Phenomenological research aims to answer fundamental questions about the nature of trauma-related psycho-pathology; what it is, and how specific disorders relate to each other. This research is purposely timed to coincide with the publication of the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May 2013.
High rates of comorbidity between PTSD and other disorders suggest that current definitions and grouping of symptoms may not be optimal. This research project addresses a number of questions: Is the factor structure of PTSD symptoms the same for groups who differ according to symptom severity, chronicity or trauma exposure? How does PTSD fit into existing models of the structure of mood and anxiety disorders? Are the latent factors underlying PTSD differentially related to the latent factors underlying mood and anxiety disorders? Our results thus far indicate that PTSD as currently defined is a heterogeneous disorder, with some symptoms more related to depressive and generalised anxiety disorders and others more related to panic or phobic disorders. The upcoming publication of DSM-5 presents an opportunity to rework the existing classification of disorders into super-ordinate categories, based on underlying similarities.
Traumatic exposure and the phenomenology of nightmares in PTSD
Repetitive and distressing trauma-related dreams are a key diagnostic criterion of PTSD, and yet surprisingly little is known about posttraumatic nightmares (PTNMs). Of particular theoretical and clinical importance is the association between the recurrent distressing dreams of PTSD and that of normal dreams experienced after a traumatic event. To date, these dream types have been studied independently within the fields of PTSD and dreaming respectively, which employ different foci of enquiry and research methodologies. Our aim in conducting this research is to improve consistency in assessment and diagnostic practices in trauma research, by making clearer the distinction between PTNMs and normal trauma dreams that are associated with recovery. In order to adequately account for the full range of posttraumatic nightmare phenomena, additional contributing factors need to be considered; these might include sleep context or response to the nightmare experience, as well as the phenomenological features of PTNMS.
Pain and trauma
Chronic pain is a debilitating and relatively common condition in trauma populations, and is often comorbid with PTSD This research program aims to elucidate the relationship between the two conditions. A number of our studies show that PTSD and pain share vulnerability factors that may increase the risk of both disorders and explain their frequent comorbidity. Our ongoing research in this area aims to identify differential predictors of PTSD and pain, examine the predictive pathways between mental health and persistent pain, and identify the effect of acute and chronic pain on long term disability.
Delayed onset PTSD is a controversial diagnosis with important clinical and financial implications, however research into this phenomenon is typically retrospective and methodologically poor. We aimed to overcome the limitations of previous studies by conducting a rigorous, longitudinal prospective study to identify the prevalence of delayed onset PTSD in a sample of injury patients, and how delayed onset and chronic PTSD can be differentiated. Results suggest that at 12 months post-injury, delayed onset and chronic PTSD are equally common, and can be differentiated by pain severity at three months post-injury. Importantly, in many cases delayed onset PTSD developed in the absence of prior symptoms. These findings have implications for DSM-5 and suggest that diagnostic criteria should reflect the possibility of multiple PTSD trajectories.