Introducing a new condition

Professor Thanos Karatzias is challenging existing classifications of traumatic stress disorders.  

When Jason Fox spoke at Edinburgh Napier in 2017, he described how he left the armed forces having been signed off sick and put on antidepressants, but was assured that the moment he left, he would feel better. However, he found himself hiding from friends and “failing at life”. It was only much later that ‘Foxy’, the star of TV show SAS: Who Dares Wins, realised he was suffering from Post-Traumatic Stress Disorder (PTSD).

Now the University’s Professor Thanos Karatzias is doing ground-breaking work on a new condition linked to childhood and multiple trauma and its relevance to military personnel like Foxy. This work is set to lead to a new psychiatric classification of Complex PTSD and could have a wide-ranging impact on the way sufferers are treated.

Thanos has discovered that when looking at those seeking treatment for traumatic stress in adulthood, it is rare to find someone who has only been exposed to one traumatic life event. Most trauma survivors will have suffered childhood trauma which has created a vulnerability for further exposure to traumatic events in adulthood.

Referring to military personnel, Thanos says: “In a treatment-seeking population, combat stress would be the referring problem in most cases. However, if you look into their history, you would find an accumulation of different life events.”

So why is childhood trauma so important? Thanos, who has also studied trauma in prison populations, says that it can lead to a whole host of negative outcomes:

“Recent work we’ve done suggests that those who have experienced both childhood and adulthood trauma tend to commit their first offence at an earlier age and when they do it is at a more severe level than those with no childhood or adulthood trauma. We also know childhood trauma is associated with self-harm, violent offending and drug use.”

A look back to our Armed Forces Day at Craiglockhart campus...

The next step is to gain full recognition for the condition so that better treatments can be developed. To this end, Complex PTSD is proposed to be included in the International Classification of Diseases (ICD-11) as defined by the World Health Organisation (WHO).

PTSD will continue to be a condition with three clusters of symptoms while Complex PTSD will include these clusters plus three additional ones (see table).

Thanos says: “At Edinburgh Napier, we did the first study in the world of Complex PTSD using standardised measures. In our sample, 76 per cent had Complex PTSD and 24 per cent had PTSD. So Complex PTSD is far more common in any trauma population than PTSD in treatment-seeking populations.”

Thanos now hopes to take forward these core principles to create appropriate clinical interventions and models of care to improve the current situation which sees half of sufferers drop out of treatment and only 40 per cent of the remainder make a full recovery.

“I’m interested in models of care. I think that we need to change the way we are thinking about how we help people. Most people need ongoing support - they have a number of issues, not necessarily just mental health or physical health. There are social problems, interpersonal problems and so on. The treatment of Complex PTSD sits very highly on my own personal research agenda.”  

PTSD V CPTSD

ICD-11 PTSD

ICD-11 C-PTSD

Re-experience

Re-experience

Avoidance

Avoidance

Hyperarousal

Hyperarousal

Emotional dysregulation

Interpersonal difficulties

Pervasive low self-esteem

Karatzias et al. (2016) Journal of Affective Disorders

More about Edinburgh Napier and its links with the Armed Forces