Developmental approach to complex PTSD: Childhood and adult cumulative trauma as predictors of symptom complexity

Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY, USA.
Journal of Traumatic Stress (Impact Factor: 2.72). 10/2009; 22(5):399-408. DOI: 10.1002/jts.20444
Source: PubMed

ABSTRACT Exposure to multiple traumas, particularly in childhood, has been proposed to result in a complex of symptoms that includes posttraumatic stress disorder (PTSD) as well as a constrained, but variable group of symptoms that highlight self-regulatory disturbances. The relationship between accumulated exposure to different types of traumatic events and total number of different types of symptoms (symptom complexity) was assessed in an adult clinical sample (N = 582) and a child clinical sample (N = 152). Childhood cumulative trauma but not adulthood trauma predicted increasing symptom complexity in adults. Cumulative trauma predicted increasing symptom complexity in the child sample. Results suggest that Complex PTSD symptoms occur in both adult and child samples in a principled, rule-governed way and that childhood experiences significantly influenced adult symptoms.

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Available from: Marylène Cloitre, Sep 26, 2015
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    • "In the present study, cumulative trauma exposure was measured using the DAPS Relative Trauma Exposure scale, which is a sum of the respondent's lifetime number of up to 13 different types of traumatic events (e.g., natural disasters, motor vehicle accidents, assaults, and child abuse) and thus ranges from 0 to 13. The number of different types of trauma exposure , generally referred to as cumulative trauma, has been shown to predict posttraumatic distress in a number of studies (e.g., Briere, Kaltman, & Green, 2008; Cloitre et al., 2009; Follette, Polusny, Bechtle, & Naugle, 1996). The DAPS Reexperiencing, Avoidance, and Hyperarousal scales evaluate symptoms of posttraumatic stress linked to a specific trauma that are experienced over the prior month. "
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    ABSTRACT: Although trauma exposure and posttraumatic stress disorder both have been linked to suicidal thoughts and behavior, the underlying basis for this relationship is not clear. In a sample of 357 trauma-exposed individuals from the general population, younger participant age, cumulative trauma exposure, and all three DSM-IV PTSD clusters (reexperiencing, avoidance, and hyperarousal) were correlated with clinical levels of suicidality. However, logistic regression analysis indicated that when all PTSD clusters were considered simultaneously, only hyperarousal continued to be predictive. A path analysis confirmed that posttraumatic hyperarousal (but not other components of PTSD) fully mediated the relationship between extent of trauma exposure and degree of suicidal thoughts and behaviors.
    Journal of Trauma & Dissociation 09/2015; 16:153-169. · 1.72 Impact Factor
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    • "Loneliness has been shown to be associated with a range of dysfunctional psychological outcomes such as depression, anxiety, and phobias (Heinrich & Gullone, 2006), negative self-concepts and lowered self-esteem (Brage, Meredith, & Woodward, 1993), as well as personality disorders and psychosis (Tarbox & Pogue-Geile, 2008). Research has indicated that repeated exposure to traumatic life events can have detrimental effects on social relationships (Cloitre et al., 2009) and increases in perceived social isolation (Hawthorne, 2008). Palgi, Shrira, Ben-Ezra, Shiovitz Ezra, and Ayalon (2012)examined the relationship between self-and other-oriented potential lifetime traumatic events (PLTE) and loneliness in a sample of older American adults (N = 7,746). "
    • "Due to the wealth of data on the negative impact of childhood traumatic experiences and the potential impact of stress on the developing brain, research in this area may benefit from isolating childhood trauma from trauma that occurs in adolescence or adulthood. It has been suggested that traumatic experiences in childhood lead to a more diverse array of PTSD symptoms than traumatic experiences that occur in adulthood (Cloitre et al. 2009). Epigenetic changes, such as DNA methylation, may depend on when in life the adverse experience occurs, as PTSD from a childhood trauma has a different epigenetic profile than PTSD from a trauma during adulthood (Mehta et al. 2013). "
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    ABSTRACT: To develop latent classes of exposure to traumatic experiences before the age of 13 years in an urban community sample and to use these latent classes to predict the development of negative behavioral outcomes in adolescence and young adulthood. A total of 1815 participants in an epidemiologically based, randomized field trial as children completed comprehensive psychiatric assessments as young adults. Reported experiences of nine traumatic experiences before age 13 years were used in a latent class analysis to create latent profiles of traumatic experiences. Latent classes were used to predict psychiatric outcomes at age ⩾13 years, criminal convictions, physical health problems and traumatic experiences reported in young adulthood. Three latent classes of childhood traumatic experiences were supported by the data. One class (8% of sample), primarily female, was characterized by experiences of sexual assault and reported significantly higher rates of a range of psychiatric outcomes by young adulthood. Another class (8%), primarily male, was characterized by experiences of violence exposure and reported higher levels of antisocial personality disorder and post-traumatic stress. The final class (84%) reported low levels of childhood traumatic experiences. Parental psychopathology was related to membership in the sexual assault group. Classes of childhood traumatic experiences predict specific psychiatric and behavioral outcomes in adolescence and young adulthood. The long-term adverse effects of childhood traumas are primarily concentrated in victims of sexual and non-sexual violence. Gender emerged as a key covariate in the classes of trauma exposure and outcomes.
    Psychological Medicine 07/2015; -1:1-12. DOI:10.1017/S0033291715001300 · 5.94 Impact Factor
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