The underlying dimensionality of PTSD in the diagnostic and statistical manual of mental disorders: where are we going?

There has been a substantial body of literature devoted to answering one question: Which latent model of posttraumatic stress disorder (PTSD) best represents PTSD's underlying dimensionality? This research summary will, therefore, focus on the literature pertaining to PTSD's latent structure as represented in the fourth (DSM-IV, 1994) to the fifth (DSM-5, 2013) edition of the DSM. This article will begin by providing a clear rationale as to why this is a pertinent research area, then the body of literature pertaining to the DSM-IV and DSM-IV-TR will be summarised, and this will be followed by a summary of the literature pertaining to the recently published DSM-5. To conclude, there will be a discussion with recommendations for future research directions, namely that researchers must investigate the applicability of the new DSM-5 criteria and the newly created DSM-5 symptom sets to trauma survivors. In addition, researchers must continue to endeavour to identify the “correct” constellations of symptoms within symptom sets to ensure that diagnostic algorithms are appropriate and aid in the development of targeted treatment approaches and interventions. In particular, the newly proposed DSM-5 anhedonia model, externalising behaviours model, and hybrid models must be further investigated. It is also important that researchers follow up on the idea that a more parsimonious latent structure of PTSD may exist

Mental Health in Prison: A Trauma Perspective on Importation and Deprivation

Prison is primarily intended as a punishment for criminal acts. It is an establishment which aims to punish those who commit crime, protect the public from crime and criminals, and reform criminals into law abiding citizens, thus reduce re-offending. It has however, been reported that imprisonment increases vulnerabilities and heightens mental ill health. Studies across a variety of counties have reported that the prevalence of mental illness in prison far exceeds that of the general population. Several studies have suggested that prisoners experience a number of pre-prison adversities which contribute to subsequent mental ill health. However, there are additional reports that prisoners develop mental illness due to the prison environment. This debate is rooted within a theoretical framework which considers importation and deprivation models (i.e., do prisoners take mental illness with them when they are imprisoned or do factors associated with being imprisoned cause mental illness to develop?). This current paper discusses how this theoretical framework may be placed within a trauma context. Many studies report that trauma precipitates the development of mental illness. Trauma is often prevalent for individuals prior to imprisonment and often experienced during imprisonment. Thus, it is suggested that the adverse effects of trauma are cumulative and thus likely to precipitate severe mental illness suggesting that mental illness in prison is attributable to both importation and deprivation perspectives

Lay concepts of trauma in the United Kingdom: Content and predictors

OBJECTIVE: Readiness among laypeople to classify ordinary adversities as "trauma" may activate cognitive, social, and behavioral patterns that either promote proactive help-seeking or exacerbate mental health difficulties. Clinical understandings of trauma have expanded across recent decades to encompass a wide range of aversive experiences. While some have suggested lay understandings of trauma have expanded in parallel, minimal data directly reveal how the lay public conceptualize trauma. This study sought to establish the range of adversities that laypeople classify as traumatic. METHOD: In an online survey, U.K. participants (N = 214) rated the traumatic nature of 80 adversities, half of which represented prototypical precursors of trauma (e.g., physical assault and sexual abuse), and half of which involved other adversities, not typically invoked in clinical definitions of trauma. RESULTS: Prototypical precursors were judged significantly more traumatic than nonprototypical adversities, but many nonprototypical adversities were also deemed likely to cause trauma (e.g., facial disfigurement or being falsely accused of a crime). Individual variation in the propensity to interpret adversities as traumatic was significantly predicted by participants' age, ethnicity, and political orientation. CONCLUSIONS: This original evidence regarding the content and predictors of lay conceptions of trauma is relevant for sensitive delivery of clinical interventions, tailoring of other supports for populations experiencing adversity, and anticipating social responses to victims of specific adversities. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Modeling Patterns of Negative Life Events and Mental Health in Faroese Adolescents

Objectives: The objective of this study was to identify naturally occurring typologies of Faroese adolescents on the basis of their exposure to traumatic and negative life events. It was hypothesized that underlying typologies of trauma and negative life events would be uncovered. Furthermore, it was hypothesized that males would be overrepresented in classes characterized by the endorsement of a wide range of trauma and negative life events. On the basis of prior research, it was also hypothesized that females had endorsed more traumas of a sexual nature and that males had endorsed more traumas of a violent nature. Finally, post-traumatic stress, negative affectivity, and somatization were examined in the different typologies.Methods: Latent class analyses were conducted with the use of data collected from a self-report questionnaire survey from 687 Faroese eighth graders (85% response rate). The questionnaire included a traumatic and negative life event list, the Harvard Trauma Questionnaire—Part IV, and the Trauma Symptom Checklist.Results: Three classes of adolescents were identified on the basis of their exposure to potentially traumatic and negative life events. The baseline class (81.3%) had a low probability of the endorsement of all potentially traumatic and negative life events, except threats of violence and bullying. This group had low scores for post-traumatic symptoms, negative affectivity, and somatization. Class 2 (13.7%) comprised mainly males and had the highest probability of endorsement of threats of violence, physical assault, and bullying; this group also had high scores for post-traumatic stress symptoms, negative affectivity, and somatization. Finally, Class 1 (5.0%) consisted of adolescents with a relatively high risk of exposure to all potentially traumatic events and negative life events, except threats of violence. This group had the highest scores for post-traumatic stress symptoms, negative affectivity, and somatization.Conclusions: The present study can be said to be a concise picture of trauma exposure and its consequences among Faroese adolescents, and it is thereby a valuable tool for the national planning of preventive and interventional strategies and for empirically founded economic prioritization. These results emphasize the importance of choosing a trauma-informed strategy in various disciplines, such as pediatrics, child and adolescent psychiatry, social work, and school psychology when the aim is to provide the appropriate intervention

ICD-11 complex post-traumatic stress disorder and psychiatric comorbidity among UK Armed Forces veterans in Northern Ireland: a latent class analysis

Background: There is evidence to suggest that the experience of complex post-traumatic stress disorder (C-PTSD) may be commonly associated with elevated risk for several mental ill-health comorbidities.Objective: The current study seeks to contribute to the growing literature on C-PTSD comorbidity by examining the relationship between C-PTSD and other mental health disorders in a UK Armed Forces veteran sample.Method: This study used data from the Northern Ireland Veterans’ Health and Wellbeing Study (NIVHWS). The effective sample consisted of 638 veterans (90.0% male). Tetrachoric correlations examined the relationship between C-PTSD caseness and other mental health outcomes. Latent class analysis was then conducted, determining the optimal number and nature of classes in the sample in relation to C-PTSD, depression, anxiety, and suicidality.Results: C-PTSD caseness (i.e. probable diagnosis) was found to be significantly associated with positive caseness of depression, anxiety, and suicidality. Overall, four latent classes emerged, with each of these classes characterized by varying degrees of comorbidity: a ‘Resilient/Low Comorbidity’ class, a ‘Lifetime Suicidal’ class, a ‘PTSD Polymorbid’ class, and a ‘C-PTSD Polymorbid’ class.Conclusions: These findings support and extend previous results indicating the highly comorbid nature of C-PTSD. C-PTSD may be considered a highly polymorbid condition, increasing the risk for multiple mental health pathologies concurrently

A latent growth mixture modeling approach to PTSD symptoms in rape victims.

The research literature has suggested that longitudinal changes in posttraumatic stress disorder (PTSD) could be adequately described in terms of one universal trajectory, with individual differences in baseline levels (intercept) and rate of change (slope) being negligible. However, not everyone who has experienced a trauma is diagnosed with PTSD, and symptom severity levels differ between individuals exposed to similar traumas. The current study employed the latent growth mixture modeling technique to test for multiple trajectories using data from a sample of Danish rape victims (N = 255). In addition, the analysis aimed to determine whether a number of explanatory variables could differentiate between the trajectories (age, acute stress disorder [ASD], and perceived social support). Results concluded the existence of two PTSD trajectories. ASD was found to be the only significant predictor of one trajectory characterized by high initial levels of PTSD symptomatology. The present findings confirmed the existence of multiple trajectories with regard to PTSD symptomatology in a way that may be useful to clinicians working with this population