Complex Post-Traumatic Stress Disorder in College Students: Examining Network Structure and Gender Differences

Xu Zichun; Yilamujiang Abuduaini; Sun Rui; Zhou Xiao

doi:10.16719/j.cnki.1671-6981.202304030

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Journal of Psychological Science ›› 2023, Vol. 46 ›› Issue (4) : 1008-1016. DOI: 10.16719/j.cnki.1671-6981.202304030

Clinical Psychology & Consulting

Complex Post-Traumatic Stress Disorder in College Students: Examining Network Structure and Gender Differences

Xu Zichun, Yilamujiang Abuduaini, Sun Rui, Zhou Xiao

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Abstract

Prior studies have suggested that college students always report multiple traumatic experiences, such as childhood traumatic experiences (e.g. abuse and neglect). Suffering from these experiences may lead to negative psychological outcomes, including depression, post-traumatic stress disorders, and complex post-traumatic stress disorder (CPTSD). These outcomes, CPTSD in particular, may continue to exist for many years or lifetime for traumatized college students. The aim of this study was to examine college students' CPTSD and compare gender differences in its structure by using network analysis.
To be specific, CPTSD is expected to occur after exposure to prolonged and repeated interpersonal traumatic events. Its symptoms include not only the core symptoms of PTSD (e.g., re-experience, avoidance and sense of threat), but also three symptoms of disturbance in self-organization (DSO), including affective dysregulation, disturbances in relationships, and negative self-concept. The impact of gender on CPTSD is controversial, and relevant research is confined to the comparison of the incidence or severity of CPTSD, but few studies have focused on the differences in its inherent symptoms and their connectivity. To understand the structural characteristics of CPTSD among college students and potential gender differences, this study used the International Trauma Questionnaire (ITQ) to evaluate CPTSD among 813 college students, and used the method of network analysis.
First, the CPTSD symptom network of college students was constructed and the centrality of each symptom was estimated. It was found that internal reminders, being on guard and failure were the most strongly connected symptoms of the CPTSD network among college students. Second, the CPTSD symptom networks of male and female college students were constructed and the centrality of each symptom was estimated. It was found that being on guard and difficulty in staying close to others were the most strongly connected symptoms in males, whereas internal reminders, failure and difficulty in staying close to others were the most strongly connected symptoms in females. In addition, the network comparison test was conducted on the CPTSD symptom networks of male and female college students. The results found that there was no significant difference in the overall network connectivity between males and females, but there were significant differences in the local connectivity of individual symptoms, among which sense of worthlessness and failure were the most. These results, on the one hand, expand previous studies on gender differences in CPTSD, indicating that there are gender differences in the network structure of CPTSD. On the other hand, results also provide inspiration for clinical intervention. That is, the differences in CPTSD network structure between male and female students can prompt us to intervene in CPTSD. In college students, internal reminders and sense of failure are used as target symptoms for females to intervene; being on guard is used as target symptoms for males to intervene.

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CPTSD / network analysis / gender differences / college students / childhood trauma

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Xu Zichun, Yilamujiang Abuduaini, Sun Rui, Zhou Xiao. Complex Post-Traumatic Stress Disorder in College Students: Examining Network Structure and Gender Differences[J]. Journal of Psychological Science. 2023, 46(4): 1008-1016 https://doi.org/10.16719/j.cnki.1671-6981.202304030

References

[1] 蔡玉清, 董书阳, 袁帅, 胡传鹏. (2020). 变量间的网络分析模型及其应用. 心理科学进展, 28(1), 178-190.
[2] 邵宁, 马玄, 宋先兵, 何婷婷, 万宇辉. (2018). 童年期虐待与医科大学生心理亚健康的关联性研究. 现代预防医学, 45(11), 2004-2008.
[3] 田雨馨, 伍新春, 陈杰灵, 王文超. (2019). 复杂性创伤后应激障碍: 概念、评估、成因及干预. 北京师范大学学报(社会科学版), 5, 24-36.
[4] Bolger K. E., Patterson C. J., & Kupersmidt J. B. (1998). Peer relationships and self-esteem among children who have been maltreated. Child Development, 69(4), 1171-1197.
[5] Borsboom, D. (2017). A network theory of mental disorders. World Psychiatry, 16(1), 5-13.
[6] Borsboom, D., & Cramer, A. O. J. (2013). Network analysis: An integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology, 9, 91-121.
[7] Brewin C. R., Cloitre M., Hyland P., Shevlin M., Maercker A., Bryant R. A., & Reed G. M. (2017). A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clinical Psychology Review, 58, 1-15.
[8] Bringmann L. F., Elmer T., Epskamp S., Krause R. W., Schoch D., Wichers M., & Snippe E. (2019). What do centrality measures measure in psychological networks? Journal of Abnormal Psychology, 128(8), 892-903.
[9] Browne, C., & Winkelman, C. (2007). The effect of childhood trauma on later psychological adjustment. Journal of Interpersonal Violence, 22(6), 684-697.
[10] Choi K. W., Batchelder A. W., Ehlinger P. P., Safren S. A., & O'Cleirigh C. (2017). Applying network analysis to psychological comorbidity and health behavior: Depression, PTSD, and sexual risk in sexual minority men with trauma histories. Journal of Consulting and Clinical Psychology, 85(12), 1158-1170.
[11] Cloitre M., Hyland P., Bisson J. I., Brewin C. R., Roberts N. P., Karatzias T., & Shevlin M. (2019). ICD-11 posttraumatic stress disorder and complex posttraumatic stress disorder in the United States: A population-based study. Journal of Traumatic Stress, 32(6), 833-842.
[12] Cloitre M., Shevlin M., Brewin C. R., Bisson J. I., Roberts N. P., Maercker A., & Hyland P. (2018). The international trauma questionnaire: Development of a self-report measure of ICD-11 PTSD and complex PTSD. Acta Psychiatrica Scandinavica, 138(6), 536-546.
[13] Dusek, J. B., & Flaherty, J. F. (1981). The development of the self-concept during the adolescent years. Monographs of the Society for Research in Child Development, 46(4), 1-61.
[14] Dvir Y., Ford J. D., Hill M., & Frazier J. A. (2014). Childhood maltreatment, emotional dysregulation, and psychiatric comorbidities. Harvard Review of Psychiatry, 22(3), 149-161.
[15] Epskamp S., Borsboom D., & Fried E. I. (2018). Estimating psychological networks and their accuracy: A tutorial paper. Behavior Research Methods, 50(1), 195-212.
[16] Epskamp S., Cramer A. O. J., Waldorp L. J., Schmittmann V. D., & Borsboom D. (2012). qgraph: Network visualizations of relationships in psychometric data. Journal of Statistical Software, 48(4), 1-18.
[17] Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20-35.
[18] Foa E. B., Steketee G., & Rothbaum B. O. (1989). Behavioral/cognitive conceptualizations of post-traumatic stress disorder. Behavior Therapy, 20(2), 155-176.
[19] Haselgruber A., Knefel M., Sölva K., & Lueger-Schuster B. (2021). Foster children's complex psychopathology in the context of cumulative childhood trauma: The interplay of ICD-11 complex PTSD, dissociation, depression, and emotion regulation. Journal of Affective Disorders, 282, 372-380.
[20] Ho G. W. K., Hyland P., Shevlin M., Chien W. T., Inoue S., Yang P. J., & Karatzias T. (2020). The validity of ICD-11 PTSD and complex PTSD in East Asian cultures: Findings with young adults from China, Hong Kong, Japan, and Taiwan. European Journal of Psychotraumatology, 11, Article 1717826.
[21] Ho G. W. K., Karatzias T., Cloitre M., Chan A. C. Y., Bressington D., Chien W. T., & Shevlin M. (2019). Translation and validation of the Chinese ICD-11 international trauma questionnaire (ITQ) for the assessment of posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). European Journal of Psychotraumatology, 10(1), Article 1608718.
[22] Hofmann S. G., Curtiss J., & McNally R. J. (2016). A complex network perspective on clinical science. Perspectives on Psychological Science, 11(5), 597-605.
[23] Hofstede, G. (1980). Culture's consequences. CA: Sage.
[24] Hourani L., Williams J., Bray R., & Kandel D. (2015). Gender differences in the expression of PTSD symptoms among active duty military personnel. Journal of Anxiety Disorders, 29, 101-108.
[25] Hyland P., Murphy J., Shevlin M., Vallières F., McElroy E., Elklit A., & Cloitre M. (2017). Variation in post-traumatic response: The role of trauma type in predicting ICD-11 PTSD and CPTSD symptoms. Social Psychiatry and Psychiatric Epidemiology, 52(6), 727-736.
[26] Hyland P., Shevlin M., Brewin C. R., Cloitre M., Downes A. J., Jumbe S., & Roberts N. P. (2017). Validation of post-traumatic stress disorder (PTSD) and complex PTSD using the international trauma questionnaire. Acta Psychiatrica Scandinavica, 136(3), 313-322.
[27] Karatzias T., Shevlin M., Fyvie C., Grandison G., Garozi M., Latham E., & Hyland P. (2020). Adverse and benevolent childhood experiences in posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD): Implications for trauma-focused therapies. European Journal of Psychotraumatology, 11(1), Article 1793599.
[28] Karatzias T., Shevlin M., Fyvie C., Hyland P., Efthymiadou E., Wilson D., & Cloitre M. (2017). Evidence of distinct profiles of posttraumatic stress disorder (PTSD) and Complex posttraumatic stress disorder (CPTSD) based on the new ICD-11 trauma questionnaire (ICD-TQ). Journal of Affective Disorders, 207, 181-187.
[29] Kim, J., & Cicchetti, D. (2006). Longitudinal trajectories of self-system processes and depressive symptoms among maltreated and nonmaltreated children. Child Development, 77(3), 624-639.
[30] King M. W., Street A. E., Gradus J. L., Vogt D. S., & Resick P. A. (2013). Gender differences in posttraumatic stress symptoms among OEF/OIF veterans: An item response theory analysis. Journal of Traumatic Stress, 26(2), 175-183.
[31] Knefel M., Lueger-Schuster B., Bisson J., Karatzias T., Kazlauskas E., & Roberts N. P. (2020). A cross-cultural comparison of ICD-11 complex posttraumatic stress disorder symptom networks in Austria, the United Kingdom, and Lithuania. Journal of Traumatic Stress, 33(1), 41-51.
[32] McElroy E., Shevlin M., Murphy S., Roberts B., Makhashvili N., Javakhishvili J., & Hyland P. (2019). ICD-11 PTSD and complex PTSD: Structural validation using network analysis. World Psychiatry, 18(2), 236-237.
[33] McNally, R. J. (2017). Networks and nosology in posttraumatic stress disorder. JAMA Psychiatry, 74(2), 124-125.
[34] Negele A., Kaufhold J., Kallenbach L., & Leuzinger-Bohleber M. (2015). Childhood trauma and its relation to chronic depression in adulthood. Depression Research and Treatment, 2015, Article 650804.
[35] Olff M., Langeland W., Draijer N., & Gersons, B. P. R. (2007). Gender differences in posttraumatic stress disorder. Psychological Bulletin, 133(2), 183-204.
[36] Perkonigg A., Höfler M., Cloitre M., Wittchen H. U., Trautmann S., & Maercker A. (2016). Evidence for two different ICD-11 posttraumatic stress disorders in a community sample of adolescents and young adults. European Archives of Psychiatry and Clinical Neuroscience, 266(4), 317-328.
[37] Robinaugh D. J., Millner A. J., & McNally R. J. (2016). Identifying highly influential nodes in the complicated grief network. Journal of Abnormal Psychology, 125(6), 747-757.
[38] Simon N., Roberts N., Lewis C., van Gelderen M., & Bisson J. I. (2019). Associations between perceived social support, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD): Implications for treatment. European Journal of Psychotraumatology, 10(1), Article 1573129.
[39] Tamres L. K., Janicki D., & Helgeson V. S. (2002). Sex differences in coping behavior: A meta-analytic review and an examination of relative coping. Personality and Social Psychology Review, 6(1), 2-30.
[40] Tolin, D. F., & Foa, E. B. (2006). Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research. Psychological Bulletin, 132(6), 959-992.
[41] van Borkulo, C. D. (2016). NetworkComparisonTest: Statistical comparison of two networks based on three invariance measures. https://cran.r-project.org/web/packages/NetworkComparisonTest/index.html
[42] Wolf E. J., Miller M. W., Kilpatrick D., Resnick H. S., Badour C. L., Marx B. P., & Friedman M. J. (2015). ICD-11 Complex PTSD in US national and veteran samples: Prevalence and structural associations with PTSD. Clinical Psychological Science, 3(2), 215-229.