminant validity of these constructs; and (iii) provide the first comparison of ICD‐11, and Diagnostic and Statistical Manual, Fifth Edition (DSM‐5), PTSD diagnostic rates using disorder‐specific measures.