The network structure of ICD-11 Disorders Specifically Associated with Stress: Adjustment Disorder, Prolonged Grief Disorder, Posttraumatic Stress Disorder (PTSD) and Complex PTSD

Karatzias, Thanos; Knefel, Matthias; Maercker, Andreas; Cloitre, Marylene; Reed, Geoffrey; Bryant, Richard; Ben-Ezra, Menachem; Kazlauskas, Evaldas; Jowett, Sally; Shevlin, Mark; Hyland, Philip

Abstract

Introduction: The ICD-11 includes a new grouping for “Disorders Specifically Associated with Stress” that contains revised descriptions of Posttraumatic Stress Disorder (PTSD) and Adjustment Disorder (AjD) and new diagnoses in the form of Complex PTSD (CPTSD) and Prolonged Grief Disorder (PGD). These disorders are similar in that they each require a life event for the diagnosis, however they have not yet been assessed together for validity within the same sample. We set out to test the distinctiveness of the four main ICD-11 stress disorders using a network analysis approach.
Methods: Population-based, cross-sectional design. A nationally representative sample of adults from the Republic of Ireland aged 18 years and older (N = 1,020) completed standardised measures of PTSD, CPTSD, AjD and PGD. A network analysis was conducted at symptom level. Outcomes measures included the International Trauma Questionnaire, the Inventory of Complicated Grief, and the International Adjustment Disorder Questionnaire.
Results: Consistent with the taxonomic structure of the ICD-11, our results showed that although the four conditions clustered independently at disorder level, the specific symptoms of PTSD, CPTSD, PGD, and AjD clustered together very strongly, but more strongly than with symptoms of the other disorders. The majority (61%) of the variation in each symptom could be explained by its neighbouring symptoms. The strongest trans-diagnostically connecting symptom was “startle response”.
Discussion / Conclusion: Mental health professionals caring for people who have experienced a range of stressors and traumatic life events can be confident in diagnosing these conditions that have clear diagnostic boundaries. Interventions addressing stress-associated disorders should be based on diagnostic assessment to ensure close fit between symptoms and treatment.

Citation

Karatzias, T., Knefel, M., Maercker, A., Cloitre, M., Reed, G., Bryant, R., …Hyland, P. (2022). The network structure of ICD-11 Disorders Specifically Associated with Stress: Adjustment Disorder, Prolonged Grief Disorder, Posttraumatic Stress Disorder (PTSD) and Complex PTSD. Psychopathology, 55, 226-234. https://doi.org/10.1159/000523825

• Journal Article Type: Article
• Acceptance Date: Feb 24, 2022
• Online Publication Date: Mar 28, 2022
• Publication Date: 2022-07
• Deposit Date: Feb 25, 2022
• Publicly Available Date: Mar 28, 2022
• Journal: Psychopathology
• Print ISSN: 0254-4962
• Publisher: Karger Publishers
• Peer Reviewed: Peer Reviewed
• Volume: 55
• Pages: 226-234
• DOI: https://doi.org/10.1159/000523825
• Keywords: ICD-11, Disorders Specifically Associated with Stress, Network Analysis, Comorbidity, Stress based Disorders
• Public URL: http://researchrepository.napier.ac.uk/Output/2848720