Hierarchical Network Structure: A Novel Approach to Conceptualising ICD-11 Complex PTSD using a general population sample from Africa

BackgroundInvestigations have sought to model the structure of ICD-11 Complex PTSD (CPTSD) using factor analytic models, finding support for higher-order domains representing PTSD and Disturbances in Self Organisation (DSO). Network analysis has alternatively modelled CPTSD through dimensional symptom associations.MethodologyThis study investigated the hierarchical structure of CPTSD leveraging a novel Exploratory Graph Analysis (EGA) using African general population samples (n=2,524).ResultsTwo structural representations were examined: a single-order network revealing PTSD and DSO communities, and a hierarchical network identifying higher-order communities and specific symptom domains. Results indicate the superiority of the hierarchical model, confirming the conceptualization of ICD-11 PTSD and CPTSD symptom groupings.LimitationsThe cross-sectional nature of these data, and novelty of the methods used prompt calls for additional investigation to support these findings.ConclusionsSense of Threat and Affect Dysregulation may serve as bridging symptoms between communities of PTSD and DSO difficulties. These may be prioritised as the therapeutic targets for CPTSD. This pioneering approach using EGA, offers new insights into the intricate structure of CPTSD, potentially informing the use of assessments and interventions across diverse populations.