title: Alternative models of disorders of traumatic stress based on the new ICD-11 proposals.
abstract: OBJECTIVE
  Although there is emerging evidence for the factorial validity of the distinction between post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) proposed in ICD-11, such evidence has been predominantly based on using selected items from individual scales that describe these factors. We have attempted to address this gap in the literature by testing a range of alternative models of disorders of traumatic stress using a broader range of symptoms and standardized measures.
  
  
  METHODS
  Participants in this cross-sectional study were a sample of individuals who were referred for psychological therapy to a National Health Service (NHS) trauma centre in Scotland (N = 195). Participants were recruited over a period of 18 months and completed measures of stressful life events, DSM-5 PTSD, emotion dysregulation, self-esteem and interpersonal difficulties.
  
  
  RESULTS
  Overall, results indicate that a structural model incorporating six first-order factors (re-experiencing, avoidance of traumatic reminders, sense of threat, affective dysregulation, negative self-concept and disturbances in relationships) and two second-order factors (PTSD and disturbances in self-organization [DSO]) was the best fitting. The model presented with good concurrent validity. Childhood trauma was found to be more strongly associated with DSO than with PTSD.
  
  
  CONCLUSIONS
  Our results are in support of the ICD-11 proposals for PTSD and CPTSD.
authors.affiliation: School of Psychology, Ulster University, Derry, UK.
authors.forename: M
authors.initials: M
authors.lastname: Shevlin
authors.affiliation: School of Business, National College of Ireland, Dublin, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Hyland
authors.affiliation: School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK.|Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK.
authors.forename: T
authors.identifier: http://orcid.org/0000-0002-3002-0630
authors.initials: T
authors.lastname: Karatzias
authors.affiliation: Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK.
authors.forename: C
authors.initials: C
authors.lastname: Fyvie
authors.affiliation: Psychology and Counselling Directorate, Cardiff and Vale University Health Board, Cardiff, UK.
authors.forename: N
authors.initials: N
authors.lastname: Roberts
authors.affiliation: School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: J I
authors.initials: JI
authors.lastname: Bisson
authors.affiliation: Clinical, Education & Health Psychology, University College London, London, UK.
authors.forename: C R
authors.initials: CR
authors.lastname: Brewin
authors.affiliation: School of Medicine, New York University, New York, NY, USA.|National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Cloitre
mesh_terms: D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008960:Models, Psychological; D011569:Psychiatric Status Rating Scales; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*
keywords: ICD-11; complex post-traumatic stress disorder; disorders of traumatic stress; post-traumatic stress disorder