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Open AccessGrundlagen

Die einfache und komplexe Posttraumatische Belastungsstörung in der Praxis

Eine Übersicht und Einordnung der neuen ICD-11 Kriterien in Bezug auf Kinder und Jugendliche

Published Online:August 26, 2021https://doi.org/10.1026/0942-5403/a000342

Abstract

Zusammenfassung.Theoretischer Hintergrund: Die ICD-11 enthält reformulierte Kriterien für die Posttraumatische Belastungsstörung (PTBS) und die neue Diagnose komplexe PTBS (kPTBS). Fragestellung: Wie wirken sich die Neuerungen auf die Diagnostik und Behandlung von Kindern und Jugendlichen aus? Methode: In dieser Übersichtsarbeit werden die neuen Kriterien vorgestellt und mit früheren Diagnosemanualen verglichen. Bisherige Forschungsergebnisse zu PTBSICD-11 und kPTBS bei Kindern und Jugendlichen werden zusammengefasst und diskutiert. Ergebnisse: Die PTBSICD-11-Kriterien führen eher zu geringeren Prävalenzraten verglichen mit PTBSICD-10, PTBSDSM-IV und PTBSDSM-5. Erste Studien weisen darauf hin, dass evidenzbasierte traumafokussierte Therapiemanuale auch zur Behandlung der kPTBS geeignet sind. Diskussion und Schlussfolgerung: Die Anwendung neuer Kriterien stellt Praktiker_innen und Forscher_innen vor Herausforderungen. Bisherige Ergebnisse deuten an, dass die kPTBS gut behandelbar ist.


Simple and Complex Posttraumatic Stress Disorder in Clinical Practice: An Overview and Evaluation of the New ICD-11 Criteria for Children and Adolescents

Abstract.Theoretical Background: The 11th version of the International Classification of Diseases (ICD-11) includes reformulated criteria for Posttraumatic Stress Disorder (PTSD) and additional criteria for complex PTSD (CPTSD). PTSDICD-11 is narrowed down to six core symptoms across three clusters; CPTSD is a distinct disorder comprising PTSDICD-11 criteria with additional criteria addressing disturbances in self-organization (DSO): affective dysregulation, negative self-concept, and interpersonal problems. Hence, therapists may be confronted in clinical practice with young patients with these new diagnoses, even though treatment recommendations are still not existent and randomized clinical trials have yet to be conducted. Objective: To give an overview for clinicians of PTSDICD-11 and CPTSD criteria for children and adolescents. Method: First, we present the diagnostic criteria for PTSDICD-11 and CPTSD and discuss the diagnostic approach of PTSDICD-11 compared to PTSDDSM-IV, PTSDDSM-5, and PTSDICD-10. Second, we outline current research on PTSDICD-11 and CPTSD in children and adolescents. We summarize the results on prevalence rates, on group differences between young patients with PTSDICD-11 and CPTSD, and on the applicability of existing trauma-focused therapies for CPTSD. Third, we discuss possible implications for clinical practice and upcoming issues. Results: The PTSDICD-11 and CPTSD criteria are intended for use in all age groups, though developmentally adapted aspects are missing. PTSDICD-11 incidence rates appear to be lower compared to PTSDDSM-IV, PTSDDSM-5, and PTSDICD-10. Rates of PTSDICD-11 and CPTSD vary across populations; CPTSD rates appear to be lower than PTSDICD-11 rates. Findings on group differences are heterogeneous. Studies indicate that trauma-focused cognitive behavioral therapy (TF-CBT) and developmentally adapted cognitive processing therapy (D-CPT) have a positive impact on PTSDICD-11 and CPTSD symptoms. Discussion and conclusion: Results indicate that PTSDICD-11 rates are stricter than diagnoses based on other versions of the PTSD criteria. Promising first results indicate that CPTSD symptoms can be treated successfully with existing trauma-focused treatment manuals. However, the benefit of additional treatment phases to address DSO symptoms needs further study. So far, data on PTSDICD-11 and CPTSD in children and adolescents are limited. Because most of the studies used archival data to map ICD-11 symptoms, their results have to be interpreted cautiously. A first screening questionnaire for PTSDICD-11 and CPTSD has already been published and validated for children and adolescents. Further research using clinical interviews for PTSDICD-11 and CPTSD is necessary to gain further insight into the implications of the new diagnoses.

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