Positive Symptoms of Psychosis and International Classification of Diseases 11th Revision (ICD-11) Complex Post-traumatic Stress Disorder: A Network Analysis in a Canadian Sample from Montreal: Symptômes positifs de psychose et trouble de stress post-traumatique complexe (CIM-11): Une analyse de réseau dans un échantillon canadien de Montréal

Abstract

Objectives

Traumatic experiences constitute a risk factor for developing different psychopathologies, such as post-traumatic stress disorder (PTSD), complex PTSD (CPTSD), and positive symptoms of psychosis. However, on the symptom level, it is still unclear how CPTSD and positive symptoms of psychosis associate with each other. The present study aimed to shed light on these dynamics by investigating the symptoms network of CPTSD and positive symptoms of psychosis.

Methods

A network analysis was performed on CPTSD and psychosis symptoms among a Canadian community sample with a history of traumatic life events (n = 747). Measures included the international trauma questionnaire and the mPRIME screen.

Results

In total, 4.8% of the sample reached the criteria of probable PTSD and 7% fulfilled the criteria of probable CPTSD. PTSD and CPTSD groups had a significantly higher severity of positive symptoms of psychosis compared to the no-disorder group. Network analysis revealed 3 distinct communities of symptoms of PTSD, disturbances in self-organization, and psychosis. Affective dysregulation served as the bridging symptom between the communities. Hearing one's own thoughts aloud was the most central symptom in the network.

Conclusions

Findings show that positive symptoms of psychosis can be considered trauma-related responses. Furthermore, interventions targeting affective dysregulation as well as the experience and distress associated with hearing one's own thoughts aloud may contribute to symptom reduction and improved functioning.

Understanding the Link Between Trauma and Psychosis: Insights From a Canadian Study

Plain Language Summary

Traumatic experiences can deeply affect mental health, leading to conditions like post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). CPTSD includes symptoms like difficulty controlling emotions, negative self-perceptions, and relationship challenges, alongside traditional PTSD symptoms such as flashbacks and avoidance of reminders. Interestingly, trauma is also linked to psychosis symptoms, such as delusions and hearing voices. This study explored how CPTSD and psychosis symptoms are connected, using data from 747 adults in Montreal who had experienced trauma. Researchers analysed how different symptoms interacted in a network to identify key symptoms linking the conditions. They found that difficulties in calming down when upset acted as a bridge between trauma-related symptoms and psychosis symptoms. Additionally, hearing one’s own thoughts aloud was identified as a central symptom in the network. The study highlights the importance of addressing emotional regulation difficulties and auditory experiences in treating individuals with CPTSD and psychosis-like symptoms. These findings could help clinicians target key symptoms for better mental health outcomes. However, the study's findings may not apply to all populations due to its focus on a specific group from Montreal, and further research is needed to understand the cause-and-effect relationships.