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Trauma-focused cognitive behavioural therapy such as prolonged exposure is considered firsthand choice for treatment of posttraumatic stress disorder (PTSD) but is seldom available in regular care. Digital therapy is proposed to bridge this gap, but its effectiveness for severe and complex PTSD is uncertain. The primary objective of the current study was to examine the feasibility, acceptability, and preliminary effects of digital therapist-guided prolonged exposure (Huddinge Online Prolonged Exposure; HOPE). Thirty participants with moderate to severe PTSD, with the majority self-reporting complex PTSD symptoms, received HOPE over a ten-week period. Eighty percent of participants had been diagnosed with other psychiatric comorbidity by a mental health professional. Primary outcome was the feasibility and acceptability of treatment. Participants were repeatedly assessed using clinician- and self-rated outcome measures at baseline, during the treatment period, post-treatment, and at 1-month and 6-month follow-ups to estimate preliminary treatment effects. The Clinician Administered PTSD Scale version 5 (CAPS-5), administered by independent assessors, evaluated PTSD symptom severity. : HOPE proved feasible and effective, delivering evidence-based treatment content in a psychiatric outpatient setting with reduced therapist time. The treatment was well-tolerated, with no severe adverse events and a 17% dropout rate. Sixty-four percent completed the exposure-based portion of the treatment, and overall satisfaction measured by the Client Satisfaction Questionnaire was moderate. Furthermore, significant reductions in PTSD symptoms as assessed with the CAPS-5 (Cohen's  = 1.30 [95% CI -1.79 to -0.82]) at the primary endpoint 1 month which were sustained at the 6-month follow up. Altogether, this study indicate feasibility of treating severe and complex PTSD through a digital PE intervention, thereby building upon and extending previous research findings. Large-scale controlled trials are needed to further validate the specific effect and long-term benefits of HOPE. ClinicalTrials.gov identifier: NCT05560854.

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.

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.

There is controversy over the extent to which the new International Classification of Diseases (ICD-11) diagnosis of complex posttraumatic stress disorder (CPTSD) is distinct from posttraumatic stress disorder (PTSD). This study aimed to conduct the first investigation of distinctive neural processes during threat processing in CPTSD relative to PTSD. This cross-sectional functional magnetic resonance study included 99 participants who met criteria for PTSD (PTSD = 32, CPTSD = 28) and 39 trauma-exposed controls. PTSD was assessed with the Clinician-Administered PTSD Scale (CAPS). CPTSD was assessed with an adapted version of the International Trauma Questionnaire. Neural responses were measured across the brain while threat or neutral faces were presented at both supraliminal and subliminal levels. During supraliminal presentations of threat stimuli, there was greater bilateral insula and right amygdala activation in CPTSD participants relative to PTSD. Reduced supraliminal right dorsolateral prefrontal cortex activation and increased subliminal amygdala and insula activation were observed as common dysfunction for both CPTSD and PTSD groups relative to trauma controls. There were no significant differences in terms of subliminal presentations and no differences in functional connectivity. Dissociative responses were positively associated with right insula activation (r = 0.347, p < 0.01). These results provide the first evidence of distinct neural profiles of CPTSD and PTSD during threat processing. The observation of increased insula and right amygdala activation in CPTSD accords with the proposal that CPTSD is distinguished from PTSD by disturbances in emotion regulation and self-concept.

Background Posttraumatic stress disorder is a mental health condition outlining psychological sequelae experienced after encountering a traumatic event. Complex posttraumatic stress disorder, however, is increasingly recognized as being distinct from posttraumatic stress disorder. This is due to an observed variation from what is traditionally defined as a traumatic event, as well as greater heterogeneity in its presentation. Cultural factors may also influence definitions of traumatic events and heterogeneity in presentation. Case presentation In this case, a 27-year-old Malay male presented with a 9-year history of obsessive–compulsive symptoms of predominantly sexual content. Although initially treated as obsessive–compulsive disorder, persistent negative self-image and features of complex posttraumatic stress disorder surfaced in the course of therapy, stemming from a culturally-related punitive upbringing as well as bullying by peers. He responded markedly well to trauma-based psychotherapy and remains well at time of writing. Conclusion A diagnosis of complex posttraumatic stress disorder should be considered in the individual who presents with mental health difficulties, particularly if the individual’s symptoms are atypical to classical diagnostic criteria or the individual does not respond to conventional treatment. It is important to note the role of cultural background—this may give rise to unique presentations of complex posttraumatic stress disorder, and the triggering events may not be traditionally defined as traumatic. Cultural background may also potentially inform treatment and future prevention strategies for complex posttraumatic stress disorder.

Background The number of refugees worldwide is at an all-time high with many being exposed to potentially traumatic events and the loss of loved ones. The 11 th revision of the International Statistical Classification of Diseases and Related Health Problems now includes prolonged grief disorder and complex posttraumatic stress disorder and revised criteria for posttraumatic stress disorder. An overview of these stress-related disorders among people who have become refugees is therefore needed. Consequently, we conducted a systematic review to determine prevalence rates, comorbidities, and associated factors for each of the disorders. Method We systematically searched PubMed, Web of Science, and PsycArticles to identify studies that reported prevalence rates, predictors or associated factors, and/or comorbid mental disorders for either (1) prolonged grief disorder, (2) posttraumatic stress disorder, or (3) complex posttraumatic stress disorder among refugees. The selection process followed the PRISMA guidelines. Results A total of 36 studies met the inclusion criteria. Most of the studies were of high quality. There was substantial variation in prevalence rates by disorder, with prolonged grief ranging from 6 to 54%, posttraumatic stress disorder ranging from 0.4 to 80%, and complex posttraumatic stress disorder ranging from 3 to 74.6%. Pooled prevalence for posttraumatic stress disorder was estimated at 29.8% in treatment seeking samples and 9.92% in population samples. For complex posttraumatic stress disorder, it was estimated at 57.4% in treatment seeking samples and 7.8% in population samples. Posttraumatic stress disorder was among the most frequent comorbidities for prolonged grief disorder while depressive symptoms were the most frequently occurring co-morbidity across all three disorders. Sociodemographic variables, trauma exposure, and loss characteristics were associated with higher symptom severity. Postmigration living difficulties played an important role in prolonged grief and complex posttraumatic stress disorder. Conclusion The review revealed substantial differences in prevalence rates between the three studied disorders but underscored a very high prevalence of ICD-11 stress-related disorders among refugees. The identified associated factors point to subgroups that may be particularly at risk and establishes a foundational basis for targeted interventions and potential policy changes. Future research should incorporate longitudinal investigations and emphasize culturally sensitive assessments.

Individuals with higher resilient coping may manage war-related trauma better than individuals with lower resilient coping. If so, resilient coping may weaken the relationship between war trauma and posttraumatic stress disorders. This study aimed to investigate the role of resilient coping in moderating the associations between cumulative war trauma exposure and ICD-11 posttraumatic stress disorders during war. This cross-sectional study included N = 851 Ukrainian students living in the Ukraine between December 2022 and January 2023 during the Russian-Ukrainian war. We tested a model in which resilient coping was specified as a moderator of the effect of war-related cumulative trauma exposure (Harvard Trauma Questionnaire-R) on ICD-11 posttraumatic stress disorder (PTSD), and disturbances in self-organization (DSO) symptom levels (International Trauma Questionnaire-R), respectively. We used Structural Equation Modeling and controlled our analysis for previous trauma exposure, gender, years of study, and level of income. In contrast to our hypothesis, the level of resilient coping did not moderate the effect of cumulative war trauma exposure on PTSD and DSO symptom levels. Instead, we found a strong direct effect of the level of resilient coping on PTSD and DSO symptom levels. Resilient coping may directly affect the level of PTSD and DSO symptoms but may not weaken the association between trauma exposure and posttraumatic stress disorders during war. •Cumulative war trauma was directly associated with ICD-11 (complex) symptoms of posttraumatic stress disorder, regardless of the degree of resilient coping.•Resilient coping was directly negatively associated with symptoms of (complex) posttraumatic stress disorder.•Evidence-based interventions to strengthen resilient coping may reduce the (complex) symptoms of posttraumatic stress disorder during war.

: Complex posttraumatic stress disorder (cPTSD) was recently added to the ICD-11. Refugees might be particularly vulnerable to develop this disorder, due to key risk factors including trauma history, comorbid symptoms, and post-migration stressors. However, most prevalence estimates rely on self-report questionnaires, which are less reliable than clinical interviews. This study aimed to assess PTSD and cPTSD prevalence in treatment-seeking refugees using clinician ratings, and to examine risk factors influencing diagnostic status and symptom severity. :  = 104 treatment-seeking refugees were assessed for cPTSD and PTSD , as well as symptom severity and single symptom endorsement using a new clinical interview, the Complex PTSD Item Set Additional to the CAPS. Trauma history, comorbid symptoms (dissociation, sleep problems, somatic symptoms, anxiety, depression, social impairment), and post-migration stressors were investigated as predictors for cPTSD diagnostic status and symptom severity using Wilcoxon Rank sum tests, logistic and linear regression. : Prevalences for cPTSD and PTSD were 14.42% (  = 15) and 63.46% (  = 66), respectively. Participants with and without cPTSD did not differ regarding the frequency of traumatic events experienced. However, cPTSD symptom severity was significantly positively associated with the frequency of experienced traumatic events. In regression analyses, comorbid symptoms were significantly associated with cPTSD diagnostic status and symptom severity with depressive symptoms being a significant predictor. Post-migration stressors were associated with cPTSD diagnostic status and symptom severity, and the perception of the present financial situation was a significant predictor for cPTSD severity. : The prevalence of cPTSD was relatively low in this refugee sample. This discrepancy to earlier prevalence estimates could be due to the assessment since we used a clinical interview instead of a self-report questionnaire. More investigations into cPTSD diagnostic assessments are needed, and clinical interviews should be used more often.

Background: Perceived social support (PSS) is one of the most important risk factors for the onset and maintenance of posttraumatic stress disorder (PTSD) symptoms, however the relationship between PSS and Complex PTSD (CPTSD) is unknown. The evidence-base for CPTSD treatment is currently lacking, though increasingly important given the recent publication of the ICD-11, which now allows for a formal diagnosis of CPTSD. Objective: This research aims to develop understanding of the relationship between PSS and CPTSD with a view to informing the development of new and existing treatments. Method: A cross-sectional study was undertaken with 246 individuals recruited to the National Centre for Mental Health (NCMH) cohort. Measures of PSS and PTSD/CPTSD were undertaken with this clinical sample and linear and logistic regression were conducted to assess for associations between PSS and the PTSD symptom clusters of DSM-5 and ICD-11, and to explore the predictive utility of any PSS association on the likelihood of a CPTSD presentation. Results: It was found that individuals with a presentation of CPTSD tend to exhibit lower levels of PSS, compared with individuals not presenting with CPTSD, and lower PSS had a statistically significant unique association with the likelihood of presenting with CPTSD. Conclusions: Intervention aiming to improve PSS could be particularly helpful for some individuals with CPTSD, especially those with disturbances in relationships, and there is opportunity to develop skills training within a phase-based approach to treatment that targets factors related to PSS. * Individuals with a presentation of Complex Posttraumatic Stress Disorder (CPTSD) tend to exhibit particularly low levels of perceived social support (PSS), compared with individuals not presenting with CPTSD.* Lower PSS was found to have a statistically significant unique association with the likelihood of presenting with CPTSD.* Intervention aiming to improve PSS could be particularly helpful for some individuals with CPTSD, especially those with disturbances in relationships.

This study assessed the prevalence rates, construct validity, predictors, and psychosocial factors linked to ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD), as assessed by the (ITQ) in a German-speaking sample of Swiss older adults. Participants were  = 1526 older adults aged 65+ (  = 72.34;  = 6.20 years; age range = 65-95; female = 72.0%). Confirmatory factor analysis (CFA) tested alternative models of the latent structure of the ITQ. Risk factors and psychological outcomes associated with the ITQ subscales were also examined. From the total sample, 86.2% had experienced at least one potentially traumatic event (PTE), with a median of three PTEs per person. Probable PTSD and CPTSD prevalence was 0.4% and 2.4%, respectively. CFA results indicated that a two-factor second-order model best captured the latent structure of the ITQ. Female gender and specific traumas, such as physical and sexual assault, were uniquely associated with PTSD. Fewer, non-specific factors were linked to disturbances in self-organization (DSO; encompassing affective dysregulation, a negative self-view, and difficulties in relationships). The PTSD and CPTSD factors were significantly associated with loneliness, anxiety, depression, and well-being. Results found that despite high trauma exposure among Swiss older adults, the prevalence of ICD-11 PTSD and CPTSD was low, with no significant gender differences. A two-factor second-order model provided the best fit for the ITQ. These findings indicate significant trauma exposure in Swiss older adults and the need for targeted interventions that address the trauma-specific and associated psychosocial challenges (i.e. loneliness, anxiety, depression, well-being) facing older adults.