The structure of PTSD symptoms according to DSM-5 and IDC-11 proposal: A multi-sample analysis

Abstract

Posttraumatic stress disorder (PTSD) symptoms structure is a subject of ongoing debate since its inclusion in DSM-III classification in 1980. Different research on PTSD symptoms structure proved the better fit of four-factor and five-factor models comparing to the one proposed by DSM-IV. With the publication of DSM-5 classification, which introduced significant changes to PTSD diagnosis, the question arises about the adequacy of the proposed criteria to the real structure of disorder symptoms. Recent analyses suggest that seven-factor hybrid model is the best reflection of symptoms structure proposed to date. At the same time, some researchers and ICD-11 classification postulate a simplification of PTSD diagnosis restricting it to only three core criteria and adding additional diagnostic unit of complex-PTSD. This research aimed at checking symptoms' structure according to well-known and supported four-, five-, six- and seven-factor models based on DSM-5 symptoms and the conceptualization proposed by the ICD-11 as well as examining the relation between PTSD symptoms categories with borderline personality disorder. Four different trauma populations were examined with self-reported Posttraumatic Diagnostic Scale for DSM-5 (PDS-5) measure. The results suggest that six- and seven-factor hybrid model as well as three-factor ICD-11 concept fits the data better than other models. The core PTSD symptoms were less related to borderline personality disorder than other, broader, symptoms categories only in one sample. Combination of ICD-11 simplified PTSD diagnosis with the more complex approach (e.g. basing on a seven-factor model) may be an attractive proposal for both scientists and practitioners, however does not necessarily lower its comorbidity with borderline personality disorder.

When Did Posttraumatic Stress Disorder Get So Many Factors? Confirmatory Factor Models Since DSM–5

“…M. Chen, Yoon, Harford, and Grant (2017) modeled a bifactor model using exploratory structural equation modeling in which a general distress factor accounted for most of the variance and orthogonal factors were distinguished on top of that. Several studies examined changes in prevalence rates based on different models of PTSD (e.g., Cyniak-Cieciura et al, 2017). All of this is in line with good external validation techniques (Elhai & Palmieri, 2011), and we encourage their continued application in the literature.…”

“…One article reported CFA results (Yang et al, 2017) that had been published in another as the first wave of a longitudinal invariance study (Wang et al, 2017); only the findings from the latter were used in the current review. One article reported results for two independent samples (Sachser et al, 2017) and another for four independent samples (Cyniak-Cieciura, Staniaszek, Popiel, Pragłowska, & Zawadzki, 2017). Our final sample was 23 publications, representing 27 independent samples.…”

The Relationship Between Temperament Traits and Post-Traumatic Stress Disorder Symptoms and Its Moderators: Meta-Analysis and Meta-Regression

“…The ES turned out to be insignificant only in the case of sensory sensitivity in prospective studies, groups exposed to occupational and combat trauma, in the studies using DSM -5 classification and FCB-TI(R) version. This result may be related either to changes in DSM definition of PTSD (as new symptoms of rather cognitive than emotional or somatic nature were added—the posttraumatic cognitions) or in FCB-TI version (as Sensory Sensitivity Scale content was significantly changed; see Cyniak-Cieciura et al, 2018; Cyniak-Cieciura et al, 2017). On the other hand, the result may also be related to the small number of studies using a prospective design, DSM -5 and FCB-TI(R) versions, and occupational and combat trauma populations, suggesting we need more studies of these types in order to be allowed to draw more specific conclusions.…”

PTSD: Past, present and future implications for China

“…Recent study showed that a seven-factor hybrid model that divided the current DSM-5 criteria into re-experiencing (B1–B5), avoidance (C1–C2), negative affect (D1–D4), anhedonia (D5–D7), externalizing behavior (E1–E2), anxious arousal (E3–E4) and dysphoric arousal (E5–E6) best described the underlying dimensionality of PTSD as defined in the DSM-5. 36 …”