DSM-5 Model Research Articles

Convergent, discriminant, and criterion validity of DSM-5 traits.

Section III of the Diagnostic and Statistical Manual of Mental Disorders (5th edi.; DSM-5; American Psychiatric Association, 2013) contains a system for diagnosing personality disorder based in part on assessing 25 maladaptive traits. Initial research suggests that this aspect of the system improves the validity and clinical utility of the Section II Model. The Computer Adaptive Test of Personality Disorder (CAT-PD; Simms et al., 2011) contains many similar traits as the DSM-5, as well as several additional traits seemingly not covered in the DSM-5. In this study we evaluate the convergent and discriminant validity between the DSM-5 traits, as assessed by the Personality Inventory for DSM-5 (PID-5; Krueger et al., 2012), and CAT-PD in an undergraduate sample, and test whether traits included in the CAT-PD but not the DSM-5 provide incremental validity in association with clinically relevant criterion variables. Results supported the convergent and discriminant validity of the PID-5 and CAT-PD scales in their assessment of 23 out of 25 DSM-5 traits. DSM-5 traits were consistently associated with 11 criterion variables, despite our having intentionally selected clinically relevant criterion constructs not directly assessed by DSM-5 traits. However, the additional CAT-PD traits provided incremental information above and beyond the DSM-5 traits for all criterion variables examined. These findings support the validity of pathological trait models in general and the DSM-5 and CAT-PD models in particular, while also suggesting that the CAT-PD may include additional traits for consideration in future iterations of the DSM-5 system. (PsycINFO Database Record

Do gender and directness of trauma exposure moderate PTSD's latent structure?

The PTSD diagnosis and latent structure were substantially revised in the transition from DSM-IV to DSM-5. However, three alternative models (i.e., anhedonia model, externalizing behavior model, and hybrid model) of PTSD fit the DSM-5 symptom criteria better than the DSM-5 factor model. Thus, the psychometric performance of the DSM-5 and alternative models' PTSD factor structure needs to be critically evaluated. The current study examined whether gender or trauma directness (i.e., direct or indirect trauma exposure) moderates the PTSD latent structure when using the DSM-5 or alternative models. Model performance was evaluated with measurement invariance testing procedures on a large undergraduate sample (n=455). Gender and trauma directness moderated the DSM-5 PTSD and externalizing behavior model and did not moderate the anhedonia and hybrid models' latent structure. Clinical implications and directions for future research are discussed.

Characterizing Spitefulness in Terms of the DSM-5 Model of Pathological Personality Traits

Spitefulness refers to the willingness of an individual to incur a cost in order to inflict harm on someone else. Individual differences in spitefulness have been found to be associated with a range of outcomes including aggression and difficulties understanding the mental states of other individuals. The purpose of the present studies was to examine the associations that spitefulness had with pathological personality traits in order to expand what is known about the nomological network of spitefulness. Study 1 examined the connections between spitefulness and pathological personality traits captured by the brief form of the Personality Inventory for the DSM-5 (PID-5-BF) in 1836 undergraduates. Study 2 examined the associations that spitefulness had with pathological personality traits captured by the PID-5 in 414 community members. Across these two studies, spitefulness was found to have consistent positive associations with the pathological personality traits of antagonism (β = .32 in Study 1 and β = .28 in Study 2) and disinhibition (β = .12 in Study 1 and β = .29 in Study 2). Discussion focuses on the implications of these findings for the understanding of spitefulness.

Continuity between DSM-5 Categorical Criteria and Traits Criteria for Borderline Personality Disorder.

Borderline personality disorder (BPD) includes a heterogeneous constellation of symptoms operationalized with 9 categorical criteria. As the field of personality disorder (PD) research moves to emphasize dimensional traits in its operationalization, it is important to delineate continuity between the 9 DSM-IV/Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) categorical criteria for BPD and the trait dimensions in DSM-5 Section III. To date, no study has attempted such validation. We examined the associations between the 9 categorical DSM-IV/DSM-5 criteria for BPD and the trait dimensions of the alternative DSM-5 model for PDs in consecutively recruited psychiatric outpatients (N = 142; 68% female; age: mean 29.02, SD 8.38). This was investigated by means of bivariate correlations, followed by multiple logistic regression analysis. The categorical BPD criteria were associated with conceptually related DSM-5 Section III traits (P > 0.001), except for the criterion of chronic feelings of emptiness. Consistent with the proposed traits criteria for BPD in DSM-5 Section III, we found Emotional lability, Anxiousness, Separation insecurity, Depressivity, Impulsivity, Risk taking, and Hostility to capture conceptually coherent BPD categorical criteria, while Suspiciousness was also strongly associated with BPD criteria. At the domain level, this applied to Negative affectivity, Disinhibition, and Psychoticism. Notably, Emotional lability, Impulsivity, and Suspiciousness emerged as unique predictors of BPD (P > 0.05). In addition to the proposed BPD traits criteria, Suspiciousness and features of Psychoticism also augment BPD features. Provided that these findings are replicated in forthcoming research, a modified traits operationalization of BPD is warranted.

Utility of the 3Di Short Version for the Diagnostic Assessment of Autism Spectrum Disorder and Compatibility with DSM-5.

The Developmental Diagnostic Dimensional Interview-short version (3Di-sv) provides a brief standardized parental interview for diagnosing autism spectrum disorder (ASD). This study explored its validity, and compatibility with DSM-5 ASD. 3Di-sv classifications showed good sensitivity but low specificity when compared to ADOS-2-confirmed clinical diagnosis. Confirmatory factor analyses found a better fit against a DSM-5 model than a DSM-IV-TR model of ASD. Exploration of the content validity of the 3Di-sv for the DSM-5 revealed some construct underrepresentation, therefore we obtained data from a panel of 3Di-trained clinicians from ASD-specialized centers to recommend items to fill these gaps. Taken together, the 3Di-sv provides a solid basis to create a similar instrument suitable for DSM-5. Concrete recommendations are provided to improve DSM-5 compatibility.Electronic supplementary materialThe online version of this article (doi:10.1007/s10803-016-2713-9) contains supplementary material, which is available to authorized users.

Development and Preliminary Psychometric Evaluation of a Brief Self-Report Questionnaire for the Assessment of the DSM-5 level of Personality Functioning Scale: The LPFS Brief Form (LPFS-BF).

The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) alternative model for personality disorders (PDs) introduced a new paradigm for the assessment of PDs that includes levels of personality functioning indexing the severity of personality pathology irrespective of diagnosis. In this study, we describe the development and preliminary psychometric evaluation of a newly developed brief self-report questionnaire to assess levels of personality functioning, the Level of Personality Functioning Scale-Brief Form (LPFS-BF; Bender, Morey, & Skodol, 2011). Patients (N = 240) referred to a specialized setting for the assessment and treatment of PDs completed the LPFS-BF, the Brief Symptom Inventory (BSI; Derogatis, 1975), the Severity Indices of Personality Problems (SIPP-118; Verheul et al., 2008), and were administered the Structured Clinical Interview for DSM-IV Axis I Personality Disorders (SCID-I; APA, 1994; First, Spitzer, Gibbon, & Williams, 1997) and the SCID Axis II Personality Disorders (SCID-II; First, Spitzer, Gibbon, Williams, & Benjamin, 1996). When constrained to a 2-factor oblique solution, the LPFS-BF yielded a structure that corresponded well to an interpretation of Self- and Interpersonal Functioning scales. The instrument demonstrated fair to satisfactory internal consistency and promising construct validity. The LPFS-BF constitutes a short, user-friendly instrument that provides a quick impression of the severity of personality pathology, specifically oriented to the DSM-5 model. Clearly, more research is needed to test its validity and clinical utility.

Gratitude, depression and PTSD: Assessment of structural relationships

Gratitude, the tendency to appreciate positive occurrences in one’s life that can be partially attributed to another person, has been shown to be a robust predictor of greater well-being. Researchers have also found gratitude to be inversely related to several emotional disorders, including major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). Both of these emotional disorders are highly comorbid and share dysphoric symptoms (e.g., restricted affect, detachment, anhedonia) that could account for deficits in the experience and expression of gratitude. We used confirmatory factor analysis to test the relationships between gratitude and the symptom factors of PTSD (using the DSM-5 model) and MDD in a sample of trauma-exposed college students (N=202). Results indicated that gratitude is more strongly related to PTSD’s negative alterations in mood and cognition (NAMC) factor than to other PTSD factors. Implications of these findings for the study of gratitude and trauma are discussed, including whether gratitude and gratitude-based interventions might prove particularly suited to targeting depressive symptoms.

Exploring differences between the ICD-11 and DSM-5 models of PTSD: Does it matter which model is used?

Alternative symptom profiles for posttraumatic stress disorder (PTSD) are presented in the DSM-5 and ICD-11. This study compared DSM-5 PTSD symptom profiles with ICD-11 PTSD symptom profiles among a large group of trauma-exposed individuals from Denmark. Covariates, and rates of co-occurrence with other psychiatric disorders were also investigated. A sample of treatment-seeking adult survivors of childhood sexual abuse (n=434) were assessed using self-report measures of PTSD and other psychiatric disorders. A significantly larger proportion of individuals met caseness for DSM-5 PTSD (60.0%) compared to ICD-11 PTSD (49.1%). This difference was largely attributable to low endorsement of the ICD-11 re-experiencing criteria. Replacement of the ‘recurrent nightmares’ symptom with the ‘recurrent thoughts/memories’ symptom seemed to balance the proportion of individuals meeting caseness for both taxonomies. Levels of co-occurrence with anxiety and thought disorder were higher for the DSM-5 model of PTSD compared to the ICD-11 model. Current results merit careful consideration in the selection of symptom indicators for the new ICD model of PTSD, particularly with respect to the re-experiencing symptom category.

Discriminant validity and gender differences in DSM-5 posttraumatic stress disorder symptoms

BackgroundThe posttraumatic stress disorder (PTSD) literature is replete with investigations of factor structure, however, few empirical studies have examined discriminant validity and the moderating role of gender on factor structure and symptom expression. This study aimed to address these gaps. MethodsAn online, population-based study of 3175 Australian adults was conducted. This study analyzed data from 642 participants who reported a traumatic event. Overall, 10.2% (13.4% females, 7.6% males) met diagnostic criteria for current PTSD. ResultsConfirmatory factor analyses indicated that eight factor models provided excellent fit to the data. The DSM-5 model, anhedonia and hybrid models provided strong fit to the data, based on statistical fit indices and parsimony. The models’ factors were significantly associated with a number of external correlates. Factor structure was gender invariant for the three models, albeit significant latent mean-level differences were apparent in relation to the intrusion/re-experiencing and alterations in arousal and reactivity factors. Bonferroni-adjusted Wald chi-square tests indicated significant gender differences in four DSM-5 PTSD symptoms: females reported significantly higher rates of negative beliefs, diminished interest, restricted affect and sleep disturbance symptoms compared to men. LimitationsResponse rate to the survey was low. However, the number of respondents who completed the survey was high and population weights were employed to account for self-selection biases and aid generalizability. ConclusionsThe findings provide support for the DSM-5, anhedonia and hybrid models compared to alternative models based on DSM-5 symptoms. Discriminant validity analyses indicated similar patterns of significant associations with the transdiagnostic factors, potentially suggesting that all the PTSD factors are related to non-specific distress. Further research investigating how gender influences PTSD symptom expression is warranted, including possible gender differences in symptom item interpretation.

Personality disorder in DSM-5: an oral history.

As the revision process leading to DSM-5 began, the domain of personality disorder embodied the highest aspirations for major change. After an initial prototype-based proposal failed to gain acceptance, the Personality and Personality Disorders Work Group (P&PDWG) developed a hybrid model containing categorical and dimensional components. A clash of perspectives both within the P&PDWG and between the P&PDWG and DSM-5 oversight committees led to the rejection of this proposal from the main body of DSM-5. Major issues included conflicting ways of conceptualizing validation, differences of opinion from personality disorder experts outside the P&PDWG, divergent concepts of the magnitude of evidence needed to support substantial changes, and the disagreements about clinical utility of the hybrid model. Despite these setbacks, the 'Alternative DSM-5 Model of Personality Disorder' is presented in Section III of the DSM-5. Further research should clarify its performance relative to the DSM-IV criteria reprinted in the main DSM-5 text.

Less is more? Assessing the validity of the ICD-11 model of PTSD across multiple trauma samples

BackgroundIn the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the symptom profile of posttraumatic stress disorder (PTSD) was expanded to include 20 symptoms. An alternative model of PTSD is outlined in the proposed 11th edition of the International Classification of Diseases (ICD-11) that includes just six symptoms.Objectives and methodThe objectives of the current study are: 1) to independently investigate the fit of the ICD-11 model of PTSD, and three DSM-5-based models of PTSD, across seven different trauma samples (N=3,746) using confirmatory factor analysis; 2) to assess the concurrent validity of the ICD-11 model of PTSD; and 3) to determine if there are significant differences in diagnostic rates between the ICD-11 guidelines and the DSM-5 criteria.ResultsThe ICD-11 model of PTSD was found to provide excellent model fit in six of the seven trauma samples, and tests of factorial invariance showed that the model performs equally well for males and females. DSM-5 models provided poor fit of the data. Concurrent validity was established as the ICD-11 PTSD factors were all moderately to strongly correlated with scores of depression, anxiety, dissociation, and aggression. Levels of association were similar for ICD-11 and DSM-5 suggesting that explanatory power is not affected due to the limited number of items included in the ICD-11 model. Diagnostic rates were significantly lower according to ICD-11 guidelines compared to the DSM-5 criteria.ConclusionsThe proposed factor structure of the ICD-11 model of PTSD appears valid across multiple trauma types, possesses good concurrent validity, and is more stringent in terms of diagnosis compared to the DSM-5 criteria.

The latent structure of personality functioning: Investigating criterion a from the alternative model for personality disorders in DSM-5.

The alternative model for the classification of personality disorders (PD) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) Section III comprises 2 major components: impairments in personality functioning (Criterion A) and maladaptive personality traits (Criterion B). In this study, we investigated the latent structure of Criterion A (a) within subdomains, (b) across subdomains, and (c) in conjunction with the Criterion B trait facets. Data were gathered as part of an online study that collected other-ratings by 515 laypersons and 145 therapists. Laypersons were asked to assess 1 of their personal acquaintances, whereas therapists were asked to assess 1 of their patients, using 135 items that captured features of Criteria A and B. We were able to show that (a) the structure within the Criterion A subdomains can be appropriately modeled using generalized graded unfolding models, with results suggesting that the items are indeed related to common underlying constructs but often deviate from their theoretically expected severity level; (b) the structure across subdomains is broadly in line with a model comprising 2 strongly correlated factors of self- and interpersonal functioning, with some notable deviations from the theoretical model; and (c) the joint structure of the Criterion A subdomains and the Criterion B facets broadly resembles the expected model of 2 plus 5 factors, albeit the loading pattern suggests that the distinction between Criteria A and B is somewhat blurry. Our findings provide support for several major assumptions of the alternative DSM-5 model for PD but also highlight aspects of the model that need to be further refined.

Exploring the fit of Western PTSD models across three non-Western low- and middle-income countries.

The purpose of this study was to examine the fit of existing Western posttraumatic stress disorder (PTSD) models across 3 non-Western low and middle income countries (LMIC). Secondary data analysis was conducted from studies among torture survivors in Northern Iraq, sexual violence survivors in the Democratic Republic of Congo (DRC), and Burmese refugees in Thailand. Confirmatory factor analyses were conducted on Harvard Trauma Questionnaire (HTQ) data to compare established Western PTSD models using (a) the 3-factor Diagnostic and Statistical Manual (DSM) 4th edition model, (b) the 4-factor “numbing” model, (c) the 4-factor “dysphoria” model, and (d) the 4- factor DSM-5 model. For both the DRC and Burma all models had adequate fit. Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) determined that the 4-factor “numbing” model was the best fit for the DRC and the 4-factor “dysphoria” model was the best fit for Burma. For Iraq, none of the models had adequate fit. Results support previous research which indicates inconsistency among Western models of PTSD among populations from LMIC. Further research should explore whether this is indicative of the context or potentially other factors.

The alternative DSM-5 model for personality disorders.

The alternative DSM-5 model for personality disorders.

Emerging approaches to the conceptualization and treatment of personality disorder.

Personality disorders are both prevalent and debilitating, but controversies abound concerning the definition, assessment and treatment of these conditions. This review examines major approaches to conceptualizing the personality disorders, as recently emerging in DSM-5, Section III, and the research domain criteria initiative of the National Institute of Mental Health. Three prominent models for understanding these disorders (neural functioning, interpersonal model, and the cognitive-affective processing system model) are considered with their relevant empirical foundations. The implications for future psychopathology and treatment research and practice are detailed. Personality disorders (PD) are prevalent in the general popula- tion (10.56% median prevalence across studies; see Lenzenweger, 2008). They are highly debilitating, exerting a powerful impact on work functioning as well as interpersonal and intimate relations. However, there are many impediments to the assessment and treatment of patients with a personality disorder, not the least of which are the controversies in defining personality disorder, the range of severity across the disorders, the difficulties in identifying the key dimensions of personality dysfunction, the striking heter- ogeneity amongst patients that carry the same personality disorder diagnosis, and the paucity of treatment research on the majority of the personality disorder types. In this overview, which is necessarily selective and nonexhaus- tive, we explore a number of empirical developments in person- ality pathology research, with a particularly focus on the potential impact of these developments on conceptualization, assessment and treatment. While there is substantial agreement about the limitations of the PD nosology articulated in the Diagnostic and Statistical Manual for Mental Disorders, now in its fifth edition (DSM-5; APA, 2013), there is less agreement about how to ad- vance our conceptualization. The alternative DSM-5 model for personality disorders, retained in Section 3 of the DSM-5, pro-

DSM-5, trouble de la personnalité schizotypique et nosographie psychanalytique structurale française

ObjectivesIn this article, we present the evolution in the diagnostic criteria in the DSM-5 for schizotypal personality disorder, which is included both in personality disorders and in the new schizophrenia spectrum. The different interpretations (categorical versus fully dimensional) of experiences assimilated to psychosis raise important issues in contemporary approaches to mental health. One major aspect of the problem appears to be the development of the paradoxical notions of “healthy”, “benign” or even “happy” schizotypy. We consider the choice of favouring the dimensional approach, setting this alongside the French structural psychoanalytical nosography, and in particular the definition by Bergeret of the schizophrenic character and the notion of suppléances in Lacanian structural psychoanalytical clinical practice. MethodWe reviewed the points in common between the new DSM-5 model and the French structural psychoanalytical model, by way of a comparative study of recent English language publications in the field of schizotypy and some French psychoanalytical clinical studies. ResultsThe two formerly opposing models have drawn considerably closer, with the acceptation of a dimensional perspective in the DSM-5. The choice of a dimensional rather than a categorical approach has undeniably contributed to reducing the gap between the psychiatric classification and French psychoanalytical nosography. Insofar as the new model for personality disorders – still requiring empirical validation – focuses on personality traits and functioning (assessed not only with regard to the self, but also on interpersonal level, approached via the ability for empathy and intimacy), it relies on far more stable aspects than symptoms alone, and at the same time places them on a continuum from normal to pathological. We consider this amounts to genuine progress in the detection and understanding of psychopathology. DiscussionThe DSM-5 can no longer claim to be a-theoretical (despite the long-standing position of its authors). Moreover, the American Psychiatric Association (APA) confirms that the Big Five factorial theory was used to define the field of personality and personality traits. However, the APA forgets to mention the implicit influence of the American psychoanalytical work by Kernberg, published earlier. Indeed the new severity scale for alterations in the functioning of personality in the DSM-5, whether for self or for interpersonal relationships, presents a fair number of similarities with the conceptualisations by Kernberg concerning the degrees of alteration in self and in object relations, established by this author to distinguish levels of severity in different narcissistic pathologies. Nevertheless, we feel that the new options taken up by the APA are curiously contradictory. Although they are closer to the psychoanalytical model in the new conception proposed for personality disorders, they are in some respects surprisingly distant: the paranoia disorder has disappeared and only certain of its indicators are maintained (such as persecutory delusion) in an excessively wide schizophrenia spectrum. This misses the reality of the various levels of dissociation present in psychotic entities, already reported by psychiatric pioneers, like Bleuler and by a large number of contemporary psychoanalytical psychopathologists. These levels are not strictly organised in identical manner on the intrapsychic level, and their clinical symptomatology during decompensation does not take exactly the same form. We suggest that substantially different levels of dissociation, leading to explicitly distinct symptom profiles, provide a spectrum that it would be more legitimate to call “psychosis” rather than “schizophrenia”, whilst maintaining a distinction in the contemporary psychoanalytical model between schizophrenia, paranoid schizophrenia and paranoia. ConclusionThe authors propose a more integrative approach. This would involve symptoms, functioning dimensions and personality traits, by taking into consideration the intrapsychic mechanisms that underpin their expression, despite the difficulties in objectifying these mechanisms. The markers for these mechanisms are linked in particular to the nature of the conflicts experienced by patients, the nature of their distress and dominant defences, as well as their object investment mode and areas of conflict.

Latent Factor Structure of DSM-5 Posttraumatic Stress Disorder.

The current study examined the latent factor structure of posttraumatic stress disorder (PTSD) based on DSM-5 criteria in a sample of participants (N = 374) recruited for studies on trauma and health. Confirmatory factor analyses (CFA) were used to compare the fit of the previous 3-factor DSM-IV model of PTSD to the 4-factor model specified in DSM-5 as well as to a competing 4-factor "dysphoria" model (Simms, Watson, & Doebbeling, 2002) and a 5-factor (Elhai et al., 2011) model of PTSD. Results indicated that the Elhai 5-factor model (re-experiencing, active avoidance, emotional numbing, dysphoric arousal, anxious arousal) provided the best fit to the data, although substantial support was demonstrated for the DSM-5 4-factor model. Low factor loadings were noted for two of the symptoms in the DSM-5 model (psychogenic amnesia and reckless/self-destructive behavior), which raises questions regarding the adequacy of fit of these symptoms with other core features of the disorder. Overall, the findings from the present research suggest the DSM-5 model of PTSD is a significant improvement over the previous DSM-IV model of PTSD.

The OPD structure questionnaire captures the general features of personality disorder

The alternative DSM-5 model of personality disorder (PD) links general criteria and severity of PD to impairments in self and interpersonal functioning. This approach is very similar to the Level of Structural Impairment Axis of the Operationalized Psychodynamic Diagnosis (OPD-2). In this study we investigate the relationship of these 2 approaches based on 2 new self-report questionnaires. 228 psychotherapeutic inpatients filled out the OPD Structure Questionnaire (OPD-SQ), the General Assessment of Personality Disorder (GAPD), and the Patient Health Questionnaire (PHQ-D). The correlation between the latent general factors of OPD-SQ and GAPD was 0,91. After controlling for depressive symptoms the correlation was 0,86. The general factors of the OPD-SQ and the GAPD are almost identical. The OPD-SQ captures the general features of PD in terms of self-reported impairments in self and interpersonal functioning.

An evaluation of the DSM-5 factor structure for posttraumatic stress disorder in survivors of traumatic injury

Confirmatory factor analytic studies of the latent structure of DSM-5 PTSD symptoms using self-report data (Elhai et al., 2012; Miller et al., 2013) have found that the four-factor model implied by the DSM-5 diagnostic criteria provided adequate fit to their data. However, the fit of this model is yet to be assessed using data derived from gold standard structured interview measures. This study evaluated the fit of the DSM-5 four-factor model and an alternative four-factor model in 570 injury survivors six years post-injury using the Clinician Administered PTSD Scale (Blake et al., 1990), updated to include items measuring new DSM-5 symptoms. While both four-factor models fitted the data well, very high correlations between the ‘Intrusions’ and ‘Avoidance’ factors in both models and between the ‘Negative Alterations in Cognitions and Mood’ and ‘Arousal and Reactivity’ factors in the DSM-5 model and the ‘Dysphoria’ and ‘Hyperarousal’ factors in the alternative model were evident, suggesting that a more parsimonious two-factor model combining these pairs of factors may adequately represent the latent structure. Such a two-factor model fitted the data less well according to χ2 difference testing, but demonstrated broadly equivalent fit using other fit indices. Relationships between the factors of each of the four-factor models and the latent factors of Fear and Anxious-Misery/Distress underlying Internalizing disorders (Krueger, 1999) were also explored, with findings providing further support for the close relationship between the Intrusion and Avoidance factors. However, these findings also suggested that there may be some utility to distinguishing Negative Alterations in Cognition and Mood symptoms from Arousal and Reactivity symptoms, and/or Dysphoria symptoms from Hyperarousal symptoms. Further studies are required to assess the potential discriminant validity of the two four-factor models.

Dimensional structure of DSM-5 posttraumatic stress symptoms: Support for a hybrid Anhedonia and Externalizing Behaviors model

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.