Network Analysis of Posttraumatic Stress Experiences of Adults Seeking Psychological Treatment for Childhood Sexual Abuse.

Network analysis proposes that mental disorders may best be construed as causal systems embodied in networks of functionally interconnected symptoms. We employed network analysis to test how adult survivors of childhood sexual abuse (CSA) experienced symptoms of posttraumatic stress, using alternative conceptualizations of posttraumatic stress disorder (PTSD). Given the characteristics of the sample (i.e., the nature of and time since trauma), we hypothesized that (a) symptoms related to arousal would not be prominent in the networks and (b) symptoms related to negative alternations in cognition and mood (NACM) would be core components in the network. Danish adults seeking psychological treatment for CSA (n = 473) completed the Harvard Trauma Questionnaire and Trauma Symptom Checklist. Three alternative models (DSM-5, DSM-5 with dissociation, and ICD-11 complex PTSD [CPTSD]) were estimated using regularized partial correlation models. In the DSM-5 network, strong associations emerged for experiences of NACM (blame and guilt) and intrusions (thoughts and flashbacks). The addition of "depersonalization" and "derealization" to the DSM-5 model produced a strong association, but these experiences were largely unrelated to other PTSD clusters. In the CPTSD network, interpersonal problems and negative self-concept were central to the survivors' experiences. For this highly-specific survivor group who experienced traumatic CSA many years ago, experiences related to NACM appeared to be more central to the posttrauma experience than those of arousal. If replicated, these findings could help inform treatment plans for specific groups of survivors. Methodological implications as to the usefulness of network models in the psychopathological research literature are discussed.