Support for the location of negative posttraumatic cognitions in the diagnosis of posttraumatic stress disorder

ObjectiveTo investigate the extent to which negative posttraumatic cognitions predict, and so can be best located within, the DSM-5 (APA, 2013) individual symptom clusters of posttraumatic stress disorder (PTSD).MethodAn online survey of traumatic experiences, featuring 528 adults.ResultsNegative posttraumatic cognitions seem best placed within the Numbing/Detachment symptom cluster. Negative posttraumatic cognitions relating to the self predict higher levels of symptoms across the clusters. While negative cognitions relating to the world contributed to most symptom groups, self-blame cognitions did not.ConclusionsOur findings support the placement of posttraumatic cognitions as part of the Numbing/Detachment symptom cluster within the DSM-5rather than the Intrusion, Avoidance and Hyperarousal clusters.     

Posttraumatic Stress Disorder Symptom Clusters and Acquired Capability for Suicide: A Reexamination Using DSM-5 Criteria

This study used the interpersonal–psychological theory of suicide to explore the relationships among DSM-5 posttraumatic stress disorder (PTSD) symptom clusters derived from the six-factor anhedonia model and facets of acquired capability for suicide (ACS). In a sample of 373 trauma-exposed undergraduates, most PTSD symptom clusters were negatively associated with facets of ACS in bivariate correlations, but the anhedonia cluster was positively associated with ACS in regression models. Structure coefficients and commonality analysis indicated that anhedonia served as a suppressor variable for the other symptom clusters. Our findings further elucidate the complex relationship between specific PTSD symptom clusters and ACS.     

Latent structure of the Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) in South African mortuary workers

This study applied confirmatory factor analysis (CFA) to determine the dimensionality of PTSD symptoms as measured by the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5, Weathers et al., 2013). Participants were 150 trauma-exposed mortuary workers. Six alternative factor solutions resulted from the CFA; including Dysphoria model (four-factor), Dysphoric Arousal model (five-factor), Anhedonia model (six-factor), Externalising model (six-factor), and Hybrid model (seven-factor). Compared to the other models, the five-factor Dysphoric Arousal model had superior fit to the data. Overall, the current results provide evidence for the factorial validity and reliability of scores for the PCL-5 for research use in the South African context.     

A longitudinal analysis of anxiety and depressive symptoms

The authors modeled depressive and anxiety symptom data from 1,391 participants in a longitudinal study of middle-aged and older Swedish twins (M age = 60.9 years, SD = 13.3). Although anxiety and depression were highly correlated, a model with distinct Anxiety and Depression factors fit the data better than models with Positive and Negative Affect factors or a single Mental Health factor. Lack of well-being was associated with anxiety rather than depression. Over two 3-year intervals, anxiety symptoms led to depressive symptoms, but the relationship was not reciprocal. Anxiety symptoms were more stable than depression. These findings provide additional support for the idea that anxiety symptoms may reflect a personality trait such as neuroticism more than do depressive symptoms and suggest that low positive affect may not be as specific to depression among older adults as in younger people.     

Anxiety between personality and cognition: The gray zone

The aim of the study was to explore relations between Gray’s revised Reinforcement Sensitivity Theory (rRST) systems (Behavior Inhibition, Behavior Activation and Fight/Flight/Freeze System – BIS, BAS and FFFS) and two cognitive vulnerabilities to anxiety disorders (Intolerance of Uncertainty – IU and Anxiety Sensitivity – AS). The sample comprised 223 participants. The results suggested that BIS was a significant predictor of all components of the anxiety vulnerability measures. However, Freeze and Flight had also significant contributions, particularly in explaining vulnerabilities to physical and social threats as well as inhibitory behaviours while facing uncertainty. The findings provide insights into the nature of AS and IU which is in accordance with the rRST.     

The Temporal Relations of PTSD Symptoms Among Treatment-Seeking Victims of Sexual Assault: A Longitudinal Study

This prospective study assessed the temporal relationships between the symptom clusters of PTSD in two nonprobability samples of treatment-seeking victims of sexual abuse: rape victims and adult survivors of childhood sexual abuse. Both groups were assessed at three time periods using self-report measures of PTSD symptomology. Findings from two cross-lagged panel analyses indicated weak temporal relationships between the symptom clusters of PTSD; however, avoidance and emotional numbing symptoms were found to exert the strongest cross-lagged effects. Avoidance and emotional numbing symptoms were also found to be the strongest predictor of subsequently meeting caseness for PTSD in both samples. Results suggest that there are minimal cross-lagged effects between the PTSD symptom clusters after three months from traumatic exposure.     

A meta-analytic investigation of the structure of posttraumatic stress disorder symptoms

Converging lines of evidence have called into question the validity of conceptualizations of posttraumatic stress disorder (PTSD) based on the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2000) and suggested alternative structural models of PTSD symptomatology. We conducted a meta-analysis of 40 PTSD studies (N = 14,827 participants across studies) that used a DSM-based measure to assess PTSD severity. We aggregated correlation matrices across studies and then applied confirmatory factor analysis to the aggregated matrices to test the fit of competing models of PTSD symptomatology that have gained support in the literature. Results indicated that both prominent 4-factor models of PTSD symptomatology yielded good model fit across subsamples of studies; however, the model comprising Intrusions, Avoidance, Hyperarousal, and Dysphoria factors appeared to fit better across studies. Results also indicated that the best fitting models were not moderated by measure or sample type. Results are discussed in the context of structural models of PTSD and implications for the diagnostic nosology.     

<Emphasis Type="Italic">DSM-5</Emphasis> Posttraumatic Stress Disorder Symptom Structure in Disaster-Exposed Adolescents: Stability across Gender and Relation to Behavioral Problems

Given the significant modifications to posttraumatic stress disorder (PTSD) symptom criteria from DSM-IV to DSM-5, a better understanding of the dimensionality underlying DSM-5 PTSD symptoms among adolescents is needed. However, to date, whether gender moderates the latent structure of DSM-5 PTSD symptoms in youth remains unclear. Meanwhile, little is known about how distinct PTSD dimensions relate to adolescent behavioral problems. The aim of this study was to fill these gaps. A sample of 1184 disaster-exposed Chinese adolescents (53.8 % girls) with age ranging from 13 to 17 years (M = 14.3, SD = 0.8) completed the PTSD Checklist for DSM-5, and the Withdrawn, Aggressive Behavior, and Delinquent Behavior subscales of the Youth Self-Report. Confirmatory factor analyses revealed that the seven-factor hybrid PTSD model provided the best fit to the data for both girls and boys. Measurement equivalence of this model held across gender, although girls had higher mean scores than boys on some factors. Differential patterns of associations emerged between PTSD dimensions and behavioral problems, with anhedonia symptoms most strongly relating to social withdrawal, and externalizing behavior symptoms most strongly relating to aggression and delinquency. These findings further support the gender invariance and external criterion validity of the newly refined hybrid model that best represents DSM-5 PTSD symptom structure in youth, and carry implications for accurate assessment, diagnosis, and gender comparison of DSM-5 PTSD symptomatology, and potential symptom targets for PTSD intervention among adolescent disaster survivors.     

Associations between lower order anxiety sensitivity dimensions and DSM-5 posttraumatic stress disorder symptoms

Anxiety sensitivity (AS), a well-established individual difference variable reflecting a tendency to fear bodily sensations associated with arousal, has been implicated in the development and maintenance of posttraumatic stress disorder (PTSD). Despite these associations, little research has examined the relations between AS subfactors (eg physical, cognitive, and social) and PTSD symptoms and none have examined these associations in the context of DSM-5 (Diagnostic Statistical Manual of Mental Disorders, Fifth Edition) PTSD clusters (ie intrusion, avoidance, negative alterations in cognitions/mood, and arousal). Participants included 50 veterans presenting to an outpatient Veteran Affairs Clinic for psychological services. Upon intake, veterans completed a brief battery of self-report questionnaires to assist with differential diagnosis and treatment planning. Results revealed unique associations between lower order AS dimensions, in particular the cognitive concerns dimension, and all four DSM-5 PTSD symptom clusters. Given the malleable nature of AS cognitive concerns, as well as the growing number of veterans in need of care, future research should determine the extent to which targeting this cognitive risk factor reduces PTSD symptom severity among veterans.     

The latent structure of posttraumatic stress disorder: Different models or different populations?

Factor analytic studies of the structure of self-reported posttraumatic stress disorder (PTSD) symptoms have consistently supported two 4-factor models; the "Dysphoria" and the "Emotional Numbing" model. The fit of both models has been satisfactory; however, it has been difficult to unequivocally determine which model is best. This study aimed to test the hypothesis that there is no single "correct" model, but rather that the models represent different subpopulations. A confirmatory factor 2-class mixture model was specified with the Dysphoria model in one class and the Emotional Numbing model in the other. This model was tested using data from participants from 4 trauma groups. This model fitted the data better than 1 and 2-class models of the Dysphoria, Emotional Numbing, and cross-factor loading model. It was concluded that the search for the "correct" model of PTSD based on the assumption of a single homogenous population may not be a worthwhile research endeavor. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Dimensionality of posttraumatic stress symptoms: a confirmatory factor analysis of DSM-IV symptom clusters and other symptom models

Recent exploratory [Taylor, S., Kuch, K., Koch, W. J., Crockett, D. J., & Passey, G. (1998). The structure of posttraumatic stress symptoms. Journal of Abnormal Psychology, 107, 154-160.] and confirmatory [Buckley, T. C., Blanchard, E. B., & Hickling, E. J. (1998). A confirmatory factor analysis of posttraumatic stress symptoms. Behaviour Research and Therapy, 36, 1091-1099; King, D. W., Leskin, G. A., King, L. A., & Weathers, F. W. (1998). Confirmatory factor analysis of the clinician-administered PTSD scale: evidence for the dimensionality of posttraumatic stress disorder. Psychological Assessment, 10, 90-96.] factor analytic investigations suggest that the three symptom clusters of posttraumatic stress disorder (PTSD) as defined in the Diagnostic and Statistical Manual [4th ed.; DSM-IV; American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.] may not provide the best conceptualization of symptom dimensionality. However, the alternative models have not been in agreement, nor have they been compared against each other or models based on the DSM-IV. The purpose of the present investigation was to test a series of dimensional models suggested by these recent factor analytic investigations and the DSM-IV. Using data collected with the PTSD Checklist--Civilian Version [Weathers, F. W., Litz, B. T., Huska, J. A., & Keane, T. M. (1994). PCL-C for DSM-IV. Boston: National Center for PTSD--Behavioral Science Division.] from 349 referrals to a primary care medical clinic, we used confirmatory factor analysis to evaluate a: (1) hierarchical four-factor model, (2) four-factor intercorrelated model, (3) hierarchical three-factor model, (4) three-factor intercorrelated model, and (5) hierarchical two-factor model. The hierarchical four-factor model (comprising four first-order factors corresponding to reexperiencing, avoidance, numbing, and hyperarousal all subsumed by a higher-order general factor) provided the best overall fit to the data; although, all models met some standards specified for good model fit. More research is needed to establish the dimensional nature of PTSD symptoms and to assess whether identified dimensions differ as a function of the trauma experience. Implications for assessment, diagnosis, and treatment are also discussed.     

Differentiating anxious and depressive self-statements in youth: factor structure of the Negative Affect Self-Statement Questionnaire among youth referred to an anxiety disorders clinic

Conducted a factor analysis on the items from the Negative Affect Self-Statement Questionnaire (NASSQ; Ronan, Kendall, & Rowe, 1994). This analysis yielded 4 factors (Depressive Self-Statements, Anxiety/Somatic Self-Statements, Negative Affect Self-Statements, and Positive Affect Self-Statements) broadly consistent with both the content-specificity hypothesis (Beck & Clark, 1988) and L. A. Clark and Watson's (1991b) tripartite model of anxiety and depression. The association between children's self-talk and measures of trait anxiety and depression was also examined. Self-statements with content theoretically specific to depression were the best predictors of self-reported depressive symptoms, but the results were less clear for trait anxiety. Overall, these results provide evidence for the discriminability of anxious and depressive self-talk in youth and for the utility of the NASSQ as a cognitive assessment instrument.     

Construct validity of the posttraumatic stress disorder checklist in cancer survivors: analyses based on two samples

The measurement of posttraumatic stress disorder (PTSD) is critically important for the identification and treatment of this disorder. The PTSD Checklist (PCL; F. W. Weathers and J. Ford, 1996) is a self-report measure that is increasingly used. In this study, the authors investigated the factorial validity of the PCL with data from 236 cancer survivors who received a bone marrow or stem cell transplantation. The authors examined the fit of these data with the clinical model of 3 symptom clusters for PTSD, as proposed in the Diagnostic and Statistical Manual of Mental Disorders, and alternative models tested in prior research. By using confirmatory factor analysis the authors found that a 4-first-order-factor model of PTSD provided the best fit. The relations of PTSD symptoms with sociodemographic and medical variables were also explored.     

Posttraumatic Stress Disorder Symptom Clusters and the Interpersonal Theory of Suicide in a Large Military Sample

Prior studies examining posttraumatic stress disorder (PTSD) symptom clusters and the components of the interpersonal theory of suicide (ITS) have yielded mixed results, likely stemming in part from the use of divergent samples and measurement techniques. This study aimed to expand on these findings by utilizing a large military sample, gold standard ITS measures, and multiple PTSD factor structures. Utilizing a sample of 935 military personnel, hierarchical multiple regression analyses were used to test the association between PTSD symptom clusters and the ITS variables. Additionally, we tested for indirect effects of PTSD symptom clusters on suicidal ideation through thwarted belongingness, conditional on levels of perceived burdensomeness. Results indicated that numbing symptoms are positively associated with both perceived burdensomeness and thwarted belongingness and hyperarousal symptoms (dysphoric arousal in the 5‐factor model) are positively associated with thwarted belongingness. Results also indicated that hyperarousal symptoms (anxious arousal in the 5‐factor model) were positively associated with fearlessness about death. The positive association between PTSD symptom clusters and suicidal ideation was inconsistent and modest, with mixed support for the ITS model. Overall, these results provide further clarity regarding the association between specific PTSD symptom clusters and suicide risk factors.     

The structure of PTSD among two cohorts of returning soldiers: before, during, and following deployment to Iraq

Evidence suggests either a four-factor emotional numbing or dysphoria model likely reflects the underlying structure of posttraumatic stress disorder (PTSD). Questions remain as to which of these structures best represents PTSD, how the structure changes with time, the applicability of models to returning veterans, and the validity of the symptom clusters. The present study addresses these questions among two longitudinal samples of National Guard soldiers assessed prior to, during, and following a combat deployment to Iraq. Findings support a four-factor intercorrelated dysphoria model of PTSD that remains stable across samples and time points. Differential associations were observed among PTSD symptom clusters over time and between symptom clusters and both depression and combat exposure, supporting important distinctions between symptom clusters.     

Anxiety sensitivity and distress tolerance typologies and relations to posttraumatic stress disorder: A cluster analytic approach

A growing literature suggests a relationship between a high anxiety sensitivity (AS; the fear of anxiety and its related consequences)/low distress tolerance (DT; the capacity tolerate internal negative states) profile and posttraumatic stress disorder (PTSD) symptoms. However, specific profiles have not been identified or examined specifically in Veteran samples. Thus, the aims of the present study were to establish empirically derived profiles created from response patterns on the Anxiety Sensitivity Index and Distress Tolerance Scale and to examine associations with PTSD symptom clusters among a sample of combat-exposed Veterans (N = 250). A cluster analytic approach was used to identify AS/DT profiles, and a series of multivariate analyses of variance with post hoc analyses was conducted to examine the relationship between each AS/DT profile and each PTSD symptom cluster. Results indicated a 3-cluster solution including a high AS/low DT “at risk” profile, a low AS/high DT “resilient” profile, and an average AS/DT “intermediate” profile. The at-risk profile was associated with significantly greater symptoms in each PTSD cluster (i.e., hyperarousal, avoidance, re-experiencing) when compared to the other two profiles. The at-risk profile was also associated with greater depressive symptoms and lower self-reported resilience. These findings extend the previous literature by identifying a high AS/low DT “at risk” profile and its associations with PTSD symptoms, underscoring the potential utility in targeting these affect-regulation constructs for clinical intervention.     

Factor Structure of the PTSD Checklist in a Sample of OEF/OIF Veterans Presenting to Primary Care: Specific and Nonspecific Aspects of Dysphoria

Although DSM-IV-TR diagnostic criteria for posttraumatic stress disorder (PTSD) include three primary symptom clusters, recent evidence from confirmatory factor analyses suggest that the latent structure of PTSD is better represented by four factors, which will likely be reflected in the upcoming DSM-5. Given this likely transition from three to four clusters, the present study sought to examine specific and non-specific aspects of dysphoria in the factor structure of PTSD symptoms in a sample of OEF/OIF combat veterans presenting to a Veterans Affairs primary care clinic. PTSD symptoms were assessed using the PCL-M (Weathers et al. 1993). Results from confirmatory factor analyses suggested that a dysphoria factor involving a number of non-specific distress symptoms may be an important part of the PTSD symptom profile. After controlling for variance due to general psychological distress, we further found that factor loadings on the dysphoria factor were attenuated but continued to significantly load onto the factor, suggesting that dysphoria may be a specific part of the PTSD symptom constellation.     

Irrational and Metacognitive Beliefs Mediate the Relationship Between Content Beliefs and GAD Symptoms: A Study on a Normal Population

Cognitive Behavioral Therapy (CBT), Rational Emotive Behavior Therapy (REBT) and Metacognitive Therapy (MCT) models show both similarities and differences in conceptualizing anxiety. This work assumes that REBT’s irrational and MCT’s metacognitive beliefs play a mediation role while CBT’s disorder specific content beliefs act as triggers. This hypothesis is tested using a regression model in which metacognitive and irrational beliefs play a mediation role while content disorder beliefs are independent variables. This paper applied this model to generalized anxiety disorder (GAD), a psychiatric diagnosis in which anxiety is the major feature. In GAD, the specific content beliefs are negative problem orientation and intolerance of uncertainty. Therefore, 149 non clinical subjects completed 4 self-report questionnaires: the Negative Orientation to the Problems Questionnaire and the Intolerance of Uncertainty Scale as measures for content cognitive beliefs, the Attitudes and Beliefs Scale for irrational beliefs, and the Metacognitive Questionnaire 30 Items Version for metacognitive beliefs. The generalized anxiety disorder questionnaire was chosen in order to measure anxiety as dependent variable. Regression analyses confirmed that irrational and metacognitive beliefs mediate the relation between cognitive content beliefs and GAD. We clinically interpret mediation as a second level regulation.     

An Investigation of the Structural Validity of Loevinger's Model and Measure of Ego Development

This study demonstrates the use of structural equation modeling for investigating a hierarchical model of personality based on Loevinger's (1976) conceptualization. This model was constructed to have a multifactorial and hierarchical structure in which the ego development construct served as the source of covariation for specific personality constructs of impulse control, interpersonal style, conscious preoccupations, and cognitive style. This model and three other conceivable models were investigated to determine which structure best represented the relations among specific personality constructs and ego development. The specific personality constructs were identified by measures chosen from the available pool of measures that were compatible with Loevinger's conceptualization. The four conceivable models were fitted to sample data from 267 adult subjects using confirmatory factor analysis and were compared with indices of model fit and methods for comparison of nested models. Results suggested that the four specific personality constructs and ego development are part of the same process. Although a hierarchical structure appeared tenable for this process, the role of ego development perhaps is not as dominant as envisioned by Loevinger. These results must be considered tentative due to measurement limitations.     

Parents’ differential susceptibility to the effects of marital quality on sensitivity across the first year

The current investigation examined the differential susceptibility of parents to the effects of marital quality on changes in parenting. We predicted that parents who were high on the personality constructs Negative Affect and Constraint would be more susceptible to the effects of marital quality on their level of sensitivity. Sensitivity was assessed at 3.5 and 13 months for both mothers and fathers during a triadic interaction. Consistent with the differential susceptibility theory, results suggested that when mothers were high on Negative Affect and when fathers were high on Constraint, their marital quality was associated with changes in sensitivity. This investigation suggests that personality factors may create “vulnerabilities” in parents that make them differentially susceptible to the effects of the family environment on parenting.