Validation of post‐traumatic stress disorder (PTSD) and complex PTSD using the International Trauma Questionnaire
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Objective: The 11th version of the International Classification of Diseases (ICD‐11) has proposed two related trauma diagnoses: Post‐traumatic stress disorder (PTSD) and Complex PTSD(CPTSD). Using a newly developed, disorder‐specific measure of PTSD and CPTSD called the International Trauma Questionnaire(ITQ) the current study will (i) assess the factorial validity of ICD‐11 PTSD and CPTSD; (ii) provide the first test of the discriminant validity of these constructs; and (iii) provide the first comparison of ICD‐11, and Diagnostic and Statistical Manual, Fifth Edition (DSM‐5),PTSD diagnostic rates using disorder‐specific measures. Method: ICD‐11 and DSM‐5 PTSD‐specific measures were completed by a British clinical sample of trauma‐exposed patients (N =171). The structure and validity of ICD‐11 PTSD and CPTSD were assessed by means of factor analysis and assessing relationships with criterion variables. Results: Diagnostic rates under ICD‐11 were significantly lower than those under DSM‐5. A two‐factor second‐order model reflecting the distinction between PTSD and CPTSD best represented the data from the ITQ; and the PTSD and CPTSD factors differentially predicted multiple psychological variables. Conclusion: The factorial and discriminant validity of ICD‐11 PTSD and CPTSD was supported, and ICD‐11 produces fewer diagnostic cases than DSM‐5.
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Chronic and cumulative exposure to multiple types of interpersonal trauma, especially in formative developmental periods in childhood but also including in adulthood, has repeatedly been shown to have an incremental dose-response relationship to cPTSD.
“Chronic and cumulative exposure to multiple types of interpersonal trauma, especially in formative developmental periods in childhood but also including in adulthood [35], has repeatedly been shown to have an incremental dose-response relationship to cPTSD [6, 12, 18, 20, 51, 52, 54, 75, 77, 87, 122, 155].”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [75]
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Experimental — accuracy not yet measuredA significant number of factor analytic studies converge on the proposed factor structure of complex PTSD, with evidence of two overarching factors of PTSD symptoms and disturbances in self-organization.
“A significant number of factor analytic studies tend to converge on the proposed factor structure of the disorder, with evidence of two overarching factors of PTSD symptoms and disturbances in self-organization 9-12 .”
From Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges (2019) · cites this paper as [10]
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Cites
The Measurement of Observer Agreement for Categorical Data
Landis, J. R., & Koch, G. G. (1977) · Biometrics · doi:10.2307/2529310 · Cited by 81,148 · see citing works
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.10.1092 · Cited by 31,765 · see citing works
Comparative fit indexes in structural models.
Bentler, P. M. (1990) · Psychological Bulletin · doi:10.1037/0033-2909.107.2.238 · Cited by 25,266 · see citing works
Structural model evaluation and modification: An interval estimation approach
Steiger, J. H. (1990) · Multivariate Behavioral Research · doi:10.1207/s15327906mbr2502_4 · Cited by 7,408 · see citing works
Bayesian model selection in social research
Raftery, A. E. (1995) · Sociological Methodology · doi:10.2307/271063 · Cited by 6,823 · see citing works
Flora, D. B., & Curran, P. J. (2004) · Psychological Methods · doi:10.1037/1082-989x.9.4.466 · Cited by 3,105 · see citing works
Yuan, K.-H., & Bentler, P. (2000) · Sociological Methodology · doi:10.1111/0081-1750.00078 · Cited by 1,847 · see citing works
Estimation of composite reliability for congeneric measures
Raykov, T. (1997) · Applied Psychological Measurement · doi:10.1177/01466216970212006 · Cited by 1,775 · see citing works
The Distress Tolerance Scale: Development and Validation of a Self-Report Measure
Simons, J. S., & Gaher, R. M. (2005) · Motivation and Emotion · doi:10.1007/s11031-005-7955-3 · Cited by 1,730 · see citing works
The Posttraumatic Cognitions Inventory (PTCI): development and validation
Foa, E. B., Ehlers, A., Clark, D. M., Tolin, D. F., & Orsillo, S. M. (1999) · Psychological Assessment · doi:10.1037/1040-3590.11.3.303 · Cited by 1,727 · see citing works
Brewin, C. R., Gregory, J. D., Lipton, M., & Burgess, N. (2010) · Psychological Review · doi:10.1037/a0018113 · Cited by 1,226 · see citing works
Self-citationManea, L., Gilbody, S., & McMillan, D. (2015) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2014.09.009 · Cited by 795 · see citing works
Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis
Cloitre, M., Garvert, D. W., Brewin, C. R., Bryant, R. A., & Maercker, A. (2013) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v4i0.20706 · Cited by 751 · cited 1× · see citing works
“While the existing literature has indicated that CPTSD can be meaningfully distinguished from PTSD due to exposure to childhood traumatization (12), chronic traumatization (38), increased psychological distress (13), and female sex (39), the current findings demonstrate that PTSD and DSO possess differentially associa…”
Self-citationTreatment of complex PTSD: results of the ISTSS expert clinician survey on best practices.
Cloitre, M., Courtois, C. A., Charuvastra, A., Carapezza, R., Stolbach, B. C., & Green, B. L. (2011) · Journal of Traumatic Stress · doi:10.1002/jts.20697 · Cited by 593 · see citing works
Maercker, A., Brewin, C. R., Bryant, R. A., Cloitre, M., Reed, G. M., van Ommeren, M., Humayun, A., Jones, L. M., Kagee, A., Llosa, A. E., et al. (2013) · The Lancet · doi:10.1016/s0140-6736(12)62191-6 · Cited by 533 · see citing works
Self-citationBrewin, C. R. (2014) · Psychological Bulletin · doi:10.1037/a0033722 · Cited by 492 · cited 1× · see citing works
“This emphasis is based on evidence demonstrating that intrusive recollections of traumatic life events are common across psychiatric disorders (36); that re-experiencing in the here and now distinguishes intrusive cognitive processes in PTSD from those observed in other disorders (37).”
BackgroundSelf-citationKaratzias, T., Shevlin, M. E., Fyvie, C., Hyland, P., Efthymiadou, E., Wilson, D., Roberts, N. P., Bisson, J. I., Brewin, C. R., & Cloître, M. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.09.032 · Cited by 365 · see citing works
Self-citationValidity of the Generalized Anxiety Disorder‐7 Scale in an Acute Psychiatric Sample
Kertz, S., Bigda‐Peyton, J., & Bjorgvinsson, T. (2013) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.1802 · Cited by 271 · see citing works
On the Occurrence of Standardized Regression Coefficients Greater Than One
Deegan, J. (1978) · Educational and Psychological Measurement · doi:10.1177/001316447803800404 · Cited by 227 · see citing works
Karatzias, T., Shevlin, M., Fyvie, C., Hyland, P., Efthymiadou, E., Wilson, D., Roberts, N., Bisson, J., Brewin, C., & Cloitre, M. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.10.009 · Cited by 169 · see citing works
Self-citationPerkonigg, A., Höfler, M., Cloitre, M., Wittchen, H.-U., Trautmann, S., & Maercker, A. (2016) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-015-0639-4 · Cited by 144 · see citing works
Self-citationO'Donnell, M. L., Alkemade, N., Nickerson, A., Creamer, M., McFarlane, A. C., Silove, D., Bryant, R. A., & Forbes, D. (2014) · British Journal of Psychiatry · doi:10.1192/bjp.bp.113.135285 · Cited by 131 · see citing works
Hyland, P., Shevlin, M. E., Elklit, A., Murphy, J., Vallières, F., Garvert, D. W., & Cloître, M. (2016) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000114 · Cited by 129 · see citing works
Self-citationThe factor structure of complex posttraumatic stress disorder in traumatized refugees
Nickerson, A., Cloître, M., Bryant, R. A., Schnyder, U., Morina, N., & Schick, M. (2016) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v7.33253 · Cited by 108 · see citing works
Less is more? Assessing the validity of the ICD-11 model of PTSD across multiple trauma samples
Hansen, M., Hyland, P., Armour, C., Shevlin, M. E., & Elklit, A. (2015) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v6.28766 · Cited by 98 · see citing works
Self-citationTay, A. K., Rees, S. J., Chen, J., Kareth, M., & Silove, D. M. (2015) · BMC Psychiatry · doi:10.1186/s12888-015-0480-3 · Cited by 84 · see citing works
The impact of proposed changes to ICD-11 on estimates of PTSD prevalence and comorbidity
Wisco, B. E., Miller, M. W., Wolf, E. J., Kilpatrick, D. G., Resnick, H. S., Badour, C. L., Marx, B. P., Keane, T. M., Rosen, R. C., & Friedman, M. J. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.04.043 · Cited by 79 · see citing works
Murphy, S., Elklit, A., Dokkedahl, S., & Shevlin, M. (2016) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v7.32678 · Cited by 71 · see citing works
Self-citationAlternative models of disorders of traumatic stress based on the new ICD‐11 proposals
Shevlin, M., Hyland, P., Karatzias, T., Fyvie, C., Roberts, N., Bisson, J., Brewin, C., & Cloitre, M. (2017) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12695 · Cited by 66 · see citing works
Self-citationHyland, P., Shevlin, M. E., McNally, S., Murphy, J., Hansen, M., & Elklit, A. (2015) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2015.11.002 · Cited by 64 · see citing works
Self-citationWittkampf, K. A., Baas, K. D., van Weert, H. C. P. M., Lucassen, P. L., & Schene, A. H. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.10.030 · Cited by 40 · see citing works
Hyland, P., Brewin, C. R., & Maercker, A. R. A. (2017) · Journal of Traumatic Stress · doi:10.1002/jts.22171 · Cited by 34 · see citing works
Self-citationBaker, S. R., Victor, J. B., Chambers, A. L., & Halverson, C. F. (2004) · Assessment · doi:10.1177/1073191104269871 · Cited by 34 · see citing works
What happened to harmonization of the PTSD diagnosis? The divergence of ICD11 and DSM5
Bisson, J. I. (2013) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796013000164 · Cited by 32 · see citing works
Self-citationRaykos, B. C., Byrne, S. M., & Watson, H. (2009) · Eating Behaviors · doi:10.1016/j.eatbeh.2009.07.001 · Cited by 26 · see citing works
The structure of DSM-5 posttraumatic stress disorder symptoms in war veterans
Konecky, B. D., Meyer, E. C., Kimbrel, N. A., & Morissette, S. B. (2015) · Anxiety Stress & Coping · doi:10.1080/10615806.2015.1081178 · Cited by 25 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Maercker A, Brewin CR, Bryant RA et al. Proposals for mental disorders specifically associated with stress in the ICD-11. Lancet 2013;381:1683-1685.
- Kline RB. Principles and Practice of Structural Equation Modeling (4th edn). New York, NY: Guilford Press; 2011.
Cited by
Sorted by citations
Cloitre, M., Shevlin, M., Brewin, C. R., Bisson, J. I., Roberts, N. P., Maercker, A., Karatzias, T., & Hyland, P. (2018) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12956 · Cited by 1,314 · see citing works
Self-citationShevlin, M., McBride, O., Murphy, J., Miller, J. G., Hartman, T. K., Levita, L., Mason, L., Martinez, A. P., McKay, R., Stocks, T. V. A., et al. (2020) · BJPsych Open · doi:10.1192/bjo.2020.109 · Cited by 770 · see citing works
Self-citationA review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD
Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R. A., Humayun, A., Jones, L. M., Kagee, A., Rousseau, C., et al. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.09.001 · Cited by 678 · see citing works
Self-citationPost‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges
Bryant, R. A. (2019) · World Psychiatry · doi:10.1002/wps.20656 · Cited by 528 · see citing works
Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis
Karatzias, T., Murphy, P., Cloitre, M., Bisson, J., Roberts, N., Shevlin, M., Hyland, P., Maercker, A., Ben-Ezra, M., Coventry, P., et al. (2019) · Psychological Medicine · doi:10.1017/s0033291719000436 · Cited by 352 · see citing works
Self-citationGlover, V., O'Donnell, K. J., O'Connor, T. G., & Fisher, J. (2018) · Development and Psychopathology · doi:10.1017/s095457941800038x · Cited by 271 · see citing works
Ben-Ezra, M., Karatzias, T., Hyland, P., Brewin, C. R., Cloitre, M., Bisson, J. I., Roberts, N. P., Lueger-Schuster, B., & Shevlin, M. (2018) · Depression and Anxiety · doi:10.1002/da.22723 · Cited by 241 · see citing works
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Ford, J. D., & Courtois, C. A. (2021) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-021-00155-9 · Cited by 209 · see citing works
“incremental dose-response relationship to cPTSD [6, 12, 18, 20, 51, 52, 54, 75, 77, 87, 122, 155].”
Redican, E., Nolan, E., Hyland, P., Cloitre, M., McBride, O., Karatzias, T., Murphy, J., & Shevlin, M. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102381 · Cited by 156 · see citing works
Self-citationHyland, P., Shevlin, M., Fyvie, C., & Karatzias, T. (2018) · Journal of Traumatic Stress · doi:10.1002/jts.22272 · Cited by 148 · see citing works
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Jowett, S., Karatzias, T., Shevlin, M., & Albert, I. (2020) · Personality Disorders: Theory, Research, and Treatment · doi:10.1037/per0000346 · Cited by 116 · see citing works
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Ehlers, A., Wild, J., Warnock-Parkes, E., Grey, N., Murray, H., Kerr, A., Rozental, A., Thew, G., Janecka, M., Beierl, E. T., et al. (2023) · The Lancet Psychiatry · doi:10.1016/s2215-0366(23)00181-5 · Cited by 68 · see citing works
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Hyland, P., Karatzias, T., Shevlin, M., Cloitre, M., & Ben-Ezra, M. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112871 · Cited by 37 · see citing works
Self-citation
- Authors
- Hyland, P., Shevlin, M., Brewin, C. R., Cloitre, M., Downes, A. J., Jumbe, S., Karatzias, T., Bisson, J. I., & Roberts, N. P.
- Affiliations
- National College of Ireland (IE)
- University of Ulster (GB)
- University College London (GB)
- School of Medicine New York University New York NY USA
- Betsi Cadwaladr University Health Board (GB)
- Queen Mary University of London (GB)
- NHS Lothian (GB)
- Cardiff University (GB)
- Cardiff and Vale University Health Board (GB)
- Corresponding author
- Hyland, P.
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2017-07-11
- Volume
- 136
- Issue
- 3
- Pages
- 313-322
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- OpenAlex
- W2735413536
- Cited by
- 295
- References
- 37
- Citations by year
- 2026: 28 · 2025: 39 · 2024: 38 · 2023: 29 · 2022: 38 · 2021: 30 · 2020: 48 · 2019: 22 · 2018: 18 · 2017: 4
- FWCI
- 31.13
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Ulster University Research Portal (Ulster University) (publishedVersion, other-oa)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- Maynooth University ePrints and eTheses Archive (Maynooth University) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Research Output (Edinburgh Napier University) (submittedVersion, cc-by)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
- Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion, cc-by)
- 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, International Trauma Questionnaire, ICD-11, DSM-5, diagnostic validity, factorial validity, discriminant validity, trauma exposure, diagnostic rate
- MeSH terms
- Psychological Trauma, Adolescent, Adult, Aged, Female, Humans, 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
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