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Stein J, El-Haj-Mohamad R, Stammel N, Vöhringer M, Wagner B, Nesterko Y, Böttche M, Knaevelsrud C. Changes in trauma appraisal during brief internet-based exposure and cognitive restructuring treatment for Arabic-speaking people with PTSD. Eur J Psychotraumatol 2024; 15:2324631. [PMID: 38511498 PMCID: PMC10962287 DOI: 10.1080/20008066.2024.2324631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/01/2024] [Indexed: 03/22/2024] Open
Abstract
Background: Maladaptive trauma appraisal plays an important role in the development and maintenance of posttraumatic stress disorder (PTSD). While studies have demonstrated the effectiveness of exposure and cognitive treatments for PTSD symptomatology, the effect of such treatments on specific trauma appraisals is still not well understood.Objective: The study investigated the effect of an exposure and a cognitive restructuring internet-based treatment on specific trauma appraisals in Arabic-speaking participants with PTSD.Method: 334 participants received either an exposure (n = 167) or a cognitive restructuring (n = 167) internet-based treatment. PTSD symptom severity (PCL-5) and specific trauma appraisals (TAQ) were assessed at pre- and post-treatment. Changes in specific trauma appraisals within and between the two treatments were analyzed using multi-group change modelling. Associations between changes in PTSD symptom severity and changes in trauma appraisals were evaluated using Pearson product-moment correlation. For both treatments, participants with versus without reliable improvement were compared regarding changes in specific trauma appraisals using Welch tests. Analyses were performed on 100 multiple imputed datasets.Results: Both treatments yielded significant changes in shame, self-blame, fear, anger, and alienation (all ps < .001). Changes in betrayal were only significant in the cognitive restructuring treatment (p < .001). There was no evidence of differences between treatments for any specific trauma appraisal. Changes in PTSD symptom severity were significantly associated with changes in trauma appraisals (all ps < .001). In both treatments, participants who experienced reliable improvement in PTSD symptom severity showed significantly larger pre- to post-treatment changes in specific trauma appraisals compared to those without reliable improvement. Again, differences in betrayal were only significant in the cognitive restructuring treatment.Conclusions: The findings indicate that both treatments are effective in reducing trauma appraisals in Arabic-speaking people with PTSD. Changes in trauma appraisal seem to be associated with changes in PTSD symptomatology.Trial registration: German Clinical Trials Register identifier: DRKS00010245.
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Affiliation(s)
- Jana Stein
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
| | - Rayan El-Haj-Mohamad
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
| | - Nadine Stammel
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Max Vöhringer
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
| | - Birgit Wagner
- Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| | - Yuriy Nesterko
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Maria Böttche
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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Thomas S, Schäfer J, Kanske P, Trautmann S. Patterns of social-affective responses to trauma exposure and their relation to psychopathology. PLoS One 2024; 19:e0289664. [PMID: 38442107 PMCID: PMC10914253 DOI: 10.1371/journal.pone.0289664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 02/01/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION Traumatic event exposure is a risk factor for the development and maintenance of psychopathology. Social-affective responses to trauma exposure (e.g. shame, guilt, revenge, social alienation) could moderate this relationship, but little is known about their relevance for different types of psychopathology. Moreover, the interplay of different social-affective responses to trauma exposure in predicting psychopathology is poorly understood. METHODS In a sample of N = 1321 trauma-exposed German soldiers, we examined cross-sectional associations of trauma-related social alienation, revenge, guilt and shame with depressive disorder, alcohol use disorder, posttraumatic stress disorder and dimensional measures of depression and anxiety. Latent class analysis was conducted to identify possible patterns of social-affective responses to trauma exposure, and their relation to psychopathology. RESULTS All social-affective responses to trauma exposure predicted current posttraumatic stress disorder, depressive disorder, alcohol use disorder and higher depressive and anxiety symptoms. Three latent classes fitted the data best, reflecting groups with (1) low, (2) moderate and (3) high risk for social-affective responses to trauma exposure. The low-risk group demonstrated the lowest expressions on all psychopathology measures. CONCLUSIONS Trauma-related social alienation, shame, guilt, and revenge are characteristic of individuals with posttraumatic stress disorder, depressive disorder, alcohol use disorder, and with higher anxiety and depressive symptoms. There was little evidence for distinctive patterns of social-affective responses to trauma exposure despite variation in the overall proneness to show social-affective responses. Social-affective responses to trauma exposure could represent promising treatment targets for both cognitive and emotion-focused interventions.
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Affiliation(s)
- Sarah Thomas
- Institute of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Judith Schäfer
- Institute of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Philipp Kanske
- Institute of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Sebastian Trautmann
- Institute of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
- Department of Psychology, Faculty of Human Science, Medical School Hamburg, Hamburg, Germany
- ICPP Institute of Clinical Psychology and Psychotherapy, Medical School Hamburg, Hamburg, Germany
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Quiroga-Garza A, Cepeda-Lopez AC, Villarreal Zambrano S, Villalobos-Daniel VE, Carreno DF, Eisenbeck N. How Having a Clear Why Can Help Us Cope With Almost Anything: Meaningful Well-Being and the COVID-19 Pandemic in México. Front Psychol 2021; 12:648069. [PMID: 34093332 PMCID: PMC8175781 DOI: 10.3389/fpsyg.2021.648069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/26/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) has resulted in an increase in known risk factors for mental health problems. Mexico adopted lockdown and physical distancing as a containment strategy with potential consequences on day to day life, such as social isolation, loss of income and loneliness that can have important consequences in terms of mental health. Objective: We aimed to examine the effect of the initial phases of the COVID-19 pandemic on psychological distress, well-being and perceived physical health among Mexican-base respondents and to examine whether coping strategies would play a potential intermediating role in relation to these variables. Under the Existential Positive Psychology perspective, an emphasis was made on meaning-centered coping. Methods: A cross-sectional study was conducted between April 30 and June 16th 2020 among 604 Mexicans-base respondents of which 471 were women and 132 men. Data was collected by using online questionnaires. Psychological distress was measured using the Depression, Anxiety, and Stress Scale (DASS-21). The Brief COPE Inventory was used to assess problem-focused and emotion-focused coping strategies. We also used the Meaning-Centered Coping Scale (MCCS). PERMA-Profiler was used to assess well-being, perceived physical health, and loneliness. Profiler and Descriptive analyses and bivariate linear regression were performed to examine the association of variables. Results: 45.9% of the participants reported moderate to extremely severe psychological distress. Our results demonstrate that problem-focused and emotion-focused coping were positively related to psychological distress, whereas meaning-centered coping was negatively associated with distress. Furthermore, psychological distress played a potential negative role in the perceived physical health, while meaning-centered coping and well-being buffered the negative influence of psychological distress on perceived physical health (completely standardized indirect effect = -0.01, SE: 0.012, 95% CI [-0.065; -0.017]. Conclusion: Meaning-centered coping was found to suppress the negative influence of psychological distress on sensation of decreased physical health corroborating the critical role of meaning in life in promoting well-being. Future studies can further examine the value of the critical role of meaning in life in promoting well-being as a protective factor against severe distress during traumatic events. Findings of this study can be used to orient policies and interventions aimed to alleviate suffering in the midst of the COVID-19 pandemic.
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Affiliation(s)
| | - Ana C. Cepeda-Lopez
- Department of Basic Sciences, School of Medicine, Universidad de Monterrey, Monterrey, Mexico
| | | | | | - David F. Carreno
- Department of Psychology, Universidad de Almería, Almería, Spain
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Bohus M, Biermann M, Vonderlin R, Priebe K, Kleindienst N. Traumaspezifische Ausrichtung in der Behandlung von Borderline-Störungen mit komorbider Posttraumatischer Belastungsstörung. PSYCHOTHERAPEUT 2020. [DOI: 10.1007/s00278-020-00441-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Harned MS, Fitzpatrick S, Schmidt SC. Identifying Change Targets for Posttraumatic Stress Disorder Among Suicidal and Self-Injuring Women With Borderline Personality Disorder. J Trauma Stress 2020; 33:610-616. [PMID: 32216138 DOI: 10.1002/jts.22504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 08/27/2019] [Accepted: 09/12/2019] [Indexed: 12/26/2022]
Abstract
Research on psychotherapies for posttraumatic stress disorder (PTSD) is increasingly focused on understanding not only which treatments work but why and for whom they work. The present pilot study evaluated the temporal relations between five hypothesized change targets-posttraumatic cognitions, guilt, shame, general emotion dysregulation, and experiential avoidance-and PTSD severity among women with PTSD, borderline personality disorder, and recent suicidal and/or self-injurious behaviors. Participants (N = 26) were randomized to receive 1 year of dialectical behavior therapy (DBT) with or without the DBT prolonged exposure (DBT PE) protocol for PTSD. Potential change targets and PTSD were assessed at 4-month intervals during treatment and at 3-month posttreatment follow-up. Time-lagged mixed-effects models indicated that between-person differences in all change targets except guilt were associated with more severe PTSD, η2 s = .32-.55, and, except for general emotion dysregulation, slowed the rate of change in PTSD severity over time, η2 s = .20-.39. In DBT but not in DBT + DBT PE, individuals with higher levels of guilt and experiential avoidance relative to their own average had more severe PTSD at the next assessment point, η2 s = .12-.25. The associations between the proposed change targets and PTSD severity were not bidirectional, except for general emotion dysregulation, η2 = .50; and posttraumatic cognitions, η2 = .06. These preliminary findings suggest that trauma-related cognitions, shame, and guilt, as well as problems regulating them, may be important change targets for improving PTSD in this patient population.
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Affiliation(s)
- Melanie S Harned
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.,VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Skye Fitzpatrick
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Sara C Schmidt
- VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Psychology, University of Washington, Seattle, Washington, USA
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Görg N, Böhnke JR, Priebe K, Rausch S, Wekenmann S, Ludäscher P, Bohus M, Kleindienst N. Changes in Trauma-Related Emotions Following Treatment With Dialectical Behavior Therapy for Posttraumatic Stress Disorder After Childhood Abuse. J Trauma Stress 2019; 32:764-773. [PMID: 31476252 DOI: 10.1002/jts.22440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 03/11/2019] [Accepted: 03/16/2019] [Indexed: 01/13/2023]
Abstract
Dialectical behavior therapy for posttraumatic stress disorder (DBT-PTSD) is a trauma-focused therapy shown to reduce core PTSD symptoms, such as intrusions, hyperarousal, and avoidance. Preliminary data indicate effects on elevated trauma-related emotions (e.g., guilt and shame) and possibly radical acceptance of the traumatic event. However, it is unclear if improvements in these variables are significant after controlling for changes in core PTSD symptoms and to what extent nonclinical levels are obtained. In the current study, 42 individuals who met criteria for PTSD after childhood abuse and were participating in a 3-month residential DBT-PTSD program were evaluated at the start of the exposure phase of DBT-PTSD and the end of treatment; a nonclinical sample with a history of childhood abuse was the reference group. Multivariate analyses of variance and multivariate analyses of covariance controlling for change in core PTSD symptoms were used to evaluate changes in several elevated trauma-related emotions (fear, anger, guilt, shame, disgust, sadness, and helplessness) and in radical acceptance. In a repeated measures multivariate analyses of variance, both elevated trauma-related emotions and radical acceptance significantly improved during DBT-PTSD, λ = 0.34, p < .001; η2 = .56; t(40) = -5.66, p < .001, SMD = 0.88, even after controlling for changes in PTSD symptoms, λ = 0.35, p < .001, η2 = .65; Λ = 0.86, p = .018, η2 = .14, respectively. Posttreatment, 31.0% (for acceptance) to 76.2% (for guilt) of participants showed nonclinical levels of the investigated outcomes, suggesting that both trauma-related emotions and radical acceptance changed after the 3-month residential DBT-PTSD program.
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Affiliation(s)
- Nora Görg
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Germany.,Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University, Frankfurt am Main, Germany
| | - Jan R Böhnke
- Dundee Centre for Health and Related Research, School of Nursing and Health Sciences, University of Dundee, Dundee, United Kingdom
| | - Kathlen Priebe
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Germany
| | - Sophie Rausch
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Germany
| | - Stefanie Wekenmann
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Petra Ludäscher
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Germany
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Germany.,Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Germany
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Khosravani V, Messman-Moore TL, Mohammadzadeh A, Ghorbani F, Amirinezhad A. Effects of childhood emotional maltreatment on depressive symptoms through emotion dysregulation in treatment-seeking patients with heroin-dependence. J Affect Disord 2019; 256:448-457. [PMID: 31252238 DOI: 10.1016/j.jad.2019.06.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/05/2019] [Accepted: 06/21/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although individuals who experience childhood emotional maltreatment (CEM) are more likely to use maladaptive emotion regulation strategies, resulting in vulnerability to depression, no research has examined whether emotion dysregulation may explain the association between CEM and current depressive symptoms in a clinical sample of heroin-dependent individuals. OBJECTIVES The current study aimed to assess the direct effect of CEM on current depressive symptoms and its indirect effect via emotion dysregulation in a treatment-seeking sample of males with heroin dependence. In a cross-sectional design, participants (N = 350) completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Difficulties in Emotion Regulation Scale (DERS), the Obsessive-Compulsive Drug Use Scale (OCDUS), and the Beck Depression Inventory-II (BDI-II). RESULTS Emotional abuse and neglect severity had significant direct effects on current depressive symptoms and significant indirect effects through emotion dysregulation after controlling for clinical factors related to heroin use. LIMITATIONS Study limitations include the cross-sectional design and use of self-report scales. CONCLUSIONS Findings suggest emotion dysregulation may increase depressive symptoms in heroin users who experienced CEM. Training in emotion regulation strategies may decrease depressive symptoms in heroin-dependent individuals with CEM. Additional research with a longitudinal design to confirm these results is warranted.
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Affiliation(s)
- Vahid Khosravani
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran.
| | | | | | - Fatemeh Ghorbani
- Clinical Research Development Center of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Amirinezhad
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
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The role of emotion dysregulation in the relation of childhood trauma to heroin craving in individuals with heroin dependence. Drug Alcohol Depend 2019; 195:132-139. [PMID: 30634108 DOI: 10.1016/j.drugalcdep.2018.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/02/2018] [Accepted: 12/11/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Difficulties in emotion regulation (DER) may be important in heroin craving in individuals with heroin dependence who have experienced childhood trauma (CT). However, no research has been performed on DER in the context of heroin dependence. The aim of this study was to evaluate direct and indirect relations of CT to the subscales of heroin craving (i.e., heroin thoughts and interference, intention to use heroin and control of its consumption, and resistance to thoughts and decisions to use heroin) via DER dimensions in individuals with a DSM diagnosis of heroin dependence. METHODS In a cross-sectional design, 330 males with heroin dependence completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Difficulties in Emotion Regulation Scale (DERS), the Obsessive-Compulsive Drug Use Scale-Form Heroin (OCDUS-Form Heroin), and the Depression Anxiety Stress Scales (DASS). RESULTS The results revealed that CT had no direct relations to the subscales of heroin craving, but it indirectly was related to all three subscales of heroin craving via one of the DER dimensions named limited access to emotion regulation strategies (Strategies) after adjusting for demographic and clinical factors. CONCLUSIONS The findings suggest that Strategies may be related to heroin craving in individuals with heroin dependence who have CT. This proposes that treatment and prevention attempts focused on training the use of effective emotion regulation strategies may be useful to reduce heroin craving in individuals with heroin dependence who have experienced a history of CT.
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Bradley A, Karatzias T, Coyle E. Derealization and self-harm strategies are used to regulate disgust, fear, and sadness in adult survivors of childhood sexual abuse. Clin Psychol Psychother 2018; 26:94-104. [PMID: 30230102 DOI: 10.1002/cpp.2333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 11/08/2022]
Abstract
Emotion regulation (ER) difficulties have been identified as an important target for clinical intervention in the treatment of post-traumatic stress disorder (PTSD) symptoms in survivors of childhood sexual abuse (CSA). However, there is limited research regarding the use of specific strategies to regulate specific emotions following exposure to traumatic events. The aim of the current study was to investigate the indirect effects of four trauma-related emotions (anger, sadness, disgust, and fear) on PTSD severity via two mediators: derealization and self-harm. In particular, we tested that if the two hypothetical mediators operate sequentially, derealization precedes self-harm and/or self-harm precedes derealization. A predominate female clinical sample (N = 109) of CSA survivors completed measures of experience of emotions, ER, and post-traumatic stress. Bivariate and serial mediation analyses were conducted to test the direct and indirect effects of trauma-related emotions on PTSD severity. Serial mediation analyses indicated that there were significant total effects of all trauma-related emotions on PTSD severity. Three trauma-related emotions (sadness, disgust, and fear) were indirectly associated to PTSD severity via derealization and self-harm and via self-harm and derealization. Results indicate that difficulties in regulating the emotions of sadness, disgust, and fear may result in more severe derealization and self-harm as coping strategies, which in turn lead to greater PTSD severity. The sequence of mediators does not hold great importance in these pathways. Overall, our findings suggest that therapeutically targeting derealization and self-harm might enable the reduction of PTSD among CSA survivors.
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Affiliation(s)
- Aoife Bradley
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Thanos Karatzias
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.,NHS Lothian, Rivers Centre for Traumatic Stress, Royal Edinburgh Hospital, Edinburgh, UK
| | - Eimear Coyle
- Clinical Psychology Department, NHS Fife, Fife, UK
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Abstract
The World Health Organization (WHO) has included complex post-traumatic stress disorder (C-PTSD) in the final draft of the 11th edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), which was published in June, 2018 and is scheduled to be submitted to WHO's World Health Assembly for official endorsement in 2019. Mental health providers will want to be informed about this diagnosis in order to provide effective treatment. Complex PTSD, or developmental PTSD as it is also called, refers to the constellation of symptoms that may result from prolonged, chronic exposure to traumatic experiences, especially in childhood, as opposed to PTSD which is more typically associated with a discrete traumatic incident or set of traumatic events. Although it has been a controversial diagnosis and is not included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), lines of evidence support its distinct profile and utility. In this case study, we elucidate and discuss some aspects of the diagnosis and its treatment.
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