Powers Abigail, Fani Negar, Carter Sierra, Cross Dorthie, Cloitre Marylene, Bradley Bekh
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GAUSA.
Atlanta VA Medical Center, Atlanta, GAUSA.
Eur J Psychotraumatol. 2017 Jun 15;8(1):1338914. doi: 10.1080/20008198.2017.1338914. eCollection 2017.
: Complex posttraumatic stress disorder (CPTSD) is proposed for inclusion in the ICD-11 as a diagnosis distinct from posttraumatic stress disorder (PTSD), reflecting deficits in affective, self-concept, and relational domains. There remains significant controversy over whether CPTSD provides useful diagnostic information beyond PTSD and other comorbid conditions, such as depression or substance use disorders. : The present study examined differences in psychiatric presentation for three groups: traumatized controls, DSM-5 PTSD subjects, and ICD-11 CPTSD subjects. : The sample included 190 African American women recruited from an urban public hospital where rates of trauma exposure are high. PTSD was measured using Clinician Administered PTSD Scale for DSM-5 and CPTSD was measured using clinician administered ICD-Trauma Interview. Psychiatric diagnoses and emotion dysregulation were also assessed. In a subset of women ( = 60), emotion recognition was measured using the Penn Emotion Recognition Task. : There were significant differences across groups on current and lifetime major depression (< .001) and current and lifetime alcohol and substance dependence (< .05), with CPTSD showing the highest rates of comorbidities. CPTSD women also showed significantly higher levels of childhood abuse and lower rates of adult secure attachment. Multivariate analysis of variance showed significantly more severe PTSD and depression symptoms and, as expected, more severe emotion dysregulation and dissociation, compared to DSM-5 PTSD and traumatized control groups. Individuals with CPTSD also had higher levels of emotion recognition to faces on a computer-based behavioural assessment, which may be related to heightened vigilance toward emotional cues from others. CPTSD women had better facial emotion recognition on a computer-based assessment, which may suggest heightened vigilance toward emotional cues. : Our results suggest clear, clinically-relevant differences between PTSD and CPTSD, and highlight the need for further research on this topic with other traumatized populations, particularly studies that combine clinical and neurobiological data.
复杂性创伤后应激障碍（CPTSD）被提议纳入《国际疾病分类第11版》（ICD - 11），作为一种与创伤后应激障碍（PTSD）不同的诊断，反映情感、自我概念和关系领域的缺陷。关于CPTSD除了PTSD和其他共病情况（如抑郁症或物质使用障碍）之外是否能提供有用的诊断信息，仍然存在重大争议。本研究考察了三组人群在精神症状表现上的差异：受创伤对照组、《精神疾病诊断与统计手册第5版》（DSM - 5）定义的PTSD患者以及ICD - 11定义的CPTSD患者。样本包括从一家城市公立医院招募的190名非裔美国女性，该医院创伤暴露率较高。使用针对DSM - 5的临床医生管理的PTSD量表来测量PTSD，使用临床医生管理的ICD创伤访谈来测量CPTSD。还评估了精神疾病诊断和情绪调节障碍情况。在一部分女性（n = 60）中，使用宾夕法尼亚情绪识别任务来测量情绪识别能力。三组在当前和终生的重度抑郁症（p <.001）以及当前和终生的酒精及物质依赖方面（p <.05）存在显著差异，CPTSD的共病率最高。CPTSD女性童年期受虐待的程度也显著更高，成人期安全依恋率更低。多变量方差分析显示，与DSM - 5定义的PTSD组和受创伤对照组相比，CPTSD患者的PTSD和抑郁症状明显更严重，并且正如预期的那样，情绪调节障碍和分离症状也更严重。在基于计算机的行为评估中，CPTSD患者对面部表情的情绪识别水平也更高，这可能与对他人情绪线索的警惕性提高有关。在基于计算机的评估中，CPTSD女性的面部情绪识别能力更好，这可能表明对情绪线索的警惕性提高。我们的研究结果表明PTSD和CPTSD之间存在明显的、与临床相关的差异，并强调需要对其他受创伤人群在该主题上进行进一步研究，特别是结合临床和神经生物学数据的研究。
