复杂性创伤后应激障碍的预测因素：创伤特征、解离及共病精神病理学的作用。
Predictors of complex PTSD: the role of trauma characteristics, dissociation, and comorbid psychopathology.
作者信息
Guzman Torres E, Krause-Utz A, Sack M
机构信息
Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität, Munich, Germany.
Department Clinical Psychology, Institute of Psychology, Universiteit Leiden, Leiden, the Netherlands.
出版信息
Borderline Personal Disord Emot Dysregul. 2023 Jan 5;10(1):1. doi: 10.1186/s40479-022-00208-7.
BACKGROUND
Complex Posttraumatic Stress Disorder (CPTSD) has previously been associated with earlier trauma onset, repeated interpersonal traumatization, more dissociation, and more comorbid psychopathology. However, it is still debated if the afore-mentioned risk factors are related to CPTSD diagnosis or rather indicative of a more severe form of post-traumatic distress. The aim of this study was to compare patients with a CPTSD diagnosis to those with PTSD in trauma characteristics (onset, chronicity, interpersonal nature, familiarity with perpetrator), dissociation, and psychiatric comorbidities, while accounting for symptom severity.
METHODS
In total, N = 81 patients with a trauma history (n = 43 with CPTSD; n = 37 with PTSD) underwent diagnostic interviews by trained clinicians and completed measures on CPTSD symptom severity, trauma characteristics, and dissociation (Screening for Complex PTSD; Dissociative Experience Scale Taxon).
RESULTS
Patients with CPTSD reported earlier onset of trauma, more trauma perpetrated by acquaintances or family members, and more comorbidities than those with PTSD, also when accounting for symptom severity. No group differences in chronicity and dissociation were found. Severity of CPTSD was associated with earlier onset, familiarity with perpetrator, more comorbid (affective) disorders, and dissociation in both diagnostic groups.
CONCLUSION
Findings largely confirm earlier research, suggesting that CPTSD is associated with traumatic events that start earlier in life and are perpetrated by acquaintances. Focusing on transdiagnostic symptoms, such as dissociation, may help to detain symptom deterioration. Due to the small sample size, findings need to be interpreted with caution and further research is needed to replicate findings in larger samples. Future research should also elucidate possible working mechanisms besides dissociation, such as emotion dysregulation or negative self-image.
背景
复杂性创伤后应激障碍（CPTSD）此前一直与更早的创伤发作、反复的人际创伤、更多的解离症状以及更多的共病精神病理学相关。然而，上述风险因素是与CPTSD诊断相关，还是更表明创伤后痛苦的更严重形式，仍存在争议。本研究的目的是比较CPTSD诊断患者与PTSD患者在创伤特征（发作、慢性病程、人际性质、与肇事者的熟悉程度）、解离症状和精神共病方面的差异，同时考虑症状严重程度。
方法
共有N = 81名有创伤史的患者（n = 43名CPTSD患者；n = 37名PTSD患者）接受了训练有素的临床医生的诊断访谈，并完成了关于CPTSD症状严重程度、创伤特征和解离症状的测量（复杂性PTSD筛查；解离体验量表分类）。
结果
CPTSD患者报告的创伤发作更早，熟人或家庭成员实施的创伤更多，并且在考虑症状严重程度时，共病也比PTSD患者更多。未发现两组在慢性病程和解离症状方面存在差异。CPTSD的严重程度与更早的发作、与肇事者的熟悉程度、更多的共病（情感）障碍以及两个诊断组中的解离症状相关。
结论
研究结果在很大程度上证实了早期研究，表明CPTSD与生命早期开始且由熟人实施的创伤事件相关。关注跨诊断症状，如解离症状，可能有助于阻止症状恶化。由于样本量较小，研究结果需要谨慎解释，需要进一步研究以在更大样本中复制研究结果。未来的研究还应阐明除了解离症状之外的可能作用机制，如情绪调节障碍或负面自我形象。
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