Network analysis of posttraumatic stress experiences of adults seeking psychological treatment for childhood sexual abuse (CSA)

Network analysis proposes that mental disorders may best be construed as causal systems embodied in networks of functionally interconnected symptoms. In this study, network analysis was used to test how adult survivors of childhood sexual abuse (CSA) experienced symptoms of posttraumatic stress, using alternative conceptualisations of PTSD. Given the characteristics of the sample (i.e. the nature of and duration since trauma) it was hypothesised that: (1) symptoms relating to arousal were not expected to be prominent in the networks; and (2) symptoms relating to negative alternations in cognition and mood (NACM) would be core components in the network. Danish adults seeking psychological treatment for CSA (n=473) completed the Harvard Trauma Questionnaire and Trauma Symptom Checklist. Three alternative models (DSM-5; DSM-5 with dissociation; and ICD-11 Complex PTSD) were estimated using state-of-the-art regularized partial correlation models. In the DSM-5 network, strong associations emerged for experiences of NACM (e.g. blame, guilt) and intrusions (thoughts and flashbacks). Adding ‘depersonalisation’ and ‘derealisation’ to the DSM-5 model produced a strong association, although these experiences were largely unrelated to other PTSD clusters. In the CPTSD network, interpersonal problems and negative self-concept were central to the survivors’ experiences. For this highly-specific survivor group who experienced traumatic CSA many years ago, experiences relating to NACM appeared to be more central to the post-trauma experience than those of arousal. If replicated elsewhere, these findings could help inform treatment plans for specific groups of survivors. Methodological implications as to the usefulness of network models in the psychopathological research literature are discussed.