Does requiring trauma exposure affect rates of ICD-11 PTSD and complex PTSD? Implications for DSM-5

Hyland, Philip; Karatzias, Thanos; Shevlin, Mark; Mcelroy, Eoin; Ben-Ezra, Menachem; Cloitre, Marylène; Brewin, Chris R.

Abstract

Objective: There is little evidence that posttraumatic stress disorder (PTSD) is more likely to follow traumatic events defined by Criterion A than non-Criterion A stressors. Criterion A events might have greater predictive validity for ICD-11 PTSD which is a condition more narrowly defined by core features. We evaluated the impact of using Criterion A, an ‘expanded’ trauma definition in line with ICD-11 guidelines, and no exposure criterion on rates of ICD-11 PTSD and Complex PTSD (CPTSD). We also assessed if five psychologically threatening events included in the expanded definition were as strongly associated with PTSD and CPTSD as ‘standard’ Criterion A events.

Method: A nationally representative sample from Ireland (N = 1,020) completed self-report measures.

Results: Most participants were trauma-exposed based on Criterion A (82%) and the ‘expanded’ (88%) criterion. When no exposure criterion was used, 13.7% met diagnostic requirements for PTSD or CPTSD; 13.2% when the expanded criterion was used, and 13.2% when Criterion A was used. The five psychologically threatening events were as strongly associated with PTSD and CPTSD as the Criterion A events. In a multivariate analysis, only the psychologically threatening events were significantly associated with PTSD (stalking) and CPTSD (bullying, emotional abuse, and neglect).

Conclusions: Certain non-Criterion A events involving extreme fear and horror should be considered traumatic. The ICD-11 approach of providing clinical guidance rather than a formal definition offers a viable solution to some of the problems associated with the current and previous attempts to define traumatic exposure.

Citation

Hyland, P., Karatzias, T., Shevlin, M., Mcelroy, E., Ben-Ezra, M., Cloitre, M., & Brewin, C. R. (2021). Does requiring trauma exposure affect rates of ICD-11 PTSD and complex PTSD? Implications for DSM-5. Psychological Trauma: Theory, Research, Practice, and Policy, 13(2), 133-141. https://doi.org/10.1037/tra0000908

• Journal Article Type: Article
• Acceptance Date: May 6, 2020
• Online Publication Date: Sep 10, 2020
• Publication Date: 2021-02
• Deposit Date: May 21, 2020
• Publicly Available Date: May 21, 2020
• Print ISSN: 1942-9681
• Publisher: American Psychological Association
• Peer Reviewed: Peer Reviewed
• Volume: 13
• Issue: 2
• Pages: 133-141
• DOI: https://doi.org/10.1037/tra0000908
• Keywords: trauma exposure, Criterion A, PTSD, Complex PTSD
• Public URL: http://researchrepository.napier.ac.uk/Output/2664275