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Background: The WHO International Classification of Diseases, 11th version (ICD-11), includes a trauma-related diagnosis of complex posttraumatic stress disorder (CPTSD) distinct from posttraumatic stress disorder (PTSD). Results from previous studies support the validity of this distinction. However, no studies to date have evaluated the ICD-11 model of PTSD and CPTSD in treatment-seeking military veterans. Objective: To determine if the distribution of symptoms in treatment-seeking Danish veterans was consistent with the ICD-11 PTSD and CPTSD symptom profiles. Based on previous studies, we hypothesized that separate classes representing PTSD and CPTSD would be found that membership of a potential CPTSD-class would be predicted by a larger number of childhood traumas, and that a potential distinction between PTSD and CPTSD would be supported by differences in sociodemographic and functional outcomes. Method: Participants (N = 1,541) were formerly deployed Danish soldiers who completed proxy measures of ICD-11 PTSD and disturbances in self-organization (DSO) symptoms, along with self-report measures of traumatic life events, prior to starting treatment at the Military Psychology Department of the Danish Defence. Results: All hypotheses were supported. Latent profile analysis (LPA) revealed separate classes representing PTSD and CPTSD. In comparison to the PTSD-class, membership of the CPTSD-class was predicted by more childhood traumatic experiences, and members of this class were more likely being single/divorced/widowed and more likely to use psychotropic medication. Besides a PTSD-class and a CPTSD-class, LPA revealed a Low Symptoms-class, a Moderate DSO-class, a Hyperarousal-class, and a High DSO-class, with clear differences in functional outcomes between classes. Conclusion: Findings replicate previous studies supporting the distinction between ICD-11 PTSD and CPTSD. In addition, there seem to be groups of treatment-seeking military veterans that do not fulfil full criteria for a trauma-related disorder. Further research should explore subsyndromal PTSD and CPTSD profiles in veterans and other populations. * The present study evaluated the ICD-11 model of PTSD and CPTSD in a sample of treatment-seeking military veterans. * Latent profile analysis revealed a CPTSD-class, a PTSD-class, a High DSO-class, a Hyperarousal-class, a Moderate DSO-class, and a Low Symptoms-class. * CPTSD is a more debilitating condition than PTSD. * Compared to the PTSD-class, membership of the CPTSD-class was predicted by increased exposure to childhood traumatic experiences.

Background: While empirical support for the ICD-11 distinction between posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) is growing, empirical research into the ICD-11 model of CPTSD in military populations is scarce and inconsistent. Objective: To replicate a study from our own group identifying distinct classes based on CPTSD symptoms using the International Trauma Questionnaire (ITQ) and to identify predictors and functional outcomes associated with a potential distinction between PTSD and CPTSD. Method: Formerly deployed treatment-seeking Danish soldiers (N = 294) completed the ITQ and self-report measures of traumatic life events prior to treatment. Latent profile analysis (LPA) was used to extract classes based on CPTSD symptoms. Results: LPA revealed four classes; (1) high CPTSD symptoms ('CPTSD', 28.7%); (2) high PTSD symptoms and lower DSO symptoms ('PTSD', 23.5%); (3) high DSO symptoms ('DSO', 17.3%); and (4) low symptoms ('Low Symptoms', 30.5%). In comparison to the PTSD-class, CPTSD-class membership was not predicted by traumatic events in adult life and in childhood. The CPTSD class was more often single/divorced/widowed compared to the PTSD class. Moreover, the CPTSD class more often used psychotropic medicine compared to the DSO-class and Low Symptoms-class. Conclusion: Using the ITQ, this study yields empirical support for the ICD-11 model of CPTSD within a clinical sample of veterans. The results replicate findings from our previous study that also identified distinct profiles of ICD-11 PTSD and CPTSD. The study identified separate classes representing CPTSD, PTSD, DSO and Low Symptoms in treatment-seeking military veterans based on the International Trauma Questionnaire. CPTSD is a more debilitating condition than PTSD. Findings replicate a previous LPA study of treatment-seeking Danish veterans.

The International Trauma Questionnaire (ITQ) is a self-report measure for post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD), corresponding to the diagnostic criteria in the International Classification of Diseases, 11th Revision (ICD-11). A 12-item version of the ITQ based on samples from English-speaking countries has been presented, and the wider generalizability to other languages needs to be examined. The current study examines the psychometric properties of scores from a longer, preliminary 22-item version of the ITQ and the current reduced 12-item version by means of generalizability theory (G-theory) and confirmatory factor analysis (CFA). The 22-item version of the ITQ was translated into Norwegian and administered to patients in two trauma treatment trials (total N = 202). A generalizability study was used to investigate the psychometric properties of scores reflecting CPTSD. G-theory was also used to investigate alternative measurement designs to optimize the sufficient number of items that provide acceptable generalizability and dependability of scores. Model fit to the theoretical factor structure was then examined by CFA, both for the 22-item version and for the 12-item version of the ITQ. The two subscales negative self-concept and relational disturbances had acceptable generalizability coefficients. We found substantial measurement error related to affective dysregulation, mainly attributable to affective hyperactivation. A latent factor structure model with two separate affective dysregulation factors: hyperactivation and deactivation, represented the data well in the 22-item version. The proposed confirmatory structure model for the 12-item short form did not converge in the CFA. This study supports the applicability of the ITQ in a non-English-speaking country and provides support for the validity of the Norwegian translation. Further research is needed to improve the psychometric properties of the affective dysregulation subscale.

Background: The ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD diagnoses have been examined in several studies using the International Trauma Questionnaire (ITQ). The cross-cultural validity of the ITQ has not previously been studied using item responses theory methods focused on the issue of equal item functioning and thus comparability of scores across language groups. Objective: To investigate the cross-cultural validity of the ITQ scales considering specifically local independence of items and differential item functioning (DIF) in a cross-cultural sample of refugees. Method: Data from 490 treatment-seeking refugees were included, covering Danish, Arabic, and Bosnian languages and different levels of interpreter-assisted administration. Rasch and graphical log-linear Rasch models were used. Results: There was strong local dependence among items from the same symptom clusters in the PTSD and disorders in self-organization (DSO) scales, except between affective dysregulation items. Weak local dependence was discovered between an item from the affective dysregulation cluster and an item from the disturbed relationship cluster. There was no evidence of DIF related to language or interpreter assistance. There was evidence of DIF for two PTSD items relative to gender and time since the traumatic event. The targeting of the scales to the study population was not optimal. Reliability varied from 0.55 to 0.78 for subgroups. Conclusions: The PTSD and the DSO scales have stable psychometric properties across the Danish, Arabic, and Bosnian language versions and different levels of assisted administration. Scores are comparable across these groups. However, DIF relative to gender and time since trauma introduces considerable measurement bias. DIF-adjusted summed scale scores or estimated person parameters should be used to avoid measurement bias. Future research should investigate whether scales including more and/or alternative items that require higher levels of PTSD and DSO to be endorsed will improve targeting and measurement precision for refugee populations. A first cross-cultural validity study of the ITQ using IRT. PTSD and DSO subscales functioned invariantly across Danish, Arabic, and Bosnian, and also across degrees of interpreter assistance. Two PTSD items did not function invariantly across gender and time since trauma. The Danish, Arabic, and Bosnian ITQ can be used for screening treatment-seeking refugees, taking into account the item bias in the PTSD subscale, and suboptimal targeting and reliability, which require extensions or modification of items.

Este estudio presenta los resultados preliminares de la evaluación neuropsicológica de la atención y la memoria en un grupo de 35 niños, niñas y adolescentes, víctimas del conflicto armado en Colombia que presentan síntomas de estrés postraumático y/o depresión. Los datos forman parte de una investigación más amplia que evalúa los efectos neuropsicológicos del trauma psicológico en este grupo etáreo. Los resultados permiten concluir que los participantes en su conjunto presentan puntajes más bajos en atención y memoria y que dicho efecto tiende a acentuarse en la adolescencia. Dadas las características de la muestra analizada, los autores consideran que tanto los síntomas neuropsiquiátricos como las conductas inadecuadas y el bajo rendimiento cognitivo, podrían tener un factor común asociado a las situaciones de violencia que no ha sido suficientemente analizado. Palabras claves: Atención, Memoria, Trastorno de Estrés Postraumático (TEPT), Depresión, Evaluación Neuropsicológica. This paper presents the preliminary results of a neuropsychological assessment of attention and memory carried out to a group of 35 children and adolescents that were victims of the armed conflict in Colombia; who presented symptoms of PTSD and / or depression. The data belong to a larger study that evaluates the neuropsychological effects of psychological trauma in a particular age group. The results suggest that participants experience lower attention and memory scores and it might increase during adolescence years. According to the characteristics of the sample, the authors consider that the neuropsychological symptoms, the inadequate behavior, and low cognitive performance might have a common component associated to situations of violence; which have not been further analyzed. Keywords: Attention, Memory, Post-Traumatic Stress Disorders (PTSD), Depression, Neuropsychological Assessment.

Background: Despite the established efficacy of psychological therapies for post-traumatic stress disorder (PTSD) there has been little systematic exploration of dropout rates. Objective: To ascertain rates of dropout across different modalities of psychological therapy for PTSD and to explore potential sources of heterogeneity. Method: A systematic review of dropout rates from randomized controlled trials (RCTs) of psychological therapies was conducted. The pooled rate of dropout from psychological therapies was estimated and reasons for heterogeneity explored using meta-regression. Results:: The pooled rate of dropout from RCTs of psychological therapies for PTSD was 16% (95% CI 14-18%). There was evidence of substantial heterogeneity across studies. We found evidence that psychological therapies with a trauma-focus were significantly associated with greater dropout. There was no evidence of greater dropout from therapies delivered in a group format; from studies that recruited participants from clinical services rather than via advertisements; that included only military personnel/veterans; that were limited to participants traumatized by sexual traumas; that included a higher proportion of female participants; or from studies with a lower proportion of participants who were university educated. Conclusions: Dropout rates from recommended psychological therapies for PTSD are high and this appears to be particularly true of interventions with a trauma focus. There is a need to further explore the reasons for dropout and to look at ways of increasing treatment retention.

ICD-11 distinguishes post-traumatic stress disorder (PTSD) from complex PTSD (CPTSD) by introducing disturbances in self-organization (DSO) as a defining feature of CPTSD. Accurate identification of these conditions requires instruments aligned with the ICD-11 framework. The International Trauma Questionnaire (ITQ) was specifically developed to assess PTSD and CPTSD from ICD-11, but the Serbian version has not yet been validated in a clinical population. This study aimed to evaluate the psychometric properties of the Serbian version of the ITQ in a clinical sample, including its factor structure, reliability, and concurrent and discriminant validity in relation to trauma exposure, childhood adversity, emotional distress, emotional dysregulation, dissociation, suicidality, and quality of life. A total of 199 adult psychiatric patients at the Institute of Mental Health in Belgrade completed the ITQ, Life Events Checklist (LEC-5), Impact of Event Scale-Revised (IES-R), Adverse Childhood Experiences Questionnaire (ACE-Q), Depression Anxiety Stress Scales (DASS-21), Difficulties in Emotion Regulation Scale (DERS), Brief Dissociative Experiences Scale (DES-B), Suicidal Ideation Attributes Scale (SIDAS), and the Manchester Short Assessment of Quality of Life (MANSA). Confirmatory factor analysis was used to compare competing ICD-11 models of PTSD and CPTSD. Both the six-factor correlated model and the second-order PTSD-DSO model showed good fit, whereas the single-factor model of CPTSD was not supported. CPTSD was more common than PTSD (25.7% vs. 18.7%) and was associated with higher levels of emotional dysregulation, dissociation, suicidality, and poorer quality of life. PTSD symptoms were more strongly associated with trauma-related distress, while DSO showed stronger associations with depression, anxiety, and negative self-concept. The Serbian version of the ITQ demonstrates good reliability, validity, and clinical utility for the assessment of PTSD and CPTSD according to ICD-11. Its use may improve diagnostic differentiation and support more targeted trauma-informed treatment in Serbian clinical settings.

The human circadian system creates and maintains cellular and systemic rhythmicity essential for the temporal organization of physiological processes promoting homeostasis and environmental adaptation. Sleep disruption and loss of circadian rhythmicity fundamentally affects master homeostasic regulating systems at the crossroads of peripheral and central susceptibility pathways, similar to acute or chronic stress and, thus, may play a central role in the development of stress-related disorders. Direct and indirect human and animal PTSD research accordingly suggests circadian-system-linked sleep, neuroendocrine, immune, metabolic and autonomic dysregulation, linking circadian misalignment to PTSD pathophysiology. Additionally, there is evidence that sleep and circadian disruption may represent a vital pre-existing risk factor in the prediction of PTSD development, while sleep-related symptoms are among the most prominent in trauma-associated disorders. These facts may represent a need for a shift towards a more chronobiological understanding of traumatic sequel and could support better prevention, evaluation and treatment of sleep and circadian disruption as first steps in PTSD management. In this special issue, we highlight and review recent advances from human sleep and chronobiological research that enhances our understanding of the development and maintenance of trauma-related disorders. Sleep and circadian disruption may be crucially involved in the development and maintenance of traumatic-stress-related disorders. There is a need for a chronobiological shift towards better evaluation, understanding and treatment of traumatic stress sequel.

Background: Mobile health applications (apps) are considered to complement traditional psychological treatments for Post-Traumatic Stress Disorder (PTSD). However, the use for clinical practice and quality of available apps is unknown. Objective: To assess the general characteristics, therapeutic background, content, and quality of apps for PTSD and to examine their concordance with established PTSD treatment and self-help methods. Method: A web crawler systematically searched for apps targeting PTSD in the British Google Play and Apple iTunes stores. Two independent researchers rated the apps using the Mobile App Rating Scale (MARS). The content of high-quality apps was checked for concordance with psychological treatment and self-help methods extracted from current literature on PTSD treatment. Results: Out of 555 identified apps, 69 met the inclusion criteria. The overall app quality based on the MARS was medium (M = 3.36, SD = 0.65). Most apps (50.7%) were based on cognitive behavioural therapy and offered a wide range of content, including established psychological PTSD treatment methods such as processing of trauma-related emotions and beliefs, relaxation exercises, and psychoeducation. Notably, data protection and privacy standards were poor in most apps and only one app (1.4%) was scientifically evaluated in a randomized controlled trial. Conclusions: High-quality apps based on established psychological treatment techniques for PTSD are available in commercial app stores. However, users are confronted with great difficulties in identifying useful high-quality apps and most apps lack an evidence-base. Commercial distribution channels do not exploit the potential of apps to complement the psychological treatment of PTSD.

Background: Humans have an evolutionary need for a well-preserved internal 'clock', adjusted to the 24-hour rotation period of our planet. This intrinsic circadian timing system enables the temporal organization of numerous physiologic processes, from gene expression to behaviour. The human circadian system is tightly and bidirectionally interconnected to the human stress system, as both systems regulate each other's activity along the anticipated diurnal challenges. The understanding of the temporal relationship between stressors and stress responses is critical in the molecular pathophysiology of stress-and trauma-related diseases, such as posttraumatic stress disorder (PTSD). Objectives/Methods: In this narrative review, we present the functional components of the stress and circadian system and their multilevel interactions and discuss how traumatic stress can affect the harmonious interplay between the two systems. Results: Circadian dysregulation after trauma exposure (posttraumatic chronodisruption) may represent a core feature of trauma-related disorders mediating enduring neurobiological correlates of traumatic stress through a loss of the temporal order at different organizational levels. Posttraumatic chronodisruption may, thus, affect fundamental properties of neuroendocrine, immune and autonomic systems, leading to a breakdown of biobehavioral adaptive mechanisms with increased stress sensitivity and vulnerability. Given that many traumatic events occur in the late evening or night hours, we also describe how the time of day of trauma exposure can differentially affect the stress system and, finally, discuss potential chronotherapeutic interventions. Conclusion: Understanding the stress-related mechanisms susceptible to chronodisruption and their role in PTSD could deliver new insights into stress pathophysiology, provide better psychochronobiological treatment alternatives and enhance preventive strategies in stress-exposed populations. * The human circadian and stress system are both essential for biobehavioural regulation with numerous reciprocal interaction. * Posttraumatic chronodisruption (i.e., circadian dysregulation after trauma) represents a core feature of PTSD, mediating neurobiological correlates of trauma through multilevel temporal order loss.