Complex PTSD symptoms predict positive symptoms of psychosis in the flow of daily life

Peter Panayi; Emmanuelle Peters; Richard Bentall; Amy Hardy; Katherine Berry; William Sellwood; Robert Dudley; Eleanor Longden; Raphael Underwood; Craig Steel; Hassan Jafari; Richard Emsley; Liam Mason; Rebecca Elliott; Filippo Varese

doi:10.1017/S0033291724001934

Complex PTSD symptoms predict positive symptoms of psychosis in the flow of daily life

Peter Panayi, Emmanuelle Peters, Richard Bentall, Amy Hardy, Katherine Berry, William Sellwood, Robert Dudley, Eleanor Longden, Raphael Underwood, Craig Steel, Hassan Jafari, Richard Emsley, Liam Mason, Rebecca Elliott, Filippo Varese

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Post-traumatic stress disorder (PTSD) has been shown to predict psychotic symptomology. However, few studies have examined the relative contribution of PTSD compared to broader post-traumatic sequelae in maintaining psychosis. Complex PTSD (cPTSD), operationalized using ICD-11 criteria, includes core PTSD (intrusions, avoidance, hyperarousal) as well as additional "disturbances of self-organisation" (DSO; emotional dysregulation, interpersonal difficulties, negative self-concept) symptoms, more likely to be associated with complex trauma histories. It was hypothesized that DSOs would be associated with positive psychotic symptoms (paranoia, voices, and visions) in daily life, over and above core PTSD symptoms.

METHODS: This study (N = 153) employed a baseline subsample of the Study of Trauma And Recovery (STAR), a clinical sample of participants with comorbid post-traumatic stress and psychosis symptoms. Core PTSD, DSO and psychosis symptoms were assessed up to 10 times per day at quasi-random intervals over six consecutive days using Experience Sampling Methodology.

RESULTS: DSOs within the preceding 90 min predicted paranoia, voices, and visions at subsequent moments. These relationships persisted when controlling for core PTSD symptoms within this timeframe, which were themselves significant. The associations between DSOs and paranoia but not voices or visions, were significantly stronger than those between psychosis and core PTSD symptoms.

CONCLUSIONS: Consistent with an affective pathway to psychosis, the findings suggest that DSOs may be more important than core PTSD symptoms in maintaining psychotic experiences in daily life among people with comorbid psychosis and cPTSD, and indicate the potential importance of addressing broad post-traumatic sequelae in trauma-focused psychosis interventions.

Original language	English
Pages (from-to)	1-12
Number of pages	12
Journal	Psychological Medicine
DOIs	https://doi.org/10.1017/S0033291724001934
Publication status	E-pub ahead of print - 4 Oct 2024

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10.1017/S0033291724001934

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Panayi, P., Peters, E., Bentall, R., Hardy, A., Berry, K., Sellwood, W., Dudley, R., Longden, E., Underwood, R., Steel, C., Jafari, H., Emsley, R., Mason, L., Elliott, R., & Varese, F. (2024). Complex PTSD symptoms predict positive symptoms of psychosis in the flow of daily life. Psychological Medicine, 1-12. Advance online publication. https://doi.org/10.1017/S0033291724001934

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title = "Complex PTSD symptoms predict positive symptoms of psychosis in the flow of daily life",

abstract = "BACKGROUND: Post-traumatic stress disorder (PTSD) has been shown to predict psychotic symptomology. However, few studies have examined the relative contribution of PTSD compared to broader post-traumatic sequelae in maintaining psychosis. Complex PTSD (cPTSD), operationalized using ICD-11 criteria, includes core PTSD (intrusions, avoidance, hyperarousal) as well as additional {"}disturbances of self-organisation{"} (DSO; emotional dysregulation, interpersonal difficulties, negative self-concept) symptoms, more likely to be associated with complex trauma histories. It was hypothesized that DSOs would be associated with positive psychotic symptoms (paranoia, voices, and visions) in daily life, over and above core PTSD symptoms.METHODS: This study (N = 153) employed a baseline subsample of the Study of Trauma And Recovery (STAR), a clinical sample of participants with comorbid post-traumatic stress and psychosis symptoms. Core PTSD, DSO and psychosis symptoms were assessed up to 10 times per day at quasi-random intervals over six consecutive days using Experience Sampling Methodology.RESULTS: DSOs within the preceding 90 min predicted paranoia, voices, and visions at subsequent moments. These relationships persisted when controlling for core PTSD symptoms within this timeframe, which were themselves significant. The associations between DSOs and paranoia but not voices or visions, were significantly stronger than those between psychosis and core PTSD symptoms.CONCLUSIONS: Consistent with an affective pathway to psychosis, the findings suggest that DSOs may be more important than core PTSD symptoms in maintaining psychotic experiences in daily life among people with comorbid psychosis and cPTSD, and indicate the potential importance of addressing broad post-traumatic sequelae in trauma-focused psychosis interventions.",

author = "Peter Panayi and Emmanuelle Peters and Richard Bentall and Amy Hardy and Katherine Berry and William Sellwood and Robert Dudley and Eleanor Longden and Raphael Underwood and Craig Steel and Hassan Jafari and Richard Emsley and Liam Mason and Rebecca Elliott and Filippo Varese",

note = "Publisher Copyright: Copyright {\textcopyright} The Author(s), 2024. Published by Cambridge University Press.",

year = "2024",

month = oct,

day = "4",

doi = "10.1017/S0033291724001934",

language = "English",

pages = "1--12",

journal = "Psychological Medicine",

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T1 - Complex PTSD symptoms predict positive symptoms of psychosis in the flow of daily life

AU - Panayi, Peter

AU - Peters, Emmanuelle

AU - Bentall, Richard

AU - Hardy, Amy

AU - Berry, Katherine

AU - Sellwood, William

AU - Dudley, Robert

AU - Longden, Eleanor

AU - Underwood, Raphael

AU - Steel, Craig

AU - Jafari, Hassan

AU - Emsley, Richard

AU - Mason, Liam

AU - Elliott, Rebecca

AU - Varese, Filippo

PY - 2024/10/4

Y1 - 2024/10/4

N2 - BACKGROUND: Post-traumatic stress disorder (PTSD) has been shown to predict psychotic symptomology. However, few studies have examined the relative contribution of PTSD compared to broader post-traumatic sequelae in maintaining psychosis. Complex PTSD (cPTSD), operationalized using ICD-11 criteria, includes core PTSD (intrusions, avoidance, hyperarousal) as well as additional "disturbances of self-organisation" (DSO; emotional dysregulation, interpersonal difficulties, negative self-concept) symptoms, more likely to be associated with complex trauma histories. It was hypothesized that DSOs would be associated with positive psychotic symptoms (paranoia, voices, and visions) in daily life, over and above core PTSD symptoms.METHODS: This study (N = 153) employed a baseline subsample of the Study of Trauma And Recovery (STAR), a clinical sample of participants with comorbid post-traumatic stress and psychosis symptoms. Core PTSD, DSO and psychosis symptoms were assessed up to 10 times per day at quasi-random intervals over six consecutive days using Experience Sampling Methodology.RESULTS: DSOs within the preceding 90 min predicted paranoia, voices, and visions at subsequent moments. These relationships persisted when controlling for core PTSD symptoms within this timeframe, which were themselves significant. The associations between DSOs and paranoia but not voices or visions, were significantly stronger than those between psychosis and core PTSD symptoms.CONCLUSIONS: Consistent with an affective pathway to psychosis, the findings suggest that DSOs may be more important than core PTSD symptoms in maintaining psychotic experiences in daily life among people with comorbid psychosis and cPTSD, and indicate the potential importance of addressing broad post-traumatic sequelae in trauma-focused psychosis interventions.

AB - BACKGROUND: Post-traumatic stress disorder (PTSD) has been shown to predict psychotic symptomology. However, few studies have examined the relative contribution of PTSD compared to broader post-traumatic sequelae in maintaining psychosis. Complex PTSD (cPTSD), operationalized using ICD-11 criteria, includes core PTSD (intrusions, avoidance, hyperarousal) as well as additional "disturbances of self-organisation" (DSO; emotional dysregulation, interpersonal difficulties, negative self-concept) symptoms, more likely to be associated with complex trauma histories. It was hypothesized that DSOs would be associated with positive psychotic symptoms (paranoia, voices, and visions) in daily life, over and above core PTSD symptoms.METHODS: This study (N = 153) employed a baseline subsample of the Study of Trauma And Recovery (STAR), a clinical sample of participants with comorbid post-traumatic stress and psychosis symptoms. Core PTSD, DSO and psychosis symptoms were assessed up to 10 times per day at quasi-random intervals over six consecutive days using Experience Sampling Methodology.RESULTS: DSOs within the preceding 90 min predicted paranoia, voices, and visions at subsequent moments. These relationships persisted when controlling for core PTSD symptoms within this timeframe, which were themselves significant. The associations between DSOs and paranoia but not voices or visions, were significantly stronger than those between psychosis and core PTSD symptoms.CONCLUSIONS: Consistent with an affective pathway to psychosis, the findings suggest that DSOs may be more important than core PTSD symptoms in maintaining psychotic experiences in daily life among people with comorbid psychosis and cPTSD, and indicate the potential importance of addressing broad post-traumatic sequelae in trauma-focused psychosis interventions.

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U2 - 10.1017/S0033291724001934

DO - 10.1017/S0033291724001934

M3 - Article

C2 - 39363544

SN - 0033-2917

SP - 1

EP - 12

JO - Psychological Medicine

JF - Psychological Medicine

ER -

Complex PTSD symptoms predict positive symptoms of psychosis in the flow of daily life

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