ABSTRACT
Victims of traumatic events that involve repeated interpersonal aggression and low or no chance of escape frequently report intense Self-Conscious Emotions (SCEs), such as Shame, Guilt, and Humiliation. Humiliation is the reaction to a forced loss of status and is hypothesized to have unique contributions to the development and maintenance of Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD). However, previous studies did not include humiliation or did not simultaneously probe the relative contribution of each SCE to posttraumatic symptoms. This study aimed to investigate the dynamics between specific SCEs and trauma-related symptomatology in the general population who suffered a form of complex trauma. Four hundred forty-nine people (77.11% women) exposed to domestic violence and sexual abuse answered an online survey. We investigated whether each emotion would accurately predict probable PTSD and CPTSD levels above the proposed cutoff. We estimated a network model to understand the dynamics of their interactions and whether the traumatic event type would moderate relationships between SCEs and posttraumatic stress symptoms, comparing networks of two types of complex trauma. No SCE predicted PTSD, but humiliation was a predictor of CPTSD while controlling for Shame and Guilt. Humiliation was also the most central SCE domain in the networks of both traumatic events. Our results stress the relevance of Humiliation to understanding posttraumatic stress symptoms and the necessity to consider humiliation when studying the emotional processing in complex trauma.
Subject(s)
Stress Disorders, Post-Traumatic , Humans , Stress Disorders, Post-Traumatic/psychology , Female , Male , Adult , Middle Aged , Surveys and Questionnaires , Shame , Guilt , Adolescent , Emotions , Domestic Violence/psychologyABSTRACT
In 2018, Complex Post Traumatic Stress Disorder (CPTSD) was officially recognized as a distinct syndrome in the International Classification of Diseases, 11th Revision (ICD-11). This recognition aimed to differentiate between neurotic disorders secondary to stressful situations and somatoform disorders, and disorders specifically associated with stress. The inclusion of CPTSD in the ICD-11 marked the culmination of two decades of research focused on understanding its symptoms, treatments, and risk factors. However, despite the progress made, a comprehensive meta-analysis to elucidate the specific risk factors and impact on the development of CPTSD is still lacking. The objective of this article is to conduct such a meta-analysis. A total of 24 studies were selected for analysis, and the findings revealed several key risk factors associated with the development of CPTSD. The main risk factor identified is having experienced sexual abuse in childhood (k = 12; OR = 2.880). In addition, childhood physical abuse (k = 11; OR = 2.841), experiencing emotional neglect during childhood (k = 5; OR = 2.510), physical abuse throughout life (k = 8; OR = 2.149) and being a woman (k = 13; OR = 1.726) were also significant risk factors.
Subject(s)
Sex Offenses , Stress Disorders, Post-Traumatic , Female , Humans , International Classification of Diseases , Risk Factors , Sex Offenses/psychology , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/diagnosis , MaleABSTRACT
Abstract: Background: Current literature shows that posttraumatic stress disorder and complex posttraumatic stress disorder symptoms differ. Although the psychological treatments available for posttraumatic disorder are well established, little is known about the effectiveness of those aimed at the treatment of complex posttraumatic stress. Objective: To evaluate the efficacy of psychological treatments for complex posttraumatic stress disorder. Method: A systematic qualitative search was conducted according to PRISMA guidelines, searching four psychological and health electronic databases: Medline, Pilots, PsycINFO, and Pubmed. Three reviewers independently selected the studies in two phases: preselection (criteria for complex posttraumatic stress disorder, replicable psychological treatment, and treatment effect) and selection (additional criteria: type of study, participants, and treatment). Results: Of the 615 studies reviewed, 25 were preselected, eight of which met the inclusion and methodological quality criteria. Five studies explored adult populations (with one exception, all were randomized clinical trials) and three child populations (clinical studies with pre- post-treatment design, with and without control group). Most studies with adult populations included psychoeducation, cognitive restructuration, and exposure therapy. The studies with child samples included EMDR and mindfulness as the most frequent treatment components. Discussion and conclusion: The evidence was insufficient to determine the most effective treatment. More research on this issue is required.
Resumen: Antecedentes: La literatura actual muestra una diferenciación entre los síntomas de trastorno por estrés postraumático y estrés postraumático complejo (TEPTC). Si bien los tratamientos psicológicos para el primer tipo de sintomatología están claramente establecidos, son menos conocidas las intervenciones para el TEPTC. Objetivo. Evaluar la eficacia de las terapias psicológicas para reducir los síntomas del TEPTC. Método: Se realizó una revisión sistemática cualitativa basada en la guía de publicación PRISMA. Se usaron cuatro bases de datos: Medline, Pilots, Psycinfo y Pubmed. Con base en criterios previamente definidos, tres revisores independientes eligieron los trabajos en dos fases: preselección (criterios para TEPTC, tratamiento psicológico replicable, datos sobre efectos) y selección (considerando tres criterios adicionales: tipo de estudio, de participantes y de intervención). Resultados: De los 615 encontrados, se preseleccionó un total de 25 artículos para revisión de texto completo, de los cuales se seleccionaron un total de ocho. Cinco trabajos incluyeron población adulta (a excepción de un estudio, todos eran ensayos clínicos controlados aleatorizados) y el resto infantil (diseño pre-post-tratamiento, con o sin grupo control). Mayoritariamente, los componentes de los tratamientos para adultos fueron: psicoeducación, reestructuración cognitiva y exposición. Los estudios con muestras infantiles incluyeron técnicas más heterogéneas, si bien el uso del EMDR y mindfulness fueron comunes a dos de las intervenciones. Discusión y conclusión: Dada la escasez de estudios encontrados y los problemas de control metodológico, no es posible destacar un tratamiento de elección para el TEPCT con eficacia superior al resto. Se requiere de más investigación en este ámbito.