Assessing posttraumatic stress disorder with or without reference to a single, worst traumatic event: Examining differences in factor structure.

The authors examined the effects of a methodological manipulation on the Posttraumatic Stress Disorder (PTSD) Checklist’s factor structure: specifically, whether respondents were instructed to reference a single worst traumatic event when rating PTSD symptoms. Nonclinical, trauma-exposed participants were randomly assigned to 1 of 2 PTSD assessment conditions: referencing PTSD symptoms to their worst trauma (trauma-specific group, n = 218) or to their overall trauma history in general (trauma-general group, n = 234). A 3rd group of non-trauma-exposed participants (n = 464) rated PTSD symptoms globally from any stressful event. Using confirmatory factor analysis, the authors show that the 4-factor PTSD model proposed by D. W. King, G. A. Leskin, L. A. King, and F. W. Weathers (1998; separating effortful avoidance and emotional numbing) demonstrated the best model fit for trauma-general and non-trauma-exposed participants. The 4-factor PTSD model proposed by L. J. Simms, D. Watson, and B. N. Doebbeling (2002; emphasizing a general dysphoria factor) demonstrated the best model fit for trauma-specific participants. Measurement invariance testing revealed that non-trauma-exposed participants were different from both trauma-exposed groups on factor structure parameters, but trauma groups were not substantially different from each other. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of posttraumatic stress disorder symptom structure models in Hispanic and White college students.

This study tested measurement invariance between Hispanic (n = 226) and White (n = 278) college students’ responses to a well-validated measure of posttraumatic stress disorder (PTSD) symptoms. Participants completed the PTSD Checklist—Civilian Version (PCL–C; Weathers, Litz, Herman, Juska, & Keane, 1993); however, trauma histories were not assessed, nor were responses to the PCL–C indexed to a specific traumatic event. Eight models were tested using within-groups confirmatory factor analysis (CFA); 3 models (D. King, Leskin, King, & Weathers, 1998; Simms, Watson, & Doebbeling, 2002; Smith, Redd, DuHamel, Vickberg, & Ricketts, 1999) showed good fit for both ethnic groups, although differences in the degree of fit were observed between the 2 ethnic groups. Models that demonstrated good fit were then compared for equivalence using multiple group CFA. Factor loadings were equivalent between groups, but intercepts differed between groups in all 3 models. Mean item score differences between Hispanic and White groups were observed on items assessing emotional upset with reminders (Item B4) and emotional distancing (Item C5). D. King and colleagues (1998) model resulted in the best measurement invariance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Construct Validity of the Posttraumatic Stress Disorder Checklist in Cancer Survivors: Analyses Based on Two Samples.

The measurement of posttraumatic stress disorder (PTSD) is critically important for the identification and treatment of this disorder. The PTSD Checklist (PCL; F. W. Weathers & J. Ford, 1996) is a self-report measure that is increasingly used. In this study, the authors investigated the factorial validity of the PCL with data from 236 cancer survivors who received a bone marrow or stem cell transplantation. The authors examined the fit of these data with the clinical model of 3 symptom clusters for PTSD, as proposed in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994), and alternative models tested in prior research. By using confirmatory factor analysis the authors found that a 4-first-order-factor model of PTSD provided the best fit. The relations of PTSD symptoms with sociodemographic and medical variables were also explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping style use predicts posttraumatic stress and complicated grief symptom severity among college students reporting a traumatic loss.

Problem-focused coping, and active and avoidant emotional coping were examined as correlates of grief and posttraumatic stress disorder (PTSD) severity among 123 college students reporting the unexpected death of an immediate family member, romantic partner, or very close friend. The authors administered to participants, via the Internet, 5 survey instruments that measured demographic characteristics, traumatic event exposure (Stressful Life Events Screening Questionnaire; L. Goodman, C. Corcoran, K. Turner, N. Yuan, & B. L. Green, 1998), complicated grief (CG) severity (Inventory of Complicated Grief--Revised--Short Form; A. E. Latham & H. G. Prigerson, 2004; H. G. Prigerson & S. C. Jacobs, 2001), PTSD severity (PTSD Checklist; F. W. Weathers, B. T. Litz, D. S. Herman, J. A. Huska, & T. M. Keane, 1993), and coping style use (Brief COPE; C. S. Carver, 1997). Results demonstrated that CG and PTSD severity were both significantly positively correlated with problem-focused, and active and avoidant emotional coping styles. The authors used path analysis to control for time since the loss and trauma frequency and found that only avoidant emotional coping remained significant in predicting CG and PTSD severity. Results are discussed in terms of their clinical implications for treating individuals with traumatic losses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Change in posttraumatic stress disorder symptoms: Do clinicians and patients agree?

This study assessed the longitudinal association between clinician and patient ratings of posttraumatic stress disorder (PTSD) symptoms over the course of 2 different randomized clinical trials of veterans with chronic PTSD. One trial, the Department of Veterans Affairs Cooperative Study 420 (CSP 420; N = 360) compared trauma-focused and present-centered group therapies, and the 2nd trial compared cognitive processing theory and a waitlist control condition (N = 60). Linear mixed effects modeling revealed significant associations between clinician ratings (Clinician-Administered PTSD Scale; CAPS; D. D. Blake et al., 1990) and patient ratings (Posttraumatic Stress Disorder Checklist; PCL; F. W. Weathers, B. T. Litz, J. A. Herman, J. A. Huska, & T. M. Keane, 1993) in total and symptom clusters of PTSD. Contrary to hypothesis, the amount of change on the CAPS ranged from .75 to .82 standard deviations for every 1 standard deviation change on the PCL. The CAPS and PCL were more closely associated in the trauma-focused vs. present-centered treatment condition in CSP 420, and especially regarding hyperarousal symptoms. When comparing categorization of clinically significant change on the CAPS and PCL, the authors found no differences in the percentages of agreement between clinicians and patients in improvement and exacerbation. The value of multimodal assessment of PTSD treatment outcomes is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing posttraumatic stress disorder's symptom structure between deployed and nondeployed veterans.

We tested two empirically validated 4-factor models of posttraumatic stress disorder (PTSD) symptoms using the PTSD Checklist: King, Leskin, King, and Weathers' (1998) model including reexperiencing, avoidance, emotional numbing, and hyperarousal factors, and Simms, Watson, and Doebbeling's (2002) model including reexperiencing, avoidance, dysphoria, and hyperarousal. Our aim was to determine which fit better in two groups of military veterans: peacekeepers previously deployed to a war zone (deployed group) and those trained for peacekeeping operations who were not deployed (nondeployed group). We compared the groups using multigroup confirmatory factor analysis. Adequate model fit was demonstrated among the nondeployed group, with no significant difference between King et al.'s (1998) model (separating avoidance and numbing) and Simms et al.'s (2002) similar model involving a dysphoria factor. A better fitting factor structure consistent with Simms et al.'s (2002) model was found in the deployed group. Comprehensive measurement invariance testing demonstrated significant differences between the deployed and nondeployed groups on all structural parameters, except observed variable intercepts (thus indicating similarities only in PTSD item severity). These findings add to researchers' understanding of PTSD's factor structure, given the revision of PTSD that will appear in the forthcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2010)—namely, that the factor structure may be quite different between groups with and without exposure to major traumatic events. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse.

This study compared the effectiveness of cognitive processing therapy for sexual abuse survivors (CPT-SA) with that of the minimal attention (MA) given to a wait-listed control group. Seventy-one women were randomly assigned to 1 of the 2 groups. Participants were assessed at pretreatment and 3 times during posttreatment: immediately after treatment and at 3-month and 1-year follow-up, using the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale (D. Blake et al., 1995), the Beck Depression Inventory (A. T. Beck, R. A. Steer, & G. K. Brown, 1996), the Structured Clinical Interview for the DSM-IV (R. L. Spitzer, J. B. W. Williams, & M. Gibbon, 1995; M. B. First et al., 1995), the Dissociative Experiences Scale-II (E. M. Bernstein & F. W. Putnam, 1986), and the Modified PTSD Symptom Scale (S. A. Falsetti, H. S. Resnick, P. A. Resick, & D. G. Kilpatrick, 1993). Analyses suggested that CPT-SA is more effective for reducing trauma-related symptoms than is MA, and the results were maintained for at least 1 year. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and depression symptomatology in a sample of Gulf War veterans: A prospective analysis.

The authors examined the relationship over time of posttraumatic stress disorder (PTSD) and depression symptoms in a sample of Gulf War veterans. A large sample (N?=?2,949) of Gulf War veterans was assessed immediately following their return from the Gulf region and 18–24 months later. Participants completed a number of self-report questionnaires including the Mississippi Scale for Combat–Related PTSD (T. M. Keane, J. M. Caddell, & K. L. Taylor, 1988) and the Brief Symptom Inventory (L. R. Derogatis & N. Melisaratos, 1983) at both time points and an extended and updated version of the Laufer Combat Scale (M. Gallops, R. S. Laufer, & T. Yager, 1981) at the initial assessment. A latent-variable, cross-lag panel model found evidence for a reciprocal relation between PTSD and Depression. Followup models examining reexperiencing, avoidance-numbing, and hyperarousal symptoms separately showed that for reexperiencing and avoidance-numbing symptoms, the overall reciprocal relation held. For hyperarousal symptoms, however, the association was from early hyperarousal to later depression symptoms only. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive behavioral treatment of PTSD in residents of battered women's shelters: Results of a randomized clinical trial.

Objective: This study was designed to explore the acceptability, feasibility, and initial efficacy of a new shelter-based treatment for victims of intimate partner violence (IPV; i.e., Helping to Overcome PTSD through Empowerment [HOPE]). Method: A Phase I randomized clinical trial comparing HOPE (n = 35) with standard shelter services (SSS) (n = 35) was conducted. Primary outcome measures included the Clinician-Administered PTSD Scale (CAPS; D. D. Blake et al., 1995) and the Conflict Tactic Scales-Revised (M. A. Straus, S. L. Hamby, S. Boney-McCoy, & D. B. Sugarman, 1996). Participants were followed at 1-week, 3- and 6-months postshelter. Results: Participants reported HOPE to be credible and indicated a high degree of satisfaction with treatment. Only 2 women withdrew from treatment. Both intent to treat (ITT) and minimal attendance (MA) analyses found that HOPE treatment relative to SSS was significantly associated with a lower likelihood of reabuse over the 6-month follow-up period (OR = 5.1, RR = 1.75; OR = 12.6, RR = 3.12, respectively). Results of hierarchical linear model analyses found a significant treatment effect for emotional numbing symptom severity in the ITT sample, t(67) = ?2.046, p     

Arousal, numbing, and intrusion: symptom structure of PTSD following assault

OBJECTIVE: This study investigated hypotheses concerning the importance of symptoms of numbing in posttraumatic stress disorder (PTSD). METHODS: Symptoms of PTSD were assessed in 72 female rape victims and 86 female victims of nonsexual assault approximately 3 months after the crimes occurred. A principal-components factor analysis of subjects' symptoms was then undertaken. RESULTS: The analysis yielded three factors: arousal/avoidance, numbing, and intrusion. These were somewhat different from the symptom clusters in DSM-III-R, since effortful avoidance and numbing symptoms did not load on the same factor. Numbing symptoms appeared to be particularly important in identifying individuals with PTSD. CONCLUSIONS: The results imply that there are two patterns of posttrauma symptoms, one characterizing PTSD and the second characterizing a phobic reaction.     

Confirmatory factor analysis of the PTSD Checklist and the Clinician-Administered PTSD Scale in disaster workers exposed to the World Trade Center Ground Zero.

Although posttraumatic stress disorder (PTSD) factor analytic research has yielded little support for the DSM-IV 3-factor model of reexperiencing, avoidance, and hyperarousal symptoms, no clear consensus regarding alternative models has emerged. One possible explanation is differential instrumentation across studies. In the present study, the authors used confirmatory factor analysis to compare a self-report measure, the PTSD Checklist (PCL), and a structured clinical interview, the Clinician-Administered PTSD Scale (CAPS), in 2,960 utility workers exposed to the World Trade Center Ground Zero site. Although two 4-factor models fit adequately for each measure, the latent structure of the PCL was slightly better represented by correlated reexperiencing, avoidance, dysphoria, and hyperarousal factors, whereas that of the CAPS was slightly better represented by correlated reexperiencing, avoidance, emotional numbing, and hyperarousal factors. After accounting for method variance, the model specifying dysphoria as a distinct factor achieved slightly better fit. Patterns of correlations with external variables provided additional support for the dysphoria model. Implications regarding the underlying structure of PTSD are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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

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, 1st-order solution; (b) a 2-factor, higher order solution; (c) a single-factor, higher order solution; and (d) a single-factor, 1st-order solution. The model of best fit was the 4-factor, 1st-order solution, containing moderately to highly correlated yet distinct 1st-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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The comparative effectiveness of cognitive processing therapy for male veterans treated in a VHA posttraumatic stress disorder residential rehabilitation program.

Objective: To examine the effectiveness of group cognitive processing therapy (CPT) relative to trauma-focused group treatment as usual (TAU) in the context of a Veterans Health Administration (VHA) posttraumatic stress disorder (PTSD) residential rehabilitation program. Method: Participants were 2 cohorts of male patients in the same program treated with either CPT (n = 104) or TAU (n = 93; prior to the implementation of CPT). Cohorts were compared on changes from pre- to posttreatment using the PTSD Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993) and other measures of symptoms and functioning. Minorities represented 41% of the sample, and the mean age was 52 years (SD = 9.22). The CPT group was significantly younger and less likely to receive disability benefits for PTSD; however, these variables were not related to outcome. Results: Analyses of covariance controlling for intake symptom levels and cohort differences revealed that CPT participants evidenced more symptom improvement at discharge than TAU participants on the PCL, F(3, 193) = 15.32, p     

Turning up the Noise or Turning Down the Volume? On the Nature of the Impairment of Episodic Recognition Memory by Midazolam.

E. Hirshman, J. Fisher, T. Henthom, J. Amdt, and A. Passanname (2002) found that Midazolam disrupts the mirror-patterned word-frequency effect for recognition memory by reversing the typical hit-rate advantage for low-frequency words. They noted that this result is consistent with dual-process accounts (e.g., R. C. Atkinson & J. F. Juola, 1974; G. Mandler, 1980; A. P. Yonelinas, 1994) of the word frequency effect for recognition memory (S. Joordens & W. E. Hockley. 2000; L. M. Reder et al.. 2000). The present authors show that this finding is also consistent with a variety of single-process, retrieving effectively- from-memory (REM) models (R. M. Shiffrin & M. Steyvers, 1997), the simplest of which assumes that Midazolam decreases the accuracy with which memory traces are stored. These findings therefore do not discriminate between single- and dual-process models of recognition memory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress symptoms among National Guard soldiers deployed to Iraq: Associations with parenting behaviors and couple adjustment.

Objective: In this article, we report findings from a 1-year longitudinal study examining the impact of change in posttraumatic stress disorder (PTSD) symptoms following combat deployment on National Guard soldiers' perceived parenting and couple adjustment 1 year following return from Iraq. Method: Participants were 468 Army National Guard fathers from a brigade combat team (mean age = 36 years; median deployment length = 16 months; 89% European American, 5% African American, 6% Hispanic American). Participants completed an in-theater survey 1 month before returning home from Operation Iraqi Freedom deployment (Time 1) and again 1 year postdeployment (Time 2). The PTSD Checklist—Military Version (PCL–M; Weathers, Litz, Herman, Huska, & Keane, 1993) was gathered at both times, and 2 items assessing social support were gathered at baseline only. At Time 2, participants also completed self-report measures of parenting (Alabama Parenting Questionnaire—Short Form; Elgar, Waschbusch, Dadds, & Sigvaldason, 2007), couple adjustment (Dyadic Adjustment Scale—7; Sharpley & Rogers, 1984; Spanier, 1976), parent–child relationship quality (4 items from the Social Adjustment Scale—Self-Report; Weissman & Bothwell, 1976), alcohol use (Alcohol Use Disorders Identification Test; Babor, Higgins-Biddle, Saunders, & Monteiro, 2001), and items assessing injuries sustained while deployed. Results: Structural equation modeling analyses showed that increases in PTSD symptoms were associated with poorer couple adjustment and greater perceived parenting challenges at Time 2 (both at p     

Postdisaster stress in the United States and Mexico: A cross-cultural test of the multicriterion conceptual model of posttraumatic stress disorder.

Data on symptoms of posttraumatic stress disorder (PTSD) were collected 6 months after Hurricanes Paulina (N/&=/&200; Mexico) and Andrew (non-Hispanic n/&=/&270; United States) using the Revised Civilian Mississippi Scale. A 4-factor measurement model that represented the accepted multicriterion conceptualization of PTSD fit the data of the U.S. and Mexican samples equally well. The 4 factors of Intrusion, Avoidance, Numbing, and Arousal correlated significantly and equivalently with severity of trauma in each sample. A single construct explained much of the covariance of the symptom factors in each sample. However, modeling PTSD as a unidimensional construct masked differences between samples in symptom severity. With severity of trauma controlled, the Mexican sample was higher in Intrusion and Avoidance, whereas the U.S. sample was higher in Arousal. The results suggest that PTSD is a meaningful construct to study in Latin American societies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attentional networks reveal executive function deficits in posttraumatic stress disorder.

Executive function was assessed with the Trail Making Test (Army Individual Test Battery; M. D. Lezak, 1983), the Comprehensive Trail Making Test (C. Reynolds, 2002), and a neurocognitive measure of executive control (Attentional Network Task [ANT]; J. I. Fan, B. D. McCandliss, T. Somer, A. Raz, & M. I. Posner, 2002) in 19 undergraduates with posttraumatic stress disorder (PTSD; Posttraumatic Stress Disorder Symptom Scale-Self-Report version; E. B. Foa, D. S. Riggs, C. V. Dancu, & B. O. Rothbaum, 1993), 15 high trauma participants without PTSD, and 18 low trauma control participants. Although groups did not differ on any trail making task or on the ANT measures of alerting or orienting, PTSD participants were significantly more impaired on the ANT executive network index than were high or low trauma control participants, even when level of depressive symptoms was covaried. Previous animal research identified a relationship between dopamine and the ANT measure of executive function. Elevated PTSD symptom severity and levels of hyperarousal, reexperiencing, and avoidance-numbing were associated significantly with executive function deficits indexed by the ANT. These results indicate a potentially subtle but specific deficit in executive function and a possible relationship between PTSD symptoms and irregularities in dopamine function. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Minnesota Multiphasic Personality Inventory-2, posttraumatic stress disorder, and women domestic violence survivors.

When a professional psychologist examines a woman domestic violence survivor's MMPI-2 (J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. M. Tellegen, & B. Kaemmer, 1989) profile, what unique signs will there be that she suffers from posttraumatic stress disorder (PTSD)? Existing empirical evidence and diagnostic decision rules for determining the presence of PTSD with the MMPI-2 cannot be applied to domestic violence survivors. The MMPI-2 was administered to 93 women domestic violence survivors. Results suggest that the MMPI-2 is sensitive to PTSD symptoms. Women domestic violence survivors with PTSD generate unique average MMPI-2 profiles. The Defensiveness (K) validity and 1 (Hypochondriasis [Hs]) scales may assist in discriminating between survivors with and without PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War.

Confirmatory factor analysis was used to compare 6 models of posttraumatic stress disorder (PTSD) symptoms, ranging from 1 to 4 factors, in a sample of 3,695 deployed Gulf War veterans (N = 1,896) and nondeployed controls (N = 1,799). The 4 correlated factors-intrusions, avoidance, hyperarousal, and dysphoria-provided the best fit. The dysphoria factor combined traditional markers of numbing and hyperarousal. Model superiority was cross-validated in multiple subsamples, including a subset of deployed participants who were exposed to traumatic combat stressors. Moreover, convergent and discriminant validity correlations suggested that intrusions may be relatively specific to PTSD, whereas dysphoria may represent a nonspecific component of many disorders. Results are discussed in the context of hierarchical models of anxiety and depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A test of models of personality disorder configuration.

In this study, the authors examined the degrees to which various models of personality disorder (PD) configuration are consistent with the primary data sets from clinical and community samples reported in the recent literature. Factor analyses were conducted on PD intercorrelation matrices, and the loading matrices were rotated to maximum possible fit with target matrices representing the PD configuration models. There was little support for the interpersonal circle or other circular orderings of PDs, or for T. Millon's (1990, 1996) biosocial learning theory. There was moderate support for the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV; American Psychiatric Association, 1994) dimensions, for C. R. Cloninger's (1987) tridimensional theory, and for S. Torgersen and R. Alnaes's (1989) decision tree. There was consistent, stronger support for the 5-factor model (T. A. Widiger, T. J. Trull, J. F. Clarkin, C. Sanderson, & P. T. Costa, 1994) and for an empirically derived 7-factor model by C. R. Cloninger and D. M. Svrakic (1994). However, a focus on just 4 factors seems preferable and sufficient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)