Associations Between Childhood Adversity Types and Joint Trajectories of Complex Posttraumatic Stress Disorder Symptoms in Emerging Adults: A Longitudinal Cohort Study

Abstract

Complex posttraumatic stress disorder (CPTSD) includes two distinct symptom clusters: posttraumatic stress disorder (PTSD) and disturbances in self-organization (DSO), which may differ in manifestation, trajectories, and psychosocial impact. However, longitudinal studies remain limited. This study investigates the joint developmental trajectories of PTSD and DSO symptoms in emerging adults with adverse childhood experiences (ACEs) and the influence of different ACE types. From a three-wave cohort of emerging adults assessed at two-year intervals, 2,063 individuals (58.5% male) who reported at least one ACE at baseline were included in the final analysis. Multiple-process growth mixture model was employed to identify distinct joint developmental trajectories of PTSD and DSO symptoms, and logistic regression analyses were conducted to examine the predictive associations between different types of ACEs and trajectory membership. Three heterogeneous symptom trajectory groups of CPTSD were identified among emerging adults with histories of childhood adversity: the low-symptom group (n = 1,526, 73.7%), the increasing DSO and rebounding PTSD group (n = 113, 5.4%), and the moderate DSO and decreasing PTSD group (n = 424, 20.9%). Multinomial logistic regression revealed that physical abuse, emotional neglect, and parental incarceration were associated with a greater likelihood of belonging to the increasing DSO and rebounding PTSD group. In contrast, emotional abuse, emotional neglect, and family mental illness were more strongly linked to membership in the moderate DSO and decreasing PTSD group. The results suggest the trajectories of CPTSD symptoms of college students with ACEs were heterogeneous. Different types of ACEs have varying predictive effects on CPTSD symptoms trajectories.