Skip to main content
Top
Published in: European Archives of Psychiatry and Clinical Neuroscience 4/2016

01-06-2016 | Original Paper

Evidence for two different ICD-11 posttraumatic stress disorders in a community sample of adolescents and young adults

Authors: Axel Perkonigg, Michael Höfler, Marylène Cloitre, Hans-Ulrich Wittchen, Sebastian Trautmann, Andreas Maercker

Published in: European Archives of Psychiatry and Clinical Neuroscience | Issue 4/2016

Login to get access

Abstract

For the 11th revision of the International classification of diseases, a general category of posttraumatic stress disorders has been proposed with two distinct sibling disorders: posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). General population data are examined on evidence for these two disorders. Data were drawn from a 10-year prospective longitudinal, epidemiological study with a representative community sample (N = 3021, 14–24 years at baseline) in Germany. Mixture modelling on latent classes was conducted in a subset of all reported episodes with exposure to interpersonal traumas. Associations between class membership, symptom criteria, and other mental disorders were investigated. Four distinctly interpretable latent classes were found. Class 1 episodes (N = 181) typically included core PTSD symptoms associated with strong impairment (OR 11.68; 95 % CI 4.54–30.05). 18.3 % of these episodes matched the criteria of ICD-11 PTSD. Class 2 episodes (N = 78) had a high probability of PTSD core symptoms and disturbances in self-organization and were associated with strong impairment (OR 38.47; 95 % CI 15.77–93.86). Half of them (49.4 %) matched the proposed ICD-11 criteria of CPTSD. Class 3 (N = 79) was typically characterized by episodes with disturbances in self-organization but a low probability of PTSD core symptoms and impairment. Class 4 (N = 633) was related to a relatively low probability of symptom reports. Membership in class 2 was associated with lower educational attainment, a lower social class, and more other mental disorders. Findings support the ICD-11 proposal to differentiate between PTSD and CPTSD. Further studies should extend exploration to other types of traumatic events in samples covering the full age range.
Appendix
Available only for authorised users
Literature
1.
go back to reference Maercker A, Brewin CR, Bryant RA, Cloitre M, Reed GM, van Ommeren M, Humayun A, Jones LM, Kagee A, Llosa AE, Rousseau C, Somasundaram DJ, Souza R, Suzuki Y, Weissbecker I, Wessely SC, First MB, Saxena S (2013) Proposals for mental disorders specifically associated with stress in the ICD-11. Lancet 381:1683–1685CrossRefPubMed Maercker A, Brewin CR, Bryant RA, Cloitre M, Reed GM, van Ommeren M, Humayun A, Jones LM, Kagee A, Llosa AE, Rousseau C, Somasundaram DJ, Souza R, Suzuki Y, Weissbecker I, Wessely SC, First MB, Saxena S (2013) Proposals for mental disorders specifically associated with stress in the ICD-11. Lancet 381:1683–1685CrossRefPubMed
2.
go back to reference Maercker A, Brewin CR, Bryant RA, Cloitre M, van Ommeren M, Jones LM, Humayan A, Kagee A, Llosa AE, Rousseau C, Somasundaram DJ, Souza R, Suzuki Y, Weissbecker I, Wessely SC, First MB, Reed GM (2013) Diagnosis and classification of disorders specifically associated with stress: new proposals for ICD-11. World Psychiatry 12:198–206CrossRefPubMedPubMedCentral Maercker A, Brewin CR, Bryant RA, Cloitre M, van Ommeren M, Jones LM, Humayan A, Kagee A, Llosa AE, Rousseau C, Somasundaram DJ, Souza R, Suzuki Y, Weissbecker I, Wessely SC, First MB, Reed GM (2013) Diagnosis and classification of disorders specifically associated with stress: new proposals for ICD-11. World Psychiatry 12:198–206CrossRefPubMedPubMedCentral
3.
go back to reference Cloitre M, Garvert DW, Brewin CR, Bryant RA, Maercker A (2013) Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis. Eur J Psychotraumatol. doi:10.3402/ejpt.v4i0.20706 Cloitre M, Garvert DW, Brewin CR, Bryant RA, Maercker A (2013) Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis. Eur J Psychotraumatol. doi:10.​3402/​ejpt.​v4i0.​20706
4.
go back to reference Dalenberg CJ, Glaser D, Alhassoon OM (2012) Statistical support for subtypes in posttraumatic stress disorder: the how and why of subtype analysis. Depress Anxiety 29:671–678CrossRefPubMed Dalenberg CJ, Glaser D, Alhassoon OM (2012) Statistical support for subtypes in posttraumatic stress disorder: the how and why of subtype analysis. Depress Anxiety 29:671–678CrossRefPubMed
5.
go back to reference Lanius RA, Vermetten E, Loewenstein RJ, Brand B, Schmahl C, Bremner JD, Spiegel D (2010) Emotion modulation in PTSD: clinical and neurobiological evidence for a dissociative subtype. Am J Psychiatry 167:640–647CrossRefPubMedPubMedCentral Lanius RA, Vermetten E, Loewenstein RJ, Brand B, Schmahl C, Bremner JD, Spiegel D (2010) Emotion modulation in PTSD: clinical and neurobiological evidence for a dissociative subtype. Am J Psychiatry 167:640–647CrossRefPubMedPubMedCentral
6.
go back to reference Andrews L, Joseph S, Shevlin M, Troop N (2006) Confirmatory factor analysis of posttraumatic stress symptoms in emergency personnel: an examination of seven alternative models. Pers Individ Differ 41:213–224CrossRef Andrews L, Joseph S, Shevlin M, Troop N (2006) Confirmatory factor analysis of posttraumatic stress symptoms in emergency personnel: an examination of seven alternative models. Pers Individ Differ 41:213–224CrossRef
7.
go back to reference Pietrzak RH, Tsai J, Harpaz-Rotem I, Whealin JM, Southwick SM (2012) Support for a novel five-factor model of posttraumatic stress symptoms in three independent samples of Iraq/Afghanistan veterans: a confirmatory factor analytic study. J Psychiatry Res 46:317–322CrossRef Pietrzak RH, Tsai J, Harpaz-Rotem I, Whealin JM, Southwick SM (2012) Support for a novel five-factor model of posttraumatic stress symptoms in three independent samples of Iraq/Afghanistan veterans: a confirmatory factor analytic study. J Psychiatry Res 46:317–322CrossRef
8.
go back to reference American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders: DSM-5, 5th edn. American Psychiatric Publishing, Arlington American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders: DSM-5, 5th edn. American Psychiatric Publishing, Arlington
9.
go back to reference Asmundson GJ, Stapleton JA, Taylor S (2004) Are avoidance and numbing distinct PTSD symptom clusters? J Trauma Stress 17:467–475CrossRefPubMed Asmundson GJ, Stapleton JA, Taylor S (2004) Are avoidance and numbing distinct PTSD symptom clusters? J Trauma Stress 17:467–475CrossRefPubMed
10.
go back to reference Friedman MJ, Resick PA, Bryant RA, Strain J, Horowitz M, Spiegel D (2011) Classification of trauma and stressor-related disorders in DSM-5. Depress Anxiety 28:737–749CrossRefPubMed Friedman MJ, Resick PA, Bryant RA, Strain J, Horowitz M, Spiegel D (2011) Classification of trauma and stressor-related disorders in DSM-5. Depress Anxiety 28:737–749CrossRefPubMed
11.
go back to reference Friedman MJ (2013) Finalizing PTSD in DSM-5: getting here from there and where to go next. J Trauma Stress 26:548–556CrossRefPubMed Friedman MJ (2013) Finalizing PTSD in DSM-5: getting here from there and where to go next. J Trauma Stress 26:548–556CrossRefPubMed
12.
go back to reference Rademaker AR, Van Minnen A, Ebberink F, Van Zuiden M, Hagenaars MA, Geuze E (2012) Symptom structure of PTSD: support for a hierarchical model separating core PTSD symptoms from dysphoria. Eur J Psychotraumatol. doi:10.3402/ejpt.v3i0.17580 Rademaker AR, Van Minnen A, Ebberink F, Van Zuiden M, Hagenaars MA, Geuze E (2012) Symptom structure of PTSD: support for a hierarchical model separating core PTSD symptoms from dysphoria. Eur J Psychotraumatol. doi:10.​3402/​ejpt.​v3i0.​17580
13.
go back to reference Herman JL (1992) Trauma and recovery: the aftermath of violence from domestic violence to political terrorism. Guilford Press, New York Herman JL (1992) Trauma and recovery: the aftermath of violence from domestic violence to political terrorism. Guilford Press, New York
14.
go back to reference American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Author: Washington, DC American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Author: Washington, DC
15.
go back to reference Roth S, Newman E, Pelcovitz D, Van der Kolk B, Mandel FS (1997) Complex PTSD in victims exposed to sexual and physical abuse: results from the DSM-IV field trial for posttraumatic stress disorder. J Trauma Stress 10:539–555PubMed Roth S, Newman E, Pelcovitz D, Van der Kolk B, Mandel FS (1997) Complex PTSD in victims exposed to sexual and physical abuse: results from the DSM-IV field trial for posttraumatic stress disorder. J Trauma Stress 10:539–555PubMed
16.
go back to reference Cloitre M, Courtois CC, Charuvastra A, Carapezza R, Stolbach BC, Green BL (2011) Treatment of complex PTSD: results of the ISTSS expert clinician survey on best practices. J Trauma Stress 24:616–627CrossRef Cloitre M, Courtois CC, Charuvastra A, Carapezza R, Stolbach BC, Green BL (2011) Treatment of complex PTSD: results of the ISTSS expert clinician survey on best practices. J Trauma Stress 24:616–627CrossRef
17.
go back to reference Dorahy MJ, Corry M, Shannon M, Macsherry A, Hamilton G, McRobert G, Elder R, Hanna D (2009) Complex PTSD, interpersonal trauma and relational consequences: findings from a treatment-receiving Northern Irish sample. J Affect Disord 112:71–80CrossRefPubMed Dorahy MJ, Corry M, Shannon M, Macsherry A, Hamilton G, McRobert G, Elder R, Hanna D (2009) Complex PTSD, interpersonal trauma and relational consequences: findings from a treatment-receiving Northern Irish sample. J Affect Disord 112:71–80CrossRefPubMed
18.
go back to reference Dorrepaal E, Thomaes K, Smit JH, Hoogendoorn A, Veltman DJ, van Balkom AJ, Draijer N (2012) Clinical phenomenology of childhood abuse-related complex PTSD in a population of female patients: patterns of personality disturbance. J Trauma Dissociation 13:271–290CrossRefPubMed Dorrepaal E, Thomaes K, Smit JH, Hoogendoorn A, Veltman DJ, van Balkom AJ, Draijer N (2012) Clinical phenomenology of childhood abuse-related complex PTSD in a population of female patients: patterns of personality disturbance. J Trauma Dissociation 13:271–290CrossRefPubMed
19.
go back to reference Resick PA, Bovin MJ, Calloway AL, Dick AM, King MW, Mitchell KS, Suvak MK, Wells SY, Stirman SW, Wolf EJ (2012) A critical evaluation of the complex PTSD literature: implications for DSM-5. J Trauma Stress 25:241–251CrossRefPubMed Resick PA, Bovin MJ, Calloway AL, Dick AM, King MW, Mitchell KS, Suvak MK, Wells SY, Stirman SW, Wolf EJ (2012) A critical evaluation of the complex PTSD literature: implications for DSM-5. J Trauma Stress 25:241–251CrossRefPubMed
20.
go back to reference Lieb R, Isensee B, von Sydow K, Wittchen HU (2000) The early developmental stages of psychopathology study (EDSP): a methodological update. Eur Addict Res 6:170–182CrossRefPubMed Lieb R, Isensee B, von Sydow K, Wittchen HU (2000) The early developmental stages of psychopathology study (EDSP): a methodological update. Eur Addict Res 6:170–182CrossRefPubMed
21.
go back to reference Wittchen HU, Perkonigg A, Lachner G, Nelson CB (1998) The early developmental stages of psychopathology study (EDSP)—objectives and design. Eur Addict Res 4:18–27CrossRefPubMed Wittchen HU, Perkonigg A, Lachner G, Nelson CB (1998) The early developmental stages of psychopathology study (EDSP)—objectives and design. Eur Addict Res 4:18–27CrossRefPubMed
22.
go back to reference Wittchen HU, Pfister H (1997) DIA-X-Interviews: manual für Screening-Verfahren und Interview; Interviewheft Längsschnittuntersuchung [DIA-X-Lifetime]; Ergänzungsheft [DIA-X Lifetime]; Interviewheft Querschnittuntersuchung [DIA-X 12 Monate]; Ergänzungsheft [DIA-X 12 Monate]; PC-Programm zur Durchführung des Interviews (Längs- und Querschnittuntersuchung); Auswertungsprogramm. Swets and Zeitlinger, Frankfurt Wittchen HU, Pfister H (1997) DIA-X-Interviews: manual für Screening-Verfahren und Interview; Interviewheft Längsschnittuntersuchung [DIA-X-Lifetime]; Ergänzungsheft [DIA-X Lifetime]; Interviewheft Querschnittuntersuchung [DIA-X 12 Monate]; Ergänzungsheft [DIA-X 12 Monate]; PC-Programm zur Durchführung des Interviews (Längs- und Querschnittuntersuchung); Auswertungsprogramm. Swets and Zeitlinger, Frankfurt
23.
go back to reference Reed V, Gander F, Pfister H, Steiger A, Sonntag H, Trenkwalder C, Sonntag A, Hundt W, Wittchen HU (1998) To what degree the composite international diagnostic interview (CIDI) correctly identifies DSM-IV disorders? testing validity issues in a clinical sample. Int J Methods Psychiatry Res 7:142–155CrossRef Reed V, Gander F, Pfister H, Steiger A, Sonntag H, Trenkwalder C, Sonntag A, Hundt W, Wittchen HU (1998) To what degree the composite international diagnostic interview (CIDI) correctly identifies DSM-IV disorders? testing validity issues in a clinical sample. Int J Methods Psychiatry Res 7:142–155CrossRef
24.
go back to reference Wittchen HU, Lachner G, Wunderlich U, Pfister H (1998) Test–retest reliability of the computerized DSM-IV-version of the munich-composite international diagnostic interview (MCIDI). Soc Psychiatr Psychiatric Epidemiol 33:568–578CrossRef Wittchen HU, Lachner G, Wunderlich U, Pfister H (1998) Test–retest reliability of the computerized DSM-IV-version of the munich-composite international diagnostic interview (MCIDI). Soc Psychiatr Psychiatric Epidemiol 33:568–578CrossRef
25.
go back to reference Watson D (2005) Rethinking the mood and anxiety disorders: a quantitative hierarchical model for DSM-V. J Abnorm Psychol 114:522–536CrossRefPubMed Watson D (2005) Rethinking the mood and anxiety disorders: a quantitative hierarchical model for DSM-V. J Abnorm Psychol 114:522–536CrossRefPubMed
26.
go back to reference Perkonigg A, Kessler RC, Storz S, Wittchen HU (2000) Traumatic events and posttraumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatry Scand 101:46–59CrossRef Perkonigg A, Kessler RC, Storz S, Wittchen HU (2000) Traumatic events and posttraumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatry Scand 101:46–59CrossRef
27.
go back to reference Derogatis LR (1986) SCL-90-R. Self-report symptom inventory. In: Collegium internationale psychiatriae scalaru M (eds) Internationale Skalen für Psychiatrie. Beltz, Weinheim Derogatis LR (1986) SCL-90-R. Self-report symptom inventory. In: Collegium internationale psychiatriae scalaru M (eds) Internationale Skalen für Psychiatrie. Beltz, Weinheim
28.
go back to reference Franke GH (2000) Symptom checkliste von L. R. Derogatis Manual. Beltz Test Gmbh, Göttingen Franke GH (2000) Symptom checkliste von L. R. Derogatis Manual. Beltz Test Gmbh, Göttingen
29.
go back to reference Royall RM (1986) The prediction approach to robust variance estimation in two-stage cluster sampling. J Am Stat Assoc 81:119–123CrossRef Royall RM (1986) The prediction approach to robust variance estimation in two-stage cluster sampling. J Am Stat Assoc 81:119–123CrossRef
30.
31.
go back to reference Sclove S (1987) Application of model-selection criteria to some problems in multivariate analysis. Psychometrika 52:333–343CrossRef Sclove S (1987) Application of model-selection criteria to some problems in multivariate analysis. Psychometrika 52:333–343CrossRef
32.
33.
go back to reference Lo Y, Mendell NR, Rubin DB (2001) Testing the number of components in a normal mixture. Biometrika 88:767–778CrossRef Lo Y, Mendell NR, Rubin DB (2001) Testing the number of components in a normal mixture. Biometrika 88:767–778CrossRef
34.
go back to reference Asparouhov T, Muthén B (2014) Auxiliary variables in mixture modeling: three-step approaches using mplus. Structural equation modeling. Multidiscip J 21:1–13 Asparouhov T, Muthén B (2014) Auxiliary variables in mixture modeling: three-step approaches using mplus. Structural equation modeling. Multidiscip J 21:1–13
35.
go back to reference Elklit A, Hyland P, Shevlin M (2014) Evidence of symptom profiles consistent with posttraumatic stress disorder and complex posttraumatic stress disorder in different trauma samples. Eur J Psychotraumatol. doi:10.3402/ejpt.v5.24221 Elklit A, Hyland P, Shevlin M (2014) Evidence of symptom profiles consistent with posttraumatic stress disorder and complex posttraumatic stress disorder in different trauma samples. Eur J Psychotraumatol. doi:10.​3402/​ejpt.​v5.​24221
36.
go back to reference Knefel M, Garvert DW, Cloitre M, Lueger-Schuster B (2015) Update to an evaluation of ICD-11 PTSD and complex PTSD criteria in a sample of adult survivors of childhood institutional abuse by Knefel & Lueger-Schuster (2013): a latent profile analysis. Eur J Psychotraumatol. doi:10.3402/ejpt.v6.25290 PubMedPubMedCentral Knefel M, Garvert DW, Cloitre M, Lueger-Schuster B (2015) Update to an evaluation of ICD-11 PTSD and complex PTSD criteria in a sample of adult survivors of childhood institutional abuse by Knefel & Lueger-Schuster (2013): a latent profile analysis. Eur J Psychotraumatol. doi:10.​3402/​ejpt.​v6.​25290 PubMedPubMedCentral
38.
go back to reference Reed GM (2010) Toward ICD-11: improving the clinical utility of WHO’s international classification of mental disorders. Prof Psychol Res Pract 41:457–464CrossRef Reed GM (2010) Toward ICD-11: improving the clinical utility of WHO’s international classification of mental disorders. Prof Psychol Res Pract 41:457–464CrossRef
39.
go back to reference Keeley JW, Reed GM, Roberts MC, Evans SC, Robles R, Matsumoto C, Brewin CR, Cloitre M, Perkonigg A, Rousseau C, Gureje O, Lovell AM, Sharan P, Maercker A Disorders specifically associated with stress: a case-controlled field study for ICD-11 mental and behavioural disorders. Inter J Clinic Health Psychol (in press) Keeley JW, Reed GM, Roberts MC, Evans SC, Robles R, Matsumoto C, Brewin CR, Cloitre M, Perkonigg A, Rousseau C, Gureje O, Lovell AM, Sharan P, Maercker A Disorders specifically associated with stress: a case-controlled field study for ICD-11 mental and behavioural disorders. Inter J Clinic Health Psychol (in press)
Metadata
Title
Evidence for two different ICD-11 posttraumatic stress disorders in a community sample of adolescents and young adults
Authors
Axel Perkonigg
Michael Höfler
Marylène Cloitre
Hans-Ulrich Wittchen
Sebastian Trautmann
Andreas Maercker
Publication date
01-06-2016
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Psychiatry and Clinical Neuroscience / Issue 4/2016
Print ISSN: 0940-1334
Electronic ISSN: 1433-8491
DOI
https://doi.org/10.1007/s00406-015-0639-4

Other articles of this Issue 4/2016

European Archives of Psychiatry and Clinical Neuroscience 4/2016 Go to the issue