Post-traumatic Stress Disorder and Complex Post-traumatic Stress Disorder in an urban, seriously mentally ill population

Abstract

This research involved an investigation of Post-traumatic Stress Disorder (PTSD) as currently defined by the Diagnostic and Statistical Manual of Mental Disorders (4th Edition) (American Psychiatric Press, 1994) and Complex PTSD (Herman, 1992) a newly proposed diagnostic concept, in a seriously mentally ill population residing in an urban setting. The purposes of this study were to determine prevalence rates of both types of PTSD (DSM IV PTSD and Complex PTSD) for this population; to examine levels of depression, dissociation, anxiety, somatization in persons meeting criteria for these diagnoses of PTSD; to explore levels of psychiatric severity of individuals with PTSD diagnoses; and to examine a potential link between different types of trauma experienced and type of PTSD exhibited.

Subjects were 47 randomly selected individuals, diagnosed with a severe and persistent mental illness, receiving case management services from Central Kansas City Mental Health Services in Kansas City, Missouri. These individuals participated in a multi-method, multi-trait research battery that included diagnostic instruments for both DSM IV PTSD and Complex PTSD; measures of depression, dissociation, anxiety, and somatization; and a questionnaire about type of trauma the individual may have experienced. Other information was gathered with a demographics questionnaire and by chart review.

Results from data analysis indicated that the overall incidence of PTSD is greater in this population than in the general population and that it is under-diagnosed in this population (only 2 out of 25 subjects meeting diagnostic criteria for PTSD carried the diagnosis formally in agency records). Further, subjects with any type of PTSD had higher levels of anxiety, depression, and dissociation, but not of somatization, than those without PTSD. In fact, individuals diagnosed with Complex PTSD and DSM IV PTSD had the highest symptom levels of these syndromes compared with subjects who did not meet criteria for PTSD or DSM IV PTSD alone. Interestingly, no significant differences were found between diagnostic groups with respect to psychiatric severity, as measured by total time hospitalized for mental health reasons and numbers of crisis contacts initiated in the last 12 months, using multivariate analysis of variance (MANOVA). Finally, an association was found between type of trauma experienced and type of PTSD diagnosis (No PTSD, DSM IV PTSD only, both DSM IV PTSD and Complex PTSD). Implications and limitations and of the study are discussed along with recommendations for future research.