Hébert Martine, Amédée Laetitia Mélissande
Canada Research Chair in Interpersonal Traumas and Resilience, Département de sexologie, Université du Québec à Montréal, Montréal, Québec, Canada.
Département de psychologie, Université du Québec à Montréal, Montréal, Québec, Canada.
Eur J Psychotraumatol. 2020 Sep 16;11(1):1807171. doi: 10.1080/20008198.2020.1807171.
PTSD symptoms are frequent in child victims of sexual abuse. Yet, authors have argued that early trauma could lead to alterations in development that go far beyond the primary symptoms of PTSD and have proposed Complex PTSD as an alternative diagnosis encompassing difficulties in affect regulation, relationships and self-concept. To delineate profiles in child victims of sexual abuse and explore whether profiles are associated with treatment response to Trauma-Focused Cognitive Behavioural Therapy. Latent class analysis was used to identify symptom profiles at baseline assessment of 384 children ages 6 to 14, recruited in a Child Advocacy Centre following disclosure of sexual abuse. Dimensions of Complex PTSD diagnosis as proposed by the ICD-11 were derived from self-report questionnaires. Latent class analysis identified a best fitting model of three classes: Classic PTSD regrouping 51% of children, Complex PTSD describing 23% of children, and Resilient describing 25% of children. Trauma-focused therapy was associated with a significant reduction of dissociation, internalizing, and externalizing problems for children of all three classes. Trauma-focused therapy was also linked to a significant reduction of PTSD symptoms with larger effect size ( = .90; 95%CI: 0.63-1.16) for children classified in the Complex PTSD class. These findings highlight the utility of a person-oriented approach to enhance our understanding of the diversity of profiles in child victims. The results offer empirical support for the ICD-11 PTSD and Complex PTSD distinction in a clinical sample of sexually abused children and the relevance of this distinction in foreseeing treatment outcomes.
创伤后应激障碍（PTSD）症状在遭受性虐待的儿童受害者中很常见。然而，一些作者认为，早期创伤可能导致发育改变，远远超出PTSD的主要症状，并提出复杂性PTSD作为一种替代诊断，包括情感调节、人际关系和自我概念方面的困难。为了描绘遭受性虐待儿童的症状概况，并探讨这些概况是否与针对创伤的认知行为疗法的治疗反应相关。采用潜在类别分析来识别384名6至14岁儿童在基线评估时的症状概况，这些儿童是在儿童权益保护中心披露性虐待事件后招募的。国际疾病分类第11版（ICD - 11）提出的复杂性PTSD诊断维度来自自我报告问卷。潜在类别分析确定了一个最佳拟合模型，分为三类：经典PTSD组占51%的儿童，复杂性PTSD组占23%的儿童，适应良好组占25%的儿童。针对创伤的治疗与所有三类儿童的解离、内化和外化问题的显著减少相关。针对创伤的治疗还与复杂性PTSD组儿童的PTSD症状显著减少相关，效应量更大（= 0.90；95%置信区间：0.63 - 1.16）。这些发现凸显了以人为本的方法在增强我们对受虐儿童症状概况多样性理解方面的作用。研究结果为ICD - 11在性虐待儿童临床样本中对PTSD和复杂性PTSD的区分以及这种区分在预测治疗结果方面的相关性提供了实证支持。
