Evidence for a unique PTSD construct represented by PTSD's D1–D3 symptoms

Abstract

Two models of posttraumatic stress disorder (PTSD) have received the most empirical support in confirmatory factor analytic studies: King, Leskin, King, and Weathers' (1998) Emotional Numbing model of reexperiencing, avoidance, emotional numbing and hyperarousal; and Simms, Watson, and Doebbeling's (2002) Dysphoria model of reexperiencing, avoidance, dysphoria and hyperarousal. These models only differ in placement of three PTSD symptoms: sleep problems (D1), irritability (D2), and concentration problems (D3). In the present study, we recruited 252 women victims of domestic violence and tested whether there is empirical support to separate these three PTSD symptoms into a fifth factor, while retaining the Emotional Numbing and Dysphoria models' remaining four factors. Confirmatory factor analytic findings demonstrated that separating the three symptoms into a separate factor significantly enhanced model fit for the Emotional Numbing and Dysphoria models. These three symptoms may represent a unique latent construct. Implications are discussed.

DSM-5 posttraumatic stress symptom dimensions and health-related quality of life among Chinese earthquake survivors

“…Some researchers proposed that dysphoric arousal symptoms are associated with general distress which is shared by mental disorders other than PTSD. Dysphoric arousal symptoms are not unique to PTSD, but are included in disorders like generalized anxiety disorder or major depression (Elhai et al, 2011). As suggested by some researchers (Spitzer, First, & Wakefield, 2007), dysphoric arousal should be excluded from PTSD diagnostic criteria because these symptoms are not core symptoms specific to PTSD.…”

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

“…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. This latter model was the best fitting model in the confirmatory factor analysis (CFA) studies of DSM-IV PTSD (Armour et al, 2016a).…”

Modeling posttraumatic stress disorder among victimized women on probation and parole : examining the impact of childhood victimization.

“…However, the model fit, as assessed by commonly reported fit statistics, in these confirmatory factor analysis studies is merely adequate but not good, indicating that improvements can be made to these four factor models. Elhai et al (2011) five factor "dysphoric arousal" model has recently emerged as a promising alternative, and the DSM-5, with its updated criteria, offers another promising means of understanding PTSD structure, but due to its novelty, has yet to be studied among any population. No extant research, according to this review, has ever examined PTSD factor structure among women involved with the criminal justice system, which is unfortunate because research suggests that PTSD symptomology is often population specific Yufik & Simms, 2010), and victimization is exceptionally common among this population.…”

“…The next chapter will present the history and development of PTSD as a disorder and the gendered-pathways perspective which theoretically links childhood victimization with current PTSD among women involved in the criminal justice system. Table 3 Numbing Model of PTSD symptoms based upon King et al (1998) Latent Factor Posttraumatic Diagnostic-Symptom Severity Subscale Item (Foa, 1996) Table 4 Dysphoria Model of PTSD symptoms based upon Simms et al (2002) Latent Factor Posttraumatic Diagnostic-Symptom Severity Subscale Item (Foa, 1996) PTSD Dysphoria Model CFA Table 5 Dysphoric arousal model of PTSD symptoms based upon Elhai et al (2011) Latent Factor Posttraumatic Diagnostic-Symptom Severity Subscale Item (Foa, 1996) This chapter reviews the emergence of PTSD as a mental health construct laying the foundation for an understanding of the current factor structure of PTSD which is addressed in Chapter III. Additionally, the gendered pathways perspective is described providing theoretical linkages between childhood victimization and PTSD among women involved with the criminal justice system.…”

“…Dysphoria Model of PTSD based upon Simms, et al (2002) Table 5. Dysphoric Arousal Model of PTSD based upon Elhai, et al, (2011) …”