Complex PTSD linked to psychotic symptoms following developmental trauma

Key takeaways:

• The results highlight post-traumatic stress disorders as a modifiable risk factor for psychosis conversion.
• The researchers said future studies should probe what PTSD symptoms affect psychotic symptom severity.

Complex PTSD was significantly associated with the severity of psychotic symptoms among people who experienced developmental trauma though symptom severity had no relationship with the broader diagnosis of ICD-11 PTSD, data show.

The results point to the importance of assessing and treating complex PTSD in survivors of developmental trauma and highlight post-traumatic stress disorders as a potential modifiable risk factor for conversion to psychosis, researchers wrote in The Lancet Psychiatry.

“Health systems must assess individuals with previous developmental trauma for complex PTSD and treat those affected,” Ava J. C. Mason, MSc, of the division of psychiatry at University College London, and colleagues wrote. “These individuals should also be assessed for psychotic symptoms, and if necessary, preventative measures should be taken to reduce risk of conversion.”

Mason and colleagues aimed to see if psychotic symptom severity among survivors of developmental trauma had any relationship to PTSD, as defined in ICD-11, or complex PTSD, a new diagnosis added last year. Complex PTSD includes additional symptoms of affective dysregulation, negative self-concept and relationship disturbance, they wrote.

Their study analyzed data from 1,273 participants across two sites: one in the U.K. (n = 475) and one in South Korea (n = 798). Participants were 67% women (n = 851) with a mean age of 26.9 years (SD = 6).

Self-reported questionnaires indicated that 5% of participants (n = 64) had PTSD and 41% (582) had complex PTSD. Psychotic symptom severity was evaluated using the Community Assessment of Psychic Experiences questionnaire.

Using linear regression and adjusting for sociodemographic variables, complex PTSD was found to be significantly associated with increased total psychotic symptom severity (total severity beta = 22.62; SE 1.65; P < .0001) compared with participants without PTSD or complex PTSD.

Complex PTSD was associated with the severity of both positive (beta = 12.07; SE 0.99; P < .0001) and negative (beta = 10.5; SE 0.95; P < .0001) psychotic symptoms.

There was no significant association between psychotic symptom severity and ICD-11 PTSD (beta = -2.4; SE 3.28; P = .47). The result follows previous indications that ICD-11 PTSD is a “significant predictor” of psychotic symptoms and suggests the relationship is specific to complex PTSD, Mason and colleagues wrote.

The researchers called for future studies with large sample sizes to probe what specific PTSD symptoms affect psychotic symptom severity, as well as to determine “whether there is comorbidity between complex PTSD and psychotic symptoms, or whether they exist as separate disorders with shared risk factors.”

Limitations of the study included its cross-sectional nature, the sample’s low prevalence of PTSD compared with complex PTSD, inclusion of participants at both sites with higher-than-average educational attainment, and use of self-report questionnaires.