Dimensional structure of DSM-5 posttraumatic stress symptoms: Support for a hybrid Anhedonia and Externalizing Behaviors model |
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| Institution: | 1. Psychology Research Institute, University of Ulster, Coleraine, Northern Ireland, UK;2. United States Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, USA;3. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA;4. Department of Psychology, University of Toledo, USA;5. Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA;6. Department of Psychiatry, University of Toledo, USA;7. United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA;1. Ulster University, School of Psychology and Psychology Research Institute, Magee Campus, Derry, Northern Ireland, Ireland;2. National College of Ireland, School of Business, Dublin, Ireland;3. Edinburgh Napier University, School of Health and Social Care, Edinburgh, UK;4. NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK;5. Cardiff University, School of Medicine, Cardiff, UK;6. Psychology and Counselling Directorate, Cardiff and Vale University Health Board, Cardiff, UK;1. Department of Psychology, University of Toledo, United States;2. Department of Psychiatry, University of Toledo, United States;3. Department of Epidemiology, Columbia University, United States;4. Department of Psychiatry, Case Western Reserve University, United States;5. University Hospitals Case Medical Center, United States;6. VA Ann Arbor Health System, Ann Arbor, Michigan, United States;7. Department of Psychiatry, University of Michigan, United States;8. School of Public Health, Boston University, United States;1. Australian Centre for Posttraumatic Mental Health and Department of Psychiatry, Level 3, 161 Barry St, Carlton 3053, Australia;2. Department of Psychology, and Department of Psychiatry, University of Toledo, Mail Stop #948 2801, West Bancroft Street, Toledo, OH 43606-3390, USA;3. School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia;4. Centre for Traumatic Stress Studies, Level 2, 122 Frome St, Adelaide, South Australia 5000, Australia;5. Psychiatry Research & Teaching Unit, Level 1, Mental Health Centre, Liverpool Hospital, Liverpool, NSW 2170, Australia;6. National Center for PTSD (116B-2), VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA;1. Department of Psychiatry, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands;2. Department of Psychiatry, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands;3. Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE Diemen, The Netherlands;1. Durham Veterans Affairs Medical Center, Durham, NC, USA;2. The VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA;3. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA;4. VA Center for Health Services Research in Primary Care, Durham, NC, USA |
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| Abstract: | Several revisions to the symptom clusters of posttraumatic stress disorder (PTSD) have been made in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Central to the focus of this study was the revision of PTSD's tripartite structure in DSM-IV into four symptom clusters in DSM-5. Emerging confirmatory factor analytic (CFA) studies have suggested that DSM-5 PTSD symptoms may be best represented by one of two 6-factor models: (1) an Externalizing Behaviors model characterized by a factor which combines the irritability/anger and self-destructive/reckless behavior items; and (2) an Anhedonia model characterized by items of loss of interest, detachment, and restricted affect. The current study conducted CFAs of DSM-5 PTSD symptoms assessed using the PTSD Checklist for DSM-5 (PCL-5) in two independent and diverse trauma-exposed samples of a nationally representative sample of 1484 U.S. veterans and a sample of 497 Midwestern U.S. university undergraduate students. Relative fits of the DSM-5 model, the DSM-5 Dysphoria model, the DSM-5 Dysphoric Arousal model, the two 6-factor models, and a newly proposed 7-factor Hybrid model, which consolidates the two 6-factor models, were evaluated. Results revealed that, in both samples, both 6-factor models provided significantly better fit than the 4-factor DSM-5 model, the DSM-5 Dysphoria model and the DSM-5 Dysphoric Arousal model. Further, the 7-factor Hybrid model, which incorporates key features of both 6-factor models and is comprised of re-experiencing, avoidance, negative affect, anhedonia, externalizing behaviors, and anxious and dysphoric arousal symptom clusters, provided superior fit to the data in both samples. Results are discussed in light of theoretical and empirical support for the latent structure of DSM-5 PTSD symptoms. |
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| Keywords: | Posttraumatic stress disorder DSM-5 7-Factor hybrid model Confirmatory factor analysis Latent structure |
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