基于症状结构的 CPTSD 独立性研究： 与 PTSD 和 BPD 共病的比较
文献类型：学位论文
| 作者 | 蔡金苹 |
| 答辩日期 | 2024-06 |
| 文献子类 | 硕士 |
| 授予单位 | 中国科学院大学 |
| 授予地点 | 中国科学院心理研究所 |
| 其他责任者 | 王玮文 |
| 关键词 | 复杂性创伤后应激障碍 创伤后应激障碍 边缘型人格障碍 共病 创伤应激谱系 |
| 学位名称 | 应用心理硕士 |
| 学位专业 | 应用心理 |
| 其他题名 | Independence of Complex PTSD Structure: Distinguishing with PTSD-BPD Comorbid |
| 中文摘要 | Objective: Complex Post-traumatic Stress Disorder (CPTSD) is a recently proposed diagnosis for trauma-related psychiatric conditions. However, debate surrounds its classification as an independent category. Post-traumatic Stress Disorder (PTSD) and Disturbances in Self-Organization (DSO) are core criteria for CPTSD, with DSO symptoms overlapping Borderline Personality Disorder (BPD). While prior studies have compared CPTSD to PTSD and BPD individually, none have directly compared it to comorbid PTSD and BPD (hereafter referred to as comorbidity). This study investigates the necessity of CPTSD as a distinct diagnosis. Methods: This study first conducted a systematic review of the literature on the relationship between the symptom structures of CPTSD, PTSD, and BPD. Second, an empirical study was conducted based on the trauma stress spectrum model. According to screening tool criteria, both student and patient groups were divided into mutually exclusive five groups: CPTSD, comorbidity, PTSD, BPD, and a control group. The study compared these groups regarding prevalence, population overlap, trauma background, core symptoms, and related clinical features. The impact of differing PTSD diagnostic criteria was also evaluated.Finally, latent profile analysis (LPA) was employed to explore latent symptom pattern groups under different PTSD criteria and compare the data-driven groups with the diagnostic groups. Results: From empirical studies based on different trauma levels and across different PTSD diagnostic systems demonstrated that: Firstly, the overlap between CPTSD and comorbidity exceeds 50%, with a particularly high overlap rate observed among patients experiencing higher levels of trauma. Secondly, the disparities in trauma backgrounds across different diagnoses were primarily attributable to the cumulative number of type II traumas, rather than type I traumas. Notably, the CPTSD group exhibited the highest cumulative count of type II traumas, followed closely by the comorbidity group. Thirdly, when considering core and related clinical symptoms, the CPTSD group closely resembles the comorbidity group. However, in the two core symptom clusters of PTSD and DSO, as well as in the related clinical symptoms of anxiety and depression, the CPTSD group displayed more severe manifestations than the comorbidity group. Conversely, the comorbidity group exhibited the most severe BPD core symptoms. Fourthly, LPA analysis revealed that, regardless of whether the subjects are college students or patients, the three core symptom clusters of PTSD, DSO, and BPD exhibited distinct distribution patterns based on varying severities (categorized as high, medium, and low) rather than specific symptom combinations. Interestingly, the CPTSD and comorbidity groups closely aligned with the highest severity category. Finally, different PTSD criteria exerted minimal influence on the independence of CPTSD and comorbidity, with the primary difference lying in the number of type II traumas reported. Conclusion: These studies indicate that there are no significant differences in the symptom structure among CPTSD, PTSD, and BPD within our sample. CPTSD appeared more similar to comorbidity and positioned at the most severe end of the trauma stress spectrum, although exhibiting greater symptom severity in specific domains compared to comorbidity. This study is the first to conduct empirical research on the independent validation of the symptom structure of CPTSD from the perspective of comorbidity, refining the current framework for comparing the independence of CPTSD and providing empirical evidence for the hypothesis that CPTSD may be a comorbidity of PTSD and BPD, providing empirical support for cross-diagnostic interventions and treatment for trauma populations. |
| 英文摘要 | 目的：复杂性创伤后应激障碍（Complex Post-traumatic Stress Disorder, Complex PTSD, CPTSD）是新近提出的一个与创伤相关的精神病理诊断。但对于 CPTSD 能否作为一个独立的精神疾病诊断尚未达成一致的共识。创伤后应激障 碍（Post-traumatic Stress Disorder, PTSD）和自我组织紊乱（Disturbances in Self-Organization，DSO）是构成 CPTSD 诊断的两个必要条件，而 DSO 与边缘 型人格障碍（Borderline Personality Disorder, BPD）在症状标准方面具有重叠性。 从目前对 CPTSD 与 PTSD、BPD 的两两鉴别诊断研究结果来看，虽然大部分结 论支持了 CPTSD 与 PTSD、BPD 有良好的区分效度，但尚无研究对 CPTSD 与 PTSD 和 BPD 共病（以下简称共病）进行比较。因此仍需要对 CPTSD 能否作为一个独立的精神诊断做进一步探究。 方法：本研究首先对 CPTSD 与 PTSD 和 BPD 的症状结构关系的研究进行系 统综述；其次，根据创伤应激谱系模型，在创伤暴露严重程度不同的群体（大学 生和精神科患者）中开展了实证研究。根据筛查工具的标准，将大学生和患者群 体各自划分为互斥的五组：CPTSD、共病、PTSD、BPD 和非上述诊断的对照组， 从检出率、人群重叠率、创伤背景、核心症状和相关临床表现等多个方面对 CPTSD、共病、PTSD 及 BPD 进行系统比较，并且评估不同 PTSD 诊断标准的 影响；最后，采用潜在剖面分析法（Latent Profile Analysis, LPA），在不同的 PTSD 标准下，探索具有相同核心症状模式的人群类别，并比较数据驱动的人群类别与不同诊断组之间的关系。 结果：在不同体系的 PTSD 诊断标准下，基于不同创伤水平群体的实证研究 表明：（1）CPTSD 与共病的重叠率超过 50%；在创伤水平较高的患者群体当中， CPTSD 组和共病组的重叠率更高；（2）不同诊断组在创伤背景上的差异主要体 现在 II 型创伤累计数量而非 I 型创伤，CPTSD 组在 II 型创伤累计数量上最高， 其次为共病组；（3）在核心及相关临床症状上，CPTSD 组与共病组较为接近， 但在 DSO 核心症状及焦虑和抑郁两个相关临床症状上，CPTSD 组比共病组更为 严重；而在 BPD 核心症状上，共病组最严重；（4）LPA 结果表明，无论在大学 生还是患者群体，PTSD，DSO，BPD 三个核心症状簇呈现出基于严重程度不同 的分布模式（高，中，低三类别），而非特定的症状组合，并且 CPTSD 组和共 病组几乎与严重程度最高的类别重合。（5）不同的 PTSD 标准对于 CPTSD 与共 病的独立性影响很小，仅在疾病的检出率和 II 型创伤累积数量方面存在差异。 结论：综合本研究的结果可以发现，在我们的样本中，CPTSD、PTSD 与BPD，没有呈现症状结构本质差异。CPTSD 与共病更为相似，且处在创伤应激谱系中最严重的一端，并且在某些症状表现上，CPTSD 比共病更为严重。本研 究首次从共病的角度开展了 CPTSD 症状结构的独立性验证的实证研究，完善了 当前对 CPTSD 独立性比较的框架，并从实证的角度检验了 CPTSD 可能是 PTSD 和 BPD 共病的假设，为跨诊断干预和治疗创伤群体提供了实证基础。 |
| 语种 | 中文 |
| 源URL | [http://ir.psych.ac.cn/handle/311026/48130]  |
| 专题 | 心理研究所_健康与遗传心理学研究室 |
| 推荐引用方式 GB/T 7714 | 蔡金苹. 基于症状结构的 CPTSD 独立性研究： 与 PTSD 和 BPD 共病的比较[D]. 中国科学院心理研究所. 中国科学院大学. 2024. |
入库方式： OAI收割
来源：心理研究所
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