From polyvictimization to heterogeneous sequelae: Four-wave longitudinal investigation of children's complex PTSD symptom trajectories

Complex post-traumatic stress disorder (CPTSD) is clinically associated with chronic and repeated traumatic exposures during childhood, but related research examining trajectories of CPTSD alongside their risk and protective factors remains critically scarce. This study aims to investigate CPTSD trajectories and identify predictors among de facto unattended children in China. 298 de facto unattended children were assessed at 4 intervals in 2 years on CPTSD symptoms and external (threats and deprivation experiences) and internal associated factors (feelings of loneliness, security, and hope). Parallel process latent growth analysis (PP-LCGA) was used to determine the joint trajectories of PTSD and disturbances in self-organization (DSO) symptoms of CPTSD. Multinomial logistic regression was performed to identify risk and protective factors. The results indicated that PTSD and DSO symptoms develop synchronously overall. Four heterogeneous groups of CPTSD symptoms were identified: low symptoms group (29.87%), moderate symptoms group (47.43%), persistent high symptoms group (12.75%), and delayed deterioration group (11.07%). Additionally, different external factors (threats and deprivation experiences) were detected as important associated factors of different trajectories. As for internal factors, the sense of loneliness emerged as a significant risk factor, whereas the sense of security functioned as a protective factor. The observed concurrent development of PTSD and DSO symptoms lends support to the distinction of CPTSD as an independent diagnostic entity. Our findings call for further attention to experiences of deprivation and the enhancement of children's sense of security, which may strengthen their adaptive capacity, thereby protecting and promoting their mental health.