Alternative models of disorders of traumatic stress based on the new ICD-11 proposals

Acta Psychiatr Scand. 2017 May;135(5):419-428. doi: 10.1111/acps.12695. Epub 2017 Jan 30.


Objective: Although there is emerging evidence for the factorial validity of the distinction between post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) proposed in ICD-11, such evidence has been predominantly based on using selected items from individual scales that describe these factors. We have attempted to address this gap in the literature by testing a range of alternative models of disorders of traumatic stress using a broader range of symptoms and standardized measures.

Method: Participants in this cross-sectional study were a sample of individuals who were referred for psychological therapy to a National Health Service (NHS) trauma centre in Scotland (N = 195). Participants were recruited over a period of 18 months and completed measures of stressful life events, DSM-5 PTSD, emotion dysregulation, self-esteem and interpersonal difficulties.

Results: Overall, results indicate that a structural model incorporating six first-order factors (re-experiencing, avoidance of traumatic reminders, sense of threat, affective dysregulation, negative self-concept and disturbances in relationships) and two second-order factors (PTSD and disturbances in self-organization [DSO]) was the best fitting. The model presented with good concurrent validity. Childhood trauma was found to be more strongly associated with DSO than with PTSD.

Conclusion: Our results are in support of the ICD-11 proposals for PTSD and CPTSD.

Keywords: ICD-11; complex post-traumatic stress disorder; disorders of traumatic stress; post-traumatic stress disorder.

MeSH terms

  • Cross-Sectional Studies
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Humans
  • Life Change Events
  • Male
  • Models, Psychological
  • Psychiatric Status Rating Scales
  • Stress Disorders, Post-Traumatic / psychology*