Distinguishing PTSD, complex PTSD, and borderline personality disorder using exploratory structural equation modeling in a trauma-exposed urban sample

• Type of Material: Article
• Authors: Abigail Powers, Emory University; Jessica M Petri, Emory University; Chelsea Sleep, Cincinnati VA Medical Center; Yara Mekawi, University of Louisville; Emma C Lathan, Emory University; Karen Shebuski, Georgia State University; Bekh Bradley, Emory University; Negar Fani, Emory University
• Language: English
• Date: 2022-04-02
• Publisher: PERGAMON-ELSEVIER SCIENCE LTD
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 Elsevier Ltd. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.janxdis.2022.102558
• Title of Journal or Parent Work: JOURNAL OF ANXIETY DISORDERS
• Volume: 88
• Start Page: 102558
• End Page: 102558
• Grant/Funding Information: This work was supported by National Institute of Mental Health Grants MH071537, R01-MH100122, and F32-MH102890; Eunice Kennedy Shriver National Institute of Child Health and Human Development Grant R01-HD071982; and National Center for Complementary & Integrative Health Grant K23-AT009713.
• Keywords: Social Sciences; VALIDITY; Trauma; Psychology, Clinical; Borderline personality disorder; Science & Technology; SCALE; Posttraumatic stress disorder; Psychiatry; Complex posttraumatic stress disorder; Psychology; Life Sciences & Biomedicine; PROPOSALS

Abstract

There is debate about the validity of the complex posttraumatic stress disorder (CPTSD) diagnosis and whether disturbances in self-organization (DSO) in CPTSD can be differentiated from borderline personality disorder (BPD). How PTSD is defined may matter. The present study used exploratory structural equation modeling (ESEM) to replicate and extend prior work by including two models to examine how PTSD (ICD-11, DSM-5), DSO, and BPD symptoms relate. Participants (N = 470; 98.1% women; 97.7% Black) were recruited from medical clinics within an urban hospital. PTSD, CPTSD, and BPD were assessed using semi-structured interviews and trauma-related avoidance, aggressive behavior, and anxious attachment were assessed using self-report measures. ESEM models of PTSD, DSO, and BPD symptoms were run. We found a three-factor ESEM model of CPTSD (ICD-11 PTSD and DSO symptoms) and BPD symptoms best fit the data and found support for discriminant validity between factors across trauma-related avoidance, aggressive behavior, and anxious attachment. For DSM-5 PTSD, a two-factor ESEM model was best-fitting (PTSD and DSO/BPD). The findings demonstrate clear distinguishing and overlapping features of ICD-11 PTSD, CPTSD, and BPD and the necessity to consider the diagnostic structure of PTSD in determining the additive value of CPTSD as a distinct construct.