Academic journal article European Journal of Psychotraumatology

Differential Predictors of DSM-5 PTSD and ICD-11 Complex PTSD among African American Women

Academic journal article European Journal of Psychotraumatology

Differential Predictors of DSM-5 PTSD and ICD-11 Complex PTSD among African American Women

Article excerpt

1. Introduction

For the upcoming International Classification of Diseases, 11th version (ICD-11), the World Health Organization (WHO) has proposed the inclusion of complex posttraumatic stress disorder (CPTSD) as a new diagnosis that is related to, but separate from, posttraumatic stress disorder (PTSD) (Maercker et al., 2013). A diagnosis similar to CPTSD was first operationalized under the diagnosis of Disorders of Extreme Stress Not Otherwise Specified (DESNOS) for DSM-IV field trials (Roth, Newman, Pelcovitz, van der Kolk, & Mandel, 1997). Although DESNOS was not included in the DSM-IV, the symptom criteria for the proposed ICD11 CPTSD were selected using data from this the field trial along with data gathered from expert clinicians (Cloitre et al., 2011; van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005). The proposed CPTSD disorder requires an ICD-11 PTSD diagnosis but also includes three additional features, including problems in affective, self-concept, and relational domains to meet criteria for the disorder (Cloitre, Garvert, Brewin, Bryant, & Maercker, 2013). In contrast to PTSD symptoms for which negative reactions such as fear and horror are tied directly to trauma-related stimuli, the disturbances in affect, self-concept, and relationships must be shown to be pervasive and occur across a variety of contexts, even in the absence of trauma reminders, and to create significant distress and functional impairment for individuals.

CPTSD is typically (although not exclusively) associated with chronic, repeated traumas, particularly those occurring in early life, such as childhood abuse (Briere & Rickards, 2007; Herman, 1992; Hyland et al., 2017). The concept of CPTSD was first introduced by Judith Herman (Herman, 1992), who described the long-term impact of chronic stress on emotion regulation, selforganization, self-perception, and interpersonal functioning. Relative deficits in these areas of functioning have been identified in research on the impact of childhood maltreatment. Research shows that maltreated children have difficulty with emotional expression, recognition, and reactivity and difficulty in social interactions compared to non-exposed children (Maughan & Cicchetti, 2002; Pollak, Cicchetti, Hornung, & Reed, 2000; Shields & Cicchetti, 2001; Southam-Gerow & Kendall, 2002). These emotional and interpersonal difficulties can persist into adulthood and contribute to many psychological problems (Alink, Cicchetti, Kim, & Rogosh, 2009; Kim & Cicchetti, 2010). This exposure to childhood maltreatment often occurs in combination with insecure attachment to caregivers, reflecting negative internal working models of self and others, which in turn is associated with problems in emotion regulation and interpersonal relationships (Bailey, Moran, & Pederson, 2007; Pearlman & Courtois, 2005). While PTSD (as defined by the ICD-11) remains a core component of CPTSD, the symptoms of CPTSD may be associated with poorer treatment outcomes (Cloitre, Petkova, Su, & Weiss, 2016), and thus identifying the presence of CPTSD may lead to considerations of expanded treatment interventions (Cloitre et al., 2011; Cloitre, Miranda, Stovall-McClough, & Han, 2005).

There remains controversy over the clinical utility of CPTSD as a disorder (Resick et al., 2012; Wolf et al., 2015). Resick et al. (2012) conducted a comprehensive review of research on CPTSD and concluding that data were insufficient to support a distinct diagnostic category from DSM-5 PTSD. One major criticism raised in the review and in the field more broadly is the significant overlap between CPTSD and many other disorders including PTSD, major depressive disorder (MDD), and borderline personality disorder (BPD). It is also possible that CPTSD may be an alternate phenotypic expression of PTSD and not an independent syndrome. Despite these criticisms, however, there is empirical and neurobiological evidence suggesting distinctions between CPTSD and DSM-IV defined PTSD (Lanius, Frewen, Vermetten, & Yehuda, 2010; Lanius et al. …

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