Does requiring trauma exposure affect rates of ICD-11 PTSD and complex PTSD? Implications for DSM–5.
Open accessAbstract
OBJECTIVE: There is little evidence that posttraumatic stress disorder (PTSD) is more likely to follow traumatic events defined by Criterion A than non-Criterion A stressors. Criterion A events might have greater predictive validity for International Classification of Diseases (ICD)-11 PTSD, which is a condition more narrowly defined by core features. We evaluated the impact of using Criterion A, an expanded trauma definition in line with ICD-11 guidelines, and no exposure criterion on rates of ICD-11 PTSD and Complex PTSD (CPTSD). We also assessed whether 5 psychologically threatening events included in the expanded definition were as strongly associated with PTSD and CPTSD as standard Criterion A events. METHOD: = 1,020) completed self-report measures. RESULTS: Most participants were trauma-exposed based on Criterion A (82%) and the expanded (88%) criterion. When no exposure criterion was used, 13.7% met diagnostic requirements for PTSD or CPTSD, 13.2% when the expanded criterion was used, and 13.2% when Criterion A was used. The 5 psychologically threatening events were as strongly associated with PTSD and CPTSD as the Criterion A events. In a multivariate analysis, only the psychologically threatening events were significantly associated with PTSD (stalking) and CPTSD (bullying, emotional abuse, and neglect). CONCLUSIONS: Certain non-Criterion A events involving extreme fear and horror should be considered traumatic. The ICD-11 approach of providing clinical guidance rather than a formal definition offers a viable solution to some of the problems associated with the current and previous attempts to define traumatic exposure. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Psychologically threatening events can have negative mental health consequences for male victims too, including psychological IPV.
“It is important to recognize that psychologically threatening events can have negative mental health consequences for male victims too [17, 92, 93], including psychological IPV, and thus, preventive efforts and treatment interventions should also be available for male victims.”
From The psychological subtype of intimate partner violence and its effect on mental health: a systematic review with meta-analyses (2022) · cites this paper as [17]
The Results (pp. 14–15) associate psychologically threatening events, including emotional abuse, with PTSD and complex PTSD. The analyses adjusted for sex, but the paper does not report a male-specific finding or identify these events as psychological intimate partner violence. Those parts of the attributed claim are not established by this source. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPsychologically threatening events are traumatic for male victims too and should be acknowledged as such.
“Although the psychologically threatening events were not particularly associated with partner abuse in that study, it suggests that psychologically threatening events are traumatic for male victims too and should be acknowledged as such [17].”
From The psychological subtype of intimate partner violence and its effect on mental health: a systematic review with meta-analyses (2022) · cites this paper as [17]
The Clinical Impact Statement (p. 3) says psychologically threatening events were associated with PTSD and complex PTSD, and the Discussion (p. 16) argues that strict trauma definitions can hinder recognition and treatment. The sample included men (Participants and procedures, p. 9), but the paper does not report whether these associations held specifically for male victims. Its findings therefore support the general point, not the male-specific conclusion. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn a multivariate analysis controlling for sex and all other traumatic events, only psychologically threatening non-Criterion A events were associated with PTSD and C-PTSD.
“More so, a multivariate analysis, controlling for sex and all other traumatic events, revealed that only the psychologically threatening non-Criterion A events were associated with PTSD and C-PTSD [17].”
From The psychological subtype of intimate partner violence and its effect on mental health: a systematic review with meta-analyses (2022) · cites this paper as [17]
Non-Criterion A psychologically threatening events, such as stalking or neglect, were as strongly associated with PTSD and complex-PTSD as common Criterion A events.
“Findings revealed that non-Criterion A psychologically threatening events, e.g., stalking or neglect, were as strongly associated with PTSD and complex-PTSD (C-PTSD), as common Criterion A events.”
From The psychological subtype of intimate partner violence and its effect on mental health: a systematic review with meta-analyses (2022) · cites this paper as [17]
Emerging evidence suggests that psychologically threatening events can have a severe impact on mental health.
“emerging evidence suggests that psychologically threatening events can have a severe impact on mental health [17].”
From The psychological subtype of intimate partner violence and its effect on mental health: a systematic review with meta-analyses (2022) · cites this paper as [17]
Emerging evidence suggests that psychologically threatening events can have a severe impact on mental health, including PTSD symptomatology.
“our understanding of what constitutes a traumatic event has changed in recent years with emerging evidence suggesting that psychologically threatening events can have a severe impact on mental health, including PTSD symptomatology [17].”
From The psychological subtype of intimate partner violence and its effect on mental health: a systematic review with meta-analyses (2022) · cites this paper as [17]
Hyland et al. found psychologically threatening events to be a predictor of both PTSD and C-PTSD, after controlling for gender and the influence of other traumatic events.
“This notion is further stressed by Hyland et al. [17] who found psychologically threatening events to be a predictor of both PTSD and C-PTSD, after controlling for gender and the influence of other traumatic events.”
From The psychological subtype of intimate partner violence and its effect on mental health: a systematic review with meta-analyses (2022) · cites this paper as [17]
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References 31 · Cited by 144
Research works printed but not linked: 2
- American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders (3 rd ed.). American Psychiatric Association: Washington, DC.
- Kilpatrick, D. G., Resnick, H. S., Freedy, J. R., Pelcovitz, D., Resick, P., & Roth, S. (1998). Posttraumatic stress disorder field trial: Evaluation of the PTSD construct-Criteria A through E. In TA Widiger, AJ Frances, HA Pincus, R Ross, MB First, W Davis et al. (Eds.), DSM-IV sourcebook (Vol. 4, pp. 803-844). Washington, DC: American Psychiatric Association.
- Authors
- Hyland, P., Karatzias, T., Shevlin, M., McElroy, E., Ben-Ezra, M., Cloitre, M., & Brewin, C. R.
- Affiliations
- National University of Ireland, Maynooth (IE)
- Edinburgh Napier University (GB)
- University of Leicester (GB)
- University College London (GB)
- Venue
- Psychological Trauma: Theory, Research, Practice, and Policy
- Published
- 2021-02
- Volume
- 13
- Issue
- 2
- Pages
- 133-141
- ISSN
- 1942-9681 (ISSN-L)
- 1942-969X
- OpenAlex
- W3019428281
- Cited by
- 144
- References
- 31
- Citations by year
- 2026: 32 · 2025: 30 · 2024: 25 · 2023: 13 · 2022: 26 · 2021: 14 · 2020: 4
- FWCI
- 5.67
- Type
- journal article
- Language
- en
- Open access
- green
- pure.ulster.ac.uk
- Licence
- other-oa
- Locations
- Psychological Trauma Theory Research Practice and Policy (publishedVersion)
- PubMed (publishedVersion)
- Ulster University Research Portal (Ulster University) (publishedVersion, other-oa)
- Maynooth University ePrints and eTheses Archive (Maynooth University) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Research Output (Edinburgh Napier University) (submittedVersion, cc-by)
- Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- post-traumatic stress disorder, complex PTSD, ICD-11, DSM-5, Criterion A, stalking, bullying, emotional abuse, emotional neglect, diagnostic validity
- MeSH terms
- Psychological Trauma, Adolescent, Adult, Aged, Female, Humans, Ireland, Male, Middle Aged, Psychiatric Status Rating Scales, Stress Disorders, Post-Traumatic, Reproducibility of Results, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders, Young Adult, Self Report
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