International Society for Traumatic Stress Studies

Assessing and Diagnosing Trauma

The ISTSS 34th Annual Meeting is the largest gathering of professionals dedicated to trauma treatment, education, research and prevention. There will be several workshops, symposia and expert trainings on assessing and diagnosing trauma.


Concurrent Session One: Symposium

Thursday, November 8 | 9:45 AM to 11:00 AM

Traumagenic Community, Family, and Interpersonal Contexts as Risk Factors for Vulnerable Youth

Chair: Kerig, Patricia, PhD

Adolescents comprise a highly vulnerable group for whom exposure to trauma is prevalent and related to significant negative emotional, social, and behavioral outcomes. Youth trauma exposure commonly occurs in the contexts of their social interactions, whether in communities, families, peer relationships, and intimate partnerships, all of which may comprise “risky contexts” for adolescent development. This symposium brings together four papers from independent laboratories devoted to identifying both risk and protective factors for posttraumatic stress symptoms amongst youth who encounter these risky contexts. The first paper uses a large, longitudinal database to investigate trauma exposure in the context of justice involvement as a predictor of youth outcomes, whereas the second paper focuses on traumatic grief and loss amongst gang-involved youth exposed to community violence. The third paper considers the role of parental trauma history and PTSD in the trauma symptoms and substance abuse of their adolescent children. The fourth paper investigates perpetration trauma arising from intimate partner violence as a predictor of posttraumatic symptoms in a sample of at-risk youth. Taken together, these papers shed valuable light on youth trauma and improve our understanding of the contexts on which prevention and intervention efforts for adolescent PTSD need to focus.

The Longitudinal Patterns of Continuous Violence Exposure as Predictors of Reoffending in African American and Latino Adolescent Offenders

Gaylord-Harden, Noni, PhD; Burnside, Amanda, MA; Sargent, Elizabeth, BA; Phan, Jenny, BA
Loyola University Chicago, Chicago, Illinois, USA

While disproportionately high rates of violence exposure exacerbate delinquent behavior of juvenile offenders, there is little evidence of the role of trauma in reoffending. The goal of this study is to examine continuous trauma exposure as a predictor of reoffending in serious adolescent offenders.  Participants were 1,080 African American and Latino male adolescents convicted of a felony (M = 16.04, SD = 1.14; 51.9% African American) from the Pathways to Desistance study (Schubert et al., 2004). All participants completed self-report measures of trauma exposure.  Re-arrest data was obtained from court records.  Preliminary latent transition analyses resulted in two latent statuses across four annual time points: status 1 (43% of the sample) had relatively high levels of witnessing violence and victimization, and status 2 had lower levels of exposure. Relative proportions of statuses were fairly stable during the first two years, but there were large shifts in participants’ membership in statuses in the last two time periods.  Final analyses will examine these statuses and shifts in statuses as predictors of reoffending.

Gangs, Grief, and Community Violence: How Traumatic Loss Impacts Gang-Involved and Justice-Involved Youth

Dierkhising, Carly, PhD; Sanchez, Jose, PhD Student; Gutierrez, Luis, MS
California State University Los Angeles, Los Angeles, California, USA

Justice-involved youth are a highly victimized population; however, justice-involved youth are not a homogenous group. Research on subpopulations within juvenile justice highlight a range of social, familial, and community contexts of risk such as, victims of sexual exploitation, crossover youth, polyvictimized youth, and gang-involved youth. A commonality among these subpopulations are high rates of trauma exposure; yet, it is the type, severity, and impact of their particular trauma histories that distinguish these subpopulations. The current study examines the differences between gang-involved youth and their justice-only counterparts on their experiences of traumatic loss, grief, community violence and behavioral health problems in a sample (N = 62) of  formerly incarcerated youth (mean age = 18 years old: 93.8% youth of color). Gang-involved youth had double the rates of community violence exposure (F (1, 61) = 12.64, p < .001), and significantly higher rates of posttraumatic stress symptoms (F (1, 61) = 5.443, p < .05), drug and alcohol use (F (1, 61) = 12.29, p < .01), and experiences of traumatic loss (Χ2 (2, N = 62) = 4.27, p < .05). Descriptions of youth’s loss experiences will be discussed as well as implications for integrating trauma-focused services into gang intervention services.

Concordance of Substance Abusing Adolescents’ PTSD Symptoms with their Parent’s Trauma History and PTSD Symptoms

Ford, Julian, PhD
University of Connecticut Health Center, Farmington, Connecticut, USA

Concordance between child and parent trauma histories and PTSD symptoms was assessed in 45 dyads with high risk marijuana-abusing/dependent adolescents (33% female, 63% of color) and a caregiver (46% single parents, 53% annual income <$20,000) with the Traumatic Events Screening Instrument (TESI) and self-report PTSD questionnaires at baseline in a Multisystemic Therapy clinical trial. Parent-child concordance for total PTSD symptoms was low (r = -.05, p >.75), but parent psychogenic amnesia was associated with several youth PTSD symptoms (r = .30-.52, p = .05-.001: physical intrusions, avoidance, numbing, sleep problems, hypervigilance/ hyperarousal) and parent situational avoidance was associated with youths’ thought avoidance and sleep problems (r = -.31-32, p < .05). Youth detachment symptoms correlated with parent intrusion, thought avoidance, and hypervigilance PTSD symptoms (r = .35-.45, p = .05-.15). Parent history of actual/threatened physical assault and community violence were associated with almost 50% higher levels of youth intrusive re-experiencing, emotional numbing, hypervigilance, and total symptoms (M[SD] = 34/23 vs. 23/18). Parental sexual trauma and witnessing traumatic accidents also were associated with multiple youth PTSD symptoms: intrusion, numbing, guilt, nightmares, and hypervigilance. Implications for trauma-informed addiction treatment are discussed.

The Roles of Perpetration Trauma and Rumination in Posttraumatic Stress Symptoms Associated with Adolescent Intimate Partner Violence

Mozley, Michaela, MS, PhD Student; Modrowski, Crosby, MS (PhD Student); Kerig, Patricia, PhD
University of Utah, Salt Lake City, Utah, USA

Trauma is associated with many negative outcomes for youth, including posttraumatic stress (PTS) and the recapitulation of violence in their intimate relationships (Wekerle et al, 2009). Research also indicates that the perpetration of violence itself can constitute a form of trauma, termed perpetration trauma (PT), which in turn is related to elevated levels of PTS (Kerig et al., 2106). Little research to date, however, has illuminated the underlying processes that link intimate partner violence (IPV), PT, and PTS. One potential contributor to this association is sadness rumination (Ehring et al., 2008). To investigate this hypothesis, data were gathered from a sample of 235 justice-involved youth (184 boys, 51 girls) who completed self-report measures of IPV, PT, sadness rumination, and PTS. Results of moderated-mediational analyses utilizing Hayes (2013) PROCESS macro indicated that IPV was related to each of the four DSM-5 PTSD symptom clusters through sadness rumination, and that these effects were stronger when youth endorsed PT. Additionally, consistent with hypotheses, these indirect effects were particularly strong for criterion B, intrusion symptoms, CI=[.041,.245], and criterion D, negative alterations in cognitions and mood, CI=[.048,.326]. Results suggest that interventions seeking to interrupt the cycle of IPV may benefit from considering rumination and PT.

Concurrent Session Two: Symposium

Thursday, November 8 | 11:15 AM to 12:30 PM

Examining Similarities and Discrepancies in Outcomes Assessed by the CAPS-5 and PCL-5

Chair: Marx, Brian, PhD;
Discussant: Schnurr, Paula, PhD

The Clinician Administered PTSD Scale (CAPS) was updated to reflect changes to the PTSD criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). In addition to being edited to maintain DSM correspondence, the CAPS administration and scoring procedures were significantly revised. These changes led to concerns about the extent to which the DSM-5 version of the CAPS (CAPS-5) is psychometrically similar to the CAPS for DSM-IV (CAPS-IV) as well as the degree of correspondence between the CAPS-5 and PTSD Checklist for DSM-5 (PCL-5). Given the heavy reliance by many practitioners on self-report instruments to provide information about probable PTSD status and symptom severity, information on the degree of correspondence between the CAPS-5 and PCL-5, as well as factors that affect correspondence, is vital. In this symposium four researchers will present findings from several different studies with veteran, active duty, and civilian trauma survivors to systematically explore the validity of these concerns as well as factors, such as demographic characteristics (e.g., race, ethnicity, and gender), emotion regulation strategies and cognitive functioning that might impact psychometric performance and degree of concordance between CAPS and PCL. Discussant Dr. Paula Schnurr will provide a critical analysis and interpretation of findings.

Understanding the Concordance between the CAPS-5 and the PCL-5

Bovin, Michelle, PhD1; Lee, Daniel, MS2; Thompson-Hollands, Johanna, PhD3; Dutra, Sunny, PhD Student2; Kleiman, Sarah, PhD4; Moshier, Samantha, PhD5; Sloan, Denise, PhD1; Marx, Brian, PhD6

National Center for PTSD, VA Boston Healthcare System, Boston University School of Medicine, Boston, Massachusetts, USA
2National Center for PTSD, Boston VA Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA
3VA Boston Health Care System/Boston University, Boston, Massachusetts, USA
4Boston VA Medical Center, Jamaica Plain, Massachusetts, USA
5VA - National Center for PTSD, Boston, Massachusetts, USA
6National Center for PTSD, VA Boston Healthcare System and Boston University, Boston, Massachusetts, USA

Recently, questions have been raised about whether the move from DSM-IV to DSM-5 has affected the concordance between the Clinician Administered PTSD Scale (the CAPS) and the PTSD Checklist (the PCL) and if so, how. To explore these questions, we compared the concordance between these two measures for DSM-IV versus DSM-5. Further, we examined what variables predicted discordance between the two DSM-5 measures among multiple samples. Results indicated that, overall, the DSM-5 measures were more diagnostically concordant than the DSM-IV measures (κ(.5) = .73 versus .65). Further, when compared on a consistent metric, mean discordance did not significantly differ between the DSM-IV and DSM-5 measures (p = .43). Discordance between the two DSM-5 measures was significantly associated with measures of negative emotionality and cognitive functioning. Specifically, lower IQ (r = -.17; p = .02) and education (r = -.18; p = .02) as well as greater use of rumination (r = .22; p = .004) and catastrophizing (r = .23; p = .002) were associated with greater discrepancy between the CAPS and the PCL. These results suggest that the DSM-5 measures demonstrate greater diagnostic concordance than their DSM-IV predecessors. However, this concordance may be affected by a number of factors.

Longitudinal Change and Predictive Ability of the CAPS-5 and PCL-5

Thompson-Hollands, Johanna, PhD1; Lee, Daniel, MS2; Marx, Brian, PhD3; Bovin, Michelle, PhD4; Kleiman, Sarah, PhD5; Moshier, Samantha, PhD6; Dutra, Sunny, PhD Student2; Sloan, Denise, PhD4

1VA Boston Health Care System/Boston University, Boston, Massachusetts, USA
2National Center for PTSD, Boston VA Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA
3National Center for PTSD, VA Boston Healthcare System and Boston University, Boston, Massachusetts, USA
4National Center for PTSD, VA Boston Healthcare System, Boston University School of Medicine, Boston, Massachusetts, USA
5Boston VA Medical Center, Jamaica Plain, Massachusetts, USA
6VA - National Center for PTSD, Boston, Massachusetts, USA

The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the PTSD Checklist for DSM-5 (PCL-5) are widely used outcome measures in PTSD trials. It is important to understand the concordance of these measures over time. This study examines the performance of the CAPS-5 and PCL-5 in two PTSD trials over a one year period. One study was of individual treatment in a mixed veteran and civilian sample (N=126), the second was of group treatment in a sample of male veterans (N=198). Parallel process growth curve models showed extremely strong associations between the CAPS-5 and PCL-5 over time (rs = .88 and .86). Further, change in CAPS-5 and PCL-5 did not differ in their association with change in emotional and social functioning (ps ≥ .41). However, when examining change in depressive symptoms measured by the Beck Depression Inventory (BDI-II), change in the PCL-5 was significantly more highly associated with change in BDI-II scores (r=.97) than was change in the CAPS-5 (r=.84, Z test p<.001). Results demonstrate strong concordance between change in CAPS-5 and PCL-5 scores, and both measures perform similarly in predicting improvement in functioning. However, change in CAPS-5 scores appears to show greater differential patterns from self-reported depression than the PCL-5.

A Comparison of the CAPS-5 and PCL-5 in Active Duty Military and Veteran Treatment-seeking Samples

Resick, Patricia, PhD, ABPP1; Peterson, Alan, PhD2; McGeary, Donald, PhD2; Taylor, Daniel, PhD3; Mintz, Jim, PhD2; Wachen, Jennifer, PhD4

1Duke University Medical Center, Durham, North Carolina, USA
2University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
3University of North Texas, Denton, Texas, USA
4National Center for PTSD / Boston University, Boston, Massachusetts, US

With the advent of the DSM-5, the Clinician-Administered PTSD Scale (CAPS-5), and PTSD Checklist (PCL-5), had the same number of items (20), scaling (0-4), and range (0-80) unlike the interview or self-report measures for the DSM-IV.  This should have produced very similar outcomes.  This presentation will show how former interview and self-report measures from studies lined up closely and there is now a puzzling discrepancy in scores with the CAPS-5 and PCL-5.  Data from 4 ongoing studies are examined at baseline for concordance between CAPS-5 and PCL-5 and one of the studies will have posttreatment scores.  Total sample for the 4 studies with both CAPS-5 and PCL-5 is 515.  Alpha coefficients for the CAPS-5 was .82 and for PCL-5 was .91.  The scales correlated, r(513)=.67, p=.0012). it should be noted at baseline the range is truncated for these treatment seekers and would be expected to increase at posttreatment. This indicates correlations are not high enough to consider them to be “alternative forms” for measuring the same construct.  Means for the PCL-5 are significantly higher (14.9+10.5, p < ,0001, d=1.2).  At baseline, the CAPS-5 total is 33.95 (SD=9.89) while the PCL-5 mean is 48.8 (SD=14.13). Further analyses will be conducted with one study that will be completed, at posttreatment and item comparisons will be conducted to determine where the discrepancies may be. 

Comparing the CAPS-5, PCL-5 Patient Report and PCL-5 Partner Report in Dyadic PTSD Treatment Studies

Wagner, Anne, PhD1; Monson, Candice, PhD, Cpsych2; Mithoefer, Michael, MD3; Mithoefer, Ann, Other3; Pukay-Martin, Nicole, PhD4

1Ryerson University, Toronto, Ontario, Canada
2Ryerson University, Department of Psychology, Toronto, Ontario, Canada
3Private Practice, Mount Pleasant, South Carolina, USA
4Cincinnati VA Medical Center, Cincinnati, Ohio, USA

The use of multi-modal assessment of PTSD symptom severity and distress is best practice in trauma assessment and treatment. In dyadic research, standard clinician and patient report is triangulated with partner report of the traumatized individual’s symptoms (e.g., Ennis et al., 2017). With the revised Clinician-Administered PTSD Scale (CAPS)-5 and PTSD Checklist (PCL)-5 now widely used in research studies, questions exist as to their psychometric properties. We examined the convergent validity and sensitivity to change for these two measures and a collateral report version of the PCL using data from a randomized controlled trial of Cognitive-Behavioral Conjoint Therapy for PTSD (CBCT) versus Prolonged Exposure and a pilot trial of CBCT with MDMA that employed different clinician raters and patient groups.  Preliminary analyses revealed intra-class correlations ranging from .15 to .56 at baseline among the three sources, which increased to over .90 at post-treatment. Furthermore, pre-post effect sizes suggest differences in the magnitude of change based on informant source. By the time of presentation, additional treatment studies using the CAPS-5, and PCL-5 for both patient and partner will be included. These data will help inform discussion about multi-informant assessment, detection of change in symptoms and distress, and the role of treatment in assessment. 

Concurrent Session Three: Workshop Presentation

Thursday, November 8 | 3:00 PM to 4:15 PM

Everything You Always Wanted to Know About Psychometrics, but Were Afraid to Ask

Carlson, Eve, PhD
National Center for PTSD, VA Palo Alto Health Care System/Stanford University School of Medicine, Menlo Park, California, USA

Accurate measures are crucial to conducting research and clinical work, but psychometrics can be confusing and easily forgotten, and some professionals get little psychometrics training. Also, some psychometrics standards have changed over the years. This introductory level workshop will review the most critical elements for evaluating clinical and research measures and answer questions such as: Why should you doubt a claim that a measure has been “validated”? How much evidence of validity is “enough“? What the heck is Cronbach’s alpha, what does it tell you about the validity of a measure, and what does it mean if it is “too high“? What kinds of measures need evidence of sensitivity and specificity, why are those two indicators like a seesaw, and how do you evaluate the balance between the two? What’s wrong with the typical Likert scale response options you see on so many measures? What kind of response options do both the DSM-5 cross cutting measures and the NIH PROMIS measures use? When is a factor analysis more compelling than a confirmatory factor analysis? And what can item response theory analyses tell you that factor analysis can’t? The workshop will use examples from the traumatic stress literature to address these questions with the goal of increasing attendees’ confidence in selecting measures for research and clinical work.

Concurrent Session Four: Panel Presentation

Thursday, November 8 | 4:30 PM to 5:45 PM

Defining Treatment-Resistant PTSD: Research and Treatment Opportunities

Sippel, Lauren, PhD1; Galovski, Tara, PhD2; Holtzheimer, Paul, MD3; Olff, Miranda, PhD4; Schnurr, Paula, PhD5

1National Center for PTSD Executive Division, Geisel School of Medicine at Dartmouth, White River Junction, Vermont, USA
2National Center for PTSD-Women's Health Science Division, VA Boston Healthcare System and Boston University, Boston, Massachusetts, USA
3National Center for PTSD, White River Junction, Vermont, USA
4Academic Medical Center at the University of Amsterdam and Arq Psychotrauma Expert Group, Amsterdam, Noord-Holland, the Netherlands
5National Center for PTSD, Executive Division, White River Junction, Vermont, USA

Despite the range of effective treatments for posttraumatic stress disorder (PTSD), not all patients have an adequate response, even after receiving treatments with established efficacy. But at what point can a patient with PTSD be categorized as treatment resistant? There is no agreed-upon answer to this question. An operational definition of treatment-resistant PTSD (TR-PTSD) that takes type and adequacy of previous treatments into account is needed to (1) stimulate the development and evaluation of novel treatment approaches for patients for whom first-line treatments have failed; (2) facilitate empirical examination of biological mechanisms underlying poor treatment response; and (3) promote optimal treatment matching via identification of patients likely versus unlikely to respond to standard treatments. Four expert panelists will discuss a staging model of TR-PTSD that was developed based on models of treatment-resistant depression and the new VA/Department of Defense Clinical Practice Guideline for PTSD; describe strategies for determining benchmarks of non-response and designing clinical trials to study TR-PTSD; and propose potential neurobiological mechanisms of TR-PTSD. Questions and comments about audience members’ experiences with studying TR-PTSD, as well as engaging in treatment-planning and treating patients with TR-PTSD, will be welcomed. 

Concurrent Session Five: Workshop Presentation

Friday, November 9 | 9:45 AM to 11:00 AM

Validated Measurement of ICD-11 Post Traumatic Stress Disorder (PTSD) and Complex Post Traumatic Stress Disorder (CPTSD)

Bisson, Jonathan, MD1; Roberts, Neil, DPsych(Clin)2; Cloitre, Marylene, PhD3; Karatzias, Thanos, PhD, Cpsych4

1Cardiff University School of Medicine, Cardiff, Wales, United Kingdom
2Cardiff and Vale University Health Board, Cardiff, Cardiff, United Kingdom
3National Center for PTSD-Dissemination and Training Division, Menlo Park, California, USA
4Edinburgh Napier University & Rivers Centre for Traumatic Stress, Edinburgh, Scotland, United Kingdom

ICD-11 PTSD and Complex PTSD have unique diagnostic criteria that cannot be accurately assessed using measures based on other classification systems. The International Trauma Questionnaire (ITQ) and International Trauma Interview (ITI) are new measures specifically designed and carefully developed to assess ICD-11 PTSD and CPTSD. The ITQ has been shown to have excellent psychometric properties and it is anticipated that the same will be confirmed for the ITI over the next few months.  It is likely that these measures will be considered as a gold standard for the assessment of ICD-11 PTSD and CPTSD.

Developers of the ITQ and ITI will describe them, their administration, scoring and interpretation. The use of role-play and video recordings will be used to teach workshop participants how to administer the ITI and key issues will be discussed with audience interaction.

Concurrent Session Six: Symposium

Friday, November 9 | 11:15 AM to 12:30 PM

Network Analyses in the Field of Psychotraumatology 

Chair: Armour, Cherie, Professor

Several years of research in the field of Posttraumatic Stress Disorder has tended to focus on two groups, 1) those with a diagnosis of PTSD and 2) healthy controls. Moreover a wealth of studies have investigated PTSD symptom clusters and their relations with external correlates. Recently the focus has shifted towards the study of PTSD symptom networks. This approach views symptoms as co-occurring in syndromes due to causal interactions rather than understanding symptoms as indicators of an underlying common cause. Network analyses allows for the identification of the most problematic / central symptoms within the network, which has excellent clinical utility for intervention design. A recent special edition in the European Journal of Psychotraumatology curated several studies focusing on PTSD symptom networks. The current symposium showcases the next wave of PTSD network analyses research by presenting PTSD networks based on data from a wide array of traumatised populations including Veterans, Soldiers, and Refugees. The studies represent traumatised populations from the UK, the USA, Denmark, and Israel.  The results will encourage researchers to conceptualize and model PTSD data from a network perspective, which arguably has the potential to inform and improve the efficacy of therapeutic interventions.

A Network Analysis of DSM-5 Posttraumatic Stress Disorder and Functional Impairment in UK Treatment-seeking Veterans

Murphy, Dominic, Clinical Psychologist1; Armour, Cherie, Professor2; Ross, Jana, PhD3

1Combat Stress & King's College London, Leatherhead, Surrey, United Kingdom
2University of Ulster, Coleraine, Northern Ireland, United Kingdom
3University of Ulster, Coleraine, Co. Londonderry, United Kingdom

Network analysis is a relatively new methodology for studying psychological disorders. It focuses on the associations between individual symptoms which are hypothesized to causally interact with each other. The current study represents the first network analysis conducted with treatment-seeking military veterans in UK. The study aimed to examine the network structure of posttraumatic stress disorder (PTSD) symptoms and four domains of functional impairment by identifying the most central (i.e., important) symptoms of PTSD and by identifying those symptoms of PTSD that are related to functional impairment. Participants were 331 military veterans with probable PTSD. In the first step, a network of PTSD symptoms based on the PTSD Checklist for DSM-5 was estimated. In the second step, functional impairment items were added to the network. The most central symptoms of PTSD were recurrent thoughts, nightmares, negative emotional state, detachment and exaggerated startle response. Functional impairment was related to a number of different PTSD symptoms. Impairments in close relationships were associated primarily with the negative alterations in cognitions and mood symptoms and impairments in home management were associated primarily with the reexperiencing symptoms. The results are discussed in relation to previous PTSD network studies and include implications for clinical practice.

Replicability and Generalizability of Posttraumatic Stress Disorder (PTSD) Networks 

Karstoft, Karen-Inge, PhD, Cpsych1; Armour, Cherie, Professor2; Nielsen, Anni Brit Sternhagen, Other1; Fried, Eiko, PhD3

1Research and Knowledge Center, The Danish Veteran Center, Ringsted, Zealand, Denmark
2University of Ulster, Coleraine, Northern Ireland, United Kingdom
3University of Amsterdam, Amsterdam, Amsterdam, Netherlands

The growing literature conceptualizing mental disorders like posttraumatic stress disorder (PTSD) as networks of interacting symptoms faces three key challenges. Prior studies predominantly used (a) small samples with low power for precise estimation, (b) nonclinical samples, and (c) single samples. This renders network structures in clinical data, and the extent to which networks replicate across data sets, unknown. To overcome these limitations, the present cross-cultural multisite study estimated regularized partial correlation networks of 16 PTSD symptoms across four data sets of traumatized patients receiving treatment for PTSD (total N = 2,782). Despite differences in culture, trauma type, and severity of the samples, considerable similarities emerged, with moderate to high correlations between symptom profiles (0.43–0.82), network structures (0.62–0.74), and centrality estimates (0.63–0.75). We discuss the importance of future replicability efforts to improve clinical psychological science.

Posttraumatic Stress Disorder Symptoms and Risky Behaviors. A Network Analysis Approach

Armour, Cherie, Professor1; Greene, Talya, PhD MPH2; Contractor, Ateka, PhD3; Weiss, Nicole, PhD4; Dixon-Gordon, Katherine, PhD5; Ross, Jana, PhD6

1University of Ulster, Coleraine, Northern Ireland, United Kingdom
2University of Haifa, Haifa, israel, Israel
3University of North Texas, Denton, Texas, USA
4University of Rhode Island, Kingston, Rhode Island, USA
5University of Massachusetts Amherst, Amherst, Massachusetts, USA
6University of Ulster, Coleraine, Co. Londonderry, United Kingdom

The revision of PTSD's nosology in the DSM-5 included the addition of a new reckless and self-destructive behaviour symptom (E5). Previously, risky behaviours have been associated with trauma, PTSD symptom severity, and the severity of PTSD symptom clusters. The network analytic approach to psychopathology is an appropriate methodology to examine individual item level relationships. The current study utilises this methodology to examine relationships between risky behaviours and PTSD symptom clusters. Participants were recruited from Amazons Mechanical Turk platform (N = 417). Participants responded to the LEC for DSM-5, the PCL-5, and the Posttrauma Risky Behaviours Questionnaire (PRBQ). Network Analyses was conducted with eighteen nodes; the four DSM-5 PTSD clusters (community 1) and fourteen risky behaviors (community 2). Results showed that PTSD and risky behaviors clustered primarily within their respective communities, however, several bridge connections were identified; the strongest ones between the NACM symptom cluster and suicidal behavior. The avoidance and arousal PTSD symptom clusters had the highest number of direct bridge connections with risky behaviors (five each). The majority of risky behavior items had direct relationships with one or more PTSD symptom clusters, but a few did not. Results are discussed in light of limitations and clinical implications.

Dynamic Network Analysis of Negative Emotions and DSM-5 PTSD Symptom Clusters

Greene, Talya, PhD MPH1; Gelkopf, Marc, PhD1; Fried, Eiko, PhD2; Robinaugh, Don, PhD3; Lapid Pickman, Liron, MA1

1University of Haifa, Haifa, Israel, Israel
2University of Amsterdam, Amsterdam, Amsterdam, Netherlands
3Massachusetts General Hospital, Boston, Massachusetts, USA

Dynamic network analysis uses experience sampling method (ESM) data to model the within-moment (contemporaneous) and moment-to-moment (temporal) associations between variables. The present study used dynamic network analysis to explore 10 negative emotions and the 4 DSM-5 PTSD symptom clusters (intrusions, avoidance, negative cognitions and mood [NACM], and arousal), in a sample of Israeli civilians (n=96) during the Israel-Gaza War (July-Aug 2014). Participants made ESM reports on PTSD symptoms and negative emotions twice a day for 30 days via smartphone. We used a multilevel vector auto-regression model to estimate contemporaneous and temporal networks, focusing on the bridge associations between negative emotions and the PTSD symptom clusters. In the contemporaneous network, negative emotions had strong bridge connections to NACM and arousal. The negative emotions of sadness, stress, fear, and loneliness had the strongest bridge connections to the PTSD symptom clusters. Contrary to our hypothesis, in the temporal network, PTSD symptom clusters were more predictive of negative emotions than vice versa, with arousal the strongest predictor of negative emotions at the following assessment. Our findings highlight the potentially relevant role of arousal for primary or early interventions. 

Concurrent Session Seven: Workshop Presentation

Friday, November 9 | 3:00 PM to 04:15 PM

A Practical Guide to Experience Sampling Methodology

Greene, Talya, PhD MPH
University of Haifa, Haifa, Israel, Israel
Experience sampling methodology (ESM) is an intensive longitudinal assessment technique in which  participants are prompted to provide data at least once a day over a particular time period on symptoms, emotions, and behaviors, often using mobile technology.

ESM enables us to ask and answer questions that are not typically possible using traditional methods, such as: how do between-person effects differ from within-persons effects? Which symptoms and behaviors predict other symptoms and behaviors a few hours later? What is the real-time effect of environmental context on mental health?

The purpose of this workshop is to provide a user-friendly guide to researchers who are considering an ESM study, or who have collected ESM data and want to understand potential ways to handle the data.

We will discuss methodological considerations such as ESM protocol (number of items, number of daily reports, length of ESM period), sample size, questionnaires, participant incentives, data collection apps and survey software.  We will also consider different analytic approaches, including mixed effects models, multilevel mediation, dynamic networks, and growth models, with walk-through examples.

The presenter has been involved in various ESM studies, including on peritraumatic stress during conflict; PTSD following MVAs; and pain, negative affect and cannabis use.

Concurrent Session Eight: Symposium

Friday, November 9 | 4:30 PM to 05:45 PM


Understanding the Interplay of Loss and Traumatic Death with Grief and PTSD across Clinical and Community Samples

Chair: Simon, Naomi, MD, MsC

Traumatic bereavement, associated persistent grief related symptomatology and its similarities, differences and impact on posttraumatic stress disorder (PTSD) remains an important but understudied area. A persistent grief related condition has emerged as a disorder often but not always comorbid with PTSD, and has been associated with greater PTSD severity and impairment. ICD11 will be releasing criteria for prolonged grief disorder, and DSM5 has provisional criteria. This symposia pulls together research from military and civilian populations from multiple institutions and projects to examine the interplay of loss, traumatic bereavement and posttraumatic death disorder. Presentations will include data from both primary PTSD and primary grief samples. Dr Steve Cozza will present data examining optimal criteria for Persistent Grief Disorder in a Traumatically Bereaved Sample. Dr Christine Mauro will present the performance of ICD11 prolonged grief disorder in traumatic compared to non-traumatically bereaved sample. Joscelyn Fisher will data examining a cohort exposed to traumatic bereavement due to 9/11 and the impact of media coverage on psychological seqelae such as grief. Finally, Dr Elizabeth Goetter will present data demonstrating the significant impact of a co-occurring grief condition on primary PTSD outcomes in a multi-center clinical trial of prolonged exposure therapy with or without sertraline for combat veterans with PTSD. Clinical implications for identifying and treating persistent grief due to traumatic bereavement and in the setting of PTSD across populations as well as implications for the public discussion of traumatic losses will be discussed.

Prolonged Grief Disorder: Clinical Utility of ICD-11 Diagnostic Guidelines

Mauro, Christine, PhD1; Reynolds, Charles, MD2; Maercker, Andreas, PhD, MD3; Skritskaya, Natalia, PhD4; Simon, Naomi, MD, MsC5; Zisook, Sidney, MD6; Lebowitz, Barry, PhD7; Cozza, Stephen, MD8; Shear, M Katherine, MD4

1Columbia University, Mailman School of Public Health, New York, New York, USA
2University of Pittsburgh, Pittsburgh, Pennsylvania, USA
3University of Zurich, Zurich, CH, Switzerland
4Columbia University School of Social Work, New York, New York, USA
5New York University School of Medicine, New York, New York, USA
6University of California, San Diego, San Diego, California, USA
7University of California, San Francisco, San Diego, California, USA
8Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA

WHO ICD-11 is expected to include a new diagnosis for Prolonged Grief Disorder (ICD-11PGD). This study examines the validity and clinical utility of the ICD-11PGD guideline by testing its performance in a well- characterized clinical sample and contrasting it with a different criteria set with the same name (PGDPLOS). We examined data from 261 treatment-seeking participants in an NIMH-sponsored multicenter clinical trial to determine rates of diagnosis using the ICD-11PGD guideline and compared these to diagnosis using PGDPLOS criteria.  The ICD-11PGD guideline identified 95.8% (95% CI: 93.3-98.2%) of a treatment responsive cohort of patients with distressing and impairing grief. PGDPLOS criteria identified only 59.0% (95% CI: 53.0-65.0%) and were more likely to omit those who lost someone other than a spouse, were currently married, bereaved by violent means, or not diagnosed with co-occurring depression. More specifically, PGDPLOS criteria correctly diagnosed 65% of those bereaved by non-violent means compared with only 47% of those bereaved by violent means (x2= 7.6, df=1, p=0.0058). The ICD-11PGD diagnostic guideline showed good performance characteristics in this sample, while PGDPLOS criteria did not. Clinicians and researchers need to be aware of the important difference between these two identically named diagnostic methods.

Testing Criteria for a Persistent Grief Disorder in a Traumatically Bereaved Sample

Cozza, Stephen, MD1; Fisher, Joscelyn, PhD1; Zhou, Jing, MS1; Mauro, Christine, PhD2; Simon, Naomi, MD, MsC3; Shear, M Katherine, MD4

1Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
2Columbia University, Mailman School of Public Health, New York, New York, USA
3New York University School of Medicine, New York, New York, USA
4Columbia University School of Social Work, New York, New York, USA

Objective: To compare four proposed criteria sets for a disorder of impairing grief in a sample of traumatically bereaved adults. Method:  We assessed their accuracy in identifying threshold clinical cases and excluding subthreshold cases in a sample of bereaved military family members (N=1732). We calculated Kappa coefficients, described patterns of case identification, and examined the contribution of criteria restrictiveness to criteria performance. Results:  All cases identified by restrictive criteria (prolonged grief disorder/PGD and persistent complex bereavement disorder/PCBD) were also identified by less restrictive, but better-performing criteria (complicated grief/CG and ICD-11 criteria). Kappas indicated good to excellent agreement in case identification (0.53 - 0.89). Criteria differed in accurate identification of clinical cases (CG = 81%, ICD-11 = 82%, PGD criteria = 53%, PCBD = 47%), but all demonstrated accuracy in excluding subthreshold cases (86 - 96%). Differences in criteria performance were attributable to differences in numbers of required associated symptoms, and when held constant, criteria performed similarly. Conclusions: Proposed criteria describe a similar disorder of persistent impairing grief in this traumatically bereaved sample, but differ in restrictiveness. Clinically useful criteria emphasizes core, rather than associated symptoms.

Understanding the Impact of Complicated Grief on Posttraumatic Stress Disorder Outcomes in Post-9/11 Service Members and Veterans

Goetter, Elizabeth, PhD1; Hoeppner, Susanne, PhD1; Hellberg, Samantha, BA2; Acierno, Ron, PhD3; Rauch, Sheila, PhD, ABPP4; Simon, Naomi, MD1

1Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
2Massachusetts General Hospital, Boston, Massachusetts, USA
3Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
4Emory University School of Medicine/Atlanta Veteran's Administration, Atlanta, Georgia, USA

Background: Bereavement and complicated grief (CG) are more common than previously recognized amongst service members and veterans. Complicated grief (CG), a persistent and impairing form of grief, is distinct from but also co-occurs with posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Little is known about the impact of comorbid CG on PTSD outcomes or how best to address it in practice.

Method: The impact of comorbid CG on PTSD treatment outcomes in a multi-site, randomized controlled trial for veterans with combat PTSD was examined. Participants were 194 veterans (M age = 34, SD = 8; 87% male, 59% White) with PTSD who started treatment, completed a structured PTSD assessment (CAPS), and assessments of grief (Inventory of Complicated Grief).

Results: Veterans with CG at baseline presented with greater PTSD severity (p < .01). CG was associated with reduced likelihood of PTSD treatment response (without CG: 42%, with CG 17%; OR: 0.25, 95%CI: 0.10-0.59, p < .01) and remission (without CG: 40%, with CG: 15%; OR: 0.23, 95%CI: 0.09-0.57, p<.01). The effect did not vary adjusting for baseline CAPS.

Conclusions: Comorbid CG is associated with reduced response to PTSD treatment. Additional detailed outcomes analyses and clinical implications will be presented.

Effects of media coverage on traumatic bereavement due to 9/11

Fisher, Joscelyn, PhD1; Chen, Shenglin, PhD2; Zhou, Jing, MS1; Fetchet, Mary, LCSW3; Cozza, Stephen, MD1

1Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
2Uniformed Services University, Bethesda, Maryland, USA
3VOICES of September 11, New Canaan, Connecticut, USA

Background: Societal influences can affect mental health. The amount of exposure to media coverage following the death of a loved one killed in a terrorist attack is associated with complicated grief (Kristensen et al., 2016). It is unclear whether perceptions of media coverage also affect mental health. Method: Media exposure and perceptions of coverage were examined in relation to PTSD, complicated grief, depression and generalized anxiety in 9/11-bereaved family members. Results: Participants who stated that media covered their family member’s death were at lower risk for complicated grief than those who did not experience media coverage of the death (OR = .61, 95% CI: .38 - .96). 70% of these participants agreed that coverage was accurate and nearly 60% agreed that the media respected their privacy. These participants were less likely to meet threshold for depression (accuracy: OR = .51, 95% CI: .29 - .88; privacy: OR = .65, 95% CI: .46 - .90) and generalized anxiety (accuracy: OR = .55, 95% CI: .32 - .95; privacy: OR = .70, 95% CI: .51 - .96) than other participants. Neither media exposure nor perceptions were associated with PTSD. Conclusions:  Though prior research suggests media exposure is a secondary stressor and increases risk for complicated grief in bereaved family members, experiencing coverage as accurate and respectful minimizes risk for psychological disorders.

Concurrent Session Nine: Symposium

Saturday, November 10 | 9:45 AM to 11:00 AM


Refining Our Understanding of Typologies of Trauma Exposure and Traumatized Reactions Among At-Risk Adolescents

Chair: Modrowski, Crosby, MS (PhD Student)

Investigations in the study of traumatic stress increasingly have uncovered meaningful individual differences in types of trauma exposure as well as typologies of posttraumatic response in children and adolescents. Further, posttraumatic symptoms may interact with additional aspects of risk, including co-occurring mental health problems and problem behaviors that are frequently seen among youth with a history of trauma exposure. To refine our understanding of these interrelationships, this symposium brings together four papers investigating diversity in the types of trauma exposures and posttraumatic reactions demonstrated by at-risk youth. The first paper presents a latent class analysis of forms of trauma exposure and investigates polyvictimization as a predictor of dynamic risk factors and strengths among a sample of traumatized youth in the justice system. The second paper uses mixture modeling to demonstrate the utility of the construct of posttraumatic risk-seeking as a developmentally salient symptom typology particularly implicated in the adolescent period.  The third paper investigates the interrelations among PTSD symptoms, mental health difficulties, and behavioral and emotional dysregulation in institutionalized youth. The fourth paper examines the associations among specific types of maltreatment, running away, and PTSD symptoms amongst traumatized adolescents. Taken together, these papers make valuable contributions to our efforts to fine-tune our understanding of diverse types of trauma exposure and traumatized responses in children and adolescents. 

Polyvictimization and PTSD Among Detained Adolescents

Grasso, Damion, PhD1; Ford, Julian, PhD1; Cruise, Keith, PhD2; Holloway, Evan, MA3

1University of Connecticut Health Center, Farmington, Connecticut, USA
2Fordham University, New York, New York, USA
3Fordham University, Bronx, New York, USA

Although polyvictimization is linearly associated with health impairments, trauma victims show significant heterogeneity. Some show resilient outcomes; others develop symptoms spanning diagnostic categories. Person-centered analytic methods have identified subgroups of individuals with unique constellations of adversities and distinct outcomes. The current study applied latent class analysis to a sample of 341 detained youth to identify subgroups differentiated by patterns across 10 trauma domains and the 4 DSM-5 posttraumatic stress disorder (PTSD) symptom criteria. Four subgroups emerged. About 8% of youth had high probability of exposure across domains and met all PTSD criteria (poly-PTSD). Two classes reflected moderate exposure, with one differentiated by traumatic loss and meeting all PTSD criteria (loss-PTSD) and the other (mod-hyper) differentiated from a low exposure class (47.8%) by high probability of exposure across several domains and meeting criteria for hyperarousal symptoms. The poly-PTSD and loss-PTSD classes had relatively greater scores across several impairment domains, Pillai’s Trace F=2.94, p<.001. Controlling for age and sex, the poly-PTSD and mod-hyper classes had relatively fewer criminal offenses, F=2.84, p=.038, and, though non-significant, offenses were less severe. Implications for addressing the diverse needs of detained youth are discussed.

Investigating the Construct of Posttraumatic Risk-seeking in a Sample of Justice-involved Youth

Modrowski, Crosby, MS (PhD Student); Kerig, Patricia, PhD
University of Utah, Salt Lake City, Utah, USA

Previous research has confirmed the associations among trauma exposure, posttraumatic stress (PTS), and adolescent delinquency (Ford et al., 2015). One PTSS especially relevant to adolescents is engaging in risky, reckless, or self-destructive behaviors, a new symptom listed in the DSM-5 PTSD criteria. Whereas these behaviors typically are interpreted as a consequence of impaired recognition of risk, particularly amongst traumatized girls, the construct of “posttraumatic risk-seeking” has been proposed to account for the posttraumatic function and developmental salience of these symptoms from a trauma coping perspective (Kerig, 2014, 2017). In an initial validation of the construct, we sought to identify a group of posttraumatic risk-seekers and to investigate theoretically-derived correlates. Validated self-report measures were completed by a sample of 404 detained youth (25% girls, 54% ethnic minority). Mixture modeling using Mplus identified two distinct high (n = 76) and low (n= 328) risk-seeking groups. Girls were more likely to be categorized into the high risk-seeker group. Furthermore, youth who were identified as high risk-seekers reported significantly higher rates of trauma exposure, including sexual abuse, other PTSS, emotion dysregulation, and delinquency. These results have important implications related to the assessment and treatment of PTS in adolescents.

The Path from Trauma to Conduct Problems: Factors Associated with Traumatic Event Exposure and Institutional Misconduct in Detained Juveniles

Jimenez, Maria, BA1; Cruise, Keith, PhD2; Ford, Julian, PhD3

1Fordham University, Bronx, New York, USA
2Fordham University, New York, New York, USA
3University of Connecticut Health Center, Farmington, Connecticut, USA

Mental health problems and traumatic event exposure are high among justice-involved adolescents, and these factors may lead to disciplinary incidents in detention (McDougall et al., 2013). Researchers have examined the path from traumatic event exposure to mental health problems (Kerig et al., 2016), but there is limited research investigating impact on behavior in detention. This paper investigates traumatic event exposure, PTSD symptom severity, and mental health problems as predictors of disciplinary incidents in juvenile detention.  Using detention records (N = 195), intake screening data of trauma history and trauma symptoms (Structured Trauma-related Symptoms and Experiences Screen - STRESS) and mental health problems (Massachusetts Youth Screening Instrument-Version 2 - MAYSI-2), and disciplinary incidents were analyzed. On average, juveniles had 1 disciplinary incident, but variance was high (SD = 3.28, range = 0 to 33). Using negative binomial regression, the full model was significant and predicted the number of disciplinary incidents, Χ2 (7) = 46.43, p < .01) with mental health problems as a significant predictor. The number of traumatic event exposures predicted PTSD severity and mental health problems but was not a direct predictor of disciplinary incidents. Implications and relevance to juvenile detention screenings and safety protocols are discussed.

Running Away and Posttraumatic Hyperarousal as Factors in Delinquency Amongst Traumatized Youth: An Examination of the Risk Amplification Model

Mendez, Lucybel, BA/BS; Lawson, Kimberly, MA
University of Utah, Salt Lake City, Utah, USA

Although the links between interpersonal trauma exposure (ITE), sexual abuse (SA) and delinquency are well-established, the underlying factors that link these variables are less understood. According to the risk amplification model, behavioral and psychological factors may exacerbate the negative effects of ITE and SA on youth problem behavior. Running away is one potential amplifying factor identified in previous studies, especially for girls who have experienced SA. Another unexamined factor that may play a role in these relations are posttraumatic stress symptoms, particularly hyperarousal, which has been implicated in delinquency. Therefore, this study investigated the interactive effects of running away, posttraumatic hyperarousal, and gender on offending in traumatized youth. In a series of regressions using self-report measures provided by 684 youth, three-way interactions emerged demonstrating that, for girls, SA and ITE were associated with increased drug use and total delinquency for those who ran away and exhibited higher levels of hyperarousal. In contrast, for boys, ITE was associated with diverse types of offending at higher levels of hyperarousal whether they ran away or not. These findings highlight the importance of gender differences in traumatic experiences and posttraumatic reactions and of considering youth’s behavior in the context of risk amplification.

Concurrent Session Ten: Symposium

Saturday, November 10 | 11:15 AM to 12:30 PM


ICD-11 PTSD and Complex PTSD – Measurement, Evidence, Cross Cultural Comparison

Chair: Lueger-Schuster, Brigitte, PhD

The symposium will integrate presentations focusing on the newly introduced ICD-11 PTSD and Complex PTSD (CPTSD). The International Trauma Questionnaire (ITQ) was applied in several international community- and clinical samples and tested for validity, reliability, and cultural differences.

The first presentation addresses the measurement of the core symptoms of the two disorders, focusing on item refinement which was based on item response theory analysis. The second presentation looks into the assessment of trauma history, symptom comorbidity and functional impairment for the two disorders, applying the ITQ in different UK-samples. The third presentation focuses on differences and similarities for Complex PTSD and Borderline Personality Disorder in trauma exposed psychiatric samples from the UK. Finally, the fourth presentation provides a cross-cultural comparison of the structure of CPTSD, applying the ITQ in different European samples, using the network analysis approach. A robust structure of CPTSD across different international samples was found.

Assessment of differential trauma history, symptom comorbidity and functional impairment in ICD-11 PTSD and CPTSD using the 12-item ITQ

Cloitre, Marylene, PhD1; Karatzias, Thanos, PhD, Cpsych2; Hyland, Philip, PhD3; Shevlin, Mark, PhD4

1National Center for PTSD-Dissemination and Training Division, Menlo Park, California, USA
2Edinburgh Napier University & Rivers Centre for Traumatic Stress, Edinburgh, Scotland, United Kingdom
3National College of Ireland, Mayor Street, IFSC, Dublin 1, Ireland, Mayor Street, IFSC, Dublin 1, Ireland, Ireland
4University of Ulster, Derry, United Kingdom

Past research has consistently indicated that ICD-11 PTSD and CPTSD are distinguishable in regards to associated trauma history and symptom comorbidities as well as level of impairment. An important research and clinical goal is to develop a measure that is brief but accurately reflects clinically relevant differences which may have implications for treatment. This presentation will evaluate whether, consistent with past research, differences between the diagnosis PTSD and Complex PTSD will be observed regarding trauma history, symptom comorbidity and functional impairment when using the 12-item ITQ. Analyses will be conducted in a UK community sample (n=2,653) and clinical sample (n=247). Analyses will be performed to identify other characteristics which may distinguish between PTSD and CPTSD including gender, education, employment and relationship status.

Complex PTSD and Borderline Personality Disorder: Similarities and Differences in a UK Trauma Exposed Psychiatric Sample

Roberts, Neil, DPsych(Clin)1; Bisson, Jonathan, MD2

1Cardiff and Vale University Health Board, Cardiff, Cardiff, United Kingdom
2Cardiff University School of Medicine, Cardiff, Wales, United Kingdom

Complex PTSD (CPTSD) will be recognised as a disorder, distinct from PTSD with the forthcoming publication of ICD11. CPTSD shares some symptom features with Borderline Personality Disorder (BPD) and this has raised questions about the distinction between the two disorders. The All Wales PTSD Registry is an on going study of trauma exposed mental health service users. Over 300 participants have completed a range of measures, including the SCID module for BPD, along with two newly developed instruments to diagnose the proposed ICD-11 disorders: the International Trauma Questionnaire and the International Trauma Interview. Data will be presented on the overlap in rates of diagnosis of PTSD, CPTSD and BPD, along with data on similarities and differences in demographic features, symptom profile and functional difficulties between these groups. Findings will be discussed in relation to the conceptual differences between the disorders.

A Cross-cultural Comparison of ICD-11 Complex PTSD Symptom Networks in Austria, UK, and Lithuania

Lueger-Schuster, Brigitte, PhD1; Knefel, Matthias, MS (PhD Student)1; Kazlauskas, Evaldas, PhD2; Karatzias, Thanos, PhD, Cpsych3; Bisson, Jonathan, MD4; Roberts, Neil, DPsych(Clin)5

1University of Vienna, Vienna, Vienna, Austria
2Vilnius University, Vilnius, Lithuania, Lithuania
3Edinburgh Napier University & Rivers Centre for Traumatic Stress, Edinburgh, Scotland, United Kingdom
4Cardiff University School of Medicine, Cardiff, Wales, United Kingdom
5Cardiff and Vale University Health Board, Cardiff, Cardiff, United Kingdom

The 11th revision of the World Health Organization's International Classification of Diseases (ICD-11) may include a new disorder, Complex Posttraumatic Stress Disorder (CPTSD). The network approach to psychopathology enables investigation of the structure of disorders at the symptom level, allowing for analysis of direct symptom interactions. The network structure of ICD-11 CPTSD has not yet been studied and it remains unclear whether similar networks replicate across different samples. We investigated the network models of four different trauma samples including a total of 879 participants (age: M = 47.17 years, SD = 11.92; 59.04% women, drawn from Austria, Lithuania, and the UK (Scotland and Wales). In all samples the International Trauma Questionnaire (ITQ) was used to assess symptoms of ICD-11 CPTSD. Regularized partial correlation networks were estimated and the resulting networks compared. Despite several differences in the symptom presentation and cultural background, the networks across the four samples were considerably similar with high correlations between symptom profiles, network structures, and centrality estimates. These results support the replicability of CPTSD network models across different samples and provide further evidence about the robust structure of CPTSD. Implications of the network approach in research and practice are discussed.

Measuring ICD-11 PTSD and Complex PTSD using the International Trauma Questionnaire: How we got to where we are

Shevlin, Mark, PhD1; Cloitre, Marylene, PhD2; Brewin, Chris, PhD3; Bisson, Jonathan, MD4; Roberts, Neil, DPsych(Clin)5; Maercker, Andreas, PhD, MD6; Karatzias, Thanos, PhD, Cpsych7; Hyland, Philip, PhD8

1University of Ulster, Derry, n/a, United Kingdom
2National Center for PTSD-Dissemination and Training Division, Menlo Park, California, USA
3University College London, London, London, United Kingdom
4Cardiff University School of Medicine, Cardiff, Wales, United Kingdom
5Cardiff and Vale University Health Board, Cardiff, Cardiff, United Kingdom
6University of Zurich, Zurich, CH, Switzerland
7Edinburgh Napier University & Rivers Centre for Traumatic Stress, Edinburgh, Scotland, United Kingdom
8National College of Ireland, Mayor Street, IFSC, Dublin 1, Ireland, Mayor Street, IFSC, Dublin 1, Ireland, Ireland

In 2013 PTSD and Complex PTSD (CPTSD) were proposed for the 11th revision of the World Health Organization's International Classification of Diseases (ICD-11). PTSD was comprised of three symptom clusters reflecting ‘Reexperiencing in the here and now’, ‘Avoidance’, and a ‘Sense of Current Threat’. CPTSD was to include these core PTSD symptoms, plus three additional symptom clusters of ‘Affective Dysregulation’, ‘Negative Self-Concept’, and ‘Disturbed Relationships’; collectively referred to as ‘Disturbances in Self-Organization’ (DSO). Initial evidence of construct validity was derived from archival data. Subsequently, a draft self-report measure of ICD-11 PTSD and CPTSD was developed; the ‘International Trauma Questionnaire’ (ITQ) which included a larger number of potential symptoms. The development version of the ITQ yielded excellent psychometric properties, however to align with the objectives of ICD-11 that disorders should be described in terms of core symptoms, the goal was to refine the ITQ to include a final list of 12 symptom indicators: PTSD and DSO each measured by two items. The process of indicator refinement was conducted using UK community (N=1005) and clinical samples (N=247). The process of item refinement was based on item response theory analysis. This presentation will present the finalized 12-item ITQ.

Concurrent Session Eleven: Panel Presentation

Saturday, November 10 | 2:00 PM to 03:15 PM

Using the Core Curriculum on Childhood Trauma to Create Trauma-Competent Child Service Systems: Integrating Instructional Design, Evidence-Based Practice, and Implementation Science Principles

Layne, Christopher, PhD1; Studer, Margaret, MD2; Ross, Leslie, PsyD3; Grossman, Hannah, PhD4; Dunn, Jerry, PhD5; Abramovitz, Robert, MD6

1UCLA - National Center for Child Traumatic Stress, Los Angeles, California, USA
2UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, California, USA
3University of California, Los Angeles/Duke National Center for Child Traumatic Stress, Los Angeles, , California, USA
4University of California, Los Angeles/Duke National Center for Child Traumatic Stress, Los Angeles,, California, USA
5University of Missouri St. Louis, St Louis, Missouri, USA
6Hunter College School of Social Work, New York, New York, USA

Calls have been issued in the traumatic stress field (Cook, Newman, et al., 2014) and more broadly across the disciplines of psychology, social work, and psychiatry to build professional knowledge and skills needed to competently serve traumatized populations. This panel will discuss efforts by the National Child Traumatic Stress Network to design, disseminate, implement, and evaluate the Core Curriculum on Childhood Trauma. Dr. Layne will begin by discussing the mission of the Curriculum to raise the standard of care for traumatized children and families nationwide by raising the standard of professional training and education. Dr. Grossman will present a design-based research approach to creating heuristics to strengthen case formulation and critical reasoning skills. Dr. Ross will describe the incremental benefits of successively adopting manualized treatments, assessment protocols, and the Curriculum in a large community mental health agency. Dr. Dunn will describe efforts to adapt the Curriculum to encompass bachelors-level training, including simulation exercises to train child welfare workers. Dr. Stuber will draw on 27 years of medical training to discuss challenges inherent in conceptualizing, measuring, and certifying professional competencies. Dr. Abramovitz will conclude by discussing challenges in adapting the curriculum for multiple professional disciplines.