Preserve Enduring Personality Changes After Catastrophic Events (EPCACE) as a diagnostic resource

Comprehensive psychiatry, 1999

The inclusion of enduring personality change after catastrophic experience (EPCACE) as a diagnostic category in the ICD-1O represents a turning point in the evolution of the nosology of traumatic stress syndromes, yet many aspects of the diagnosis remain contentious. Given the absence of published research concerning this category, an exploratory survey of international experts was conducted using a questionnaire focusing on key aspects of the category, namely whether respondents used the diagnosis of EPCACE in their practice; which features were most salient in making a diagnosis of posttraumatic personality change; the types and characteristics of traumatic events that were judged to be most likely to cause EPCACE; and the possible limitations of the ICD-1O diagnosis. A response rate of 56.3% was obtained. A substantial portion of trauma experts working in the field of human-engendered violence recognize the possibility that certain traumas can result in personality change. However, questions were raised about the specificity of the criteria proposed for the category of EPCACE in ICD-1O. A composite profile of proposed additional features suggests that a more comprehensive array of adaptational changes are recognized than are encompassed by EPCACE.

Complex posttraumatic stress disorder (Complex PTSD) has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases, 11th version, due to be published, two decades after its first initiation. It is described as an enhanced version of the current definition of PTSD, with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognitions and interpersonal hardship, thus resembling the clinical features commonly encountered in borderline personality disorder (BPD). Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context, generally interpersonal in nature. In this manuscript, we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them, along with their clinical features. Furthermore, we suggest that besides the present distinct clinical diagnoses (PTSD; Complex PTSD; BPD), there is a cluster of these comorbid disorders, that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such. More studies are needed to confirm or reject this hypothesis, particularly in clinical terms and how they correlate to clinical entities’ biological background, endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.

Journal of Aggression, Maltreatment & Trauma, 2015

Dialogues in Clinical Neuroscience, 2018

Throughout history the consequences of psychological trauma and characteristic symptoms have involved clinical presentations that have had different names. Since the inclusion of the category of Posttraumatic Stress Disorder (PTSD) in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) with the symptomatic triad of re-experiencing the traumatic event, avoidance behaviors, and hypervigilance, this entity has been a source of controversy. Indeed, some authors have denied its existence, even considering it a diagnostic invention. In this article we review, from the clinician's perspective, historical aspects as well as the development of the nosological classifications and the contributions from the neurosciences that allow the consideration of the full validity of this diagnosis as a form of psychobiological reaction to psychological trauma.

DOI: 10.13140/2.1.4134.2409 Conference: Presented to the first joint scientific meeting of the American College of Psychoanalysts and the American Academy of Psychoanalysis and Psychodynamic Psychiatry, Washington DC. —An effort to integrate data from videotaped interviews of severely traumatized persons (especially children) with physiological, imaging, and psychological studies in light of evolutionary theory of altruism. PTSD is considered a biologically altruistic, gene-pool survival enhancing reaction to life threat. Analogy is drawn to aspects of the cellular level of immune process. Information-laden circulating proteins act as signals replicating some of the molecular characteristics of the invaders. Though the individual cell may be handicapped by immune response, the community of cells usually profits. Similarly, when life-threat is perceived by the human individual, memory focuses on that threat and is occupied by producing replicas. These are intrusive involuntary processes: thoughts, flashbacks and nightmares with details of the life-threat. Behavioral sensorimotor memory enactments occur about details of the threat. Though individual behavior, memory and perceptual life are thus impoverished, survival of surrounding individuals and the gene-pool profit from the behaviorally transmitted information. This gene-pool value was present before the development of language. Therapeutic implications are discussed. DOI: 10.13140/RG.2.1.1891.2808 2015-04-15 T 02:52:13 UTC

BJPsych Advances, 2020

SUMMARYThe diagnostic status of ‘complex’ post-traumatic stress disorder (PTSD) remains controversial. The revisions to PTSD diagnostic criteria in ICD-11 and DSM-5 take opposing positions on how best to conceptualise post-traumatic presentations that include affect dysregulation, interpersonal difficulties and negative self-concept. ICD-11 carved out a separate category of complex PTSD (CPTSD) that is distinct from PTSD, whereas DSM-5 expanded PTSD to encompass such symptoms. Each approach carries problematic implications for clinical care. ICD-11 creates a dichotomy but the criteria themselves suggest a difference in severity rather than category. Furthermore, separating CPTSD perpetuates expectations that a ‘simple’ PTSD can be easily treated with brief trauma-focused therapy. DSM-5 complicates the PTSD diagnosis, but does not revise treatment recommendations. Both ICD and DSM need to recognise that most patients with PTSD do not reflect the clinical trial samples and do not full...

PsycEXTRA Dataset

European journal of psychotraumatology, 2014

The International Classification of Diseases, 11th version (ICD-11), proposes two related stress and trauma-related disorders, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). A diagnosis of CPTSD requires that in addition to the PTSD symptoms, an individual must also endorse symptoms in three major domains: (1) affective dysregulation, (2) negative self-concepts, and (3) interpersonal problems. This study aimed to determine if the naturally occurring distribution of symptoms in three groups of traumatised individuals (bereavement, sexual victimisation, and physical assault) were consistent with the ICD-11, PTSD, and CPTSD specification. The study also investigated whether these groups differed on a range of other psychological problems. Participants completed self-report measures of each symptom group and latent class analyses consistently found that a three class solution was best. The classes were "PTSD only," "CPTSD," and "low PTSD/CPTSD.&q...

BMC Psychiatry, 2014

Background: While a large proportion of conflict-affected populations have been dually exposed to trauma and loss, there is inadequate research identifying differential symptom profiles related to bereavement and trauma exposure in these groups. The objective of this study were to (1) determine whether there are distinct classes of posttraumatic stress disorder (PTSD) and prolonged grief disorder (PGD) symptoms in bereaved trauma survivors exposed to conflict and persecution, and (2) examine whether particular types of refugee experiences and stressors differentially predict symptom profiles. Methods: Participants were 248 Mandaean adult refugees who were assessed at an average of 4.3 years since entering Australia following persecution in Iraq. PTSD, PGD, trauma exposure, adjustment difficulties since relocation, and English proficiency were measured. Latent class analysis was used to elucidate symptom profiles of PTSD and PGD in this sample. Results: Latent class analysis revealed four classes of participants: a combined PTSD/PGD class (16%), a predominantly PTSD class (25%), a predominantly PGD class (16%), and a resilient class (43%). Whereas membership in the PTSD/PGD class was predicted by exposure to traumatic loss, those in the PGD class were more likely to have experienced adaptation difficulties since relocation, and individuals in the PTSD class were more likely to have experienced difficulties related to loss of culture and support. Conclusions: This study provides evidence that specific symptom patterns emerge following exposure to mass trauma and loss. These profiles are associated with distinct types of traumatic experiences and post-migration living difficulties. These results have substantial public health implications for assessment and intervention following mass trauma.