Temporal Stability of DSM-5 Posttraumatic Stress Disorder Criteria in a Problem Drinking Sample

Posttraumatic Stress Disorder (PTSD) as defined in The Diagnostic and Statistical Manual, Fourth Edition (DSM-IV; American Psychiatric Association, 2000) included symptoms organized into three symptom clusters: Reexperiencing, Avoidance/Numbing, and Hyperarousal. Two decades of research on the disorder and its symptom structure demonstrates that four dimensions or factors better account for PTSD symptoms than three factors or other proposed factor structures (King, Leskin, King, & Weathers, 1998; King, Orazem, Lauterbach, King, Hebenstreit, & Shalev, 2009; Yufik & Simms, 2010; Biehn, Elhai, Fine, Seligman, & Richardson, 2012; Mansfield, Williams, Hourani, & Babeu, 2010; Krause, Kaltman, Goodman, & Dutton, 2007; Palmieri, Weathers, Difede, & King, 2007). Four factor models using differing measures of the DSM-IV criteria were replicated across populations (e.g., King et al., 2009; Marshall, 2004; McDonald, Beckham, Morey, Marx, Tupler & Calhoun, 2008) and across time (Krause, Kaltman, Goodman, & Dutton, 2007; Mason, Lauterbach, McKibben, Lawrence, & Fauerbach, 2013; Wang, Elhai, Dai, & Yao, 2012; Baschnagel, O'Connor, Colder, & Hawk, 2005; King, Taft, King, Hammond, & Stone, 2006). Consequently, the reformulation of PTSD for The Diagnostic and Statistical Manual, Fifth Edition (American Psychiatric Association, 2013; Friedman, Resick, Bryant, & Brewin, 2011) incorporated the research literature by organizing PTSD symptoms into four clusters, with the new symptom cluster reflecting general distress (see Table 1). The DSM-5 PTSD criteria consist of four symptom clusters: Intrusions (i.e., re-experiencing; B1–B5), Avoidance (C6, C7) Negative Alterations of Cognitions and Moods (D8–D14), and Hyperarousal (E15 – E20). In the reformulation, new symptoms were included or expanded; three fall on the Negative Alterations in Mood and Cognition factor and one on the Hyperarousal factor (see Table 1). Table 1 PCL-5a items arranged according to DSM-5 proposed factor structure Miller, Wolf, Kilpatrick, Resnick, Marx, Holowka, et. al (2012) and Elhai, Miller, Ford, Biehn, Palmieri, & Frueh, (2012) both reported that the DSM-5’s symptom clusters for PTSD provide a good fit to data collected on a national online sample of adults, a national sample of veterans, and college students, but there is not yet an evaluation of the stability of the factors over time using the DSM-5 criteria. This study fills that gap by evaluating the stability of the DSM-5 proposed factor structure over time. This temporal stability, or longitudinal invariance, is important in establishing that the measure in question is measuring the same latent constructs over time. If the factor structure of the measure changes from one time point to the next then changes in scores may be due to inconsistencies in measurement rather than true change in the construct in question (Brown, 2006, pp. 252-3). The primary aim of this study was to test the temporal stability of the DSM-5 factor structure. Longitudinal studies of PTSD symptom change (Bolton, Gray, & Litz, 2006) as well as PTSD treatment trials (Evans, Cowlishaw, Forbes, Parslow, & Lewis, 2010; Monson et al., 2006; Ready et al., 2012) frequently use the PCL to demonstrate change over time, therefore it is important to demonstrate that the PCL-5 is consistently measuring the construct over time. Replicating the factor structure across populations is also necessary to ensure that the PCL-5 is measuring the same construct across groups. Thus, this sample of returning veterans who are drinking in a problematic manner with varying levels of PTSD symptoms will inform the understanding of the PCL-5’s fidelity to the DSM-5’s diagnostics criteria across time and, to the extent that this group is different than other samples, across populations.