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

Philip Hyland, Thanos Karatzias, M Shevlin, Eoin McElroy, Menachem Ben-Ezra, Marylène Cloitre, Chris R. Brewin

Research output: Contribution to journalArticle

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.
Original languageEnglish
JournalPsychological Trauma: Theory, Research, Practice, and Policy
Publication statusAccepted/In press - 20 Apr 2020

Keywords

  • trauma exposure
  • Criterion A
  • PTSD
  • Complex PTSD.

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