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提出的 ICD-11 PTSD 和复杂 PTSD 的证据:潜在剖面分析。

Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis.

机构信息

National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA ; Department of Psychiatry and Child and Adolescent Psychiatry, New York University, Langone Medical Center, New York, NY, USA.

出版信息

Eur J Psychotraumatol. 2013 May 15;4. doi: 10.3402/ejpt.v4i0.20706. Print 2013.


DOI:10.3402/ejpt.v4i0.20706
PMID:23687563
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3656217/
Abstract

BACKGROUND: The WHO International Classification of Diseases, 11th version (ICD-11), has proposed two related diagnoses, posttraumatic stress disorder (PTSD) and complex PTSD within the spectrum of trauma and stress-related disorders. OBJECTIVE: To use latent profile analysis (LPA) to determine whether there are classes of individuals that are distinguishable according to the PTSD and complex PTSD symptom profiles and to identify potential differences in the type of stressor and severity of impairment associated with each profile. METHOD: An LPA and related analyses were conducted on 302 individuals who had sought treatment for interpersonal traumas ranging from chronic trauma (e.g., childhood abuse) to single-incident events (e.g., exposure to 9/11 attacks). RESULTS: THE LPA REVEALED THREE CLASSES OF INDIVIDUALS: (1) a complex PTSD class defined by elevated PTSD symptoms as well as disturbances in three domains of self-organization: affective dysregulation, negative self-concept, and interpersonal problems; (2) a PTSD class defined by elevated PTSD symptoms but low scores on the three self-organization symptom domains; and (3) a low symptom class defined by low scores on all symptoms and problems. Chronic trauma was more strongly predictive of complex PTSD than PTSD and, conversely, single-event trauma was more strongly predictive of PTSD. In addition, complex PTSD was associated with greater impairment than PTSD. The LPA analysis was completed both with and without individuals with borderline personality disorder (BPD) yielding identical results, suggesting the stability of these classes regardless of BPD comorbidity. CONCLUSION: Preliminary data support the proposed ICD-11 distinction between PTSD and complex PTSD and support the value of testing the clinical utility of this distinction in field trials. Replication of results is necessary.

摘要

背景:世界卫生组织的《国际疾病分类》第 11 版(ICD-11)提出了两个相关诊断,创伤后应激障碍(PTSD)和创伤及应激相关障碍谱系中的复杂 PTSD。

目的:使用潜在剖面分析(LPA)来确定是否存在根据 PTSD 和复杂 PTSD 症状特征可区分的个体类别,并确定与每个特征相关的应激源类型和损伤严重程度的潜在差异。

方法:对 302 名因人际创伤寻求治疗的个体进行 LPA 及相关分析,创伤类型从慢性创伤(如儿童期虐待)到单一事件(如 9/11 袭击暴露)不等。

结果:LPA 揭示了三类个体:(1)复杂 PTSD 类,其 PTSD 症状升高,且自我组织的三个领域存在障碍:情绪调节障碍、消极自我概念和人际关系问题;(2)PTSD 类,其 PTSD 症状升高,但自我组织症状领域的得分较低;(3)低症状类,其所有症状和问题的得分均较低。慢性创伤对复杂 PTSD 的预测作用强于 PTSD,反之,单一事件创伤对 PTSD 的预测作用更强。此外,复杂 PTSD 与更大的损伤相关,而 PTSD 则不然。LPA 分析分别在包含和不包含边缘型人格障碍(BPD)个体的情况下进行,结果相同,这表明这些类别是稳定的,与 BPD 共病无关。

结论:初步数据支持 ICD-11 对 PTSD 和复杂 PTSD 的区分,并支持在现场试验中检验这种区分的临床实用性,需要进行结果复制。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/89b0/3656217/cdf7d7b5cea0/EJPT-4-20706-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/89b0/3656217/469fe9ec7521/EJPT-4-20706-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/89b0/3656217/b4c78f06943d/EJPT-4-20706-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/89b0/3656217/cdf7d7b5cea0/EJPT-4-20706-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/89b0/3656217/469fe9ec7521/EJPT-4-20706-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/89b0/3656217/b4c78f06943d/EJPT-4-20706-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/89b0/3656217/cdf7d7b5cea0/EJPT-4-20706-g003.jpg

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