The co-occurrence of PTSD and dissociation: differentiating severe PTSD from dissociative-PTSD

Purpose A dissociative-posttraumatic stress disorder (PTSD) subtype has been included in the DSM-5. However, it is not yet clear whether certain socio-demographic characteristics or psychological/clinical constructs such as comorbid psychopathology differentiate between severe PTSD and dissociative-PTSD. The current study investigated the existence of a dissociative-PTSD subtype and explored whether a number of trauma and clinical covariates could differentiate between severe PTSD alone and dissociative-PTSD. Methods The current study utilized a sample of 432 treatment seeking Canadian military veterans. Participants were assessed with the Clinician Administered PTSD Scale (CAPS) and self-report measures of traumatic life events, depression, and anxiety. CAPS severity scores were created reflecting the sum of the frequency and intensity items from each of the 17 PTSD and 3 dissociation items. The CAPS severity scores were used as indicators in a latent profile analysis (LPA) to investigate the existence of a dissociative-PTSD subtype. Subsequently, several covariates were added to the model to explore differences between severe PTSD alone and dissociative-PTSD. Results The LPA identified five classes: one of which constituted a severe PTSD group (30.5 %), and one of which constituted a dissociative-PTSD group (13.7 %). None of the included, demographic, trauma, or clinical covariates were significantly predictive of membership in the dissociative-PTSD group compared to the severe PTSD group. Conclusions In conclusion, a significant proportion of individuals report high levels of dissociation alongside their PTSD, which constitutes a dissociative-PTSD subtype. Further investigation is needed to identify which factors may increase or decrease the likelihood of membership in a dissociative-PTSD subtype group compared to a severe PTSD only group

Predicting criminality from child maltreatment typologies and posttraumatic stress symptoms

BACKGROUND: The associations between childhood abuse and subsequent criminality and posttraumatic stress disorder (PTSD) are well known. However, a major limitation of research related to childhood abuse and its effects is the focus on one particular type of abuse at the expense of others. Recent work has established that childhood abuse rarely occurs as a unidimensional phenomenon. Therefore, a number of studies have investigated the existence of abuse typologies. METHODS: The study is based on a Danish stratified random probability survey including 2980 interviews of 24-year-old people. The sample was constructed to include an oversampling of child protection cases. Building on a previous latent class analysis of four types of childhood maltreatment, three maltreatment typologies were used in the current analyses. A criminality scale was constructed based on seven types of criminal behavior. PTSD symptoms were assessed by the PC-PTSD Screen. RESULTS: Significant differences were found between the two genders with males reporting heightened rates of criminality. Furthermore, all three maltreatment typologies were associated with criminal behavior with odds ratios (ORs) from 2.90 to 5.32. Female gender had an OR of 0.53 and possible PTSD an OR of 1.84. CONCLUSION: The independent association of participants at risk for PTSD and three types of maltreatment with criminality should be studied to determine if it can be replicated, and considered in social policy and prevention and rehabilitation interventions

Multimodal ptsd characterization via the startlemart game

Computer games have recently shown promise as a diagnostic and treatment tool for psychiatric rehabilitation. This paper examines the potential of combining multiple modalities for detecting affective responses of patients interacting with a simulation built on game technology, aimed at the treatment of mental diagnoses such as Post Traumatic Stress Disorder (PTSD). For that purpose, we couple game design and game technology to create a game-based tool for exposure therapy and stress inoculation training that utilizes stress detection for the automatic profiling and potential personalization of PTSD treatments. The PTSD treatment game we designed forces the player to go through various stressful experiences while a stress detection mechanism profiles the severity and type of PTSD by analyzing the physiological responses to those in-game stress elicitors in two separate modalities: skin conductance (SC) and blood volume pulse (BVP). SC is often used to monitor stress as it is connected to the activation of the sympathetic nervous system (SNS). By including BVP into the model we introduce information about para-sympathetic activation, which offers a more complete view of the psycho-physiological experience of the player; in addition, as BVP is also modulated by SNS, a multimodal model should be more robust to changes in each modality due to particular drugs or day-to-day bodily changes. Overall, the study and analysis of 14 PTSD-diagnosed veteran soldiers presented in this paper reveals correspondence between diagnostic standard measures of PTSD severity and SC and BVP responsiveness and feature combinations thereof. The study also reveals that these features are significantly correlated with subjective evaluations of the stressfulness of experiences, represented as pairwise preferences. More importantly, the results presented here demonstrate that using the modalities of skin conductance and blood volume pulse captures a more nuanced representation of player stress responses than using skin conductance alone. We conclude that the results support the use of the simulation as a relevant treatment tool for stress inoculation training, and suggest the feasibility of using such a tool to profile PTSD patients. The use of multiple modalities appears to be key for an accurate profiling, although further research and analysis are required to identify the most relevant physiological features for capturing user stress.peer-reviewe

ICD-11 PTSD and complex PTSD in treatment-seeking Danish veterans: a latent profile analysis

Background: The WHO International Classification of Diseases, 11th version (ICD-11), includes a trauma-related diagnosis of complex posttraumatic stress disorder (CPTSD) distinct from posttraumatic stress disorder (PTSD). Results from previous studies support the validity of this distinction. However, no studies to date have evaluated the ICD-11 model of PTSD and CPTSD in treatment-seeking military veterans. Objective: To determine if the distribution of symptoms in treatment-seeking Danish veterans were consistent with the ICD-11 PTSD and CPTSD symptom profiles. Based on previous studies, we hypothesized that separate classes representing PTSD and CPTSD would be found, that membership of a potential CPTSD-class would be predicted by a larger number of childhood traumas, and that a potential distinction between PTSD and CPTSD would be supported by differences in sociodemographic and functional outcomes.Method: Participants (N =1,541) were formerly deployed Danish soldiers who completed proxy measures of ICD-11 PTSD and disturbances in self-organization (DSO) symptoms, along with self-report measures of traumatic life events, prior to starting treatment at the Military Psychology Department of the Danish Defence.Results: All hypotheses were supported. Latent profile analysis (LPA) revealed separate classes representing PTSD and CPTSD. In comparison to the PTSD-class, membership of the CPTSD-class was predicted by more childhood traumatic experiences, and members of this class were more likely being single/divorced/widowed and more likely to use psychotropic medication. Besides a PTSD-class and a CPTSD-class, LPA revealed a Low Symptoms-class, a Moderate DSO-class, a Hyperarousal-class, and a High DSO-class, with clear differences in functional outcomes between classes.Conclusion: Findings replicate previous studies supporting the distinction between ICD-11 PTSD and CPTSD. In addition, there seems to be groups of treatment-seeking military veterans that do not fulfill full criteria for a trauma-related disorder. Further research should explore subsyndromal PTSD and CPTSD profiles in veterans and other populations

To rank or to classify? Annotating stress for reliable PTSD profiling

In this paper we profile the stress responses of patients diagnosed with post-traumatic stress disorder (PTSD) to individual events in the game-based PTSD stress inoculation and exposure virtual environment StartleMart. Thirteen veterans suffering from PTSD play the game while we record their skin conductance. Game logs are used to identify individual events, and continuous decomposition analysis is applied to the skin conductance signals to derive event-related stress responses. The extracted skin conductance features from this analysis are used to profile each individual player in terms of stress response. We observe a large degree of variation across the 13 veterans which further validates the idiosyncratic nature of PTSD physiological manifestations. Further to game data and skin conductance signals we ask PTSD patients to indicate the most stressful event experienced (class-based annotation) and also compare the stress level of all events in a pairwise preference manner (rankbased annotation).We compare the two annotation stress schemes by correlating the self-reports to individual event-based stress manifestations. The self-reports collected through class-based annotation exhibit no correlation to physiological responses, whereas, the pairwise preferences yield significant correlations to all skin conductance features extracted via continuous decomposition analysis. The core findings of the paper suggest that reporting of stress preferences across events yields more reliable data that capture aspects of the stress experienced and that features extracted from skin conductance via continuous decomposition analysis offer appropriate predictors of stress manifestation across PTSD patients.This research was supported by the Danish Council for Technology and Innovation and by the EU funded FP7 ICT iLearnRW project (project no: 318803). We thank the PTSD patients who chose to support our research with their participation.peer-reviewe

Stress detection for PTSD via the StartleMart game

Computer games have recently shown promise as a diagnostic and treatment tool for psychiatric rehabilitation. This paper examines the positive impact of affect detection and advanced game technology on the treatment of mental diagnoses such as Post Traumatic Stress Disorder (PTSD). For that purpose, we couple game design and game technology with stress detection for the automatic profiling and the personalized treatment of PTSD via game-based exposure therapy and stress inoculation training. The PTSD treatment game we designed forces the player to go through various stressful experiences while a stress detection mechanism profiles the severity and type of PTSD via skin conductance responses to those in-game stress elicitors. The initial study and analysis of 14 PTSD-diagnosed veteran soldiers presented in this paper reveals clear correspondence between diagnostic standard measures of PTSD severity and skin conductance responses. Significant correlations between physiological responses and subjective evaluations of the stressfulness of experiences, represented as pairwise preferences, are also found. We conclude that this supports the use of the simulation as a relevant treatment tool for stress inoculation training. This points to future avenues of research toward discerning between degrees and types of PTSD using game-based diagnostic and treatment tools.This research was supported by the Danish Council for Technology and Innovation under the Games for Health project and by the FP7 ICT project SIREN (project no: 258453).peer-reviewe

Replicability and Generalizability of Posttraumatic Stress Disorder (PTSD) Networks: A Cross-Cultural Multisite Study of PTSD Symptoms in Four Trauma Patient Samples

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 estimation, (b) nonclinical samples, and (c) single samples. This renders network structures in clinical data, and the extent to which networks replicate across data sets, unknown. To overcome these limitations, the present cross-cultural multisite study estimated regularized partial correlation networks of 16 PTSD symptoms across four data sets of traumatized patients receiving treatment for PTSD (total N = 2,782). Despite differences in culture, trauma type, and severity of the samples, considerable similarities emerged, with moderate to high correlations between symptom profiles (0.43-0.82), network structures (0.62-0.74), and centrality estimates (0.63-0.75). 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 article fully reproducible