Clinical Phenomenology of Childhood Abuse–Related Complex PTSD in a Population of Female Patients: Patterns of Personality Disturbance

Abstract

Objective: Complex posttraumatic stress disorder (PTSD) involves a variety of personality disturbances presumed to result from repeated interpersonal trauma such as child abuse. As Complex PTSD patients are a heterogeneous population, we searched for clinically relevant personality-based subtypes. Method: This study used a cluster analysis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Axis II features within a sample of 71 female outpatients with systematically assessed child abuse–related Complex PTSD. Results: Two main subtypes were found: adaptive and nonadaptive. The latter was further differentiated into withdrawn, alienated, suffering, and aggressive subtypes, characterized by different levels of introversion and disinhibition. Among the nonadaptive subtypes, the severity of Complex PTSD symptoms was lowest in the withdrawn (introverted only) subtype. The subtypes differed in their level of dissociation and depression but did not differ regarding PTSD symptoms, trauma history, or parental bonding characteristics. Conclusion: Confirming earlier findings, our study found personality-based Complex PTSD subtypes, which could implicate differential treatment needs and results.

Keywords:

• posttraumatic stress disorders
• personality assessment
• child abuse
• adult survivors of child abuse

Acknowledgments

A grant was provided by ZONMW (The Netherlands Organisation for Health Research and Development, Den Haag) under contract 100-002-024.

The authors thank the main interviewers (Natalie Ran, Rinske de Vries, Carolijne Klunne, and Monique Burger) and all of the participating patients and their institutions: PsyQ (formerly GGZ Dijk en Duin), Altrecht, GGZ Noord-Holland-Noord, and GGZ inGeest (formerly GGZ Buitenamstel) for their participation in this study. The acknowledged individuals report no conflicts of interest.

This work was previously presented at the annual meeting of the American Psychiatric Association, May 2010, New Orleans, LA.