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

Authors

Cherie Armour, University of Ulster
Jack Tsai, Yale University School of Medicine & United States Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center
Tory A. Durham, University of Toledo
Ruby Charak, University of Nebraska-LincolnFollow
Tracey L. Biehn, University of Toledo
Jon D. Elhai, University of Toledo
Robert H. Pietrzak, Yale University School of Medicine & VA Connecticut Healthcare System

Document Type

Article

Date of this Version

10-30-2014

Citation

2014 Elsevier Ltd. All rights reserved

Comments

C. Armour et al. / Journal of Psychiatric Research 61 (2015) 106e113 http://dx.doi.org/10.1016/j.jpsychires.2014.10.012 0022-3956

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.