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


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
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    • "The strongest predictor for symptom severity class and PTSD was type of trauma, which in our study is mostly equivalent to the study group (IA vs. WWII). The Severe Symptoms class included mainly IA survivors, and the experience of complex childhood trauma is a major risk factor for PTSD (Briere, Kaltman, & Green, 2008;Cloitre et al., 2009). Although war-related experiences are similarly considered complex and adverse, especially when they happen in younger age (Bramsen & Van der Ploeg, 1999), it seems that in our sample long-lasting effects on current mental health have either faded over the lifespan, were buffered by unknown factors, or have not been as detrimental in comparison to the effects of IA (Bö ttche, Kuwert, & Knaevelsrud, 2012). "
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    ABSTRACT: Background: The proposal for ICD-11 postulates major changes for posttraumatic stress disorder (PTSD) diagnosis, which needs investigation in different samples. Aims: To investigate differences of PTSD prevalence and diagnostic agreement between ICD-10 and ICD-11, factor structure of proposed ICD-11 PTSD, and diagnostic value of PTSD symptom severity classes. Method: Confirmatory factor analysis and latent profile analysis were used on data of elderly survivors of childhood trauma (>60 years, N=399). Results: PTSD rates differed significantly between ICD-10 (15.0%) and ICD-11 (10.3%, z=2.02, p=0.04). Unlike previous research, a one-factor solution of ICD-11 PTSD had the best fit in this sample. High symptom profiles were associated with PTSD in ICD-11. Conclusions: ICD-11 concentrates on PTSD's core symptoms and furthers clinical utility. Questions remain regarding the tendency of ICD-11 to diagnose mainly cases with severe symptoms and the influence of trauma type and participant age on the factor structure.
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    • "This explanatory role of varied trauma exposure could be explained by the 'sensitization' hypothesis of cumulative trauma. For example, some research suggests that repeated exposure to interpersonal trauma during childhood may predispose individuals to develop greater comorbidity and more complexity in PTSD symptom presentation (Cloitre et al., 2009). Although a majority of our trauma type-specific associations were statistically accounted for by number of trauma types endorsed, this does not necessarily diminish the importance of these associations. "
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    ABSTRACT: Posttraumatic stress disorder (PTSD) is generally assessed with reference to a “worst-event” (index) trauma, though little research has examined whether symptom presentation and comorbidity differ across worst-events. Data from individuals meeting lifetime PTSD criteria in the National Comorbidity Survey – Replication (N = 398) were used to examine relations between PTSD presentation and comorbidity with the three most commonly reported “worst-event” trauma types: sexual trauma, non-sexual physical violence, and unexpected death of a loved one. Sexual trauma and non-sexual physical violence were associated with more symptomatic presentation of PTSD and lifetime trauma types compared to other worst-events. Non-sexual physical violence was associated with comorbid substance use disorder, and unexpected death of a loved one was associated with comorbid depression. Inclusion of number of lifetime trauma types as a covariate rendered most, but not all associations non-significant. These findings suggest worst-event trauma type is related to some important differences in PTSD presentation.
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    • "However measured, extreme CT is often seen as an indicator of complex trauma, defined as exposure to multiple traumas over time, frequently including early childhood abuse and/or neglect (Briere & Scott, 2015; Courtois & Ford, 2013). Cumulative/complex trauma has been linked to a wide range of simultaneously presenting but separate psychological difficulties, described in the research literature as symptom complexity (Briere et al., 2008; Cloitre et al., 2009) and in the clinical literature, including the International Classification of Diseases11 (Friedman, 2014) as complex PTSD (Herman, 1992). These wide-ranging symptoms are also sometimes seen as evidence of borderline personality disorder, although recent research suggests that complex PTSD is a phenomenologically and statistically distinct entity (Cloitre, Garvert , Weiss, Carlson, & Bryant, 2014). "
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