A Network Analysis of ICD‐11 Complex PTSD in the Iranian Population Exposed to Trauma

Abstract

Abstract Introduction: The 11th revision of the World Health Organization’s International Classification of Diseases (ICD-11) includes a new disorder, complex post-traumatic stress disorder (CPTSD), which is a heterogeneous condition, and identification of its core symptoms may inform how to conceptualize the heterogeneity. The network approach to psychopathology enables the investigation of the structure of disorders at the symptom level, which allows for the analysis of direct symptom interactions. The main objectives of the present study were to explore Complex PTSD symptom structure and identify key symptoms of Complex PTSD in the Iranian population exposed to trauma. Methods: Participants consisted of 463 people referred to comprehensive health centers in Tehran from September to December 2023 with psychopathological syndromes. Complex PTSD symptoms were assessed using the International Trauma Questionnaire (ITQ) and International Measurement of Exposure to Traumatic Event checklist. Network analysis was applied to identify the most central symptoms (nodes) and associations between symptoms (edges) by the graphical LASSO algorithm and the EBCglasso method for network estimation. Results: The results showed that the network of estimated symptoms has perfect accuracy and stability, and the most central symptoms of Complex PTSD in Iranian culture were feelings of failure and feelings of worthlessness. Furthermore, "long-term upset" was the link between PTSD symptoms and DSO. Conclusions: Feeling of failure and feeling of worthlessness were the most central symptoms in the Complex PTSD network, and they can be predictive of other symptoms of Complex PTSD. The long-term upset also uniquely predicts co-occurring symptoms of PTSD and DSO. These symptoms should be prioritized in theoretical and treatment models of Complex PTSD.