ASSESSMENT OF POSTTRAUMATIC STRESS DISORDERS

Trauma, Traumatisierung, Akute Belastungsreaktion, Posttraumatische Belastungsstörungen sowie andere Folgestörungen und Komorbiditäten nach Trauma werden definiert bzw. beschrieben. Die Klassifikationen nach ICD bzw. DSM werden vorgestellt und kritisch diskutiert. Die komplexe posttraumatische Belastungsstörung wird symptomatisch und mit einem Klassifikationsvorschlag skizziert. Die Problematik des diagnostischen Prozesses wird erläutert und Vorschläge zu dessen Gestaltung werden erörtert. Sowohl strukturierte Interviews als auch geeignete Tests zur Erfassung posttraumatischer Belastung und Symptomatik in deutscher Sprache werden beschrieben. Es wird auf die Notwendigkeit eines sparsamen Einsatzes psychodiagnostischer Instrumente verwiesen, um die Belastung traumatisierter Patienten gering zu halten.Trauma, traumatization, Acute stress reaction, Posttraumatic stress disorder and other disorders following exposure to traumatic stress are described. Classification according to ICD and DSM are presented and critically valued. The complex Posttraumatic Stress disorder is introduced in its symptoms and with a proposal for a classification. Problems in assessing traumatized individuals are referred and recommendations for interviews and testing procedure are presented. Structured interviews and tests in german language are described. Due to control stress load by the process of assessing the economic choice of instruments is recommended

Development and preliminary results of the International Trauma Exposure Measure for children and adolescents (ITEM-CA)

Background. The need for children's assessment of traumatic exposure has been an extraordinary field of research that provided relevant knowledge on the impact of traumatic events. Mainly in severe or specific traumatic events, data have been gathered with several instruments. However, the use of these instruments in low risk samples pose an ethical reflection if generating a dangerous world assumption in children can have important negative side effects. Objective. This paper intends to present preliminary results of a questionnaire targeting assessment of traumatic exposure, safe as possible for low risk children aged between 7 and 13. It intends also to reflect its construction process within the aims of assuring competent epidemiological research while counterbalancing dangerous world assumptions by children and youth in low risk samples.Method. This new Likert scale has four levels based on frequency of exposure and was developed considering the potential negative impact of each item. Several researchers, victims and organizations discussed each item considering its meaning, degree of activation on non-exposed children and linguistic adequacy. The structure is based on International Trauma Exposure Measure for adults but differentiating contexts of exposure: family/care and school/community.Results. The final version of the scale has 36 items related to traumatic or adverse events exposure and a final item to reflect in positive life events.Conclusions. There is a special question about need for help, which may provide a safe way for professional support. Preliminary results from the Portuguese dataset are presented and discussed.info:eu-repo/semantics/publishedVersio

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

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

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

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

A systematic review of the neural correlates of sexual minority stress: towards an intersectional minority mosaic framework with implications for a future research agenda

Background: Systemic oppression, particularly towards sexual minorities, continues to be deeply rooted in the bedrock of many societies globally. Experiences with minority stressors (e.g. discrimination, hate-crimes, internalized homonegativity, rejection sensitivity, and microaggressions or everyday indignities) have been consistently linked to adverse mental health outcomes. Elucidating the neural adaptations associated with minority stress exposure will be critical for furthering our understanding of how sexual minorities become disproportionately affected by mental health burdens. Following PRISMA-guidelines, we systematically reviewed published neuroimaging studies that compared neural dynamics among sexual minority and heterosexual populations, aggregating information pertaining to any measurement of minority stress and relevant clinical phenomena. Results: Only 1 of 13 studies eligible for inclusion examined minority stress directly, where all other studies focused on investigating the neurobiological basis of sexual orientation. In our narrative synthesis, we highlight important themes that suggest minority stress exposure may be associated with decreased activation and functional connectivity within the default-mode network (related to the sense-of-self and social cognition), and summarize preliminary evidence related to aberrant neural dynamics within the salience network (involved in threat detection and fear processing) and the central executive network (involved in executive functioning and emotion regulation). Importantly, this parallels neural adaptations commonly observed among individuals with posttraumatic stress disorder (PTSD) in the aftermath of trauma and supports the inclusion of insidious forms of trauma related to minority stress within models of PTSD. Conclusions: Taken together, minority stress may have several shared neuropsychological pathways with PTSD and stress-related disorders. Here, we outline a detailed research agenda that provides an overview of literature linking sexual minority stress to PTSD and insidious trauma, moral affect (including shame and guilt), and mental health risk/resiliency, in addition to racial, ethnic, and gender related minority stress. Finally, we propose a novel minority mosaic framework designed to inform future directions of minority stress neuroimaging research from an intersectional lens

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

Puedes no ser capaz de hacer algo al respecto, pero puedes sacar lo mejor de la situación: Un análisis cualitativo de experiencias relacionadas con la pandemia en seis países europeos

The complex system of stressors related to the coronavirus disease 2019 (COVID-19) pandemic has affected the global population, provoking a broad range of psychological reactions. Although numerous studies have investigated the mental health impact of COVID-19, qualitative research and cross-country comparisons are still rare.El complejo sistema de factores estresantes relacionados con la pandemia por la COVID-19 ha afectado a la población mundial, generando un amplio rango de reacciones psicológicas. A pesar de que múltiples estudios han investigado el impacto sobre la salud mental de la COVID-19, las investigaciones cualitativas y las comparaciones entre países aún son infrecuentes

Factores de riesgo y protectores para el trastorno de éstres postráumatico en individuos expuestos a trauma durante la pandemia COVID-19 – hallazgos de un estudio paneuropeo

Background: The COVID-19 pandemic is a health emergency resulting in multiple stressors that may be related to posttraumatic stress disorder (PTSD). Objective: This study examined relationships between risk and protective factors, pandemic-related stressors, and PTSD during the COVID-19 pandemic. Methods: Data from the European Society of Traumatic Stress Studies (ESTSS) ADJUST Study were used. N = 4,607 trauma-exposed participants aged 18 years and above were recruited from the general populations of eleven countries (Austria, Croatia, Georgia, Germany, Greece, Italy, Lithuania, the Netherlands, Poland, Portugal, and Sweden) from June to November 2020. We assessed sociodemographic (e.g. gender), pandemic-related (e.g. news consumption), and health-related (e.g. general health condition) risk and protective factors, pandemic-related stressors (e.g. fear of infection), and probable PTSD (PC-PTSD-5). The relationships between these variables were examined using logistic regression on multiple imputed data sets. Results: The prevalence of probable PTSD was 17.7%. Factors associated with an increased risk for PTSD were younger age, female gender, more than 3 h of daily pandemic-related news consumption (vs. no consumption), a satisfactory, poor, or very poor health condition (vs. a very good condition), a current or previous diagnosis of a mental disorder, and trauma exposure during the COVID-19 pandemic. Factors associated with a reduced risk for PTSD included a medium and high income (vs. very low income), face-to-face contact less than once a week or 3–7 times a week (vs. no contact), and digital social contact less than once a week or 1–7 days a week (vs. no contact). Pandemic-related stressors associated with an increased risk for PTSD included governmental crisis management and communication, restricted resources, restricted social contact, and difficult housing conditions. Conclusion: We identified risk and protective factors as well as stressors that may help identify trauma-exposed individuals at risk for PTSD, enabling more efficient and rapid access to care.Antecedentes: La pandemia COVID-19 es una emergencia sanitaria que genera múltiples estresores que pueden estar relacionados con el trastorno de estrés postraumático (TEPT). Objetivo: Este estudio examinó las relaciones entre los factores de riesgo y protectores, estresores relacionados con la pandemia y TEPT durante la pandemia de COVID-19. Métodos: Se utilizaron los datos del estudio ADJUST de la Sociedad Europea de Estudios de Estrés Traumático (ESTSS por sus siglas en ingles). N=4.607 participantes mayores de 18 años expuestos a trauma fueron reclutados de la población general de once países (Austria, Croacia, Georgia, Alemania, Grecia, Italia, Lituania, Países Bajos, Polonia, Portugal y Suecia) desde junio a noviembre 2020. Evaluamos factores de riesgo y protectores sociodemográficos (p.ej. género), relacionados con la pandemia (p.ej. consumo de noticias) y relacionados con la salud (p.ej. estado de salud general), estresores relacionados con la pandemia (p.ej. temor a la infección) y TEPT probable (PC-PTSD-5 por sus siglas en ingles). Las relaciones entre estas variables se examinaron mediante regresión logística en múltiples conjuntos de datos imputados. Resultados: La prevalencia de TEPT probable fue del 17.7%. Los factores asociados con un mayor riesgo de TEPT fueron edad más joven, sexo femenino, más de 3 horas de consumo diario de noticias relacionadas con la pandemia (frente a ningún consumo), un estado de salud satisfactorio, malo o muy malo (frente a un estado muy bueno), un diagnóstico de trastorno mental actual o previo y exposición a un trauma durante la pandemia de COVID-19. Los factores asociados con un riesgo reducido de TEPT incluyeron ingresos medios y altos (frente a ingresos muy bajos), contacto cara a cara menos de una vez a la semana o de 3 a 7 veces por semana (frente a ningún contacto) y contacto social digital menos de una vez a la semana o de 1 a 7 días a la semana (frente a ningún contacto). Los estresores relacionados con la pandemia asociados con un mayor riesgo de TEPT incluyeron la gestión y comunicación de crisis gubernamental, recursos restringidos, contacto social restringido y condiciones de vivienda difíciles. Conclusiones: Identificamos factores de riesgo y protectores, así como estresores que pueden ayudar a identificar a las personas expuestas a traumas en riesgo de TEPT, lo que permite un acceso más eficiente y rápido a la atención