Complex Posttraumatic Stress Disorder: An Investigation Using Factor Mixture Modeling

Abstract

It has long been established that the experience of traumatic events can result in pathological distress. Some of these reactions, such as hyperarousal or the avoidance of trauma-related cues, are recognized as prototypical stress-response symptoms and have been incorporated into the diagnostic criteria for posttraumatic stress disorder (PTSD). However, the classic symptoms of PTSD are argued to be too limiting in certain cases, as trauma survivors also exhibit symptoms such as emotion dysregulation, negative self-concept, and interpersonal problems. Thus, researchers have suggested that these additional symptoms, which remain absent from the PTSD criteria, represent a distinct diagnosis referred to as complex posttraumatic stress disorder (CPTSD). To date, the relationship between PTSD and CPTSD remains unclear and remains the subject of considerable debate, owing primarily to ambiguity surrounding the definition of CPTSD and methodological limitations of research in this area. In the present study, PTSD and CPTSD were examined using factor mixture modeling, in a trauma-exposed sample of 347 Amazon Mechanical Turk workers. Items from the PTSD Checklist for DSM-5, Patient Health Questionnaire – 4, Rosenberg Self-esteem Scale, and Interpersonal Needs Questionnaire – Revised served as indicators for the symptoms of CPTSD. Results supported a two-factor/three-class solution, including Low Symptoms, Moderate Symptoms, and High Symptoms classes, characterized by differences in symptom severity across the PTSD and additional CPTSD symptoms and not by distinct psychopathological profiles. The implications of these findings for the classification of trauma-related disorders are discussed.