Introduction: Complex post-traumatic stress disorder (CPTSD) refers to a mental disorder formed in repeated interpersonal traumatic events and includes two symptom clusters: post-traumatic stress disorder (PTSD) and disturbance in self-organization (DSO). De facto unattended children are vulnerable to CPTSD symptoms because the absence of effective parental caregiving in childhood leads to heightened exposure to trauma. There is a dearth of existing research exploring the mechanisms of CPTSD symptoms among children.
Purpose: This study aims to explore the roles of loneliness and sense of security in the developmental of children's CPTSD symptoms.
Methods: 298 de facto unattended children participated in a four-wave longitudinal study. CPTSD symptoms, loneliness, and sense of security were measured between 2021.12 and 2023.12. We conducted two random intercept cross-lagged models for PTSD, DSO symptoms and loneliness, and PTSD, DSO symptoms and security, respectively.
Results: The longitudinal relationships between loneliness, security and CPTSD symptoms were different. Loneliness was only significantly related to DSO, rather than PTSD. There were three stages in the relationship between loneliness and DSO. From T1 to T2, DSO symptoms positively predicted loneliness. From T2 to T3, they had a positive predictive relationship with each other. From T3 to T4, loneliness sustained the development of the DSO symptoms. In terms of security, security significantly predicted both PTSD and DSO symptoms from T2 to T4, but they didn't predict security.
Conclusions: This study found that loneliness and security played an important role in the development of CPTSD symptoms. DSO symptoms can destroy interpersonal communication, so it may lead to loneliness, in turn, loneliness maintain DSO symptoms. When the security mechanism collapses, it will not only cause PTSD but also DSO symptoms. Targeting loneliness and sense of security in the intervention of children with repeated trauma may help alleviate CPTSD symptoms.