Symptom structure of PTSD: support for a hierarchical model separating core PTSD symptoms from dysphoria

Abstract

BackgroundAs of yet, no collective agreement has been reached regarding the precise factor structure of posttraumatic stress disorder (PTSD). Several alternative factor-models have been proposed in the last decades.ObjectiveThe current study examined the fit of a hierarchical adaptation of the Simms et al. (2002) dysphoria model and compared it to the fit of the PTSD model as depicted in the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV), a correlated four-factor emotional numbing, and a correlated four-factor dysphoria model.MethodsData were collected using the Clinician-Administered PTSD Scale in a mixed-trauma sample of treatment-seeking PTSD patients (N=276).ResultsAll examined models provided superior fit to the three-factor model of DSM-IV. The hierarchical four-factor solution provided a better fit than competing models.ConclusionThe present study provides empirical support for a conceptualization of PTSD that includes a higher-order PTSD factor that encompasses re-experiencing, arousal, and effortful avoidance sub-factors and a dysphoria factor.

Emotional Competence and Combat-Related PTSD Symptoms in Croatian Homeland War Veterans

“…Since they are automatic and involve re-experiencing the trauma, an individual may feel as though he or she is back in danger, causing uncontrollable, distressing and highly emotional reminders of the traumatic event (Boden et al, 2013). These results are in line with the emotional processing theory of PTSD, which attribute the paradoxical increase or maintenance of re-experiencing symptoms to the inability to control the internal and external traumatic reminders (Rademaker et al, 2012). Explaining re-experiencing symptoms, Ehlers et al (2004) suggested that if individuals do not successfully incorporate their trauma memories into context and update them with the subsequent information, re--experiencing symptoms will persist and individuals will not learn that there is no present danger, and this will further negatively influence their memory and worsen the symptoms.…”

“…Cross-sectionally, five out of six subscales measuring emotional competence are associated exclusively with dysphoria symptom clusters, while the influence of emotions and mood on thinking subscale is associated with re-experiencing symptom clusters. Dysphoria PTSD symptom cluster in PCL-M includes the inability to recall aspects of trauma, loss of interest, detachment, restricted affect, sense of foreshortened future, sleep disturbance, irritability and difficulty concentrating (Pietrzak, Harpaz-Rotem, & Southwick, 2011;Rademaker et al, 2012). All of these symptoms may disrupt the ability to assert some degree of control over emotions, including the ability to cope with 9 TABLE 3 Set correlation strong emotions, both positive and negative, without feeling overwhelmed, as well as the ability to easily transition between emotional states (Boden et al, 2013;Price et al, 2006;Shepherd & Wild, 2014).…”

“…For example, avoidance symptoms include avoidance of people, places, thoughts and feeling closely associated with the traumatic event, so coping with emotions related to these events would be incomprehensible for them since they make additional effort to restrict the emotions they feel (Boden et al, 2013;Kashdan et al, 2010). PTSD models show a strong correlation between active or effortful avoidance and emotional difficulties (Badour & Feldner, 2013;Brackett et al, 2004;Palmieri & Fitzgerald, 2005;Rademaker et …”

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

“…Another proposal, different from either the broad DSM-5 or narrow ICD-11 definition of PTSD, is an ‘hierarchical model’ in which PTSD would be composed of a higher-order dysphoria factor with symptoms shared with other mood and anxiety disorders and a lower-level PTSD factor with PTSD specific (core) symptoms. This would allow the possibility to examine the aetiology and pathogenesis of PTSD within an integrative model for mood and anxiety disorders (Hunt et al, 2017; Rademaker et al, 2012; Watson, 2005). Ultimately, it seems that more research is needed to determine which PTSD model best captures PTSD symptomatology and is clinically most meaningful.…”

“…The latent factor structure of PTSD has been extensively debated for over two decades and various models have been proposed and tested (Armour, Ross, & Elhai, 2016a; Elhai & Palmieri, 2011b; Rademaker et al, 2012). For an illustration of the most common PTSD models and their symptom mapping across factors see Table 1 (adapted from Armour et al, 2016a).…”