Complex post-traumatic stress symptoms in female adolescents: the role of emotion dysregulation in impairment and trauma exposure after an acute sexual assault

Figures & data

Table 1. Items used to represent the symptoms of Post-Traumatic Stress Disorder (PTSD) and Complex Post-Traumatic Stress Disorder (CPTSD) according to ICD-11: proposed symptom indicators for CPTSD

Factors	Test items	Measures
Core PTSD symptoms	Intrusion:
	(x1) Since the incident that brought you to the sexual assault referral centre, have you experienced flashbacks?	Proforma
	(x2) Have you had a lot of upsetting dreams of the event?	DAWBA
	Avoidance:
	(x3) Do you try not to think about it?	CRIES-13
	(x4) Do you stay away from reminders (i.e. places or situations)?	CRIES-13
	Sense of threat:
	(x5) Are you alert and watchful even when there is no obvious need to be?	CRIES-13
	(x6) Do you startle more easily or feel more nervous?	CRIES-13
Emotion dysregulation	(x7) Do you get easily irritable?	CRIES-13
	(x8) I get very angry and often lose my temper	SDQ
	(x9) Do you have marked or rapid mood changes?	DAWBA
negative self-concept	(x10) I felt I was no good any more	S-MFQ
	(x11) I hated myself	S-MFQ
	(x12) I was a bad person	S-MFQ
	(x13) I thought nobody really loved me	S-MFQ
Interpersonal problems	(x14) I have one good friend or more	SDQ
	(x15) Other people my age generally like me	SDQ
	(x16) Are you really proud of being good with friends?	DAWBA
	(x17) I am usually on my own. I generally play alone or keep to myself	SDQ
	(x18) Overall, do you particularly fear or avoid social situations that involve a lot of people, meeting new people or doing things in front of other people?	DAWBA

Abbreviations: ICD = International Classification of Diseases; SDQ = Strengths and Difficulties Questionnaire; CRIES-13 = Children’s Revised Impact of Event Scale; S-MFQ = Short version of the Mood and Feelings Questionnaire; DAWBA = The Development and Well-Being Assessment.

Figure 1. Alternative models of the symptom structure of Complex Post-Traumatic Stress Disorder (CPTSD) and symptoms of emotion dysregulation, negative self-concept and interpersonal problems

Table 2. Fit indices and model comparison of Complex Post-Traumatic Stress Disorder (CPTSD) competing models

CPTSD models	X^2	df	p	CFI	TLI	RMSEA	nested models	ΔX2	Δdf	p
(a) 1-factor 1st order	266.318	135	0	.845	.824	.097
(b) 4-factor 1st order	164.293	129	.0195	.958	.951	.052
(c) 4-factor 2nd order	172.649	131	.009	.951	.943	.056	b) vs c)	7.07	2	.029

Abbreviations: CFI = comparative fit index; TLI = Tucker–Lewis index; RMSEA = root-mean-square error of approximation.

Figure 2. Symptom endorsement of complex PTSD (Post-Traumatic Stress Disorder) by class

Table 3. Regression analyses where the 4 CPTSD (Complex Post-Traumatic Stress Disorder) factors are used as independent variables predicting impairment rated by the victims (SDQ), impairment rated by clinicians (CGAS), and further trauma exposure during the 4–5 months post-sexual assault

	SDQ impairment		CGAS impairment		any further trauma exposure		further sexual trauma exposure
predictor variables	β (SE)	p [95% CI]	B (SE)	p [95% CI]	B (SE)	p [95% CI]	B (SE)	p [95% CI]
Core PTSD symptoms	.12 (.15)	.438 [−0.56, 1.28]	.08 (.15)	.606 [−4.91, 2.86]	−.57(.28)	.040*	−.56(.32)	.078
Emotion dsyregulation	.49 (.16)	.002 [0.49, 2.52]**	.54 (.14)	<.001 [−11.14, −3]**	.84(.28)	.002**	.70(.32)	.030*
Negative self-concept	.03 (.14)	.832 [−0.73, 0.91]	.18 (.14)	.203 [−6.09, 1.3]	−.16(.24)	.491	−.13(.30)	.681
Interpersonal problems	.20 (.12)	.083 [−1.38, 0.12]	.08 (.13)	.511 [−2.16, −4.36]	−.34(.22)	.119	.58(.30)	.054

Abbreviations: β = standardized coefficients; SE = standard error; CI = confidence interval; SDQ = Strengths and Difficulties Questionnaire; CGAS = Children’s Global Assessment Scale.

*p < .05, **p < .005