Transdiagnostic Perspectives on PTSD
Preliminary research suggests that applying a transdiagnostic approach to PTSD and other trauma-related disorders may be effective in treating these disorders and their related comorbidities (Gutner et al., 2019).
Fundamental to a transdiagnostic lens on PTSD is understanding the common comorbidities in addition to identifying adverse childhood experiences (ACEs) as a socioenvironmental risk factor for developing PTSD for additional trauma.
Common Comorbidities
Comorbidity, especially at high rates, can make PTSD more complex and make it challenging for health professionals to develop a treatment plan which considers how to prioritize symptom treatment (Gutner & Presseau, 2019). There are several disorders that can co-occur with PTSD, including:
- Anxiety disorder
- Major depressive disorder
- Eating disorders
- Substance use disorders
- Increased suicidality
- Chronic pain
- Traumatic brain injury
Given the high potential for comorbidity, it is important to take into account all transdiagnostic variables which might underly PTSD and its comorbidities (Kessler et al., 1995).
Emotion Regulation
Furthermore, emotion regulation processes of expressive suppression, rumination, and beliefs about one’s ability to manage negative emotions predict avoidant coping strategies and may predict the maintenance of post-traumatic stress (and other co-occurring disorders, like depression) (Post et al., 2021).
Early Childhood Adversity
Early childhood adversity is a transdiagnostic socioenvironmental risk factor for developing PTSD in those who later experience additional adult trauma (Haim-Nachum et al., 2022). Several childhood (age 0-18) adversity exposures have been empirically validated as risk factors for both physical and mental health conditions where greater exposure means greater risk. Some examples include:
- Physical abuse
- Sexual abuse
- Emotional abuse
- Physical neglect
- Emotional neglect
- Parent treated violently
- Household substance abuse
- Household mental illness
- Parental separation or divorce
- Incarcerated household member
In the chart below, you can see the prevalence of adverse childhood experiences.
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Survivors of Urban Violence
In young survivors of urban violence, adverse childhood experiences were associated with increasing PCL-5 scores and increased risk for provisional PTSD. Additionally, as participants’ cumulative adverse childhood experience scores increased, their PCL-5 scores worsened, and incremental adverse childhood experience score increases predicted increased odds for a positive provisional PTSD screen (Tabb et al., 2022).
Female Military Veterans
In 750 female military veterans surveyed, the experience of childhood adversities was strongly linked to experiencing symptoms of posttraumatic stress disorder in adulthood and experiences of emotional bullying, sexual harassment, and assault during military service (Williamson et al., 2022).
Military Veterans (Gender Non-Specific)
In military veterans returning from deployment, those who reported adverse childhood experiences in more than one category were significantly more likely to be diagnosed with post-deployment PTSD. Specifically, childhood physical neglect was most strongly associated with post-deployment PTSD (LeardMann et al., 2010).
Hurricane Sandy
By studying the relationship between adverse childhood experiences and response to Hurricane Sandy, one study demonstrated that adverse childhood experiences can alter the way traumatic events in adulthood are experienced and are associated with higher rates of fear, distress, and depressive symptoms (Wilson-Genderson et al., 2021).
Did You Know?
Those with more than 4 adverse childhood experiences are
more likely to attempt suicide
more likely to use IV drugs
more likely to have depression
Those with more than 2 adverse childhood experiences have
increased risk for an autoimmune disease
Those with more than 6 adverse childhood experiences have
reduction in lifespan
References
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245–258.
Gutner, C. A., Galovski, T., Bovin, M. J., & Schnurr, P. P. (2016). Emergence of Transdiagnostic Treatments for PTSD and Posttraumatic Distress. Current psychiatry reports, 18(10), 95.
Haines, S. K. (2019). The politics of trauma. North Atlantic Books.
Haim-Nachum, S., Sopp, M. R., Bonanno, G. A., & Levy-Gigi, E. (2022). The Lasting Effects of Early Adversity and Updating Ability on the Tendency to Develop PTSD Symptoms Following Exposure to Trauma in Adulthood. Cognitive Therapy and Research, 46, 1101-1112.
Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of general psychiatry, 52(12), 1048–1060.
LeardMann, C. A., Smith, B., & Ryan, M. A. K. (2010). Do adverse childhood experiences increase the risk of postdeployment posttraumatic stress disorder in US Marines? BMC Public Health, 10(437).
Tabb, L. P., Rich, J. A., Waite, D., Alberto, C., Harris, E., Gardner, J., Gentile, N., & Corbin, T. J. (2022). Examining Associations between Adverse Childhood Experiences and Posttraumatic Stress Disorder Symptoms among Young Survivors of Urban Violence. Journal of urban health : bulletin of the New York Academy of Medicine, 99(4), 669–679.
Williamson, C., Baumann, J., & Murphy, D. (2022). Adverse childhood experiences, military adversities, and adult health outcomes among female Veterans in the UK. Journal of Military, Veteran, and Family Health, 8(2).
Wilson-Genderson, M., Heid, A. R., Cartwright, F., & Pruchno, R. (2021). Adverse childhood experiences, adult trauma, and depressive symptom trajectories. Aging & Mental Health, 26(11), 2170-2178.