Research Output

Alternative models of disorders of traumatic stress based on the new ICD-11 proposals

  Objective Although there is emerging evidence for the factorial validity of the distinction between Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) proposed in ICD-11, such evidence has been predominantly based on using selected items from individual scales that describe these factors. We have attempted to address this gap in the literature by testing a range of alternative models of disorders of traumatic stress using a broader range of symptoms and standardised measures. Method Participants in this cross-sectional study were a sample of individuals who were referred for psychological therapy to a National Health Service (NHS) trauma centre in Scotland (N=195). Participants were recruited over a period of 18 months and completed measures of stressful life events, DSM-5 PTSD, emotion dysregulation, self–esteem, and interpersonal difficulties. Results Overall, results indicate that a structural model incorporating six first-order factors (re-experiencing, avoidance of traumatic reminders, sense of threat, affective dysregulation, negative self-concept, and disturbances in relationships) and two second order factors (PTSD and Disturbances in Self-Organization [DSO]) was the best fitting. The model presented with good concurrent validity. Childhood trauma was found to be more strongly associated with DSO than PTSD. Conclusions Our results are in support of the ICD-11 proposals for PTSD and CPTSD.

  • Type:


  • Date:

    30 January 2017

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  • Library of Congress:

    RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry

  • Dewey Decimal Classification:

    616.8 Nervous & mental disorders


Shevlin, M., Hyland, P., Karatzias, T., Fyvie, C., Roberts, N., Bisson, J. I., …Cloitre, M. (2017). Alternative models of disorders of traumatic stress based on the new ICD-11 proposals. Acta psychiatrica Scandinavica, 135(5), (419-428). doi:10.1111/acps.12695. ISSN 0001-690X



This is the peer reviewed version of the following article: Shevlin M, Hyland P, Karatzias T, Fyvie C, Roberts N, Bisson JI, Brewin CR, Cloitre M. Alternative models of disorders of traumatic stress based on the new ICD-11 proposals which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving


post-traumatic stress disorder; complex post-traumatic stress disorder; disorders of traumatic stress; ICD-11

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