RESUMEN

Individuals diagnosed with autism, attachment disorders, emotionally unstable personality disorder (EUPD) or complex post-traumatic stress disorder (CPTSD) can present with similar features. This renders differential and accurate diagnosis of these conditions difficult, leading to diagnostic overshadowing and misdiagnosis. The purpose of this study was to explore professionals' perspectives on the differential diagnosis of autism, attachment disorders and CPTSD in young people; and of autism, CPTSD and EUPD in adults. A co-produced three-round Delphi study gathered information through a series of questionnaires from 106 international professionals with expertise in assessing and/or diagnosing at least one of these conditions. To provide specialist guidance and data triangulation, working groups of experts by experience, clinicians and researchers were consulted. Delphi statements were considered to have reached consensus if at least 80% of participants were in agreement. Two hundred and seventy-five Delphi statements reached consensus. Overlapping and differentiating features, methods of assessment, difficulties encountered during differential diagnosis and suggestions for improvements were identified. The findings highlight current practices for differential diagnosis of autism, attachment disorders, CPTSD and EUPD in young people and adults. Areas for future research, clinical and service provision implications, were also identified.

RESUMEN

Complex post-traumatic stress disorder (CPTSD) was introduced in the International Classification of Diseases (ICD) 11 in 2013 to simplify diagnosis and increase clinical utility. Given the recent ICD-11 conceptualisation, there is no standard approach for its assessment, and a review of research is necessary. This systematic review focuses on ICD-11 CPTSD assessment in young people aged 7 to 17 and adults aged 18 and above, examining measures, differentiating features and clinical considerations. Data from five databases are reviewed using a narrative synthesis approach and the quality of evidence is assessed and discussed. A total of 36 studies involving 5901 participants recruited from clinical settings and 1458 professionals with CPTSD assessment experience were included. Studies predominantly focused on adults, and the most used measure for assessment was the International Trauma Questionnaire. Papers focusing on differentiating features highlighted increased symptom severity, impairment and difficulties in individuals with CPTSD, compared to those with PTSD across various characteristics in both young people and adults. This review also identified the importance of a sensitive clinical approach with adaptations based on culture and age. Although gold-standard recommendations cannot be made, this paper offers tentative clinical practice recommendations and considerations regarding ICD-11 CPTSD assessment.

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BACKGROUND: There have been several reports of inequalities for ethnic minoritised service users across National Health Service mental health services in the United Kingdom. This research aims to explore the perspectives and experiences of young people from ethnic minoritised groups accessing psychological therapy in a National Specialist Child and Adolescent Mental Health Service in England. METHOD: Semi-structured interviews were conducted to investigate how young people perceived their ethnicity and how it was considered during psychological therapy. Nine young people were interviewed, and a thematic analysis was conducted. RESULTS: Qualitative analysis revealed five themes: (1) adolescence, ethnicity, and identity; (2) ethnicity as a meaningful part of the therapeutic intervention; (3) therapeutic alliance to facilitate dialogue; (4) aversion to ethnicity exploration; and (5) treading lightly: a fine line between sensitive and overly cautious. CONCLUSIONS: The study illustrated the complexity of considering ethnicity in therapy due to conflicting views and preferences and the need for further research.

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