Confirmatory factor analysis of the clinician-administered PTSD Scale: Evidence for the dimensionality of posttraumatic stress disorder.

Abstract

The Clinician-Administered PTSD Scale (CAPS; Blake et al, 1990) is a structured interview that assesses the 17 key symptoms of posttraumatic stress disorder (PTSD) as established in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994). CAPS data from 524 treatment-seeking male military veterans were submitted to confirmatory factor analysis to test a series of nested models reflecting alternative representations of PTSD dimensionality: (a) a 4-factor, Ist-order solution; (b) a 2-factor, higher order solution; (c) a single-factor, higher order solution; and (d) a single-factor, Ist-order solution. The model of best fit was the 4factor, Ist-order solution, containing moderately to highly correlated yet distinct Ist-order factors corresponding to the reexperiencing, effortful avoidance, emotional numbing, and hyperarousal aspects of PTSD. Implications for theory, assessment, and future research are presented in this article.Posttraumatic stress disorder (PTSD) is an anxiety disorder that may result from a strong emotional reaction to extraordinarily stressful events. According to the Diagnostic and Statistical Manual of Menial Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994), the classic clusters of PTSD symptoms are reexperiencing the event (Criterion B; e.g., intrusive thoughts, nightmares), avoidance of cues and reminders of the event and emotional numbing (Criterion C; e.g., avoidance of people and places, detachment), and hyperarousal (Criterion D; e.g., exaggerated startle, hypervigilance). Associated features of the disorder include suicidal ideation, hostility, and risky behavior.An increasingly prominent measure of PTSD, used in a wide range of clinical and research settings and cited in almost 100 publications, is the Clinician-Administered PTSD Scale (CAPS;

Assessing posttraumatic stress in military service members: Improving efficiency and accuracy.

“…Results provided support for these alternative models as well, with four-factor models obtaining modestly stronger support than alternative one-or three-factor models-TLI and CFI values of .98 and .98 for the three-factor DSM-IV model, and .99 and .99 for both the King et al (1998) and Simms et al (2002) four-factor models, respectively.…”

Factorial invariance of posttraumatic stress disorder symptoms across three veteran samples

“…As detailed by King and colleagues (2006), many studies employing a variety of symptom questionnaires and populations support a 4-factor model (King, Leskin, King, & Weathers, 1998) that includes reexperiencing, avoidance, numbing, and hyperarousal factors (Andrews, Joseph, Shevlin, & Troop, 2006;Asmundson et al, 2000;Marshall, 2004;Palmieri & Fitzgerald, 2005). The reexperiencing and hyperarousal factors are analogous to DSM-IV symptom Clusters B and D, and the numbing and avoidance factors are drawn from Cluster C. In contrast, other studies have supported a 4-factor model identified by Simms and colleagues (2002), that includes intrusions, avoidance, dysphoria, and hyperarousal (Baschnagel, O'Connor, Colder, & Hawk, 2005;Messer, Hoge, & Castro, 2007).…”

“…Although there is some evidence that the expression of PTSD symptoms may differ across veteran cohorts (Davidson, Kudler, Saunders, & Smith, 1990), no studies have directly examined the factorial invariance of PTSD across veteran groups. A notable point of contrast between the King et al (1998) and Simms et al (2002) studies is that although they both employed military veteran samples (Vietnam era and GulfWar I era, respectively), different PTSD symptom structures were supported for each veteran cohort. Thus, there is a need for further examination of factorial invariance of PTSD across veteran cohorts to interpret the similarities and differences in the presentation of PTSD among veterans of different wars (Rosenheck & Fontana, 1994).…”

“…In contrast to the PCL-M, the DTS asks participants to rate both the frequency and severity of each symptom in reference to "the trauma that is most disturbing to you," on a 5-point Likert-type scale. In this way, it is more similar to the ClinicianAdministered PTSD Scale (CAPS-1) structured interview used by King et al (1998). Although initial studies of the DTS' psychometric properties have been promising, to date there have been no studies examining its factorial validity using CFA.…”

Development and Evaluation of the Dutch Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)

“…For an illustration of the most common PTSD models and their symptom mapping across factors see Table 1 (adapted from Armour et al, 2016a). Before the release of DSM-5, two four-factor models received the most empirical support: the Emotional Numbing model (King, Leskin, King, & Weathers, 1998), which divides the DSM-IV avoidance and numbing symptoms into two different factors, and the Dysphoria model (Simms, Watson, & Doebeling, 2002), which maintains the re-experiencing and avoidance factors of the Emotional Numbing model and groups some of the arousal symptoms with the numbing symptoms to create a larger, non-specific dysphoria factor separate from the remaining arousal symptoms. The five-factor Dysphoric arousal model (Elhai et al, 2011a) combines the above-mentioned models and maintains the re-experiencing, avoidance, and numbing factors of the Emotional Numbing model, but separates dysphoric arousal from anxious arousal.…”