Zusammenfassung Hintergrund Die in der ICD-11 enger gefassten Kriterien der posttraumatischen Belastungsstörung (PTBS) und die Einführung der komplexen PTBS (kPTBS) mit zusätzlichen Schwierigkeiten in der Selbstorganisation und -regulation (SSO) können deutliche Auswirkungen auf die Diagnosehäufigkeit haben. In der vorliegenden Studie wurde untersucht, aufgrund welcher ICD-11-Cluster Kinder und Jugendliche die Diagnose verfehlen und ob Bezugspersonen Veränderungen im SSO-Bereich eher auf den Entwicklungsstand oder das traumatische Ereignis attribuieren und wie diese Attributionen wiederum mit der Symptomschwere zusammenhängen. Methoden N = 88 deutschsprachige Kinder und Jugendliche (Alter: 7–17) mit traumatischen Ereignissen sowie N = 79 Bezugspersonen wurden zwischen September 2019 und November 2020 zur (k)PTBS-Symptomschwere (CATS-2) und der Attribution der SSO-Symptome (Fragebogen für Bezugspersonen) befragt. Ergebnisse Die ICD-11-Kriterien (CATS‑2 und eine entwicklungsangepasste Version) ergaben geringere Häufigkeitsraten der PTBS als DSM‑5 und ICD-10. Am seltensten wurden die ICD-11-Cluster „Wiedererleben“ und „Übererregung“ erfüllt. Veränderungen der SSO-Symptome wurden vorwiegend als ereignisbedingt eingeschätzt. Diese Attribution hing mit höherer PTBS- und SSO-Symptomschwere im Fremdbericht zusammen. Die entwicklungsbedingte Attribution hing mit einer höheren SSO-, jedoch nicht PTBS-Symptomschwere im Fremdbericht zusammen. Diskussion Im Rahmen der Diagnostik und bei der Überarbeitung von Diagnoseinstrumenten für ICD-11-(k)PTBS sollten auch entwicklungsspezifische Symptomausprägungen berücksichtigt werden. Eine Herausforderung stellt die Abgrenzung von Veränderungen im SSO-Bereich als „traumabezogen“ gegenüber „entwicklungsbedingt“ dar und erfordert mehrere Informationsquellen.

Background: Despite a large body of evidence demonstrating the effectiveness of psychotherapy for posttraumatic stress for children and adolescents, the adoption of empirically supported treatments (ESTs) in routine care is low. Objective: This implementation study aims to evaluate the dissemination of Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) for children and adolescents with posttraumatic stress symptoms (PTSS) after child abuse and neglect (CAN) with a focus on supervision. Method: In a cluster-randomized controlled trial, the study will evaluate the implementation of TF-CBT focussing on the training of therapists including the provision of supervision. The effectiveness of specialized trauma-focused supervision will be compared to supervision as usual with respect to the successful implementation of TF-CBT for youths with PTSS administered by psychotherapists with different levels of professional experience. The primary outcome is whether the patient receives a treatment with sufficient adherence to the TF-CBT manual. The unit of randomization will be the therapists. The main outcome will be analysed using multilevel logistic regressions. Secondary outcomes will concern further patient-related (reduction of PTSS and depressive symptoms) and therapist-related (professional quality of life) variables. Additional exploratory analyses are planned. Discussion: Since the trial is designed as an implementation study, it permits naturalistic referrals to the participating therapists by patients, caregivers, child and youth welfare agencies and paediatricians. The strict primary outcome will help evaluating the role of model-based supervision in the implementation process. The explorative outcomes will evaluate whether implementation success translates into better patient outcomes. We expect that the dissemination measures will lead to a successful implementation of TF-CBT and promote sustainable structures in routine care that will remain in place after study completion and offer access to ESTs for future children and youths with a history of CAN.

Background. ICD-11 presents narrowed criteria for posttraumatic stress disorder (PTSD) and introduces complex PTSD (CPTSD) with additional difficulties in self-organization (DSO). These changes can have significant effects on the frequency of the diagnosis. The aim of this study was to investigate which ICD-11 symptom clusters cause children and adolescents to miss the diagnosis and whether caregivers are more likely to attribute changes in DSO to developmental level or to the traumatic event, and how these attributions are in turn related to symptom severity. Methods. N = 88 German-speaking children and adolescents (age: 7-17 years) after traumatic events and N = 79 caregivers participated between September 2019 and November 2020 in a survey on PTSD symptom severity (CATS-2) and attribution of DSO symptoms (caregiver questionnaire). Results. The ICD-11 criteria (CATS-2 and a developmentally adapted version) showed lower frequency rates for PTSD as compared to DSM-5 and ICD-10. The ICD-11 clusters re-experiencing and hyperarousal were met the least often. Changes in DSO symptoms were predominantly rated as event-related. This attribution was associated with higher PTSD and DSO symptom severity in caregiver reports. The age-related attribution was associated with higher DSO-symptom severity, but not PTSD symptom severity in caregiver reports. Discussion. In the context of the diagnostic process and the revision of diagnostic instruments for ICD-11 (C)PTSD, development-specific symptoms should be taken into account. The trauma-related differentiation of DSO symptom changes as compared to development-related fluctuations is challenging and therefore requires several sources of information.

Background: Web-based training can be an effective way for psychotherapists to acquire knowledge about interventions. Manualized trauma-focused cognitive behavioral therapy (TF-CBT) to treat posttraumatic stress disorder (PTSD) in children and adolescents is currently the intervention with the best evidence base. A web-based training program designed to promote the dissemination of TF-CBT is TF-CBT Web. A cost-free German language version has been available since 2018 and comprises 12 learning modules. Objective: The aim of this article is to describe which target group uses such a form of continuing education, based on the characteristics of psychotherapists who have registered with the German TF-CBT website. It was investigated whether participation in the training program leads to a gain in knowledge of the contents and how users evaluate the opportunities and barriers of this learning platform. Material and methods: Users of the training program provided demographic information at the time of registration and completed a knowledge test on the content of the module before and after all 12 modules. After completion, perceived opportunities and barriers could be given in a free text feedback. Results: The comparison of means showed a significant increase in knowledge by completing the 12 training modules (d = 0.18-1.16). Of the users 38% completed the learning program. Overall, the learning program and the materials provided were rated positively. Conclusion: Using the example of TF-CBT Web, the results support the effectiveness of web-based training programs for dissemination of knowledge in the field of psychotherapeutic treatment methods. Future research should evaluate the actual implementation of the methods taught into clinical practice.

Zusammenfassung Hintergrund Webbasierte Schulungen können ein effektiver Weg sein, auf dem Psychotherapeutinnen und Psychotherapeuten Wissen über Interventionen erwerben können. Die manualisierte traumafokussierte kognitive Verhaltenstherapie (TF-KVT) hat zur Behandlung der posttraumatischen Belastungsstörung (PTBS) bei Kindern und Jugendlichen derzeit die beste Evidenzbasis. Seit 2018 steht eine kostenfreie deutschsprachige Version des Schulungsprogramms TF-KVT Web zur Verfügung, welches 12 Lernmodule umfasst. Ziel der Arbeit In diesem Beitrag soll anhand von Merkmalen der psychotherapeutisch tätigen Personen, die sich für die deutsche TF-KVT-Website registriert haben, beschrieben werden, welche Zielgruppe eine solche Form der Weiterbildung nutzt. Es wird untersucht, ob die Teilnahme am Schulungsprogramm zu einem Wissenszuwachs über die Inhalte führt, und wie die Teilnehmenden die Chancen und Barrieren dieser Lernplattform bewerten. Material und Methoden Nutzerinnen und Nutzer des Schulungsprogramms gaben im Rahmen der Registrierung demografische Informationen an und füllten vor und nach jedem Modul einen Wissenstest zu den Inhalten des Moduls aus. Nach Bearbeitung konnte in einem Freitextfeld Rückmeldung zu wahrgenommen Chancen und Barrieren gegeben werden. Ergebnisse Mittelwertvergleiche zeigten einen signifikanten Wissenszuwachs durch die Bearbeitung der Schulungskomponenten in allen 12 Modulen ( d = 0,18–1,16). Achtunddreißig Prozent der Teilnehmenden schlossen das Lernprogramm vollständig ab. Insgesamt wurden das Lernprogramm und die zur Verfügung gestellten Materialien positiv bewertet. Diskussion Die Ergebnisse stützen am Beispiel von TF-KVT Web die Wirksamkeit webbasierter Schulungsprogramme zur Wissensverbreitung im Bereich psychotherapeutischer Behandlungsmethoden. Künftige Forschung sollte die Umsetzung der vermittelten Methoden in der klinischen Praxis evaluieren.

BACKGROUND:The recent update of the International Classification of Diseases 11th revision (ICD-11) introduced the diagnosis of complex posttraumatic stress disorder (CPTSD) as a distinct entity from posttraumatic stress disorder (PTSD). Because psychophysiological alterations are a core diagnostic feature of PTSD and CPTSD, the aim of the current study was to examine potential distinctive patterns in cortical and cardiac responses to emotional words in adolescent and young adult patients with PTSD and CPTSD.METHOD:Event-related potentials and heart rate responses were studied in 81 adolescent and young adult participants, of which 17 individuals were diagnosed with ICD-11 PTSD and 32 individuals with CPTSD, each after childhood sexual and/or physical abuse. Thirty-two individuals served as healthy controls. The paradigm consisted of a passive reading task with neutral, positive, physically threatening, and socially threatening words.RESULTS:Differentiated early processing of emotional words was indicated by differences on P1 and left EPN components. Additionally, PTSD and CPTSD patients presented with specific patterns of heart rate responses to emotional words. In CPTSD patients, heart rate reactions to emotional words were more variable than in PTSD patients.CONCLUSIONS:These findings provide early evidence of differentiated cortical and cardiac response patterns in adolescent and young adult patients with CPTSD and PTSD, supporting a nosological distinction between PTSD and complex PTSD. However, due to small and unequal sample sizes, findings presented in the current study are preliminary and require future research.

Background: The study examined the psychometric properties of the Child and Adolescent Trauma Screen 2 (CATS-2) as a measure of posttraumatic stress disorder (PTSD) according to DSM-5 and (Complex) PTSD following the ICD-11 criteria in children and adolescents (7-17 years). Methods: Psychometric properties were investigated in an international sample of traumatized children and adolescents (N = 283) and their caregivers (N = 255). We examined the internal consistency (alpha), convergent and discriminant validity, the factor structure of the CATS-2 total scores, latent classes of PTSD/Complex PTSD (CPTSD) discrimination, as well as the diagnostic utility using ROC-curves. Results: The DSM-5 total score (self: alpha = .89; caregiver: alpha = .91), the ICD-11 PTSD total score (self: alpha = .67; caregiver: alpha = .79) and the ICD-11 CPTSD total score (self: alpha = .83; caregiver: alpha = .87) have proven acceptable to excellent reliability. The latent structure of the 12-item ICD-11 PTSD/CPTSD construct was consistent with prior findings. Latent profile analyses revealed that ICD-11 CPTSD was empirically distinguishable from ICD-11 PTSD using the CATS-2. ROC-analysis using the CAPS-CA-5 as outcome revealed that CATS-2 DSM-5 PTSD scores of >= 21 (screening) to >= 25 (diagnostic) were optimally efficient for detecting probable DSM-5 PTSD diagnosis. For the ICD-11 PTSD scale scores of >= 7 (screening) to >= 9 (diagnostic) were optimally efficient for detecting probable DSM-5 PTSD diagnosis. Conclusions: The CATS-2 is a brief, reliable and valid measure of DSM-5 PTSD, ICD-11 PTSD and CPTSD symptomatology in traumatized children and adolescents, allowing crosswalk between diagnostic systems using one measure.

Zusammenfassung. Theoretischer Hintergrund: Die ICD-11 enthält reformulierte Kriterien für die Posttraumatische Belastungsstörung (PTBS) und die neue Diagnose komplexe PTBS (kPTBS). Fragestellung: Wie wirken sich die Neuerungen auf die Diagnostik und Behandlung von Kindern und Jugendlichen aus? Methode: In dieser Übersichtsarbeit werden die neuen Kriterien vorgestellt und mit früheren Diagnosemanualen verglichen. Bisherige Forschungsergebnisse zu PTBSICD-11 und kPTBS bei Kindern und Jugendlichen werden zusammengefasst und diskutiert. Ergebnisse: Die PTBSICD-11-Kriterien führen eher zu geringeren Prävalenzraten verglichen mit PTBSICD-10, PTBSDSM-IV und PTBSDSM-5. Erste Studien weisen darauf hin, dass evidenzbasierte traumafokussierte Therapiemanuale auch zur Behandlung der kPTBS geeignet sind. Diskussion und Schlussfolgerung: Die Anwendung neuer Kriterien stellt Praktiker_innen und Forscher_innen vor Herausforderungen. Bisherige Ergebnisse deuten an, dass die kPTBS gut behandelbar ist.

Background Previous research indicates that not all children, adolescents and adults suffering from PTSD receive psychotherapy and if they do, trauma is not always considered during therapy. One reason for this undertreatment might be a limited readiness of licenced psychotherapists (LPTs) to treat patients who have experienced a trauma and thus suffer from PTSD symptoms.Objective The aim of this study is to explore the association between the readiness of LPTs to treat patients with PTSD symptoms and different patients' and therapists' characteristics.Method We used case vignettes to assess the readiness of LPTs in Germany in a nationwide online survey (N = 768). The vignettes described patients with PTSD and were adapted to the age group mainly treated by the therapists (children/adolescents vs. adults). The patients' characteristics in the otherwise identical vignettes were randomized for patient gender (female vs. male) and symptom cluster (internalizing vs. externalizing). Rating scales were used to assess readiness. Additionally, therapists' characteristics (age, trauma-specific training, perceived fears/doubts, and objective barriers to treating the vignette patient) were assessed.Results The patients' characteristics did not influence the treatment readiness of the LPTs. Regarding therapists' characteristics, LPTs working mainly with children and adolescents, and those who had completed trauma-specific training reported a higher readiness to treat the vignette patient.Conclusions Regarding the treatment of patients suffering from PTSD symptoms of different ages, our study indicated that the assessed therapists' characteristics were more relevant for the treatment readiness of LPTs than the patients' characteristics of age or symptom type.

Theoretical background: Numerous studies document high prevalences of child sexual and physical abuse and their severe consequences for mental health. Specifically, the diagnosis of post-traumatic stress disorder (PTSD) is associated with previous child abuse and neglect. Therefore, early and evidence-based treatments (EBTs) are crucial to ensuring and fostering the adequate development of affected individuals. To date, several EBTs have proved to be effective in the treatment of PTSD in adolescents and young adults. Objective: It is presently unclear to what extent EBTs are available for adolescents and young adults with histories of child abuse seeking treatment in Germany. Therefore, the present study wanted to gain insight into standard treatment ("treatment as usual") as delivered for adolescents and young adults with abuse-related PTSD in three German cities. Method: We analyzed the data of 39 participants of a multicenter, randomized, and controlled trial of persons aged 14 to 21 who had received treatment recommendations for the respective region following the diagnosis of PTSD. We investigated the percentage of participants who had received treatment during the following 7-month period and whether there were any differences between participants who had or had not received treatment regarding their socio-demographic, psychopathological, or trauma-specific characteristics and treatment outcomes, Results: Of the 39 participants, 21 had received some kind of intervention during the subsequent 7-month period, but only 8 reported that the traumatic events had been addressed in treatment. Participants receiving treatment differed from participants without treatment only regarding living in out-of-home placement or institutional care and receiving psychotropic medication at baseline. All participants demonstrated significant improvements in their clinician-rated as well as self-rated post-traumatic stress symptoms, regardless of whether they had received treatment or trauma-focused treatment addressing the traumatic events at all. Discussion and conclusion: This study is the first to analyze standard treatment as delivered in Germany for adolescents and young adults suffering from abuse-related PTSD and seeking treatment. Our results indicated barriers to access to EBTs in our study population. Although indicated, only about half of the participants received treatment at all, and when participants did receive treatment, the traumatic experiences were rarely addressed, which does not correspond to the recommendations of international guidelines. However, a generalization of our results is limited because of the small sample size and the lack of information on the individual reasons of the study participants who did not initiate treatment. Future research is needed to explore whether limited to EBTs might be due to system-level (e.g., tack of implementation of EBTs in community settings) or individual-level barriers (e.g., lack of motivation after referrals).

Theoretical Background: The 11th version of the International Classification of Diseases (ICD-11) includes reformulated criteria for Posttraumatic Stress Disorder (PTSD) and additional criteria for complex PTSD (CPTSD). PTSDICD-11 is narrowed down to six core symptoms across three clusters; CPTSD is a distinct disorder comprising PTSDICD-11 criteria with additional criteria addressing disturbances in self-organization (DSO): affective dysregulation, negative self-concept, and interpersonal problems. Hence, therapists may be confronted in clinical practice with young patients with these new diagnoses, even though treatment recommendations are still not existent and randomized clinical trials have yet to be conducted. Objective: To give an overview for clinicians of PTSDICD-11 and CPTSD criteria for children and adolescents. Method: First, we present the diagnostic criteria for PTSDICD-11 and CPTSD and discuss the diagnostic approach of PTSDICD-11 compared to PTSDDSM-IV, PTSDDSM-5, and PTSDICD-10. Second, we outline current research on PTSDICD-11 and CPTSD in children and adolescents. We summarize the results on prevalence rates, on group differences between young patients with PTSDICD-11 and CPTSD, and on the applicability of existing trauma-focused therapies for CPTSD. Third, we discuss possible implications for clinical practice and upcoming issues. Results: The PTSDICD-11 and CPTSD criteria are intended for use in all age groups, though developmentally adapted aspects are missing. PTSDICD-11 incidence rates appear to be lower compared to PTSDDSM-IV, PTSDDSM-5, and PTSDICD-10. Rates of PTSDICD-11 and CPTSD vary across populations; CPTSD rates appear to be lower than PTSDICD-11 rates. Findings on group differences are heterogeneous. Studies indicate that trauma-focused cognitive behavioral therapy (TF-CBT) and developmentally adapted cognitive processing therapy (D-CPT) have a positive impact on PTSDICD-11 and CPTSD symptoms. Discussion and conclusion: Results indicate that PTSDICD-11 rates are stricter than diagnoses based on other versions of the PTSD criteria. Promising first results indicate that CPTSD symptoms can be treated successfully with existing trauma-focused treatment manuals. However, the benefit of additional treatment phases to address DSO symptoms needs further study. So far, data on PTSDICD-11 and CPTSD in children and adolescents are limited. Because most of the studies used archival data to map ICD-11 symptoms, their results have to be interpreted cautiously. A first screening questionnaire for PTSDICD-11 and CPTSD has already been published and validated for children and adolescents. Further research using clinical interviews for PTSD(ICD-11 )and CPTSD is necessary to gain further insight into the implications of the new diagnoses.

Zusammenfassung. Theoretischer Hintergrund: Für die Behandlung der Posttraumatischen Belastungsstörung (PTBS) im Jugend- und jungen Erwachsenenalter liegen diverse evidenzbasierte Interventionen (EBIs) vor. Fragestellung: Inwiefern sind EBIs für Jugendliche und junge Erwachsene mit PTBS nach sexualisierter und physischer Gewalt in Deutschland verfügbar? Methode: Es wurden die Daten von 39 Teilnehmenden einer multizentrischen Behandlungsstudie analysiert, die für die Diagnose einer PTBS ambulante Behandlungsempfehlungen erhalten hatten. Ergebnisse: In den folgenden sieben Monaten erhielten 21 der Teilnehmenden eine Behandlung; bei nur acht wurden in deren Rahmen die traumatischen Erfahrungen adressiert. Alle Teilnehmenden verbesserten sich hinsichtlich der PTBS-Symptomatik unabhängig von der Art der Behandlung. Diskussion und Schlussfolgerung: Die Ergebnisse weisen auf Barrieren für den Zugang zu EBIs in unserer Stichprobe hin. Künftige Forschung sollte die Hintergründe für diese Barrieren fokussieren.

Background: ICD-11 features Complex Posttraumatic Stress Disorder (CPTSD) as a new diagnosis. To date, very few studies have investigated CPTSD in young patients, and there is a need for evidence on effective treatment.Objective: The present study evaluates the applicability of developmentally adapted cognitive processing therapy (D-CPT) for CPTSD in young patients in a secondary analysis of the treatment condition of a randomized controlled trial (RCT) investigating the efficacy of D-CPT.Methods: The D-CPT treatment group in the original study included 44 patients (14–21 years) with DSM-IV PTSD after childhood abuse. We used the ICD-11 algorithm to divide the sample into a probable CPTSD and a non-CPTSD group. We performed multilevel models for interviewer-rated and self-rated PTSD symptoms with fixed effects of group (CPTSD, non-CPTSD) and time (up to 12 months follow-up) and their interaction. Treatment response rates for both groups were calculated.Results: Nineteen (43.2%) patients fulfilled criteria for probable ICD-11 CPTSD while 25 (56.8%) did not. Both CPTSD and non-CPTSD groups showed symptom reduction over time. The CPTSD group reported higher symptom severity before and after treatment. Linear improvement and treatment response rates were similar for both groups. D-CPT reduced symptoms of disturbances in self-regulation in both groups.Discussion: Both, patients with and without probable ICD-11 CPTSD seemed to benefit from D-CPT and the treatment also reduced disturbances in self-regulation.Conclusion: This study presents initial evidence of the applicability of D-CPT in clinical practice for young patients with CPTSD. It remains debatable whether CPTSD implies different treatment needs as opposed to PTSD.

IV, DSM-5, ICD-10, and ICD-11 and focuses on PTSD and CPTSD in a treatment-seeking sample of abused young people. Data were used from two clinical trials in Germany [7, 8]. All 83 participants (71 female), aged 14–21 years (mean = 17.65, SD = 2.26), suffered from PTSD according to DSM-IV after experiencing childhood sexual or physical abuse. The majority (74%) of the participants had experienced multiple traumatic events, and 76% reported more than one perpetrator. Regarding trauma type, the most distressing event was sexual abuse for 56% and physical abuse for 44% of the patients. Data were collected before treatment with clinical interviews and self-rating questionnaires (more details in the online suppl. material; for all online suppl. material, see www. karger.com/doi/10.1159/000503794). First, we calculated PTSD prevalence according to DSM-5, ICD-10, and ICD-11 criteria. For ICD-11 PTSD and CPTSD, we used selected items from the gold-standard interview Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA [9]), the self-report measures University of California at Los Angeles PTSD Reaction Index (UCLA [10]) and the Borderline Symptom List (BSL-23 [11]; see online suppl. Table S1). In accordance with the ICD-11 algorithm [1], patients were diagnosed with either PTSD or CPTSD. For DSM-5 and ICD-10, we used selected items from CAPS-CA. When applying the DSM-5, ICD-10, and ICD-11 criteria, prevalence rates decreased compared to DSM-IV (Table 1). The lowest rates were found for ICD-11 PTSD. In total, 34% of the young people met neither ICD-11 PTSD nor CPTSD. Most patients failed ICD-11 diagnosis because they did not meet enough features specified as criteria in the hyperarousal cluster. Second, we calculated differences between ICD-11 diagnostic groups (PTSD, CPTSD, and no ICD-11 PTSD) for trauma-related variables and comorbid symptom severity using Mann-Whitney U and χ2 tests (more details in the online suppl.). Three significant differences were observed between no ICD-11 PTSD and CPTSD. The CPTSD group showed higher scores for dissociation (U = 334.50, p = 0.032), depression symptom severity (U = 298.00, p = 0.012), and number of comorbid diagnoses (U = 326.00, p = 0.012). Last, trauma-related variables and comorbid symptom severity variables were included as predictors in a multinomial logistic regression to assess their contribution to class membership. Of nine predictors, only depression symptom severity was associated with an increased likelihood of CPTSD class membership compared to no ICD-11 PTSD (OR = 0.93, p = 0.003, see online suppl. Table S3). Our finding of lower PTSD prevalence rates comparing ICD-11 to other diagnostic manuals is in line with current research [2, 3]. One-third of our study sample no longer fulfilled PTSD diagnosis, and most patients did not meet criteria due to missing features in the hyperarousal cluster despite reporting functional impairment. In ICD-11, this cluster consists of hypervigilance and startle reaction, whereas other diagnostic manuals allow for a greater variety of symptoms. ICD-11 criteria may miss some relevant PTSD symptoms for Dear Editor, The diagnostic criteria for posttraumatic stress disorder (PTSD) have been reformulated and narrowed for ICD-11 [1] to six core symptoms across the clusters re-experiencing, avoidance, and hyperarousal. In comparison, PTSD criteria in DSM-IV consist of sixteen symptoms across three clusters, in DSM-5 of twenty symptoms across four clusters, and in ICD-10 of thirteen symptoms across three clusters. The new ICD-11 diagnosis Complex PTSD (CPTSD) requires symptoms of PTSD and in addition disturbances of self-organization: affect dysregulation, negative self-concept, and interpersonal problems. Impairment represented in the disturbances of self-organization domains is not necessarily associated with trauma-related stimuli. CPTSD typically follows prolonged or multiple events, but diagnosis does not require a certain type and frequency of a traumatic event. To date, only few studies have investigated the impact of these changes to PTSD features on children and adolescents [2–5]. ICD11 criteria seem to be less sensitive than ICD-10, DSM-IV [2], and DSM-5 [3] or yield similar prevalence rates to DSM-IV and DSM5 [4]. For ICD-11 PTSD, the lowest prevalence rates were reported in the hyperarousal [2] or the re-experiencing clusters [2, 4]. Comparing ICD-11 PTSD and CPTSD, studies found evidence for two distinct disorders by performing latent class analysis, and reported a lower prevalence for the CPTSD class [5, 6]. So far, studies have focused on PTSD in two or three different diagnostic manuals [2–4]. ICD-11 PTSD and CPTSD have as yet only been compared twice: in a treatment-seeking sample with PTSD after miscellaneous traumatic events (7–17 years [5]), and in a community sample (14–24 years [6]). This study expands the comparison of prevalence rates to four diagnostic manuals: DSMReceived: May 7, 2019 Accepted after revision: September 29, 2019 Published online: October 23, 2019

Die Bereitschaften, Mediation zu nutzen und sich fur ihre Verbreitung zu engagieren, konnten in einer querschnittlichen Studie sehr gut vor allem durch wahrgenommene Potentiale vorhergesagt werden. In einer langsschnittlichen Betrachtung erweisen sich diese Bereitschaften in der Gruppe der potentiellen Mediandinnen und Medianden als valide Pradiktoren spateren Handelns. Uber die Bereitschaften hinaus qualifizieren sich zur Handlungsvorhersage vor allem die wahrgenommenen Barrieren von Mediation. Um gesellschaftspolitische Engagements und die Nutzung von Mediation zu fordern, sind daher vor allem diese Barrieren in den Blick zu nehmen, um sie zu uberwinden.