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

Published online by Cambridge University Press:  23 March 2020

M. Cyniak-Cieciura*
Affiliation:
Warsaw University, Stawki 5/7, Warsaw, Poland
K. Staniaszek
Affiliation:
Warsaw University, Stawki 5/7, Warsaw, Poland
A. Popiel
Affiliation:
Warsaw University, Stawki 5/7, Warsaw, Poland
E. Pragłowska
Affiliation:
Warsaw University, Stawki 5/7, Warsaw, Poland
B. Zawadzki
Affiliation:
Warsaw University, Stawki 5/7, Warsaw, Poland
*
* Corresponding author. E-mail address:[email protected] (M. Cyniak-Cieciura).
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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.

Type
Original article
Copyright
Copyright © European Psychiatric Association 2017

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References

Bramsen, IVan der Ploeg, HMFifty years later: the long-term psychological adjustment of aging World War II survivors. Acta Psychiatrica Scand 1999; 100: 350358.CrossRefGoogle Scholar
Goenjian, AKSteinberg, AMNajarian, LMFairbanks, LTashjian, MPynoos, RA prospective study of posttraumatic stress, anxiety and depressive reactions after earthquake and political violence. Am J Psych 2000; 157: 911916.CrossRefGoogle ScholarPubMed
Kessler, RCSonnega, ABromet, EHughes, MNelson, CBPosttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psych 1995; 52: 10481060.CrossRefGoogle ScholarPubMed
Yufik, TSimms, LJA meta-analytic investigation of the structure of posttraumatic stress symptoms. J Abn Psychol 2010; 119: 764776.CrossRefGoogle Scholar
Diagnostic and statistical manual of mental disorders, 3rd ed., Washington, DC: American Psychiatric Association; 1980.Google Scholar
Diagnostic and statistical manual of mental disorders, 3rd ed., Washington, DC: American Psychiatric Association; 2000.Google Scholar
Diagnostic and statistical manual of mental disorders, 3rd ed., Washington, DC: American Psychiatric Association; 2013.Google Scholar
King, DWLeskin, GAKing, LAWeathers, FWConfirmatory factor analysis of the Clinician-Administered PTSD Scale: evidence for the dimensionality of Posttraumatic Stress Disorder. Psychol Assess 1998; 10: 9096.CrossRefGoogle Scholar
Simms, LJWatson, DDoebbelling, BNConfirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War. J Abnor Psychol 2002; 111: 637647.CrossRefGoogle ScholarPubMed
Elhai, JDBiehn, TLArmour, CKlopper, JJFrueh, BCPalmieri, PAEvidence for a unique PTSD construct represented by PTSD's D1-D3 symptoms. J Anx Dis 2011; 25: 340345.CrossRefGoogle ScholarPubMed
Zawadzki, BPopiel, AFoa, EBJakubowska, BCyniak-Cieciura, MPragłowska, EThe structure of symptoms of posttraumatic stress disorder (PTSD) according to DSM-5 and assessed by PDS-5. Curr Iss Per Psychol 2015; 3: 111. http://dx.doi.org/10.5114/cipp.2015.49662.Google Scholar
Liu, PWang, LCao, CWang, RZhang, JZhang, B, et al.The underlying dimensions of DSM-5 posttraumatic stress disorder symptoms in an epidemiological sample of Chinese earthquake survivors. J Anx Dis 2014; 28: 345351. http://dx.doi.org/10.1016/j.janxdis.2014.03.008.CrossRefGoogle Scholar
Tsai, JHarpaz-Rotem, IArmour, CSouthwick, SMKrystal, JHPietrzak, RHDimensional structure of DSM-5 posttraumatic stress disorder symptoms: results from the National Health and Resilience in Veterans Study. J Clin Psych 2014; 76(5): 546553. http://dx.doi.org/10.4088/JCP.14m09091.CrossRefGoogle Scholar
Armour, CTsai, JDurham, TACharak, RBiehn, TLElhai, JD, et al.Dimensional structure of DSM-5 posttraumatic stress symptoms: support for a hybrid anhedonia and externalizing behaviors model. J Psych Res 2015; 61: 106113. http://dx.doi.org/10.1016/j.jpsychires.2014.10.012.CrossRefGoogle ScholarPubMed
Wang, LZhang, LArmour, CCao, CQing, YZhang, J, et al.Assessing the underlying dimensionality of DSM-5 PTSD symptoms in Chinese adolescents surviving the 2008 Wenchuan earthquake. J Anx Dis 2015; 31: 9097. http://dx.doi.org/10.1016/j.janxdis.2015.02.006.CrossRefGoogle ScholarPubMed
Seligowski, AVOrcutt, HKSupport for 7-factor hybrid model of PTSD in a community sample. Psychol Trauma Theory Res Pract Policy 2016; 8: 218221.CrossRefGoogle Scholar
Armour, CMullerova, JElhai, JDA systematic literature review of PTSD's latent structure in the Diagnostic and Statistical Manual of Mental Disorders: DSM-IV to DSM-5. Clin Psychol Rev 2016; 44: 6074.CrossRefGoogle ScholarPubMed
Brewin, CRLanius, RANovac, ASchnyder, UGalea, SReformulating PTSD for DSM-V: life after criterion A. J Traum Stress 2009; 22: 366373. http://dx.doi.org/10.1002/jts.20443.CrossRefGoogle ScholarPubMed
Spitzer, RLFirst, MBWakefield, JCSaving PTSD from itself in DSM-V. J Anx Dis 2007; 21: 233241.CrossRefGoogle ScholarPubMed
Contractor, AADurham, TABrennan, JAArmour, CWutrick, HRFrueh, BC, et al.DSM-5 PTSD's symptom dimensions and relations with major depression's symptom dimensions in a primary care sample. Psych Res 2014; 215: 146153.CrossRefGoogle Scholar
Durham, TAElhai, JDFine, THTamburrino, MCohen, GShirley, E, et al.Posttraumatic stress disorder's dysphoria dimension and relations with generalized disorder symptoms. Psych Res 2015; 228: 150155.CrossRefGoogle ScholarPubMed
Daud, AKlinteberg, BRydelius, PTrauma, PTSD and personality: the relationship between prolonged traumatization and personality impairments. Scand J Caring Sci 2008; 22: 331340. http://dx.doi.org/10.1111/j.1471-6712.2007.00532.x.CrossRefGoogle ScholarPubMed
Scheiderer, EMWood, PKTrull, TJThe comorbidity of borderline personality disorder and posttraumatic stress disorder: revisiting the prevalence and associations in a general population sample. Borderline Pers Dis Emotion Dysreg 2015;2:11. http://dx.doi.org/10.1186/s40479-015-0032-y.CrossRefGoogle Scholar
Brewin, CR“I wouldn’t start from here” – an alternative perspective on PTSD from the ICD-11: comment on Friedman (2013). J Traum Stress 2013; 26: 557559.CrossRefGoogle Scholar
Hyland, PShevlin, MMcNally, SMurphy, JHansen, MElklit, AExploring differences between the ICD-11 and DSM-5 models of PTSD: does it matter which model is used?. J Anx Dis 2016; 37: 4853.CrossRefGoogle Scholar
Morina, Nvan Emmerik, AAPAndrews, BBrewin, CRComparison of DSM-IV and proposed ICD-11 formulations of PTSD among civilian survivors of war and war veterans. J Traum Stress 2014; 2: 647654.CrossRefGoogle Scholar
Stammel, NAbbing, EMHeeke, CKnaevelsrud, CApplicability of the ICD-11 proposal for PTSD: a comparison of prevalence and comorbidity rates with the DSM-IV PTSD classification in two post-conflict samples. Eur J Psychotraum 2015;6:27070. http://dx.doi.org/10.3402/ejpt.v6.27070.CrossRefGoogle ScholarPubMed
Karatzias, TShevlin, MFyvie, CHyland, PEfthymiadou, EWilson, D, et al.An initial psychometric assessment of an ICD-11 based measure of PTSD and complex PTSD (ICD-TQ): evidence of construct validity. J Anx Dis 2016; 44: 7379. http://dx.doi.org/10.1016/j.janxdis.2016.10.009.CrossRefGoogle ScholarPubMed
Cloitre, MGarvert, DWBrewin, CRBryant, RAMaercker, AEvidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis. Eur J Psychotraum 2013;4:20706. http://dx.doi.org/10.3402/ejpt.v4i0.20706.CrossRefGoogle ScholarPubMed
Taycan, OYildirim, AAn alternative approach to the effects of multiple traumas: complex posttraumatic stress disorder. Arch Neuropsychiatr 2015; 52: 312314. http://dx.doi.org/10.5152/npa.2015.7573.CrossRefGoogle Scholar
Palic, SZerach, GShevlin, MZeligman, ZElklit, ASolomon, ZEvidence of complex posttraumatic stress disorder (CPTSD) across populations with prolonged trauma of varying interpersonal intensity and ages of exposure. Psych Res 2016; 246: 692699. http://dx.doi.org/10.1016/j.psychres.2016.10.062.CrossRefGoogle Scholar
Knefel, MGarvert, DWCloitre, MLueger-Schuster, BUpdate to an evaluation of ICD-11 PTSD and complex PTSD criteria in a sample of adult survivors of childhood institutional abuse by Knefel & Lueger-Schuster (2013): a latent profile analysis. Eur J Psychotraum 2015;6:25290. http://dx.doi.org/10.3402/ejpt.v6.25290.CrossRefGoogle Scholar
Hansen, MHyland, PArmour, CShevlin, MElklit, ALess is more? Assessing the validity of the ICD-11 model of PTSD across multiple trauma samples. Eur J Psychotraum 2015;6:28766. http://dx.doi.org/10.3402/ejpt.v6.28766.CrossRefGoogle ScholarPubMed
Gluck, TMKnefel, MTran, USLueger-Schuster, BPTSD in ICD-10 and proposed ICD-11 in elderly with childhood trauma: prevalence, factor structure, and symptom profiles. Eur J Psychotraum 2016;7:29700. http://dx.doi.org/10.3402/ejpt.v7.29700.CrossRefGoogle ScholarPubMed
Haravouri, HKiviruusu, OSuomalainen, LMarttunen, MAn evaluation of ICD-11 posttraumatic stress disorder criteria in two samples of adolescents and young adults exposed to mass shootings: factor analysis and comparisons to ICD-10 and DSM-IV. BMC Psych 2016;16:140. http://dx.doi.org/10.1186/s12888-016-0849-y.CrossRefGoogle Scholar
Forbes, DLockwood, ECreamer, MBryant, RAMcFarlane, ACSilove, D, et al.Latent structure of the proposed ICD-11 posttraumatic stress disorder symptoms: implications for the diagnostic algorithm. Br J Psych 2015; 206: 245251. http://dx.doi.org/10.1192/bjp.bp.114.150078.CrossRefGoogle ScholarPubMed
Cackowski, SNeubauer, TKleindienst, NThe impact of Posttraumatic stress disorder on the symptomatology of borderline personality disorder. Borderline Pers Disord Emotion Dysreg 2016;3:7. http://dx.doi.org/10.1186/s40479-016-0042-4.CrossRefGoogle ScholarPubMed
Cloitre, MGarvert, DWWeiss, BCarlson, EBBryant, RADistinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: a latent class analysis. Eur J Psychotraumatol 2014;15:5. http://dx.doi.org/10.3402/ejpt.v5.25097.Google Scholar
Foa, EBMcLean, CPZang, YZhong, JRauch, SPorter, K, et al. Psychometric properties of the Posttraumatic Stress Disorder Symptom Scale Interview for DSM-5 (PSSI-5). Psychol Assess 2015. http://dx.doi.org/10.1037/pas0000258.CrossRefGoogle Scholar
Zawadzki, BPopiel, APraglowska, ENewman, C Specyfika dysfunkcjonalnych przekonań w zaburzeniach osobowości: charakterystyka psychometryczna polskiej translacji i trawestacji Kwestionariusza Przekonań (Personality Beliefs Questionnaire). [In print].Google Scholar
R Development Core Team R: a language and environment for statistical computing Vienna: R Foundation for Statistical Computing; 2015Google Scholar
Rosseel, Ylavaan: an R package for structural equation modelling. J Stat Software 2015; 48: 136.Google Scholar
Kendler, KSZachar, PCraver, CWhat kinds of things are psychiatric disorders?. Psych Med 2011; 41: 11431150. http://dx.doi.org/10.1017/S0033291710001844.CrossRefGoogle ScholarPubMed
Schermelleh-Engel, KMoosbrugger, HMuller, HEvaluating the fit of structural equation models: tests of significance and descriptive goodness-of-fit measures. Meth Psychol Res Online 2003; 8: 2374.Google Scholar
De Mars, CConfirming testlet effects. App Psychol Meas 2012; 36(2): 104121. http://dx.doi.org/10.1177/0146621612437403.CrossRefGoogle Scholar
Rademaker, ARvan Minnen, AEbberink, Fvan Zuiden, MHagenaars, MAGeuze, ESymptom structure of PTSD: support for a hierarchical model separating core PTSD symptoms from dysphoria. Eur J Psychotraumatol 2012;3. http://dx.doi.org/10.3402/ejpt.v3i0.17580.CrossRefGoogle ScholarPubMed
Yang, CCEvaluating latent class analysis models in qualitative phenotype identification. Comput Stat Data Anal 2006; 50: 10901104.CrossRefGoogle Scholar
Nylund, KLAsparouhov, TMuthén, BODeciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Struct Equation Model 2007; 14: 535569.CrossRefGoogle Scholar
Maercker, ABrewin, CRBryant, RACloitre, Mvan Ommeren, MJones, LM, et al.Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11. World Psych 2013; 12: 198206. http://dx.doi.org/10.1002/wps.20057.CrossRefGoogle ScholarPubMed
Pietrzak, RHTsai, JArmour, CMota, NHarpaz-Rotem, ISouthwick, SMFunctional significance of a novel 7-factor model of DSM-5 PTSD symptoms: results from the National Health and Resilience in Veterans Study. J Affect Dis 2015; 174: 522526.CrossRefGoogle ScholarPubMed
Stein, DJMcLaughlin, KAKoenen, KCAtwoli, LFriedman, MJHill, ED, et al.DSM-5 and ICD-11 definitions of posttraumatic stress disorder: investigating “narrow” and “broad” approaches. Depr Anx 2014; 31: 494505. http://dx.doi.org/10.1002/da.22279.CrossRefGoogle ScholarPubMed
Hofmann, SToward a cognitive-behavioral classification system for mental disorders. Behav Ther 2014; 45: 576587.CrossRefGoogle Scholar
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