Change in Event Centrality and Posttraumatic Stress Disorder Symptoms During Intensive Treatment

Event centrality, defined as the extent to which a traumatic event becomes a core component of a person's identity (Berntsen & Rubin, 2006), is both a correlate and predictor of posttraumatic stress disorder (PTSD) symptoms, over and above event severity. These findings suggest that decreasing the perceived centrality of a traumatic event to one's identity might result in decreases in PTSD symptom severity. To date, few studies have examined how centrality is affected by PTSD treatment. The present study tested the hypotheses that change in centrality would be associated with both change in PTSD symptom severity and discharge PTSD symptom severity in an exposure‐based PTSD partial hospitalization program (N = 132; 86.0% White; 85.2% female; M age = 36 years). At discharge (i.e., after approximately 6 weeks of treatment), both PTSD symptoms and centrality had significantly decreased, ds = .70 and .98, respectively, with large effect sizes. Decreases in Centrality of Events Scale (CES) scores at posttreatment, baseline CES scores, and baseline PTSD Checklist for DSM‐5 (PCL‐5) scores were associated with change (i.e., decrease) in PCL‐5 scores, p < .001, as well as with posttreatment PCL‐5 scores, p < .001. Decreases in CES scores over time, baseline CES scores, and baseline PCL‐5 scores explained 31% of the variance in PCL‐5 change and 34% of the variance in posttreatment PCL‐5 scores. The results indicate the potential importance of decreasing the centrality of a traumatic event in PTSD treatment and recovery.     

Temporal Associations Between Moral Injury and Posttraumatic Stress Disorder Symptom Clusters in Military Veterans

War zone veterans who experience posttraumatic stress disorder (PTSD) symptoms might struggle with co‐occurring cognitive, emotional, and behavioral expressions of suffering that align with conceptual definitions of moral injury (MI). However, given that PTSD is a multidimensional condition, disentangling the apparent interplay with MI may inform clinical practice and research. This study incorporated a cross‐lagged design to explore temporal associations between self‐ and other‐directed outcomes related to MI and severity of DSM‐5 PTSD symptom clusters while accounting for depressive symptoms. Drawing on the Expressions of Moral Injury Scale–Military Version in a community sample of 182 previously deployed veterans, MI‐related outcomes were linked with severity of PTSD symptom clusters at two assessments spaced apart by 6 months, rs = .58–.62. Of possible models for conceptualizing the temporal nature of these associations, structural equation modeling analyses revealed a cross‐lagged primary MI model best fit veterans’ responses. Within this model, veterans’ self‐directed MI at Time 1 predicted greater PTSD symptoms at the 6‐month follow‐up. However, an equivalent cross‐lagged path also emerged between Time 1 PTSD Cluster D symptoms and self‐directed MI at Time 2, suggesting the value of a reciprocal MI model for this symptom domain. In contrast, other‐directed outcomes of MI were not linked with PTSD in the presence of other variables. Overall, these findings support the prognostic value of assessing for MI‐related outcomes among veterans who might be struggling with PTSD symptomatology, particularly with respect to self‐directed problems associated with enduring moral distress.     

Dynamic Network Analysis of Negative Emotions and DSM-5 Posttraumatic Stress Disorder Symptom Clusters During Conflict

Investigating dynamic associations between specific negative emotions and PTSD symptom clusters may provide novel insights into the ways in which PTSD symptoms interact with, emerge from, or are reinforced by negative emotions. The present study estimated the associations among negative emotions and the four DSM-5 PTSD symptom clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], and arousal) in a sample of Israeli civilians (n = 96) during the Israel–Gaza War of July–August 2014. Data were collected using experience sampling methodology, with participants queried via smartphone about PTSD symptoms and negative emotions twice a day for 30 days. We used a multilevel vector auto-regression model to estimate temporal and contemporaneous temporal networks. Contrary to our hypothesis, in the temporal network, PTSD symptom clusters were more predictive of negative emotions than vice versa, with arousal emerging as the strongest predictor that negative emotions would be reported at the next measurement point; fear and sadness were also strong predictors of PTSD symptom clusters. In the contemporaneous network, negative emotions exhibited the strongest associations with the NACM and arousal PTSD symptom clusters. The negative emotions of sadness, stress, fear, and loneliness had the strongest associations to the PTSD symptom clusters. Our findings suggest that arousal has strong associations to both PTSD symptoms and negative emotions during ongoing trauma and highlights the potentially relevant role of arousal for future investigations in primary or early interventions.     

Posttraumatic Stress Disorder Symptom Clusters,Alcohol Misuse,and Women's Use of Intimate Partner Violence

Exploring how PTSD and alcohol misuse relate to women's use of intimate partner violence (IPV) is vital to develop our understanding of why some women may engage in IPV, which can serve to maximize intervention efforts for women. This study examined the extent to which posttraumatic stress disorder (PTSD) symptom clusters are directly and indirectly related to women's use of IPV through pathways involving alcohol misuse while controlling for severity of women's IPV victimization. The sample was comprised of substance‐using, low socioeconomic status community women (N = 143) currently experiencing IPV victimization. The majority of the sample was African American (n = 115, 80.42%). This sample had an average annual household income of $14,368.68 (SD = $12,800.68) and the equivalent of a high school education (11.94 years, SD = 1.32). Path analyses indicated that the strongest statistical relationship emerged between women's use of IPV and women's IPV victimization. PTSD reexperiencing and numbing symptom severity was related to women's use of psychological, minor physical, and severe physical IPV; however, these relationships were indirect through alcohol misuse. Findings lend preliminary support for the application of the self‐medication hypothesis to the study of PTSD, alcohol misuse, and IPV among women.     

Complex Posttraumatic Stress Disorder Symptom Profiles in Traumatized Refugees

Although it is well documented that exposure to severe, cumulative trauma and postdisplacement stress increases the risk for posttraumatic stress symptom disorder (PTSD), less is known about the representation and predictors of complex PTSD (CPTSD) symptoms in refugee populations. We examined PTSD and CPTSD symptom profiles (co‐occurring PTSD and disturbances in self‐organization [DSO] symptoms) and their premigration, postmigration, and demographic predictors, using latent class analysis (LCA), in a cohort of 112 refugees resettled in Australia. The LCA identified a four‐factor model as the best fit to the data, comprising classes categorized as: (a) CPTSD, exhibiting high levels of PTSD and DSO symptoms (29.5%); (b) PTSD only (23.5%); (c) high affective dysregulation (AD) symptoms (31.9%); and (d) low PTSD and DSO symptoms (15.1%). Membership in the CPTSD and PTSD classes was specifically associated with cumulative traumatization, CPTSD OR = 1.56, 95% CI [1.15, 2.12], and PTSD OR = 1.64, 95% CI [1.15, 2.34]; and female gender, CPTSD OR = 14.18, 95% CI [1.66, 121.29], and PTSD OR = 16.84, 95% CI [1.78, 159.2], relative to the low‐symptom class. Moreover, CPTSD and AD class membership was significantly predicted by insecure visa status, CPTSD OR = 7.53, 95% CI [1.26, 45.08], and AD OR = 7.19, 95% CI [1.23, 42.05]. These findings are consistent with the ICD‐11 model of CPTSD and highlight the contributions of cumulative trauma to CPTSD and PTSD profiles as well as of contextual stress from visa uncertainty to DSO symptom profiles in refugee cohorts, particularly those characterized by AD.     

Posttraumatic Stress Disorder Symptom Clusters in Service Members Predict New‐Onset Depression Among Military Spouses

Military operations in Iraq and Afghanistan have brought increased attention to posttraumatic stress disorder (PTSD) among service members and, more recently, its impact on spouses. Existing research has demonstrated that PTSD among service members is associated with depression among military spouses. In the current study, we extended these findings by using data from service member–spouse dyads enrolled in the Millennium Cohort Family Study for which the service member had evidence of PTSD (n = 563). Prospective analyses identified the association between PTSD symptom clusters reported by the service member and new‐onset depression among military spouses. Over the 3‐year study period, 14.4% of these military spouses met the criteria for new‐onset depression. In adjusted models, service member ratings of symptoms in the effortful avoidance cluster, odds ratio (OR) = 1.61, 95% CI [1.03, 2.50], predicted an increased risk of new‐onset depression among military spouses, whereas reexperiencing symptoms, adjusted OR = 0.57; 95% CI [0.32, 1.01], were marginally protective. These findings suggest that PTSD symptom clusters in service members differentially predict new‐onset depression in military spouses, which has implications for treatment provision.     

A Prospective Study on the Association Between Caregiver Psychological Symptomatology and Symptom Clusters of Pediatric Posttraumatic Stress Disorder

This study investigated the influence of caregiver psychological symptoms on posttraumatic stress disorder (PTSD) symptoms in traumatized children. One‐hundred eleven children and caretakers were assessed in this study. Children (N = 59) with a history of exposure to interpersonal violence were evaluated for reexperiencing, avoidance/numbing, and hyperarousal symptom clusters using the Clinician‐Administered PTSD Scale for Children and Adolescents (CAPS‐CA). The 52 primary caregivers were evaluated using the Symptom Checklist‐90‐Revised (SCL‐90‐R) on 9 domains of psychological symptomatology: anxiety, depression, hostility, interpersonal sensitivity, obsessive–compulsive disorder, paranoid ideation, phobic anxiety, psychoticism, and somatization. At 14‐month follow‐up, 45 of the children were re‐evaluated with the CAPS‐CA. Caregiver psychological symptoms in the domains of anxiety, depression, interpersonal sensitivity, obsessive–compulsive disorder, and paranoid ideation were associated with less improvement in total pediatric PTSD symptoms. Analysis of PTSD symptoms by cluster showed that greater caregiver symptomatology in the domains of anxiety, depression, interpersonal sensitivity, and obsessive–compulsive disorder were associated with less improvement in the hyperarousal symptom cluster. These results suggest caregiver symptomatology may be specifically associated with hyperarousal symptoms in pediatric trauma.     

Posttraumatic Stress Disorder Symptom Network Structures: A Comparison Between Men and Women

This study estimated gender differences in the posttraumatic stress disorder (PTSD) symptom network structure (i.e., the unique associations across symptoms) using network analysis in a Latin American sample. Participants were 1,104 adults, taken from epidemiological studies of mental health following natural disasters and accidents in Mexico and Ecuador. Symptoms of DSM-IV PTSD were measured dichotomously with the Spanish version of the Composite International Diagnostic Interview. We estimated the PTSD symptom network of the full sample and in male and female subsamples as well as indices of centrality, the stability and accuracy of the modeled networks, and communities of nodes within each network. The male and female networks were compared statistically using the Network Comparison Test (NCT). Results indicated strength centrality was the only stable centrality measure, with correlation stability (CS) coefficients of .59, .28, and .44 for the full, male, and female networks, respectively. We found the most central symptoms, measured by strength centrality, were loss of interest and flashbacks for men; and concentration impairment, avoiding thoughts/feelings, and physiological reactivity for women. The NCT revealed that the global structure (M = 0.84), p = .704, and global strength (S = 5.04), p = .556, of the male and female networks did not differ significantly. Although some gender differences in the most central symptoms emerged, thus offering some evidence for gender differences pending replication in larger samples, on the whole, our results suggest that once PTSD develops, the way the symptoms are associated does not differ substantially between men and women.     

Symptom Exaggeration and Compensation Seeking Among Combat Veterans with Posttraumatic Stress Disorder

Combat veterans seeking treatment for posttraumatic stress disorder (PTSD) tend to report high levels of psychopathology on self-report instruments. The purpose of the current archival study was to replicate research on the relationships among symptom exaggeration, attempts to obtain compensation, and treatment outcome on the Beck Depression Inventory, the Mississippi Scale for Combat-Related PTSD, and selected MMPI-2 and MCMI-II subscales. Results indicated that symptom exaggeration as defined by an MMPI-2 F-K index over 13 was related to higher scores on all scales examined. Compensation seeking was not related to assessment scores or exaggeration. Neither compensation seeking nor exaggeration was related to treatment outcome. Limitations of the study and implications for future research are discussed.     

Posttraumatic Stress Disorder Symptom Clusters and Perpetration of Intimate Partner Violence: Findings From a U.S. Nationally Representative Sample

Associations between posttraumatic stress disorder (PTSD) and perpetration of intimate partner violence (IPV) have not been extensively studied in nonveteran samples. Secondary analysis was conducted using a nationally representative U.S. sample and limited to those who reported being in a relationship in the past year (N = 25,652). This sample was mostly White (72.0%), the majority had completed high school/ general educational development (GED; 87.8%), about half were female (49.2%), and the mean age was 46.44 years (SD = 15.92). We hypothesized that a diagnosis of PTSD in the past year would be associated with greater perpetration of IPV and that the arousal/reactivity and intrusion symptom clusters would evidence the strongest associations with IPV. Consistent with expectations, a PTSD diagnosis in the past year was associated with greater perpetration of IPV, OR = 2.07, 95% CI [1.89, 2.26]. Among those with a PTSD diagnosis in the past year (n = 1,742), arousal/reactivity symptom cluster scores were associated with greater perpetration of IPV for both men and women, AOR = 1.27, 95% CI [1.11, 1.44]; intrusion symptom cluster scores were associated with perpetration of IPV for men only, AOR = 1.56, 95% CI [1.20, 2.04]; whereas negative cognitions/mood symptom cluster scores were only significant among women, AOR = 1.12, 95% CI [1.01, 1.24]. Results suggested that theoretical and empirical work linking PTSD and perpetration of IPV in military samples extends to the general population.     

Place and Posttraumatic Stress Disorder

Research on traumatic stress has focused largely on individual risk factors. A more thorough understanding of risk factors may require investigation of the contribution of neighborhood context, such as the associations between perceived neighbourhood disorder and social cohesion with reported trauma exposure (yes/no) and posttraumatic stress disorder (PTSD) diagnostic status (past‐year PTSD, remitted). To examine these associations, we used a cross‐sectional analysis of an epidemiological catchment area survey (N = 2,433). Visible cues, indicating a lack of order and social control in the community (neighbourhood disorder), were associated with increased trauma exposure (adjusted odds ratio [AOR] = 1.21, 95% confidence interval [CI] [1.12, 1.31]). For trauma‐exposed individuals, neighbourhood disorder was associated with greater odds of lifetime PTSD (AOR = 1.38, 95% CI [1.10, 1.75]), and the willingness of residents who realize common values to intervene for the common good (social cohesion), was associated with lower likelihood of past‐year PTSD (AOR = 0.64, 95% CI [0.42, 0.97]). For participants with a lifetime diagnosis of PTSD (including past‐year), increased social cohesion was associated with higher odds of remission (AOR = 2.59, 95% CI [1.55, 4.30]). Environmental contexts play a role in the development and progression of PTSD. As such, traumatic stress outcomes may be better understood through a perspective that integrates individual and contextual risk factors.     

Treatment Outcomes for Military Veterans With Posttraumatic Stress Disorder: Response Trajectories by Symptom Cluster

Although effective posttraumatic stress disorder (PTSD) treatments are available, outcomes for veterans with PTSD are relatively modest. Previous researchers have identified subgroups of veterans with different response trajectories but have not investigated whether PTSD symptom clusters (based on a four‐factor model) have different patterns of response to treatment. The importance of this lies in the potential to increase treatment focus on less responsive symptoms. We investigated treatment outcomes by symptom cluster for 2,685 Australian veterans with PTSD. We used Posttraumatic Stress Disorder Checklist scores obtained at treatment intake, posttreatment, and 3‐ and 9‐month follow‐ups to define change across symptom clusters. Repeated measures effect sizes indicated that arousal and numbing symptoms exhibited the largest changes between intake and posttreatment, d_RM = ?0.61 and d_RM = ?0.52, respectively, whereas avoidance and intrusion symptoms showed more modest reductions, d_RM = ?0.36 and d_RM = ?0.30, respectively. However, unlike the other symptom clusters, the intrusions cluster continued to show significant changes between posttreatment and 3‐month follow‐up, d_RM = ?0.21. Intrusion and arousal symptoms also showed continued changes between 3‐ and 9‐month follow‐ups although these effects were very small, d_RM = ?0.09. Growth curve model analyses produced consistent findings and indicated modest initial changes in intrusion symptoms that continued posttreatment. These findings may reflect the longer time required for emotional processing, relative to behavioral changes in avoidance, numbing, and arousal, during the program; they also reinforce the importance of prioritizing individual trauma‐focused therapy directly targeting intrusions as the core component of programmatic treatment.     

Posttraumatic Stress Disorder and Childhood Traumatic Loss: A Secondary Analysis of Symptom Severity and Treatment Outcome

Loss is a commonly experienced traumatic event among children. Although the experience of loss can potentially lead to posttraumatic stress symptoms (PTSS), little is known about PTSS levels after traumatic loss versus other traumatic events. We investigated data from a randomized controlled trial (RCT) on trauma-focused cognitive behavioral therapy (TF–CBT) versus a waitlist condition for children with PTSS. In a secondary analysis, we compared participants who reported traumatic loss as their index event (n = 23) to those who reported the two most frequently reported index events in the RCT: sexual abuse (SA; n = 59) and physical violence (PV; n = 55). The index event was rated according to the participants’ most distressing traumatic event reported on the Clinician-Administered PTSD Scale for Children and Adolescents. Participants who experienced traumatic loss reported fewer PTSS and better general functioning than those who reported SA. A subgroup RCT (n = 19) revealed TF–CBT to be highly effective in reducing PTSS in cases of traumatic loss, d = 1.69. The effect sizes for PTSS indicated that all three trauma groups benefited from TF–CBT. In the waitlist group, PTSS symptoms improved for SA and PV, ds = 0.76 and 0.98, respectively, but not for traumatic loss, d = 0.23. These findings suggest that TF–CBT is a feasible and promising treatment for children who experience PTSS after traumatic loss. The results are limited by the post hoc quality of the analyses and lack of a measure of grief in the RCT.     

Emotion Dysregulation Prospectively Predicts Posttraumatic Stress Disorder Symptom Severity 3 Months After Trauma Exposure

Despite growing evidence in support of emotion dysregulation as a risk factor for the development of posttraumatic stress disorder (PTSD) following trauma exposure, few studies have examined temporal relations between emotion dysregulation and the onset and/or worsening of PTSD symptoms over time. The aim of the present study was to extend research on temporal associations between emotion dysregulation and PTSD in a sample of individuals recruited from hospital emergency departments soon after a traumatic event. Adult participants (N = 85; 62.4% female) completed self-report measures of emotion dysregulation and PTSD symptoms within 2 weeks of experiencing a traumatic event. Symptoms of PTSD were assessed approximately 3 months posttrauma. The results of a hierarchical linear regression analysis demonstrated that the inclusion of emotion dysregulation accounted for a significant amount of unique variance, β = .23, ΔR² = .04, p = .042, in 3-month PTSD symptom severity over and above other risk factors and baseline PTSD symptoms. No specific facet of emotion dysregulation emerged as a significant predictor of 3-month PTSD symptoms when all facets were included on the same step of the model, βs = −.04–.33, ps = .133–.954. These results demonstrate that posttraumatic emotion dysregulation may predict PTSD symptoms 3 months after trauma exposure. These findings are consistent with a growing body of literature that speaks to the relevance of emotional processes to the onset and maintenance of PTSD following exposure to a traumatic event.     

The Sequential Relation Between Changes in Catastrophizing and Changes in Posttraumatic Stress Disorder Symptom Severity

Catastrophizing has been discussed as a cognitive precursor to the emergence of posttraumatic stress disorder (PTSD) symptoms following the experience of stressful events. Implicit in cognitive models of PTSD is that treatment-related reductions in catastrophizing should yield reductions in PTSD symptoms. The tenability of this prediction has yet to be tested. The present study investigated the sequential relation between changes in a specific form of catastrophizing—symptom catastrophizing—and changes in PTSD symptom severity in a sample of 73 work-disabled individuals enrolled in a 10-week behavioral activation intervention. Measures of symptom catastrophizing and PTSD symptom severity were completed at pre-, mid-, and posttreatment assessment points. Cross-sectional analyses of pretreatment data revealed that symptom catastrophizing accounted for significant variance in PTSD symptom severity, β = .40, p < .001, sr = .28 (medium effect size), even when controlling for known correlates of symptom catastrophizing, such as pain and depression. Significant reductions in symptom catastrophizing and PTSD symptoms were observed during treatment, with large effect sizes, ds = 1.42 and 0.94, respectively, ps < .001. Cross-lagged analyses revealed that early change in symptom catastrophizing predicted later change in PTSD symptoms; early changes in PTSD symptom severity did not predict later change in symptom catastrophizing. These findings are consistent with the conceptual models that posit a causal relation between catastrophizing and PTSD symptom severity. The clinical implications of the findings are discussed.     

Posttraumatic Stress Symptom Trajectories Among Children Exposed to Violence

Little research has examined the developmental course of posttraumatic stress symptoms (PTSS) in children. The current study aimed to identify developmental trajectories of PTSS in childhood and to examine predictors of symptom presentation in 1,178 children from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) studies, a consortium of studies focusing on the causes and effects of child maltreatment. Most children had a history of documented reports with Child Protective Services (CPS) and all were identified as living in high‐risk environments. Using group‐based trajectory modeling, 3 unique developmental trajectories were identified: Resilient, Clinical‐Improving (PTSS in the clinical range at baseline then declining over time), and Borderline‐Stable (chronically subclinical PTSS). Children in the Clinical‐Improving group were more likely than children in the Resilient group to have reports of physical abuse (RRR = 1.76), emotional abuse (RRR = 2.55), neglect (RRR = 1.57), and exposure to violence at home and in the community (RRR = 1.04). Children in the Borderline‐Stable group were more likely than children in the Resilient group to have a CPS history of neglect (RRR = 2.44) and exposure to violence at home and in the community (RRR = 1.04). Many children living in high‐risk environments exhibit resilience to PTSS, but exposure to witnessed violence and neglect appear to put children at chronic risk for poor adjustment. These children may require more intensive, integrated clinical services that attend to multiple adverse experiences.     

An Extension of the Perseverative Cognition Hypothesis to Posttraumatic Stress Disorder Symptomatology: Cardiovascular Recovery in Relation to Posttraumatic Stress Disorder Severity and Cognitive Appraisals of Stress

Beyond the construct of cardiovascular reactivity, the measurement of cardiovascular recovery from stress represents an important index of exaggerated physiological arousal and disease risk. Cardiovascular recovery in posttraumatic stress disorder (PTSD) has not received adequate attention. The present study examined whether cardiovascular recovery following an oral speaking stressor was associated with the severity of PTSD symptoms, and whether cognitive stress appraisals of threat and challenge were significantly associated with PTSD severity and recovery. The sample consisted of 50 trauma‐exposed civilian women ranging from 19 to 49 years of age (M = 30.9, SD = 7.8). The PTSD severity indices were quantified based on structured interview. Cardiovascular recovery was assessed at two posttask time points as percentage return to baseline; the recovery measures consisted of impedance cardiography‐derived cardiac output (CO) and total peripheral resistance (TPR), heart rate and blood pressure. Total PTSD severity was associated with less CO recovery, r = ?.39, p = .006; this effect was similar across PTSD symptom categories, with significant correlations ranging from r = ?.30 to r = ?.44. However, only PTSD severity in the avoidance cluster was associated with less TPR recovery, r = ?.29, p = .047. Total PTSD severity was associated with greater threat appraisal, r = .30, p = .035, and greater threat appraisal was associated with less CO recovery, r = ?.33, p = .019. Results partially support the theory that greater PTSD severity and cognitive appraisals of threat contribute to less cardiovascular recovery when confronted with a stress‐inducing situation.     

Thinking About Trauma: The Unique Contributions of Event Centrality and Posttraumatic Cognitions in Predicting PTSD and Posttraumatic Growth

Researchers have been investigating possible pathways to negative (posttraumatic stress disorder [PTSD]) and positive (posttraumatic growth [PTG]) reactions to trauma in recent decades. Two cognitive constructs, event centrality and posttraumatic cognitions, have been implicated to uniquely predict PTSD symptoms in an undergraduate sample. The current pair of studies attempted to (a) replicate this finding in an undergraduate sample, (b) replicate this finding in a treatment‐seeking sample, and (c) explore whether these 2 cognitive constructs uniquely predict PTG. The first study consisted of 500 undergraduate students, whereas the second study consisted of 53 treatment‐seeking clients. Results indicated both posttraumatic cognitions and event centrality uniquely predicted PTSD in the undergraduate (R² = .46) and treatment‐seeking samples (R² = .46). These 2 cognitive constructs also predicted PTG in the undergraduate sample (R² = .37), but only posttraumatic cognitions predicted PTG in the treatment‐seeking sample (R² = .17). The relationships between PTG varied, depending on whether PTG for high or low event‐centrality events were assessed. The original model was supported within both populations for PTSD symptoms, and its extension to PTG was supported within the treatment‐seeking sample. These results underscore cognitive and narrative factors in the progression of trauma.     

The Complex Trauma Inventory: A Self‐Report Measure of Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder

The work group revising the criteria for trauma‐related disorders in the International Classification of Diseases (ICD‐11) made several changes. Specifically, they simplified the criteria for posttraumatic stress disorder (PTSD) and added a new trauma disorder called complex PTSD (CPTSD). These proposed changes to taxonomy require new instruments to assess these novel constructs. We developed a measure of PTSD and CPTSD (the Complex Trauma Inventory; CTI) according to the proposed domains, creating several items to assess each domain. We examined the factor structure of the CTI in two separate samples of diverse college students (n ₁ = 391; n ₂ = 391) who reported exposure to at least one traumatic event and at least occasional functional impairment. After reducing the original 50 items in the item pool to 20 items, confirmatory factor analyses supported two highly correlated second‐order factors—PTSD and disturbances in self‐organization (DSO)—with PTSD (i.e., reexperiencing, avoidance, sense of threat) and DSO (i.e., affect dysregulation, negative self‐concept, and disturbances in relationships), each loading on three of the six ICD‐11‐consistent first‐order factors, root mean square error of approximation (RMSEA) = .056, 95% confidence interval (CI) [.048, .064], comparative fit index (CFI) = .956, Tucker‐Lewis index (TLI) = .948, standardized root mean square residual (SRMR) = .043, Bayesian information criterion (BIC) = 641.55, χ²(163) = 361.02, p < .001. Internal consistencies for PTSD and DSO were good to excellent (Cronbach's αs = .89 to .92). Supplementary analyses supported the gender invariance of the CFA model, as well as convergent and discriminant validity of the CTI. The validity of the CTI supports the distinction between CPTSD and PTSD. Moreover, the CTI will assist clinicians with diagnosis, symptom tracking, treatment planning, and assessing outcomes.     

Posttraumatic Growth After MDMA-Assisted Psychotherapy for Posttraumatic Stress Disorder

3,4-Methylenedioxymethamphetamine (MDMA)–assisted psychotherapy for posttraumatic stress disorder (PTSD) has been shown to significantly reduce clinical symptomatology, but posttraumatic growth (PTG), which consists of positive changes in self-perception, interpersonal relationships, or philosophy of life, has not been studied with this treatment. Participant data (n = 60) were pooled from three Phase 2 clinical studies employing triple-blind crossover designs. Participants were required to meet DSM-IV-R criteria for PTSD with a score higher than 50 on the Clinician-Administered PTSD Scale (CAPS-IV) as well as previous inadequate response to pharmacological and/or psychotherapeutic treatment. Data were aggregated into two groups: an active MDMA dose group (75–125 mg of MDMA; n = 45) or placebo/active control (0–40 mg of MDMA; n = 15). Measures included the Posttraumatic Growth Inventory (PTGI) and the CAPS-IV, which were administered at baseline, primary endpoint, treatment exit, and 12-month follow-up. At primary endpoint, the MDMA group demonstrated more PTG, Hedges’ g = 1.14, 95% CI [0.49, 1.78], p < .001; and a larger reduction in PTSD symptom severity, Hedges’ g = 0.88, 95% CI [−0.28, 1.50], p < .001, relative to the control group. Relative to baseline, at the 12-month follow-up, within-subject PTG was higher, p < .001; PTSD symptom severity scores were lower, p < .001; and two-thirds of participants (67.2%) no longer met criteria for PTSD. MDMA-assisted psychotherapy for PTSD resulted in PTG and clinical symptom reductions of large-magnitude effect sizes. Results suggest that PTG may provide a new mechanism of action warranting further study.