Karmaşık Travma Sonrası Stres Bozukluğu: Bir Gözden Geçirme

Year 2022, , 589 - 596, 27.12.2022

Emre Han Alpay , Dilek Çelik

https://doi.org/10.18863/pgy.1050659

Cited By: 1

Abstract

Karmaşık travma, tekrarlayan, uzun süreli ve kişilerarası ilişkilerden kaynaklı travmatik olaylardan dolayı meydana gelen ve belirtileri travma sonrası stres bozukluğundan (TSSB) farklı olan bir tanıdır. Karmaşık travma ile ilgili olarak uzun yıllardır çalışmalar yapılmasına rağmen farklı bir tanı olarak kabul edilmemiştir. Dünya Sağlık Örgütü tarafından 2018 yılında yayınlanan Uluslararası Hastalık Sınıflandırmasının en güncel versiyonu olan 11. Baskısı (ICD-11), “Stres İle İlişkili Bozukluklar” kategorisi altında travma sonrası stres bozukluğu ile birlikte yeni bir tanı olan karmaşık travma sonrası stres bozukluğuna yer vermiştir. Bu yeni tanı, TSSB’nin üç tanı ölçütünün (yeniden yaşantılama, kaçınma ve hipervijilans) yanı sıra duygu disregülasyonu, kişiler arası ilişkilerde sorunlar ve olumsuz benlik kavramı olmak üzere benlik organizasyonu ile ilgili 3 yeni belirtiyi de içermektedir. Bu derleme çalışmasında ilk olarak Tanısal ve Sayımsal El Kitabının (DSM) 5. baskısın (DSM-5) ve ICD-11’e göre TSSB tanısındaki farklılıklar incelenmiştir. Daha sonra karmaşık TSSB bozukluğunun tarihçesi, tanımı ve diğer bozukluklarla arasındaki farklılıklar incelenmiştir. Son olarak Karmaşık TSSB’nin tedavisinde kullanılan yöntemler ile ilgili çalışmalar aktarılmıştır.

Keywords

Travma sonrası stres bozukluğu, karmaşık travma sonrası stres bozukluğu, ICD-11

Complex Post Traumatic Stress Disorder: A Review

Abstract

Complex trauma is a diagnosis that occurs due to repetitive, long-term and interpersonal traumatic events and its symptoms are different from post-traumatic stress disorder (PTSD). Although many studies have been conducted on complex trauma for many years, it has not been accepted as a different diagnosis. The 11th Edition of the International Classification of Diseases (ICD-11), published by the World Health Organization in 2018, includes complex post-traumatic stress disorder, a new diagnosis, besides post-traumatic stress disorder (PTSD) under the category of “Stress-Related Disorders”. In addition to the three diagnostic criteria of PTSD (re-experiencing, avoidance, and hypervigilance), 3 new symptoms related to self-organization have been added to this new diagnosis, namely emotion dysregulation, problems in interpersonal relationships, and negative self-concept. In this review study, firstly, the differences in the diagnosis of PTSD according to DSM-5 and ICD-11 were examined. Then, the history, definition and differences between complex PTSD disorder and other disorders were examined. Finally, studies on the methods used in the treatment of Complex PTSD were reviewed.

Keywords

Post-traumatic stress disorder, complex post-traumatic stress disorder, ICD-11

References

• Alpay EH, Aydın A, Bellur Z (2017) The mediating role of the emotion regulation difficulties on the relationship between childhood traumas, post traumatic stress symptoms and depression. J Clin Psychiatry, 20:218-226.
• Achterhof R, Huntjens RJC, Meewisse ML, Kiers HAL (2019) Assessing the application of latent class and latent profile analysis for evaluating the construct validity of complex posttraumatic stress disorder. Eur J Psychotraumatol, 10:182-198.
• Afzali MH, Sunderland M, Teesson M, Carragher N, Mills K, Slade TA (2017) Network approach to the comorbidity between posttraumatic stress disorder and major depressive disorder: The role of overlapping symptoms. J Affect Disord, 208:490-496.
• American Psychological Association (2012) International Society for the Study of Trauma and Dissociation. Complex Trauma Treatment Guidelines.
• American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders 3rd edition, (DSM-III). Washington, American Psychiatric Association.
• American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders 4th edition Text Revision (DSM-IV-TR). Washington, American Psychiatric Association.
• American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5). Washington, American Psychiatric Association.
• American Psychiatric Association (2022) Diagnostic and Statistical Manual of Mental Disorders 5th edition Text Revision (DSM-5-TR). Washington, American Psychiatric Association.
• Badour CL, Adams TG (2018) Contaminated by trauma: Understanding links between self-disgust, mental contamination, and post-traumatic stress disorder. In The Revolting Self: Perspectives on the Psychological, Social, and Clinical Implications of Self-Directed Disgust (Eds PG Overton, PA Powell, J Simpson) 127-149. New York, Routledge.
• Ball JS, Links PS (2009) Borderline personality disorder and childhood trauma: evidence for a causal relationship. Curr Psychiatry Rep, 11:63-68.
• Barbano AC, van der Mei WF, deRoon-Cassini TA, Grauer E, Lowe SR, Matsuoka YJ (2019) International Consortium to Prevent PTSD. Differentiating PTSD from anxiety and depression: Lessons from the ICD-11 PTSD diagnostic criteria. Depress Anxiety, 36:490-498.
• Ben-Ezra M, Karatzias T, Hyland P, Brewin CR, Cloitre M, Bisson JI et al. (2018) Posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as per ICD-11 proposals: A population study in Israel. Depress Anxiety, 35:264-274.
• Blalock JA, Minnix JA, Mathew AR, Wetter DW, McCullough JP, Cinciripini PM (2013) Relationship of childhood trauma to depression and smoking outcomes in pregnant smokers. J Consult Clin Psychol, 81:821.
• Bicanic I, De Jongh A, Ten Broeke E (2015) Stabilisation in trauma treatment: necessity or myth?. Tijdschr Psychiatr, 57:332-339.
• Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C (2013) Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst. Rev, 12:CD003388.
• Brenner L, Köllner V, Bachem R (2019) Symptom burden and work-related impairment among patients with PTSD and complex PTSD. Eur J Psychotraumatol, 10:1694766.
• Brewin CR, Cloitre M, Hyland P, Shevlin M, Maercker A, Bryant RA et al. (2017) A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clin Psychol Rev, 58:1-15.
• Brown NR, Kallivayalil D, Mendelsohn M, Harvey MR (2012) Working the double edge: Unbraiding pathology and resiliency in the narratives of early-recovery trauma survivors. Psychol Trauma, 4:102.
• Bruckmann P, Haselgruber A, Sölva K, Lueger-Schuster B (2020). Comparing rates of ICD-11 and DSM-5 Posttraumatic Stress Disorder in Austrian children and adolescents in foster care: prevalence, comorbidity and predictors. Eur J Psychotraumatol, 11:1767988.
• Cattane N, Rossi R, Lanfredi M, Cattaneo A (2017) Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms. BMC Psychiatry, 17:221.
• Charuvastra A, Cloitre M (2008) Social bonds and posttraumatic stress disorder. Annu Rev Psychol, 59:301-328.
• Classen CC, Pain C, Field NP, Woods P (2006) Posttraumatic personality disorder: A reformulation of complex posttraumatic stress disorder and borderline personality disorder. Psychiatr Clin North Am, 29:87-112.
• Cloitre M, Stovall-McClough KC, Nooner K, Zorbas P, Cherry S, Jackson CL et al. (2010) Treatment for PTSD related to childhood abuse: A randomized controlled trial. Am J Psychiatry, 167:915–924.
• Cloitre M, Courtois CA, Charuvastra A, Carapezza R, Stolbach BC, Green BL (2011) Treatment of complex PTSD: Results of the ISTSS expert clinician survey on best practices. J Trauma Stress, 24:615-627.
• Courtois CA, Ford JD, Cloitre M (2000) Best practices in psychotherapy for adults. In: Treating Complex Traumatic Stress Disorders: An Evidence-Based Guide (Eds CA Courtois, JD Ford). New York, Guilford Press.
• Cloitre M, Garvert DW, Brewin CR, Bryant RA, Maercker A (2013) Evidence for proposed ICD-11 PTSD and complex PTSD: A latent profile analysis. Eur J Psychotraumatol, 4:20706.
• Cloitre M, Garvert DW, Weiss B, Carlson EB, Bryant RA (2014) Distinguishing PTSD, complex PTSD, and borderline personality disorder: A latent class analysis. Eur J Psychotraumatol, 5:25097.
• Cloitre M, Hyland P, Bisson JI, Brewin CR, Roberts NP, Karatzias T et al. (2019) ICD-11 posttraumatic stress disorder and complex posttraumatic stress disorder in the United States: A population-based study. J Trauma Stress, 32:833-842.
• Cloitre M, Miranda R, Stovall-McClough KC, Han H (2005) Beyond PTSD: Emotion regulation and interpersonal problems as predictors of functional impairment in survivors of childhood abuse. Behav Ther, 36:119-124.
• Cloitre M, Shevlin M, Brewin CR, Bisson JI, Roberts NP, Maercker A et al. (2018) The international trauma questionnaire: Development of a self-report measure of ICD-11 PTSD and complex PTSD. Acta Psychiatr Scand, 138:536-546.
• Cook JM, Riggs DS, Thompson R, Coyne JC, Sheikh JI (2004) Posttraumatic stress disorder and current relationship functioning among World War II ex-prisoners of war. J Fam Psychol, 18:36-53
• Courtois CA, Ford JD (2009) Treating Complex Traumatic Stress Disorders: An Evidence-Based Guide. Guilford Press, New York.
• Courtois CA (2010) Understanding complex trauma, complex reactions, and treatment approaches. https://www.aaets.org/traumatic-stress-library/understanding-complex-trauma-complex-reactions-and-treatment-approaches (Accessed 11.09.2021).
• Crow TM, Levy KN, Bradley B, Fani N, Powers A (2021) The roles of attachment and emotion dysregulation in the association between childhood maltreatment and PTSD in an inner-city sample. Child Abuse Negl, 118:105139.
• Cyr G, Godbout N, Cloitre M, Bélanger C (2022) Distinguishing among symptoms of posttraumatic stress disorder, complex posttraumatic stress disorder, and borderline personality disorder in a community sample of women. J Trauma Stress, 35:186-196.
• D’Andrea W, Pole N. (2012) A naturalistic study of the relation of psychotherapy process to changes in symptoms, information processing, and physiological activity in complex trauma. Psychol Trauma, 4:438-451.
• De Jongh A, Amann BL, Hofmann A, Farrell D, Lee CW (2019) The status of EMDR therapy in the treatment of posttraumatic stress disorder 30 years after its introduction. J EMDR Pract. Res, 13:261-269.
• De Jongh, AD, Resick PA, Zoellner LA, Van Minnen A, Lee CW, Monson CM et al. (2016) Critical analysis of the current treatment guidelines for complex PTSD in adults. Depress Anxiety, 33:359-369.
• DePrince AP, Chu AT, Pineda AS (2011) Links between specific posttrauma appraisals and three forms of trauma-related distress. Psychol Trauma, 3:430.
• Dorrepaal E, Thomaes K, Smit JH, Van Balkom AJL, Van Dyck R, Veltman, DJ et al. (2010) Stabilizing group treatment for complex posttraumatic stress disorder related to childhood abuse based on psycho-education and cognitive behavioral therapy: A pilot study. Child Abuse Negl, 34:284-288.
• Dvir Y, Ford JD, Hill M, Frazier JA (2014) Childhood maltreatment, emotional dysregulation, and psychiatric comorbidities. Harv Rev Psychiatry, 22:149-161.
• Foa EB, Chrestman KR, Gilboa-Schechtman E (2009) Prolonged Exposure Therapy for Adolescents with PTSD Emotional Processing of Traumatic Experiences, Therapist Guide. London, Oxford University Press.
• Ford JD, Courtois, CA, Steele K, Hart OVD, Nijenhuis ER (2005) Treatment of complex posttraumatic self-dysregulation. J Trauma Stress, 18:437-447.
• Ford JD, Courtois CA, Cloitre M (2009) Best Practices in Psychotherapy for Adults. Treating Complex Traumatic Disorders: Scientific Foundations and Therapeutic Models. New York, Guilford Press.
• Ford JD, Courtois CA (2013) Treating Complex Traumatic Stress Disorders in Children and Adolescents: Scientific Foundations and Therapeutic Models. New York, Guilford Press.
• Frewen P, Zhu J, Lanius R (2019) Lifetime traumatic stressors and adverse childhood experiences uniquely predict concurrent PTSD, complex PTSD, and dissociative subtype of PTSD symptoms whereas recent adult non-traumatic stressors do not: Results from an online survey study. Eur J Psychotraumatol, 10:1-10
• Friedman MJ (2013) Finalizing PTSD in DSM-5: Getting here from there and where to go next. J Trauma Stress, 26:548-556.
• Galatzer-Levy IR, Bryant RA (2013) 636,120 ways to have posttraumatic stress disorder. Perspect Psychol Sci, 8:651-662.
• Glück,TM, Knefel M, Tran US, Lueger-Schuster B (2016) PTSD in ICD-10 and proposed ICD-11 in elderly with childhood trauma: prevalence, factor structure, and symptom profiles. Eur J Psychotraumatol, 7:9700.
• Herman JL (1992a) Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. J Trauma, 5:377-391.
• Herman JL (1992b) Trauma and Recovery.  New York, Basic Books.
• Hyland P, Shevlin M, Fyvie C, Karatzias T (2018) Posttraumatic stress disorder and complex posttraumatic stress disorder in DSM-5 and ICD-11: Clinical and behavioral correlates. J Trauma Stress, 31:174-180.
• Hyland P, Shevlin M, Cloitre M, Karatzias T, Vallières F, McGinty G et al. (2019) Quality not quantity: loneliness subtypes, psychological trauma, and mental health in the US adult population. Soc Psychiatry Psychiatr Epidemiol, 54:1089-1099.
• Hyland P, Shevlin M, Brewin CR, Cloitre M, Downes AJ, Jumbe S. Roberts, NP (2017a) Validation of post-traumatic stress disorder (PTSD) and complex PTSD using the International Trauma Questionnaire. Acta Psychiatr Scand, 136:313-322.
• Hyland P, Shevlin M, Elklit A, Murphy J, Vallières F, Garvert DW et al. (2017b) An assessment of the construct validity of the ICD-11 proposal for complex posttraumatic stress disorder. Psychol Trauma, 9:1-10.
• Jepsen EK, Langeland W, Heir T (2013) Impact of dissociation and interpersonal functioning on inpatient treatment for early sexually abused adults. Eur J Psychotraumatol, 4:13-32.
• Karatzias T, Murphy P, Cloitre M, Bisson J, Roberts N, Shevlin M et al. (2019a) Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis. Psychol Med, 49:1761-1775.
• Karatzias T, Cloitre M (2019b) Treating adults with complex posttraumatic stress disorder using a modular approach to treatment: rationale, evidence, and directions for future research. J Trauma Stress, 32:870–876.
• Knefel M, Garvert DW, Cloitre M, Lueger-Schuster B (2015) Update to an evaluation of ICD-11 PTSD and complex PTSD criteria in a sample of adult survivors of childhood institutional abuse by Knefel & Lueger-Schuster (2013). A latent profile analysis. Eur J Psychotraumatol, 6:25290.
• Knefel M, Lueger-Schuster B (2013) An evaluation of ICD-11 PTSD and complex PTSD criteria in a sample of adult survivors of childhood institutional abuse. Eur J Psychotraumatol, 4:22608.
• Kulkarni J (2017) Complex PTSD–a better description for borderline personality disorder? Australas Psychiatry, 25:333-335.
• Lewis KL, Grenyer BF (2009) Borderline personality or complex posttraumatic stress disorder? An update on the controversy. Harv Rev Psychiatry, 17:322-328.
• Lewis C, Roberts NP, Andrew M, Starling E, Bisson JI (2020) Psychological therapies for post-traumatic stress disorder in adults: Systematic review and meta-analysis. Eur J Psychotraumatol, 11:1729633.
• Levitt JT, Cloitre M (2005) A clinician’s guide to STAIR/MPE: Treatment for PTSD related to childhood abuse. Cogn Behav Pract, 12:40-52.
• Lonergan M (2014) Cognitive behavioral therapy for PTSD: The role of complex PTSD on treatment outcome. J Aggress Maltreat Trauma, 23:494-512.
• MacIntosh HB, Godbout N, Dubash N (2015) Borderline personality disorder: Disorder of trauma or personality, a review of the empirical literature. Can Psychol, 56:227-241.
• Maercker A, Brewin CR, Bryant RA, Cloitre M, van Ommeren M, Jones LM et al. (2013) Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11. World J Psychiatry, 12:198-206.
• Maughan A. Cicchetti D (2002) Impact of child maltreatment and interadult violence on children’s emotion regulation abilities and socioemotional adjustment. Child Dev, 73:1525-1542.
• McNally RJ (2009) Can we fix PTSD in DSM-V? Depress Anxiety, 26:597–600. 
• Mendes DD, Mello MF, Ventura P, de Medeiros Passarela C, de Jesus Mari J (2008) A systematic review on the effectiveness of cognitive behavioral therapy for posttraumatic stress disorder. Int J Psychiatry Med, 38:241-259.
• Messman-Moore TL, Bhuptani PH (2017) A review of the long-term impact of child maltreatment on posttraumatic stress disorder and its comorbidities: An emotion dysregulation perspective. Clin Psychol, 24:154-169.
• National Collaborating Centre for Mental Health (2005) Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care. Leicester, UK, Gaskell.
• O’donnell ML, Alkemade N, Nickerson A, Creamer M, McFarlane AC, Silove D et al. (2014) Impact of the diagnostic changes to post-traumatic stress disorder for DSM-5 and the proposed changes to ICD-11. Br J Psychiatry, 205:230-235.
• Oe M, Ito M, Takebayashi Y, Katayanagi A, Horikoshi M (2020) Prevalence and comorbidity of the ICD-11 and DSM-5 for PTSD caseness with previous diagnostic manuals among the Japanese population. Eur J Psychotraumatol, 11:1753938.
• Redican, E., Nolan, E., Hyland, P., Cloitre, M., McBride, O., Karatzias, T et al. (2021) A systematic literature review of factor analytic and mixture models of ICD-11 PTSD and CPTSD using the International Trauma Questionnaire. J Anxiety Disord, 79:102381.
• Pollak SD, Cicchetti D, Hornung K. Reed A (2000) Recognizing emotion in faces: developmental effects of child abuse and neglect. Dev Psychol, 36:679-688.
• Powers A, Dixon HD, Conneely K, Gluck R, Munoz A, Rochat C et al. (2019) The differential effects of PTSD, MDD, and dissociation on CRP in trauma-exposed women. Compr Psychiatry, 93:33-40.
• Resick PA, Bovin MJ, Calloway AL, Dick AM, King MW, Mitchell KS et al. (2012) A critical evaluation of the complex PTSD literature: Implications for DSM-5. J Trauma Stress,  25:241-251.
• Shevlin M, Hyland P, Roberts NP, Bisson JI, Brewin CR, Cloitre M (2018) A psychometric assessment of Disturbances in Self-Organization symptom indicators for ICD-11 Complex PTSD using the International Trauma Questionnaire. Eur J Psychotraumatol, 9:1419749.
• Shevlin M, Hyland P, Vallières F, Bisson J, Makhashvili N, Javakhishvili J et al. (2018) A comparison of DSM-5 and ICD-11 PTSD prevalence, comorbidity and disability: An analysis of the Ukrainian Internally Displaced Person’s Mental Health Survey. Acta Psychiatr Scand, 137:138-147.
• Southam-Gerow MA, Kendall PC (2002) Emotion regulation and understanding: Implications for child psychopathology and therapy. Clin Psychol Rev, 22:189-222.
• Sloan DM, Lee DJ, Litwack SD, Sawyer AT, Marx BP (2013) Written exposure therapy for veterans diagnosed with PTSD: A pilot study. J Trauma Stress, 26:776-779.
• Spitzer RL, First MB, Wakefield JC (2007) Saving PTSD from itself in DSM-V. J. Anxiety Disord. 21:233-241.
• Stein H, Allen JG (2007) Mentalizing as a framework for integrating therapeutic exposure and relationship repair in the treatment of a patient with complex posttraumatic psychopathology. Bull Menninger Clin, 71:273-290.
• Temes CM, Magni LR, Fitzmaurice GM, Aguirre BA, Goodman M, Zanarini MC (1991) Prevalence and severity of childhood adversity in adolescents with BPD, psychiatrically healthy adolescents, and adults with BPD. J Ment Health, 11:171-178.
• Terr LC (1991) Childhood traumas: An outline and overview. Am J Psychiatry, 148: 10–20.
• Tummala-Narra P (2014) Cultural identity in the context of trauma and immigration from a psychoanalytic perspective. Psychoanal Psychol, 31:396.
• van Dijke A, Ford JD, Frank LE, Van der Hart O (2015) Association of childhood complex trauma and dissociation with complex posttraumatic stress disorder symptoms in adulthood. J Trauma Dissociation, 16:428-441.
• Van der Kolk BA, Roth S, Pelcovitz D, Sunday S, Spinazzola J (2005) Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. J Trauma Stress, 18:389-399.
• van Der Kolk B, Ford JD, Pinazzola J (2019) Comorbidity of developmental trauma disorder (DTD) and post-traumatic stress disorder: Findings from the DTD field trial. Eur J Psychotraumatol, 10:1562841.
• Walsh K, Fortier MA, DiLillo D (2010) Adult coping with childhood sexual abuse: A theoretical and empirical review. Aggress Violent Behav, 15:1-13.
• Weiss DS (2012) Introduction to the special feature on complex PTSD. J Trauma Stress, 25:239-240.
• Wilson JP (2001) An overview of clinical consideration and principles in the treatment of PTSD. Treating Psychological Trauma and PTSD (Eds JP Wilson, MJ Friedman, JD Lindy):59-94. New York, Guilford Press.
• Wisco BE, Marx BP, Miller MW, Wolf E.J, Krystal JH, Southwick SM et al. (2017) A comparison of ICD-11 and DSM criteria for posttraumatic stress disorder in two national samples of US military veterans. J Affect Disord, 223:17-19.
• WHO (1992) The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva, World Health Organization. 
• WHO (2018) International Statistical Classification of Diseases and Related Health Problems (11th Revision). Geneva, World Health Organization.
• Yen S, Shea MT, Battle CL, Johnson DM, Zlotnick, C, Dolan-Sewell R et al. (2002) Traumatic exposure and posttraumatic stress disorder in borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders: Findings from the Collaborative Longitudinal Personality Disorders Study. J Nerv Ment Dis, 190:510-518
• Vallières F, Ceannt, R, Daccache, F, Abou Daher R, Sleiman J, Gilmore B et al. (2018) ICD-11 PTSD and complex PTSD amongst Syrian refugees in Lebanon: the factor structure and the clinical utility of the International Trauma Questionnaire. Acta Psychiatr Scand, 138:547-557.