Diagnostic validity of disorders of extreme stress not otherwise specified (DESNOS) among a high-risk community sample of women

Thesis (Ph. D.)--University of Rochester. Department of Clinical and Social Sciences in Psychology, 2014.Complex PTSD or, Disorders of Extreme Stress Not Otherwise Specified (DESNOS), is defined as affective and characterlogical disturbances that develop in response to a chronic history of childhood abuse. DESNOS research is founded on observations that people with chronic histories of trauma exhibit a collection of personality symptoms that extend beyond the traditional PTSD diagnosis. However, little research has tested the construct validity of the diagnosis. DESNOS has a profound impact on the development and maintenance of close relationships (Van Der Kolk, 2005; Ford & Courtois, 2009). Yet, there is a paucity of research linking maternal DESNOS to the quality of the mother-child relationship. The purpose of this dissertation was to 1) examine the validity of the DESNOS diagnosis among a high-risk community sample of women; 2) examine the hypothesized risk conferred by the diagnosis on several domains of maternal-child functioning including: Child attachment, parenting attitudes and child maltreatment; and 3) compare the impact of DESNOS on maternal-child functioning with that of PTSD. The sample included N = 73 mother-daughter dyads recruited from a high-risk community. Analyses were conducted using structural equation modeling. Results supported a simplified three-factor DESNOS diagnosis. Results also partially supported the link between complex trauma and DESNOS, more so than PTSD. Finally, DESNOS was associated with more negative parenting attitudes and more child maltreatment than was PTSD. Results validate the DESNOS diagnosis as distinct from PTSD, and highlight a number of risk factors for the intergenerational transmission of trauma and related psychopathology. Implications with regards to diagnosis and treatment are discussed