An examination of the construct validity of posttraumatic stress disorder with veterans using a revised criterion set

Abstract

Ongoing concerns exist in the literature regarding the construct of posttraumatic stress disorder (PTSD) and how to best conceptualize and measure this disorder. We compared the traditional DSM-IV PTSD symptom criteria (i.e., symptoms from clusters B, C, and D) to a revised criterion set that omits overlapping mood and other anxiety symptoms on PTSD prevalence, PTSD diagnostic caseness, associated psychiatric comorbidity, functional status, and structural validity using a cross-sectional, multi-site primary care sample of 747 veterans. After removing items theorized to overlap with mood and other anxiety disorders, PTSD prevalence was identical using both criterion sets (i.e., 12%). Overall, there were few statistically significant differences in PTSD caseness, associated psychiatric comorbidity, functional status, and structural validity across the two diagnostic criterion sets. These data provide further support that removing items that overlap with other psychiatric disorders does not significantly impact the prevalence of PTSD, its associated comorbidity and functional impairment, or its structural validity. Although the revised criterion set represents a more parsimonious model, the current study findings generally support the strong construct validity of PTSD. The implications of these study findings for research and clinical practice are discussed.

Testing a DSM‐5 reformulation of posttraumatic stress disorder: Impact on prevalence and comorbidity among treatment‐seeking civilian trauma survivors

“…Our findings are similar to results of reanalyses of the Spitzer (2007) symptom criteria Grubaugh et al, 2010), which also yielded minimal differences in PTSD prevalence and comorbidity in both a general population and a veteran sample, respectively. Our results also provide tentative evidence that Criterion A is not essential in diagnosing PTSD.…”

“…These researchers found a small but significant difference between PTSD rates under the DSM-IV (7%) and Spitzer (6%) symptom criteria, and equal comorbidity rates. In military veterans, the Spitzer reformulation also yielded equivalent prevalence and comorbidity rates (Grubaugh, Long, Elhai, Frueh, & Magruder, 2010) but in adolescents, lower rates of recent PTSD (past 6 months) were observed, with similar rates of comorbid depression and substance use disorder (Ford, Elhai, Ruggiero, & Frueh, 2009). Of note, the observed prevalence difference was reversed when the Spitzer criteria were relaxed to require three instead of four avoidance or hyperarousal symptoms.…”

The Underlying Role of Negative Affect in the Association between PTSD, Major Depressive Disorder, and Generalized Anxiety Disorder

“…Multiple studies have indicated that comorbidity rates did not significantly decrease upon removal of the overlapping symptoms, thus indicating there is more to the relationship between PTSD and MDD aside from mere overlapping symptomatology. This has been demonstrated in adult (Elhai et al 2008a;Grubaugh et al 2010) and child populations (Ford et al 2009). However, in regard to GAD and MDD, one study did demonstrate that comorbidity was significantly influenced by symptom overlap (Zbozinek et al 2012).…”

Testing the dimensionality of posttraumatic stress responses in young Chinese adult earthquake survivors: further evidence for “dysphoric arousal” as a unique PTSD construct

“…[67] Furthermore, some researchers also have found that removing these symptoms from the PTSD diagnosis does not seem to have big changes on the prevalence and comorbidity of PTSD. [68][69][70] Taken together, it would not be wise to removing these symptoms from the PTSD diagnosis, although the exact role of them within the diagnosis is less clear at this time.…”