How Can We Measure PTSD and Complex PTSD in Sexual Violence Survivors?

What you need to know

• The International Trauma Questionnaire (ITQ) is a valid tool for measuring post-traumatic stress disorder (PTSD) and complex PTSD symptoms in survivors of sexual violence.
• Complex PTSD was more common than PTSD among sexual violence survivors seeking therapy, with 56% meeting criteria for complex PTSD and 20% for PTSD.
• The study highlights the significant mental health impact of sexual violence and the need for trauma-informed care for survivors.

Understanding PTSD and Complex PTSD

Post-traumatic stress disorder (PTSD) and complex PTSD are mental health conditions that can develop after experiencing traumatic events. While PTSD has been recognized for many years, complex PTSD is a newer diagnosis that captures additional symptoms some trauma survivors experience.

PTSD is characterized by three main symptom clusters:

1. Re-experiencing the trauma (e.g., flashbacks, nightmares)
2. Avoidance of trauma reminders
3. Heightened sense of threat (e.g., being overly alert or easily startled)

Complex PTSD includes these PTSD symptoms plus three additional symptom clusters:

1. Difficulties regulating emotions
2. Negative self-concept (e.g., feeling worthless)
3. Problems with relationships

The International Trauma Questionnaire (ITQ) was developed to assess these symptoms and diagnose PTSD and complex PTSD according to the latest diagnostic criteria.

Assessing the ITQ in Sexual Violence Survivors

This study aimed to evaluate how well the ITQ measures PTSD and complex PTSD symptoms in survivors of sexual violence who were receiving therapy. The researchers worked with 114 adults attending the Dublin Rape Crisis Centre in Ireland.

Validity of the ITQ

The researchers used a statistical technique called confirmatory factor analysis to examine the structure of the ITQ. They found that two models fit the data well:

1. A six-factor model, with each factor representing one of the symptom clusters (3 for PTSD and 3 for complex PTSD)
2. A two-factor higher-order model, with PTSD and complex PTSD as broader categories encompassing their respective symptom clusters

These results suggest that the ITQ accurately captures the distinction between PTSD and complex PTSD symptoms, as well as the specific symptom clusters within each disorder. This is important because it means the questionnaire can provide detailed information about a person’s symptoms, which can help guide treatment planning.

Reliability of the ITQ

The researchers also examined the internal reliability of the ITQ, which indicates how consistently it measures each symptom cluster. Most of the symptom clusters showed good reliability, meaning the questions within each cluster were closely related. However, the questions measuring difficulties with emotion regulation showed lower reliability. This might be because people can have different types of emotion regulation problems (e.g., feeling emotionally numb vs. having intense emotional reactions), and individuals might primarily experience one type or the other.

Prevalence of PTSD and Complex PTSD

One of the most striking findings of this study was the high rate of PTSD and complex PTSD among the participants:

• 76.3% of participants met criteria for either PTSD or complex PTSD
• 56.1% met criteria for complex PTSD
• 20.2% met criteria for PTSD

These results highlight the significant psychological impact of sexual violence. It’s important to note that complex PTSD was more common than PTSD in this sample. This aligns with previous research suggesting that sexual trauma is particularly likely to lead to complex PTSD.

Implications for Treatment and Support

The high prevalence of complex PTSD among sexual violence survivors seeking therapy has important implications for treatment:

1. Trauma-informed care: Mental health professionals working with sexual violence survivors should be prepared to address the complex symptoms associated with complex PTSD, not just classic PTSD symptoms.

2. Comprehensive assessment: Using tools like the ITQ can help clinicians identify the full range of symptoms a survivor is experiencing, allowing for more tailored treatment plans.

3. Addressing self-concept and relationships: Given that complex PTSD includes symptoms related to negative self-concept and relationship difficulties, treatment may need to focus on these areas in addition to processing the traumatic memories.

4. Emotion regulation skills: With many survivors experiencing difficulties regulating emotions, teaching emotion regulation techniques may be a crucial component of treatment.

5. Longer-term support: Complex PTSD often requires longer-term treatment compared to PTSD alone. This highlights the need for accessible, ongoing mental health support for sexual violence survivors.

Conclusions

• The International Trauma Questionnaire (ITQ) is a valid and reliable tool for assessing PTSD and complex PTSD symptoms in sexual violence survivors.
• Complex PTSD is more common than PTSD among sexual violence survivors seeking therapy, affecting more than half of the participants in this study.
• These findings underscore the need for trauma-informed mental health services that can address the complex psychological impacts of sexual violence.

While this study provides valuable insights, it’s important to note that it had a relatively small sample size and focused on individuals already seeking therapy. Further research with larger and more diverse groups of sexual violence survivors would help confirm and expand upon these findings. Nonetheless, this study makes a significant contribution to our understanding of how to assess and potentially treat PTSD and complex PTSD in survivors of sexual violence.