Kothgassner Oswald D, Macura Sarah, Goreis Andreas, Klinger Diana, Pfeffer Bettina, Oehlke Sofia M, Prillinger Karin, Kafka Johanna X, Zesch Heidi Elisabeth, Felnhofer Anna, Plener Paul L
Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.
Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria.
Eur J Psychotraumatol. 2025 Dec;16(1):2532273. doi: 10.1080/20008066.2025.2532273. Epub 2025 Aug 4.
Psychophysiological dysregulations and negative alterations in cognitions and mood characterize post traumatic stress disorder (PTSD) and complex PTSD (C-PTSD), contributing to an increased risk of disorder persistence and chronic health problems. However, understanding the differences in physiological stress reactivity and negative cognitive-emotional patterns between adolescents with PTSD and C-PTSD remains a notable research gap. This study examined group differences in autonomic nervous system (ANS) reactivity during the sharing of a short trauma narrative, including resting and recovery phases, and compared subjective experiences of stress, shame, and guilt among adolescents with PTSD, C-PTSD, and trauma-exposed controls. In a repeated-measures design, 52 adolescents (14-18 years) with PTSD ( = 17), C-PTSD ( = 18), and a control group ( = 17) were assessed for heart rate, heart rate variability, and subjective experiences of stress, shame, and guilt during a standardized trauma interview, as well as during baseline and recovery phases. Linear mixed-effects models revealed a significant interaction between group and time point ( = 4.134, < .001). The C-PTSD group exhibited a significantly higher heart rate in the recovery phase compared to the PTSD ( = .010) and control groups ( = .036), alongside significantly higher subjective stress, guilt, and shame experiences. Main effects of group were identified for perceived stress ( = 7.543, = .002), guilt ( = 21.779, < .001), and shame ( = 19.309, < .001), with the C-PTSD group exhibiting higher levels compared to PTSD and control groups across all conditions. Prolonged stress responses and elevated experiences of shame and guilt in adolescents with C-PTSD align with the diagnostic criteria of affective dysregulation and negative self-concept. Objective stress measures during trauma interviews may support the diagnosis of C-PTSD. Findings highlight the importance of phase-based trauma therapies that target emotional dysregulation, shame, and guilt.
心理生理失调以及认知和情绪的负面改变是创伤后应激障碍（PTSD）和复杂性创伤后应激障碍（C-PTSD）的特征，这会增加疾病持续存在和慢性健康问题的风险。然而，了解患有PTSD和C-PTSD的青少年在生理应激反应和负面认知-情绪模式上的差异仍然是一个显著的研究空白。本研究考察了在分享简短创伤叙述期间（包括静息和恢复阶段）自主神经系统（ANS）反应的组间差异，并比较了患有PTSD、C-PTSD的青少年以及有创伤暴露经历的对照组在压力、羞耻和内疚方面的主观体验。在一项重复测量设计中，对52名年龄在14至18岁之间的青少年进行了评估，其中患有PTSD的有17名，患有C-PTSD的有18名，对照组有17名，评估内容包括在标准化创伤访谈期间以及基线和恢复阶段的心率、心率变异性以及压力、羞耻和内疚的主观体验。线性混合效应模型显示组和时间点之间存在显著交互作用（F = 4.134，p <.001）。与PTSD组（p =.010）和对照组（p =.036）相比，C-PTSD组在恢复阶段的心率显著更高，同时主观压力、内疚和羞耻体验也显著更高。在感知压力（F = 7.543，p =.002）、内疚（F = 21.779，p <.001）和羞耻（F = 19.309，p <.001）方面发现了组的主效应，在所有条件下，C-PTSD组的水平均高于PTSD组和对照组。患有C-PTSD的青少年长期的应激反应以及羞耻和内疚体验的增加与情感失调和负面自我概念的诊断标准相符。创伤访谈期间的客观应激测量可能有助于C-PTSD的诊断。研究结果突出了针对情绪失调、羞耻和内疚的基于阶段的创伤治疗的重要性。
