Prävalenz aggressiven Verhaltens bei jungen Menschen mit intellektueller Behinderung

Menschen mit intellektueller Behinderung zeigen häufig bestimmte Verhaltensweisen, die negative Konsequenzen für sie haben. Diese Verhaltensweisen werden unter dem generischen Begriff Challenging Behavior zusammengefasst. Die Prävalenzschätzungen dieser Verhaltensweisen schwanken sehr stark in epidemiologischen Studien. Zwei Gründe dafür sind die Vermischung unterschiedlicher Verhalten unter demselben Überbegriff und die Inklusion verschiedener Altersstufen. Daher wird in der vorliegenden Arbeit nur die Prävalenz aggressiven Verhaltens bei jungen Menschen mit intellektueller Behinderung systematisch, mittels Meta-Analyse, untersucht. Die Literaturrecherche in sechs wissenschaftlichen Datenbanken erzielte 1300 Treffer, von denen 28 die Inklusionskriterien erfüllten. Es wurden mehrere random effects Meta-Analysen mit Subgruppenanalysen berechnet. Es zeigt sich, dass Personen mit bestimmtem Syndrom höhere Prävalenzen aufweisen (p = .53, 95% KI = [.40-.67]) als Personen mit unspezifischer Ätiologie (p = .21, 95% KI = [.15-.27]). Autismus (OR = 2.68, 95% KI = [1.59-4.50]) und männliches Geschlecht (OR = 2.07, 95% KI = [1.07-3.93]) konnten als Risikofaktoren identifiziert werden, höheres Alter nur unter Ausschluss einer Studie. Es wurde kein Zusammenhang zwischen Schweregrad der Behinderung und Prävalenz gefunden. Die Studien zeigen größtenteils sehr heterogene Methoden und Verfahren zu Erfassung des aggressiven Verhaltens, was teilweise varianzerklärend wirkt, aber rechnerisch schwer zu berücksichtigen ist. Die Implikationen der Ergebnisse betreffen einerseits weitere Forschung, die Verwendung ähnlicher Instrumente wird diskutiert. Andererseits liefert die vorliegende Meta-Analyse 87 robustere Daten für Versorgungsysteme für Menschen mit intellektueller Behinderung. Einschränkend muss gesagt werden, dass die Subgruppenanalysen teilweise immer noch große Heterogenität aufweisen und häufig nur auf der Analyse weniger Primärstudien beruhen.Challenging behavior represents a major cause for social exclusion of people with intellectual disabilities. Aggression is one of these behaviors classified under the generic term challenging behavior. There are several reasons for the observed variety in prevalence estimates in epidemiologic research, two of them are the different topographies summed under this term and the comparison of unequal age groups. In the present Meta-Analysis these two factors are held constant, thus it aims to explain the variations of aggressive behavior in young people with intellectual disabilities. The systematic literature search yielded a total of 1300 studies, of which 28 studies fulfilled the inclusion criteria. Several random effects meta-analyses with subgroup analysis were conducted. People with specific syndromes show higher prevalences of aggressive behavior (p = .53, 95% CI = [.40-.67]) than people with unspecific etiology (p = .21, 95% CI = [.15-.27]). Autism (OR = 2.68, 95% CI = [1.59- 4.50]) and male gender (OR = 2.07, 95% CI = [1.07-3.93]) are associated with higher prevalences as well. Higher age is only a risk factor if one study is excluded from the analysis. Severity of the intellectual disability is no risk factor for aggressive behavior. The included studies apply diverse methods and techniques to assess aggressive behavior, which are difficult to consider in the calculation, but probably account for a large amount of heterogeneity. This study gives implications for future research, especially with regard to the use of similar assessment methods. Also public health systems benefit from the results presented here by providing robust data on prevalence of aggressive behavior among young people with intellectual disabilities. The fact that only a few studies could be included in various subgroup analyses limits the results and points out the paucity of epidemiological studies in this field

What makes inpatient treatment for PTSD effective? Investigating daily therapy process factors

ObjectiveTherapeutic process factors including alliance and motivation are considered to play a key role in the treatment of post-traumatic stress disorder (PTSD). Yet, our understanding of change processes in therapy is mostly based on theoretical considerations with limited empirical evidence. In order to identify process characteristics of successful inpatient treatments of PTSD, we investigated the intraindividual, interindividual, and temporal associations of daily assessments of therapy process factors like motivation, alliance, and insight.MethodTherapy process questionnaire (TPQ) assessments were collected from 101 inpatients with PTSD over 50 days, resulting in 5050 assessments. Multilevel vector autoregressive (mlVAR) modelling was applied to investigate the networks of the TPQ factors in a subgroup with good outcome regarding PTSD symptomatology and a subgroup with less favourable outcome.ResultsThe two subgroups differed markedly in their network models, suggesting that therapy processes might be different for those with good and those with poor treatment outcomes.ConclusionsOur results suggest that good treatment outcome is linked to a specific therapy process dynamic where mindfulness and insight lead to the kind of temporary well-being required to effectively engage with problems and negative emotions, while motivation to change ensures the continuity of confronting negative emotions and problems

Co-occurrence of severe PTSD, Somatic Symptoms and Dissociation in a large sample of childhood trauma inpatients: A Network Analysis

Co-occurrence of mental disorders including severe PTSD, somatic symptoms, and dissociation in the aftermath of trauma is common and sometimes associated with poor treatment outcomes. However, the interrelationships between these conditions at symptom-level are not well understood. In the present study, we aimed to explore direct connections between PTSD, somatic symptoms, and dissociation to gain a deeper insight into the pathological processes underlying their comorbidity that can inform future treatment plans. In a sample of 655 adult inpatients with a diagnosis of severe PTSD following childhood abuse (85.6% female; mean age = 47.57), we assessed symptoms of PTSD, somatization, and dissociation. We analyzed the comorbidity structure using a partial correlation network with regularization. Mostly positive associations between symptoms characterized the network structure. Muscle or joint pain was among the most central symptoms. Physiological reactivation was central in the full network and together with concentrations problems acted as bridge between symptoms of PTSD and somatic symptoms. Headaches connected somatic symptoms with others and derealization connected dissociative symptoms with others in the network. Exposure to traumatic events has a severe and detrimental effect on mental and physical health and these consequences worsen each other trans-diagnostically on a symptom-level. Strong connections between physiological reactivation and pain with other symptoms could inform treatment target prioritization. We recommend a dynamic, modular approach to treatment that should combine evidence-based interventions for PTSD and comorbid conditions which is informed by symptom prominence, readiness to address these symptoms and preference

The replicability of ICD-11 complex post-traumatic stress disorder symptom networks in adults

Background: The 11th revision of the World Health Organization's International Classification of Diseases (ICD-11) includes a new disorder, Complex Posttraumatic Stress Disorder (CPTSD). A network approach to CPTSD will enable investigation of the structure of the disorder at symptom level, which may inform the development of treatments that target specific symptoms to accelerate clinical outcomes.Aims: To test whether similar networks of ICD-11 CPTSD replicate across culturally different samples and to investigate possible differences, using a network analysis.Method: We investigated the network models of four nationally representative, community-based cross-sectional samples drawn from Germany, Israel, the UK, and the US (total N=6417). CPTSD symptoms were assessed with the International Trauma Questionnaire in all samples. Only those participants who reported significant functional impairment by CPTSD symptoms were included (N=1591 included in analysis; age: M=43.55 years, SD=15.10, range=[14;99]; 67.7% women). Regularized partial correlation networks were estimated for each sample and the resulting networks were compared.Results: Despite differences in traumatic experiences, symptom severity, and symptom profiles, the networks were very similar across the four countries. The symptoms within dimensions were strongly associated with each other in all networks, except for the two symptom indicators assessing aspects of affective dysregulation. The most central symptoms were ‘feelings of worthlessness’ and ‘exaggerated startle response’Conclusion: The structure of CPTSD symptoms appears very similar across countries. Addressing symptoms with the strongest associations in the network, such as negative self-worth and startle reactivity, will likely result in rapid treatment response

The Network Structure of ICD-11 Disorders Specifically Associated with Stress: Adjustment Disorder, Prolonged Grief Disorder, Posttraumatic Stress Disorder, and Complex Posttraumatic Stress Disorder

Introduction: The ICD-11 includes a new grouping for “disorders specifically associated with stress” that contains revised descriptions of posttraumatic stress disorder (PTSD) and adjustment disorder (AjD) and new diagnoses in the form of complex PTSD (CPTSD) and prolonged grief disorder (PGD). These disorders are similar in that they each require a life event for the diagnosis; however, they have not yet been assessed together for validity within the same sample. We set out to test the distinctiveness of the four main ICD-11 stress disorders using a network analysis approach. Methods: A population-based, cross-sectional design. A nationally representative sample of adults from the Republic of Ireland aged 18 years and older (N = 1,020) completed standardized measures of PTSD, CPTSD, AjD, and PGD. A network analysis was conducted at the symptom level. Outcome measures included the International Trauma Questionnaire, the Inventory of Complicated Grief, and the International Adjustment Disorder Questionnaire. Results: Consistent with the taxonomic structure of the ICD-11, our results showed that although the four conditions clustered independently at the disorder level, the specific symptoms of PTSD, CPTSD, PGD, and AjD clustered together very strongly but more strongly than with symptoms of the other disorders. The majority (61%) of the variation in each symptom could be explained by its neighboring symptoms. The strongest transdiagnostically connecting symptom was “startle response.” Discussion/Conclusion: Mental health professionals caring for people who have experienced a range of stressors and traumatic life events can be confident in diagnosing these conditions that have clear diagnostic boundaries. Interventions addressing stress-associated disorders should be based on diagnostic assessment to ensure close fit between symptoms and treatment

A Cross?Cultural Comparison of ICD?11 Complex Posttraumatic Stress Disorder Symptom Networks in Austria, the United Kingdom, and Lithuania

The 11th revision of the World Health Organization's International Classification of Diseases (ICD-11) may include a new disorder, Complex Posttraumatic Stress Disorder (CPTSD). The network approach to psychopathology enables investigation of the structure of disorders at the symptom level, allowing for analysis of direct symptom interactions. The network structure of ICD-11 CPTSD has not yet been studied and it remains unclear whether similar networks replicate across different samples. We investigated the network models of four different trauma samples including a total of 879 participants (age: M = 47.17 years, SD = 11.92;59.04% women) drawn from Austria, Lithuania, and the UK (Scotland and Wales). The International Trauma Questionnaire was used to assess symptoms of ICD-11 CPTSD in all samples. The prevalence of PTSD and CPTSD ranged from 23.7% to 37.3% and from 9.3% to 53.1%, respectively. Regularized partial correlation networks were estimated and the resulting networks compared. Despite several differences in the symptom presentation and cultural background, the networks across the four samples were considerably similar with high correlations between symptom profiles (.48–.87), network structures (.69-.75), and centralityestimates (.59-.82). These results support the replicability of CPTSD network models across different samples and provide further evidence about the robust structure of CPTSD. The most central symptom in all four sample specific networks and the overall network was ‘feelings of worthlessness’. Implications of the network approach in research and practice are discussed

Borderline Personality Disorder (BPD) and Complex Post Traumatic Stress Disorder (CPTSD): A network analysis in a highly traumatised clinical sample

Whether Complex Posttraumatic Stress Disorder (CPTSD) and Borderline Personality Disorder (BPD) diagnoses differ substantially enough to warrant separate diagnostic classifications, has been a subject of controversy for years. To contribute to the nomological network of cumulative evidence, the main goal of the present study was to explore, using network analysis, how the symptoms of ICD-11 PTSD and DSO are interconnected with BPD in a clinical sample of polytraumatised individuals (n=330). Participants completed measures of life events, CPTSD and BPD. Overall, our study suggests that BPD and CPTSD are largely separated. The bridges between BPD and CPTSD symptom clusters were scarce with “Affective Dysregulation” items being the only items related to BPD. The present study contributes to the growing literature on discriminant validity of CPTSD and supports its distinctiveness to BPD. Implications for treatment are discussed

The network structure of ICD-11 Disorders Specifically Associated with Stress: Adjustment Disorder, Prolonged Grief Disorder, Posttraumatic Stress Disorder (PTSD) and Complex PTSD

Introduction: The ICD-11 includes a new grouping for “Disorders Specifically Associated with Stress” that contains revised descriptions of Posttraumatic Stress Disorder (PTSD) and Adjustment Disorder (AjD) and new diagnoses in the form of Complex PTSD (CPTSD) and Prolonged Grief Disorder (PGD). These disorders are similar in that they each require a life event for the diagnosis, however they have not yet been assessed together for validity within the same sample. We set out to test the distinctiveness of the four main ICD-11 stress disorders using a network analysis approach.Methods: Population-based, cross-sectional design. A nationally representative sample of adults from the Republic of Ireland aged 18 years and older (N = 1,020) completed standardised measures of PTSD, CPTSD, AjD and PGD. A network analysis was conducted at symptom level. Outcomes measures included the International Trauma Questionnaire, the Inventory of Complicated Grief, and the International Adjustment Disorder Questionnaire.Results: Consistent with the taxonomic structure of the ICD-11, our results showed that although the four conditions clustered independently at disorder level, the specific symptoms of PTSD, CPTSD, PGD, and AjD clustered together very strongly, but more strongly than with symptoms of the other disorders. The majority (61%) of the variation in each symptom could be explained by its neighbouring symptoms. The strongest trans-diagnostically connecting symptom was “startle response”.Discussion / Conclusion: Mental health professionals caring for people who have experienced a range of stressors and traumatic life events can be confident in diagnosing these conditions that have clear diagnostic boundaries. Interventions addressing stress-associated disorders should be based on diagnostic assessment to ensure close fit between symptoms and treatment