DSM-5 Posttraumatic Stress Disorder Symptoms Research Articles

Subgroup differences in PTSD symptom presentations: A latent class analysis

Posttraumatic stress disorder (PTSD) is a highly heterogeneous disorder (Galatzer-Levy & Bryant, 2013). Mixture modeling has been used to identify homogeneous subgroups of individuals based on patterns of PTSD symptom expression. However, most of these studies are based on DSM-IV rather than DSM-5 PTSD criteria. In addition, these studies employ different indicators of latent class membership, which contributes to variability in the number and nature of latent classes identified. Additionally, there is relatively limited construct validity evidence of identified latent classes. To address these limitations, a latent class analysis (LCA) of DSM-5 PTSD symptoms was conducted in a sample of undergraduate students (N = 322) who met criteria for a subthreshold diagnosis of PTSD. The current study aimed to replicate and extend findings from the limited number of LCAs of DSM-5 PTSD criteria and examine how resulting classes meaningfully differ in external correlates. Findings revealed a three-class solution: Low Anhedonia/Externalizing Behaviors (EB), Moderate Symptoms, and High Symptoms of PTSD. Relative to the other classes, the High Symptoms class was characterized by elevated anxiety and somatic symptoms on the Personality Assessment Inventory (PAI; Morey, 1991). Relative to the Low Anhedonia/EB, the Moderate Symptoms class was characterized by numerous psychopathology domains, including depression and borderline personality traits. Results from this study suggest that, beyond classes characterized by similar PTSD symptom severity across symptoms, some individuals with similar overall PTSD symptom severity differed based on depressive symptom characteristics. Implications and future directions are discussed.

Are There Differences Among Evidence-Based Psychotherapies for Treating Different DSM-5 PTSD Symptom Clusters? A Systematic Review and Meta-analysis of Controlled Clinical Trials.

Posttraumatic stress disorder (PTSD) is a heterogeneous disease defined by four Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) symptom clusters: reexperiencing, avoidance, negative alterations in cognitions and mood, and hyperarousal. There are effective evidence-based psychotherapies (EBPs) for PTSD. However, given the variety of PTSD clinical presentations, we conducted the first meta-analysis investigating whether DSM-5 PTSD symptom clusters show different responses to EBPs. We systematically reviewed the literature for controlled clinical trials in five databases, performed a meta-analysis, and evaluated the methodological quality of the studies. We screened 633 studies and included seven. Three showed high risk, two showed some concerns, and one showed a low risk of bias. The symptom clusters do not seem to respond differently to EBPs (SMD cluster B: -0.40; 95% confidence interval [CI], -0.87 to 0.08; cluster C: -0.49; 95% CI, -0.90 to -0.08; cluster D: -0.44; 95% CI, -0.94 to 0.05; cluster E: -0.54; 95% CI, -1.07 to -0.0), even when analyzed by the therapeutic focuses. The findings dovetail nicely with the network theory of PTSD symptom, as although it is a heterogeneous disorder, the EBPs seem to promote a kind of cascade of symptom improvement.

Predicting DSM-5 PTSD symptomatology 6 months to 2 years after burn: The role of early psychological risk factors

BackgroundMajor burn injuries may have long-term mental health consequences, such as posttraumatic stress disorder (PTSD). This study extended prior work to investigate DSM-5 PTSD symptoms at 6 months, 1 year, and 2 years post-burn as well as the contribution of two sets of early psychological risk factors to DSM-5 PTSD symptoms: Established PTSD risk factors (prior adjustment problems, past trauma, perception of life threat, peritraumatic emotions and dissociation) and theory-derived cognitive factors (negative appraisals of the trauma and its sequelae, memory disorganization, trauma-related rumination, and thought suppression). MethodThe current study recruited a sample of 118 adult burn patients (75.4% men, mean age 41.8, mean TBSA 18.3%) consecutively admitted to a large regional burn center in Northern Taiwan, who were assessed at 6, 12, and 24 months following their burn injury. ResultsA total of 11.0%, 5.9%, and 7.6% met probable DSM-5 PTSD at 6 months, 1 year, and 2 years post-burn, respectively. The rates rose to 15.3%, 10.2%, and 11.0% using the cutoff method. After controlling for covariates, the regression model with theory-derived cognitive factors explained an additional significant 15.9%, 17.2%, and 17.7% of the variance in DSM-5 PTSD symptoms at 6 months, 1 year, and 2 years post-burn, respectively. In contrast, the regression model with established PTSD risk factors explained an additional significant 7.2%, 14.4%, and 10.5% of the variance in DSM-5 PTSD symptoms at 6 months, 1 year, and 2 years post-burn, respectively. Of all predictors, negative appraisals of intrusions was consistently and strongly predictive of DSM-5 PTSD symptomatology post-burn across time, followed by prior depression. ConclusionsThe results underscore the role of early cognitive risk factors in the development and persistence of DSM-5 PTSD symptomatology following burn injury.

Posttraumatic stress disorder (PTSD) symptom profiles among people who have experienced abuse: Findings from the NESARC-III study.

We sought to identify unique PTSD symptom profiles associated with the experience of physical and sexual abuse and to determine whether exposure in childhood, type of abuse, frequency of abuse and familial support were associated with profiles indicating increased symptom complexity. We analyzed data from 6,769 American adults (M = 43.93 years, SD = 15.35, 70.9% female) from the National Epidemiologic Survey on Alcohol and Related Conditions-III who reported histories of physical or sexual abuse. Latent Class Analysis was used to identify distinct profiles of the twenty PTSD symptoms outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Abuse in childhood, type of abuse, frequency of childhood abuse, emotional support in childhood and a range of demographic variables were compared across classes. Five classes were educed: High All (19.6%), Threat (14.4%), Dysphoric (13.7%), Moderate Threat (29.4%) and Low Symptom (22.9%). Contrary to our hypotheses, trauma exposure in childhood did not predict class membership while type of abuse did. The High All and Dysphoric classes had greater frequency of childhood abuse, lower support in childhood, and a history of sexual abuse when compared to their less complex, predominantly fear-based counterparts (Threat and Moderate Threat classes, respectively). These constellations of DSM-5 PTSD symptoms may be a proxy for increased "complexity" and may indicate a need for alternative or additional therapeutic interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Using network models to explore the associations between posttraumatic stress disorder symptoms and subjective cognitive functioning

Several studies have identified relationships between posttraumatic stress disorder (PTSD) and cognitive functioning. Here, we aimed to elucidate the nature of this relationship by investigating cross-sectional associations between subjective cognitive functioning (SCF) and 1) the PTSD sum score, 2) symptom domains, and 3) individual symptoms. We also investigated temporal stability by testing whether results replicated over a 3-year period. We estimated partial correlation networks of DSM-5 PTSD symptoms (at baseline) and SCF (at baseline and follow-up, respectively), using data from the National Health and Resilience in Veterans Study (NHRVS; N = 1484; Mdn = 65 years). The PTSD sum score was negatively associated with SCF. SCF was consistently negatively associated with the PTSD symptom domains ‘marked alterations in arousal and reactivity’ and ‘negative alterations in cognitions and mood’, and showed robust relations with the specific symptoms ‘having difficulty concentrating’ and ‘trouble experiencing positive feelings’. Results largely replicated at the 3-year follow-up, suggesting that some PTSD symptoms both temporally precede and are statistically associated with the development or maintenance of reduced SCF. We discuss the importance of examining links between specific PTSD domains and symptoms with SCF—relations obfuscated by focusing on PTSD diagnoses or sum scores—as well as investigating mechanisms underlying these relations.Registration Number: 37069 (https://aspredicted.org/n5sw7.pdf)

Investigating the DSM-5 and the ICD-11 PTSD symptoms using network analysis across two distinct samples.

Posttraumatic stress disorder (PTSD) has long been debated with a recent focus on the consequences of having two different diagnostic descriptions of PTSD (i.e., the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition [DSM-5] and the International Classification of Diseases-11th Edition [ICD-11]). Research has modeled PTSD as a network of interacting symptoms according to both diagnostic systems, but the relations between the two systems remain unclear regarding which symptoms are more central or interconnected. To answer this question, the present study is the first study to investigate the combined network structure of PTSD symptoms according to both systems using validated measurements (i.e., the International Trauma Questionnaire [ITQ] and the Posttraumatic Stress Disorder Checklist 5 [PCL-5] across two distinct trauma samples [a community sample, N = 2,367], and a military sample, N = 657). We estimated two Gaussian Graphical Models of the combined ICD-11 and DSM-5 PTSD symptoms across the two samples. Five of the six most central symptoms were the same across both samples. The results underline that a combination of five symptoms representing both diagnostic systems may hold central positions and potentially be important for treatment. However, the implications depend on if the different diagnostic descriptions can be reconciled in an indexical rather than constitutive perspective. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5: A Systematic Review of Existing Psychometric Evidence.

The PTSD Checklist for DSM-5 (PCL-5) is a widely used self-rated measure of DSM-5 PTSD symptoms. The goal of this systematic review was to synthesize research on the psychometric properties of the PCL-5 to guide clinical and research applications. We focused on reliability, validity, factor structure, optimal cutoff scores, and sensitivity to clinical change indices. A systematic review of the literature following PRISMA guidelines was conducted using PubMed, PsycINFO, CINAHL, and PTSDpubs with search terms capturing selected psychometric indices of the PCL-5. The inclusion criteria were: peer-reviewed publication in English; primary focus on the PCL-5 psychometrics; empirical study; and study with adult samples. The search yielded 265 studies; 56 papers (amounting to 64 studies) met inclusion criteria and were reviewed. Findings generally indicated evidence for: acceptable internal consistency and test-retest reliability; construct validity; a 7-factor Hybrid Model; recommended cutoff scores between 31-33; and ability to index sensitivity to clinical change. To further advance knowledge and applications of the PCL-5, we need more research on abbreviated versions of the PCL-5, bifactor modeling as applied to the PCL-5, as well as on PCL-5 item difficulty estimates, discrimination parameters, and clinical change score estimates.

Clinical significance of novel 8-factor model of DSM-5 PTSD in national VA PTSD residential treatment data: Internally- v. externally-cued intrusions

BackgroundIntrusion symptoms are a core defining feature of posttraumatic stress disorder (PTSD). It was recently proposed that intrusions may be comprised of two distinct underlying processes: internally-cued intrusions (e.g., trauma-related memories), and externally-cued intrusions (e.g., reactivity to trauma-related cues in one's environment). This is the first study to examine the functional correlates of these two intrusion clusters. MethodsParticipants included 7460 veterans discharged from 40 Veterans Affairs PTSD residential programs across the United States in fiscal years 2018 through 2020. Latent network modeling and structural equation modeling were used to assess the fit of an 8-factor model of PTSD symptoms, which were assessed using the PTSD Checklist for DSM-5 (PCL-5) PTSD symptoms at admission, and its association with symptoms of depression and generalized anxiety, and emotional and physical functioning. ResultsThe 8-factor model, with separate intrusion factors, showed superior model fit to the DSM-5 4-factor, 5-factor dysphoric arousal, 6-factor anhedonia, and 7-factor hybrid models of PTSD. Internally-cued intrusions were uniquely associated with dysphoric arousal, decreased avoidance, and worse physical health functioning; whereas, externally-cued intrusions were uniquely associated with greater avoidance, anxious arousal, negative affect, increased generalized anxiety symptoms, and worse emotional functioning. LimitationsLimitations include the cross-sectional design and use of self-report measures. ConclusionsFindings provide initial support for the clinical utility of a novel 8-factor model of PCL-5 PTSD symptoms, which distinguishes internally- and externally-cued intrusions. These separate intrusion symptom clusters may offer greater specificity and utility in informing the prognosis of and tailored interventions for PTSD.

A systematic examination of cognitive emotion regulation strategies, global emotion dysregulation, and cognitive insight in relation to posttraumatic stress disorder symptoms among trauma exposed patients with early nonaffective psychosis.

Previous research has shown that emotion dysregulation after trauma is associated with increased posttraumatic stress disorder (PTSD) severity. However, it remains unclear how different dimensions of emotion dysregulation and cognitive insight may interact to predict Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) PTSD symptoms in early psychosis. The present study systematically examines cognitive emotion regulation strategies, global emotion dysregulation, and cognitive insight in relation to DSM-5 PTSD symptoms among trauma-exposed patients with early nonaffective psychosis. A total of 150 outpatients with early nonaffective psychosis were screened for trauma exposure on the Stressful Life Events Questionnaire. Participants (N = 79; 52.6%) who met the DSM-5 Criterion A subsequently completed the PTSD Checklist for DSM-5, Cognitive Emotion Regulation Questionnaire, Difficulties With Emotion Regulation Questionnaire, and Beck Cognitive Insight Scale. Severity of psychotic and depressive symptoms were rated on the Brief Psychiatric Rating Scale. Multivariate regression models adjusting for age, gender, psychotic and depressive symptoms revealed that PTSD symptom clusters were associated with more maladaptive cognitive emotion regulation strategies (catastrophic thinking, rumination, and other blame) and less adaptive cognitive emotion regulation strategies (cognitive reappraisal and planning; Cohen's f² = 1.50-3.17). Further moderation analyses revealed a negative interaction between global emotion dysregulation and self-reflection on intrusive symptoms such that for patients with low self-reflectivity, global emotion dysregulation was associated with increased severity of intrusive symptoms (f² = 0.96). Our findings suggest that addressing emotion dysregulation and cognitive insight may improve intrusive symptoms, and this may prevent the development of full PTSD in patients with early nonaffective psychosis. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

An initial investigation of the association between DSM-5 posttraumatic stress disorder symptoms and nonsuicidal self-injury functions.

Despite the well-established link between posttraumatic stress disorder (PTSD) and nonsuicidal self-injury (NSSI), little is known about factors that may lead to self-injury among trauma-exposed individuals. Moreover, no research to date has examined these relations in the context of the newly revised Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) PTSD criteria. Thus, the purpose of the current study was to explore the associations between DSM-5 PTSD symptom clusters (i.e., intrusion, avoidance, negative alterations in cognitions and mood, alterations in arousal and reactivity) and self-injury functions using a small sample of college students. Participants (N = 81) were recruited for a lifetime history of NSSI and trauma exposure. Findings revealed a statistically significant path from PTSD avoidance symptoms to NSSI social functions and from PTSD negative alterations in cognitions and mood symptoms to NSSI intrapersonal functions, even after controlling for relevant covariates. Results of the current study highlight the importance of assessing for NSSI among trauma-exposed individuals. Considering that NSSI is a risk factor for suicidal behavior and potentially a clinically distinct diagnosis, future research should continue to explore these associations using larger, more diverse clinical samples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Affective Control Scale: Factor structure and associations with posttraumatic stress symptoms in trauma-exposed male veterans.

Posttraumatic stress disorder (PTSD) is characterized by broad-based difficulties with emotion. However, the extent to which the disorder is associated with fear of particular emotions remains less well understood. The Affective Control Scale (ACS) is a frequently used measure of fear of emotion, but relatively little work has been done to validate this measure, particularly for use in psychiatric research. This study examined the ACS's factor structure and its associations with PTSD symptoms among trauma-exposed male veterans. Participants (N = 347) completed online assessments, including the ACS and the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). The data supported a bifactor structure with 1 general fear of emotion factor and 4 specific fear of emotion factors (i.e., fear of anger, fear of positive affect, fear of depressed mood, and fear of anxiety). Fear of emotion was positively associated with all 4 DSM-5 PTSD symptom clusters. After controlling for general fear of emotion, fear of particular emotion states was associated with some specific PTSD symptoms. Both general and specific fears of emotion were associated with specific PTSD symptoms in trauma-exposed veterans. Despite this, results support the use of a modified ACS total score, capturing general fear of emotion, rather than the subscale scores, capturing fear of specific emotions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

DSM-5 Posttraumatic Stress Disorder Symptoms in Nonclinical Samples of Chinese and Pakistani Trauma-Exposed Adults: Factor Structure and Invariance Across Culture.

The purpose of the current study was to examine the latent structure and cross-cultural measurement validity of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) posttraumatic stress disorder (PTSD) symptoms assessed by the PTSD Checklist for DSM-5. Participants comprised trauma-exposed Chinese and Pakistani undergraduate students (N = 495 and N = 186, respectively). Confirmatory factor analysis (CFA) indicated that a seven-factor hybrid model involving intrusion, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal factors provided good fit in both samples. This model fit significantly better than three alternative models including the DSM-5 four-factor model and six-factor anhedonia and externalizing behaviors models. The subsequent multigroup CFA showed that the best-fitting hybrid model demonstrated cross-cultural measurement invariance. Our findings provide further empirical support for the seven-factor PTSD hybrid model and its cross-cultural invariance, and have implications for understanding and application of DSM-5's PTSD symptoms.

Confirmatory factor analysis of the Clinician-Administered PTSD Scale (CAPS-5) based on DSM-5 vs. ICD-11 criteria

ABSTRACT Introduction Many studies have investigated the latent structure of the DSM-5 criteria for posttraumatic stress disorder (PTSD). However, most research on this topic was based on self-report data. We aimed to investigate the latent structure of PTSD based on a clinical interview, the Clinician-Administered PTSD Scale (CAPS-5). Method A clinical sample of 345 participants took part in this multi-centre study. Participants were assessed with the CAPS-5 and the Posttraumatic Stress Disorder Checklist (PCL-5). We evaluated eight competing models of DSM-5 PTSD symptoms and three competing models of ICD-11 PTSD symptoms. Results The internal consistency of the CAPS-5 was replicated. In CFAs, the Anhedonia model emerged as the best fitting model within all tested DSM-5 models. However, when compared with the Anhedonia model, the non-nested ICD-11 model as a less complex three-factor solution showed better model fit indices. Discussion We discuss the findings in the context of earlier empirical findings as well as theoretical models of PTSD.

Associations Between PTSD Symptom Custers and Longitudinal Changes in Suicidal Ideation: Comparison Between 4-Factor and 7-Factor Models of DSM-5 PTSD Symptoms.

Objective: The association between posttraumatic stress disorder (PTSD) and suicidal ideation (SI) is well-known. However, a few studies have investigated the associations between PTSD symptom clusters based on the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) and changes in suicide risk longitudinally.Methods: We adopted a longitudinal study design using data from the National Survey for Stress and Health of 3,090 of the Japanese population. The first and second surveys were conducted on November 2016 and March 2017, respectively. The suicidal ideation attributes scale was applied to assess the severity of suicidal ideation at baseline and the follow-up period. A multivariate linear regression model was conducted to examine the associations between the 4- or 7-factor model of PTSD symptom clusters at baseline and longitudinal changes in SI.Results: Overall, 3,090 subjects were analyzed (mean age, 44.9 ± 10.9 years; 48.8% female) at Baseline, and 2,163 completed the second survey. In the 4-factor model, we found that the severity of negative alternations in cognition and mood were significantly associated with increased SI after 4 months. In the 7-factor model, we found that the severity of anhedonia and externalizing behavior at baseline was significantly associated with increased SI during the follow-up period.Conclusions: We found that the seven-factor model of DSM-5 PTSD symptoms may provide greater specificity in predicting longitudinal SI change in the general population. Closely monitoring specific PTSD core symptoms may be more effective in mitigating key clinical and functional outcomes.

Investigating centrality in PTSD symptoms across diagnostic systems using network analysis*

ABSTRACT Background: The posttraumatic stress disorder (PTSD) diagnosis has been widely debated since it was introduced into the diagnostic nomenclature four decades ago. Recently, the debate has focused on consequences of having two different descriptions of PTSD: 20 symptoms belonging to four symptom clusters in the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5), and three symptoms clusters in the 11th edition of the International Classification of Diseases (ICD-11) most often operationalized by six symptoms in the International Trauma Questionnaire (ITQ) (2017) and Hansen, Hyland, Armour, Shevlin, & Elklit (2015). Research has provided support for both models of PTSD, but at the same time indicates differences in estimated prevalence rates of PTSD (Hansen et al., 2015, 2017). A growing body of research has modelled PTSD both theoretically and statistically as a network of interacting symptoms (Birkeland, Greene, & Spiller, 2020), yet it remains more unclear how the two diagnostic systems perform regarding which symptoms are more central/interconnected. Objectives and methods: We estimated two 23-item Gaussian Graphical Models to investigate whether ICD-11 or DSM-5 PTSD symptoms are more central in two trauma-exposed samples: a community sample (N = 2,367) and a military veteran sample (N = 657). PTSD DSM-5 was measured with the PTSD checklist-5 (PCL-5) and the PTSD ICD-11 was measure by the ITQ PTSD subscale. Results: Five of the six most central symptoms estimated via the expected influence centrality metric across the two samples were identical and represented symptoms from both diagnostic systems operationalized by the PCL-5 and the ITQ. Conclusions: The results of the present study underline that symptoms from both diagnostic systems hold central positions. The implications of the results are discussed from the perspectives of an indexical (i.e. the diagnostic systems reflect both shared and different aspects of PTSD) and a constitutive view (i.e., the diagnostic systems represent different disorders and the results cannot be reconciled per se) of mental health diagnoses (Kendler, 2017).

Intolerance of Uncertainty and DSM-5 PTSD Symptom Severity among Trauma Exposed Latina College Women

ABSTRACT Approximately 56 to 84% of college students report having experienced at least one lifetime traumatic or adverse life event. However, little is known about trauma exposure among Latina college students and the association of cognitive vulnerabilities to Posttraumatic Stress Disorder (PTSD) symptoms among this population. Therefore, the purpose of the study was to: (a) explore the traumatic events experienced by 436 Latina college women, and (b) examine the unique contribution of intolerance of uncertainty (IU) and its two subscales (prospective and inhibitory IU) to PTSD-5 symptom severity among the 263 (76%) trauma-exposed Latina college women in the sample. Most frequently reported trauma events included interpersonal bullying and ridicule, attempted sexual assault, traumatic bereavement, and life-threatening accident or natural disaster. As expected, when controlling for college stress and anxiety sensitivity: (a) IU scores were associated with overall PTSD symptom severity and with two of the four PTSD-5 cluster symptoms, arousal/reactivity, and negative alteration in cognition/mood, and (b) IU was not associated with the PTSD-5 intrusion cluster symptoms’ severity. Inconsistent with expectations, IU was not uniquely associated with the avoidance of PTSD-5 cluster symptoms. Paralysis in the face of uncertainty (inhibitory IU) was more strongly related to PTSD symptom severity than concerns regarding anticipated uncertainty (prospective IU). Results suggest that IU is a transdiagnostic cognitive vulnerability that plays a unique role in relation to PTSD symptom severity among trauma exposed Latina college women. Therefore, interventions to ameliorate IU could complement established psychological and pharmacological PTSD treatments with this population.

A Bayesian Structural Equation Modeling Factor Analysis of the UCLA Posttraumatic Stress Disorder Reaction Index for DSM-5 in a Polyvictimized Sample of Adolescents.

The revised criteria for posttraumatic stress disorder (PTSD) in the fifth edition of the Diagnostic and Statistical Manual necessitated the development of new screening tools for youth, one of the most widely used of which is the UCLA Posttraumatic Stress Disorder Reaction Index for DSM-5 (RI-5). Thus far, the few studies that have investigated the RI-5's factor structure have supported a four-factor model. However, to date this research has been limited to youth with histories of exposure to single-event traumatic stressors, a significant limitation as evidence suggests many trauma-exposed youth report exposure to multiple types of traumatic stressors, or polyvictimization. It is imperative to determine the generalizability of previous factor models to specific populations which they are purported to represent. We investigated whether the RI-5's four-factor model replicated in a sample of 455 polyvictimized justice-involved adolescents. Initial confirmatory factor analysis demonstrated that the four-factor model did not converge. Therefore, we utilized Bayesian Structural Equations Modeling (BSEM) to determine why the previously proposed factor structure did not converge. The BSEM model suggested that the global factor structure was acceptable and did not require addition or subtraction of any factor or cross-factor loadings. However, small and moderate residual covariances resulted in model misspecification, suggesting there may be additional associations not captured by the current DSM-5 model for polyvictimized youth. Future work should continue examining the RI-5's factor structure in order to better understand whether the current results are unique and how measurements assessing DSM-5 PTSD symptom criteria perform in diverse trauma-exposed youth populations.

Test of the dynamic interplay between DSM-5 PTSD symptom clusters in children and adolescents

BackgroundRevealing the dynamic interplay between posttraumatic stress disorder (PTSD) symptom clusters has always been an important topic in traumatic stress studies. Based on longitudinal studies, different hypotheses have been proposed to explain PTSD symptom dynamics. But currently, no study have been conducted to test these hypotheses in children and adolescents. MethodsData were derived from a longitudinal study of child and adolescent traumatic event survivors of an explosion accident (N = 659). DSM-5 PTSD symptoms was measured by the PTSD Checklist-5 (PCL-5) at 4, 8, and 13 months after the disaster. Latent difference score (LDS) modeling was used to evaluate the dynamic interplay between clusters. ResultsThe results of LDS model indicated that intrusion level positively predicted subsequent rate of increase for hyperarousal (p = .008) and negative changes in cognitions and mood symptoms (p = .036). Also, intrusion level trended to positively predict subsequent increase rate of avoidance symptoms (p = .059). ConclusionsThis study expands previous knowledge of dynamic relations between symptom clusters during the maintenance and fluctuation of child and adolescent PTSD symptoms. By using new methodology, this study provided novel evidence for the hypothesis that intrusion symptom plays an important role in maintaining other PTSD symptoms.

Trauma Exposure, Post-traumatic Stress Symptoms, and Indices of Parenting.

Previous studies have reported that trauma exposure and post-traumatic stress symptoms (PTSS) may increase the risk for parenting difficulties, yet it is not clear whether trauma exposure and PTSS independently contribute to parenting-related indices or whether there is an indirect effect of trauma exposure on parenting-related outcomes through PTSS. Further, the associations between PTSS and parenting outcomes utilizing the most recent Diagnostic and Statistical Manual (DSM-5) post-traumatic stress disorder (PTSD) criteria are unknown. The aims of the current study were to determine: (a) whether trauma exposure and PTSS are related to parenting indices; (b) if trauma exposure is associated with parenting factors indirectly through PTSS; and (c) whether the DSM-5 PTSD symptom clusters are each linked with parenting outcomes. Participants were 225 trauma-exposed parents (Mage = 36.81; SD = 8.32) from a Midwestern University or Amazon's Mechanical Turk (MTurk). Cumulative trauma had an indirect effect on parental satisfaction, support, involvement, limit-setting, and autonomy via PTSS. The specific PTSD symptom clusters also demonstrated distinct ties to parenting outcomes. Higher levels of alterations in reactivity and arousal symptoms were associated with lower parental support and satisfaction, as expected. Avoidance symptoms were also inversely related to parental autonomy. However, a positive relationship was noted between intrusion symptoms and support, and changes in cognitions and mood were unrelated to parenting indices. PTSS may better explain decrements in aspects of parenting than trauma exposure. Certain types of PTSD symptoms, particularly trauma-related changes in reactivity and arousal, may be relevant in understanding and improving parenting outcomes among trauma-exposed parents.

An exploration of the DSM-5 posttraumatic stress disorder symptom latent variable network

ABSTRACT Background Both the latent variable model and the network model have been widely used to conceptualize mental disorders. However, it has been pointed out that there is no clear dichotomy between the two models, and a combination of these two model could enable a better understanding of psychopathology. The recently proposed latent network model (LNM) has provided a statistical framework to enable this combination. Evidence has shown that posttraumatic stress disorder (PTSD) could be a suitable candidate disorder to study the combined model. In the current study, we initiated the first investigation of the latent network of PTSD symptoms. Methods The latent network of DSM-5 PTSD symptoms was estimated in 1196 adult survivors of China’s 2008 Wenchuan earthquake. Validation testing of the latent network was conducted in a replication sample of children and adolescent who experienced various trauma types. PTSD symptoms were measured by the PTSD Checklist for DSM-5 (PCL-5). The latent network was estimated using the seven-factor hybrid model of DSM-5 PTSD symptoms, analysed using the R package lvnet. Results The latent network model demonstrated good fit in both samples. A strong weighted edge between the intrusion and avoidance dimensions was identified (regularized partial correlation = 0.75). The externalizing behaviour dimension demonstrated the highest centrality in the latent network. Conclusions This study is the first to investigate the latent network of DSM-5 PTSD symptoms. Results suggest that both latent symptom dimension and associations between the dimensions should be considered in future PTSD studies and clinical practices.