A Bayesian network analysis of posttraumatic stress disorder symptoms in adults reporting childhood sexual abuse

Abstract

Background: The network approach to mental disorders offers a novel framework for conceptualizing posttraumatic stress disorder (PTSD) as a causal system of interacting symptoms. Objective: In this study, we extended this work by estimating the structure of relations among PTSD symptoms in adults reporting personal histories of childhood sexual abuse (CSA; N = 179). Method: We employed two complementary methods. First, using the graphical LASSO, we computed a sparse, regularized partial correlation network revealing associations (edges) between pairs of PTSD symptoms (nodes). Next, using a Bayesian approach, we computed a directed acyclic graph (DAG) to estimate a directed, potentially causal model of the relations among symptoms. Results: For the first network, we found that physiological reactivity to reminders of trauma, dreams about the trauma, and lost of interest in previously enjoyed activities were highly central nodes. However, stability analyses suggest that these findings were unstable across subsets of our sample. The DAG suggests that becoming physiologically reactive and upset in response to reminders of the trauma may be key drivers of other symptoms in adult survivors of CSA. Conclusions: Our study illustrates the strengths and limitations of these network analytic approaches to PTSD.

The Study of Psychopathology from the Network Analysis Perspective: A Systematic Review

“…Across studies, results disclosed strong associations among avoidance symptoms [28, 29] and between hypervigilance and startle response [28, 30-33]. Particularly, McNally et al [34] found that physiological responses to reminders of trauma predicted symptoms such as “being upset” “flashbacks,” and “traumatic dreams,” in a sample of adults who reported histories of childhood sexual abuse. According to these authors, physiological reactivity, which is associated in NA with being female [32], may play a potential causal role in the activation of the PTSD network.…”

PTSD symptomics: network analyses in the field of psychotraumatology

“…Finally, in a sample of 179 US adult survivors of childhood sexual abuse, McNally, Heeren, and Robinaugh (2017) in ‘A Bayesian network analysis of posttraumatic stress disorder symptoms in adults reporting childhood sexual abuse’ extend the existing PTSD network analysis research by applying two distinct network models. Firstly, the authors computed an undirected regularized partial correlation network (based on the DSM-IV PTSD symptoms).…”

“…These network models estimate conditional dependence relations among items: what is the association between A and B after partialling out the influence of C? In such undirected networks, suggest McNally et al (2017), the causal relationships between symptoms cannot be inferred. Thus, in the second step, the authors utilized a Bayesian approach to computing a directed acyclic network, which leads to a directed network structure often referred to as a ‘causal skeleton’.…”

Psychotraumatology on the move

“…neurobiological research, like the oxytocin paper by Frijling (2017), the methodological ones, e.g. McNally, Heeren, and Robinaugh (2017)’s paper on Bayesian statistics, and public health (e.g. Magruder et al, 2017).…”