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Dimensional structure of DSM-5 posttraumatic stress symptoms: support for a hybrid Anhedonia and Externalizing Behaviors model.
J Psychiatr Res 2015; 61:106-13JP

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.

Authors+Show Affiliations

Psychology Research Institute, University of Ulster, Coleraine, Northern Ireland, UK. Electronic address: armour.cherie@gmail.com.United States Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.Department of Psychology, University of Toledo, USA.Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA.Department of Psychology, University of Toledo, USA.Department of Psychology, University of Toledo, USA; Department of Psychiatry, University of Toledo, USA.Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

25479765

Citation

Armour, Cherie, et al. "Dimensional Structure of DSM-5 Posttraumatic Stress Symptoms: Support for a Hybrid Anhedonia and Externalizing Behaviors Model." Journal of Psychiatric Research, vol. 61, 2015, pp. 106-13.
Armour C, Tsai J, Durham TA, et al. Dimensional structure of DSM-5 posttraumatic stress symptoms: support for a hybrid Anhedonia and Externalizing Behaviors model. J Psychiatr Res. 2015;61:106-13.
Armour, C., Tsai, J., Durham, T. A., Charak, R., Biehn, T. L., Elhai, J. D., & Pietrzak, R. H. (2015). Dimensional structure of DSM-5 posttraumatic stress symptoms: support for a hybrid Anhedonia and Externalizing Behaviors model. Journal of Psychiatric Research, 61, pp. 106-13. doi:10.1016/j.jpsychires.2014.10.012.
Armour C, et al. Dimensional Structure of DSM-5 Posttraumatic Stress Symptoms: Support for a Hybrid Anhedonia and Externalizing Behaviors Model. J Psychiatr Res. 2015;61:106-13. PubMed PMID: 25479765.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dimensional structure of DSM-5 posttraumatic stress symptoms: support for a hybrid Anhedonia and Externalizing Behaviors model. AU - Armour,Cherie, AU - Tsai,Jack, AU - Durham,Tory A, AU - Charak,Ruby, AU - Biehn,Tracey L, AU - Elhai,Jon D, AU - Pietrzak,Robert H, Y1 - 2014/11/22/ PY - 2014/07/23/received PY - 2014/10/01/revised PY - 2014/10/30/accepted PY - 2014/12/7/entrez PY - 2014/12/7/pubmed PY - 2015/8/15/medline KW - 7-Factor hybrid model KW - Confirmatory factor analysis KW - DSM-5 KW - Latent structure KW - Posttraumatic stress disorder SP - 106 EP - 13 JF - Journal of psychiatric research JO - J Psychiatr Res VL - 61 N2 - 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. SN - 1879-1379 UR - https://www.unboundmedicine.com/medline/citation/25479765/Dimensional_structure_of_DSM_5_posttraumatic_stress_symptoms:_support_for_a_hybrid_Anhedonia_and_Externalizing_Behaviors_model_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3956(14)00318-5 DB - PRIME DP - Unbound Medicine ER -