The memory and identity theory of ICD-11 complex posttraumatic stress disorder

The 11th version of the International Classification of Diseases (ICD-11) includes complex posttraumatic stress disorder (CPTSD) as a separate diagnostic entity alongside posttraumatic stress disorder (PTSD). ICD-11 CPTSD is defined by six sets of symptoms, three that are shared with PTSD (reexperiencing in the here and now, avoidance, and sense of current threat) and three (affective dysregulation, negative self-concept, and disturbances in relationships) representing pervasive "disturbances in self-organization" (DSO). There is considerable evidence supporting the construct validity of ICD-11 CPTSD, but no theoretical account of its development has thus far been presented. A theory is needed to explain several phenomena that are especially relevant to ICD-11 CPTSD such as the role played by prolonged and repeated trauma exposure, the functional independence between PTSD and DSO symptoms, and diagnostic heterogeneity following trauma exposure. The memory and identity theory of ICD-11 CPTSD states that single and multiple trauma exposure occur in a context of individual vulnerability which interact to give rise to intrusive, sensation-based traumatic memories and negative identities which, together, produce the PTSD and DSO symptoms that define ICD-11 CPTSD. The model emphasizes that the two major and related causal processes of intrusive memories and negative identities exist on a continuum from prereflective experience to full self-awareness. Theoretically derived implications for the assessment and treatment of ICD-11 CPTSD are discussed, as well as areas for future research and model testing. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Characterising the geomorphological and physicochemical effects of water injection dredging on estuarine systems

Dredging is a globally important aquatic system management activity, used for navigation improvement, contamination removal, aggregate production and/or flood risk mitigation. Despite widespread application, understanding of the environmental effects of some dredging types remains limited. Field campaigns in 2016 and 2017 in the River Parrett estuary, UK, therefore investigated the geomorphic and physicochemical effects of Water Injection Dredging (WID), a poorly studied hydrodynamic dredging technology. WID, applied to restore channel capacity for the maintenance of flood water conveyance in the tidal River Parrett, influenced surface elevations but not grain-size characteristics of dredged bed sediments. Topographic alterations due to the 2016 WID operation were short-lived, lasting less than 10 months, although benefits of the 2017 WID operation, in terms of volumetric change, outlasted the ≈ 12-month study period. Dredging had a significant impact on water physicochemistry (pH, dissolved oxygen, total suspended solids and turbidity) when comparing pre- and during- dredging conditions within the dredge reach, although time-series analysis found dredging effects were comparable in magnitude to tidal effects for some parameters. WID is typically targeted at the thalweg and not the banks, rendering the geomorphic signature of the method different to those of other, often more invasive dredging technologies (e.g. mechanical dredging methods). Further, thalweg not bankside dredging may have potential positive ecological implications, particularly where the majority of biomass is located within the channel margins, as in the tidal River Parrett. Collectively, data suggest WID can be an effective method for sediment dispersal within tidal systems although regular application may be required to maintain cross sectional areas, particularly where management precedes periods of low flows and/or high rates of sediment accumulation. In future, more work is required to better understand both the physical and ecological implications of WID as a flood risk management tool in estuaries and rivers

Does requiring trauma exposure affect rates of ICD-11 PTSD and complex PTSD? Implications for DSM-5

Objective: There is little evidence that posttraumatic stress disorder (PTSD) is more likely to follow traumatic events defined by Criterion A than non-Criterion A stressors. Criterion A events might have greater predictive validity for ICD-11 PTSD which is a condition more narrowly defined by core features. We evaluated the impact of using Criterion A, an ‘expanded’ trauma definition in line with ICD-11 guidelines, and no exposure criterion on rates of ICD-11 PTSD and Complex PTSD (CPTSD). We also assessed if five psychologically threatening events included in the expanded definition were as strongly associated with PTSD and CPTSD as ‘standard’ Criterion A events. Method: A nationally representative sample from Ireland (N = 1,020) completed self-report measures. Results: Most participants were trauma-exposed based on Criterion A (82%) and the ‘expanded’ (88%) criterion. When no exposure criterion was used, 13.7% met diagnostic requirements for PTSD or CPTSD; 13.2% when the expanded criterion was used, and 13.2% when Criterion A was used. The five psychologically threatening events were as strongly associated with PTSD and CPTSD as the Criterion A events. In a multivariate analysis, only the psychologically threatening events were significantly associated with PTSD (stalking) and CPTSD (bullying, emotional abuse, and neglect). Conclusions: Certain non-Criterion A events involving extreme fear and horror should be considered traumatic. The ICD-11 approach of providing clinical guidance rather than a formal definition offers a viable solution to some of the problems associated with the current and previous attempts to define traumatic exposure

The Need for Research on PTSD in Children and Adolescents: A commentary on Elliot et al., 2020

The recent release of the 11th version of The International Classification of Diseases (ICD?11: WHO, 2018) marked a significant departure from the previous similarities between it and the Diagnostic and Statistical Manual of Mental Disorders (DSM?5; APA, 2013) in terms of their conceptualization of posttraumatic stress disorder (PTSD). The ICD?11 proposed a reduced symptom set for PTSD and a sibling disorder called Complex PTSD. There have been numerous studies that have provided support for the integrity of, and distinction between, PTSD and CPTSD diagnoses in adult samples. Elliot and colleagues (2020) have added to the research literature by providing a valuable examination of the differences between ICD and DSM PTSD/CPTSD in a sample of youth aged 8 to 17 years. This commentary reviews this study and reflects on the need for greater understanding of developmental changes in the presentation of PTSD and Complex PTSD

ICD?11 Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in the United States: A Population?Based Study

The primary aim of this study was to provide an assessment of the current prevalence rates of ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) among the adult population of the United States and to identify characteristics and correlates associated with each disorder. A total of 7.2% of the sample met criteria for either PTSD or CPTSD where the prevalence rate for PTSD was 3.4% and for CPTSD was 3.8%. Females were more likely than males to meet criteria for both PTSD and CPTSD. Cumulative adulthood trauma was associated with PTSD and CPTSD, however cumulative childhood trauma was more strongly associated with CPTSD than PTSD. Among traumatic stressors occurring in childhood, sexual and physical abuse by caregivers were identified as events associated with risk for CPTSD while sexual assault (by non-caregiver) and abduction were risk factors for PTSD. Adverse childhood events (ACEs) were associated with both PTSD and CPTSD and equally so. Those with CPTSD reported substantially higher psychiatric burden and lower psychological well-being compared to those with PTSD, and with neither diagnosis

The role of negative cognitions, emotion regulation strategies, and attachment style in complex post-traumatic stress disorder: Implications for new and existing therapies

Objective We set out to investigate the association between negative trauma-related cognitions, emotional regulation strategies, and attachment style and Complex Posttraumatic Stress Disorder (CPTSD). As the evidence regarding the treatment of CPTSD is emerging, investigating psychological factors that are associated with CPTSD can inform the adaptation or the development of effective interventions for CPTSD. Method A cross sectional design was employed. Measures of CPTSD, negative trauma-related cognitions, emotion regulation strategies, and attachment style were completed by a British clinical sample of trauma-exposed patients (N = 171). Logistic regression analysis was used to assess the predictive utility of these psychological factors on diagnosis of CPTSD as compared to PTSD. Results It was found that the most important factor in the diagnosis of CPTSD was negative trauma-related cognitions about the self, followed by attachment anxiety, and expressive suppression. Conclusions Targeting negative thoughts and attachment representations while promoting skills acquisition in emotional regulation hold promise in the treatment of CPTSD. Further research is required on the development of appropriate models to treat CPTSD that tackle skills deficit in these areas

A high-tech, low-cost, Internet of Things surfboard fin for coastal citizen science, outreach, and education

Coastal populations and hazards are escalating simultaneously, leading to an increased importance of coastal ocean observations. Many well-established observational techniques are expensive, require complex technical training, and offer little to no public engagement. Smartfin, an oceanographic sensor–equipped surfboard fin and citizen science program, was designed to alleviate these issues. Smartfins are typically used by surfers and paddlers in surf zone and nearshore regions where they can help fill gaps between other observational assets. Smartfin user groups can provide data-rich time-series in confined regions. Smartfin comprises temperature, motion, and wet/dry sensing, GPS location, and cellular data transmission capabilities for the near-real-time monitoring of coastal physics and environmental parameters. Smartfin\u27s temperature sensor has an accuracy of 0.05 °C relative to a calibrated Sea-Bird temperature sensor. Data products for quantifying ocean physics from the motion sensor and additional sensors for water quality monitoring are in development. Over 300 Smartfins have been distributed around the world and have been in use for up to five years. The technology has been proven to be a useful scientific research tool in the coastal ocean—especially for observing spatiotemporal variability, validating remotely sensed data, and characterizing surface water depth profiles when combined with other tools—and the project has yielded promising results in terms of formal and informal education and community engagement in coastal health issues with broad international reach. In this article, we describe the technology, the citizen science project design, and the results in terms of natural and social science analyses. We also discuss progress toward our outreach, education, and scientific goals

Evidence for the coherence and integrity of the complex PTSD (CPTSD) diagnosis: response to Achterhof et al., (2019) and Ford (2020)

This letter to the editor responds to a recent EJPT editorial and following commentary which express concerns about the validity of the ICD-11 complex PTSD (CPTSD) diagnosis. Achterhof and colleagues caution that latent profile analyses and latent class analyses, which have been frequently used to demonstrate the discriminative validity of the ICD-11 PTSD and CPTSD constructs, have limitations and cannot be relied on to definitively determine the validity of the diagnosis. Ford takes a broader perspective and introduces the concept of ‘cPTSD’ which describes a wide ranging set of symptoms identified from studies related to DSM-IV, DSM-V and ICD-11 and proposes that the validity of the ICD-11 CPTSD is in question as it does not address the multiple symptoms identified from previous trauma-related disorders. We argue that ICD-11 CPTSD is a theory-driven, empirically supported construct that has internal consistency and conceptual coherence and that it need not explain nor resolve the inconsistencies of past formulations to demonstrate its validity. We do agree with Ford and with Achterhof and colleagues that no one single statistical process can definitively answer the question of whether CPTSD is a valid construct. We reference several studies utilizing many different statistical approaches implemented across several countries, the overwhelming majority of which have supported the validity of ICD-11 as a unique construct. We conclude with our own cautions about ICD-11 CPTSD research to date and identify important next steps

Posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as per ICD-11 proposals: A population study in Israel

Background: The current study sought to advance the existing literature by providing the first assessment of the factorial and discriminant validity of the ICD-11 proposals for PTSD and CPTSD in a nation-wide level.Methods: A nationally representative sample from Israel (n = 1003) using a disorder-specific measure (ITQ; International Trauma Questionnaire) in order to assess PTSD and Complex PTSD along with the Life Events Checklist and the World Health Organization Well-Being Index.Results: Estimated prevalence rates of PTSD and CPTSD were 9.0% and 2.6% respectively. The structural analyses indicated that PTSD and disturbances in self-organization symptom clusters were multidimensional, but not necessarily hierarchical, in nature and there were distinct classes that were consistent with PTSD and CPTSD. Conclusions: These results partially support the factorial validity and strongly support the discriminant validity of the ICD-11 proposals for PTSD and CPTSD in a nationally representative sample using a disorder-specific measure, findings also supported the international applicability of these diagnoses.Further research is required to determine the prevalence rates of PTSD and CPTSD in national representative samples across different countries and explore the predictive utility of different types of traumatic life events on PTSD and CPTSD