A meta-analytic investigation of the structure of posttraumatic stress disorder symptoms.

Yufik, Tom; Simms, Leonard J.

doi:10.1037/a0020981

Cited by 323Posttraumatic Stress Disorder ResearchAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesSleep and related disorders

A meta-analytic investigation of the structure of posttraumatic stress disorder symptoms.

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Yufik, Tom, Simms, Leonard J.·2010·Journal of Abnormal Psychology

DOI 10.1037/a0020981PMC PMC4229035

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Abstract

Converging lines of evidence have called into question the validity of conceptualizations of posttraumatic stress disorder (PTSD) based on the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2000) and suggested alternative structural models of PTSD symptomatology. We conducted a meta-analysis of 40 PTSD studies (N = 14,827 participants across studies) that used a DSM-based measure to assess PTSD severity. We aggregated correlation matrices across studies and then applied confirmatory factor analysis to the aggregated matrices to test the fit of competing models of PTSD symptomatology that have gained support in the literature. Results indicated that both prominent 4-factor models of PTSD symptomatology yielded good model fit across subsamples of studies; however, the model comprising Intrusions, Avoidance, Hyperarousal, and Dysphoria factors appeared to fit better across studies. Results also indicated that the best fitting models were not moderated by measure or sample type. Results are discussed in the context of structural models of PTSD and implications for the diagnostic nosology.

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Based on CFA studies on the structure of PTSD criteria, the DSM-5 revised the diagnostic structure of PTSD from a three-factor model with 17 symptoms to a four-factor model comprising 20 symptoms.
“Based on confirmatory factor analytic (CFA) studies on the structure of posttraumatic stress disorder (PTSD) criteria [13, 14], the DSM-5 revised the diagnostic structure of PTSD from a three-factor-model with 17 symptoms to a four-factor-model comprising 20 symptoms.”
From The German version of the posttraumatic stress disorder checklist for DSM-5 (PCL-5): psychometric properties and diagnostic utility (2017) · cites this paper as [14]

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King LA King DW Orazem MA Palmieri PA 2006 Research on the latest structure of PTSD PTSD Research Quarterly 17 1 8
Yufik T Simms LJ 2010 An investigation of Criterion A in posttraumatic stress disorder Manuscript in preparation PMC4229035 21090877

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Self-citation
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Anxiety and depression as bidirectional risk factors for one another: A meta-analysis of longitudinal studies.
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Development and Validation of New Anxiety and Bipolar Symptom Scales for an Expanded Version of the IDAS (the IDAS-II)
Watson, D., O’Hara, M. W., Naragon-Gainey, K., Koffel, E., Chmielewski, M., Kotov, R., Stasik, S. M., & Ruggero, C. J. (2012) · Assessment · doi:10.1177/1073191112449857 · Cited by 470 · see citing works
Dimensional structure of DSM-5 posttraumatic stress symptoms: Support for a hybrid Anhedonia and Externalizing Behaviors model
Armour, C., Tsai, J., Durham, T. A., Charak, R., Biehn, T. L., Elhai, J. D., & Pietrzak, R. H. (2015) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2014.10.012 · Cited by 384 · see citing works
Acute and Chronic Posttraumatic Stress Symptoms in the Emergence of Posttraumatic Stress Disorder: A Network Analysis
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The German version of the posttraumatic stress disorder checklist for DSM-5 (PCL-5): psychometric properties and diagnostic utility
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The underlying dimensions of DSM-5 posttraumatic stress disorder symptoms in an epidemiological sample of Chinese earthquake survivors
Liu, P., Wang, L., Cao, C., Wang, R., Zhang, J., Zhang, B., Wu, Q., Zhang, H., Zhao, Z., Fan, G., et al. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.03.008 · Cited by 277 · see citing works
The factor structure of posttraumatic stress disorder: A literature update, critique of methodology, and agenda for future research
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Personality, Emotions, and the Emotional Disorders
Watson, D., & Naragon-Gainey, K. (2014) · Clinical Psychological Science · doi:10.1177/2167702614536162 · Cited by 242 · see citing works
DSM-5 AND ICD-11 DEFINITIONS OF POSTTRAUMATIC STRESS DISORDER: INVESTIGATING “NARROW” AND “BROAD” APPROACHES: Research Article: DSM-5 and ICD-11 Definitions of PTSD
Stein, D. J., McLaughlin, K. A., Koenen, K. C., Atwoli, L., Friedman, M. J., Hill, E. D., Maercker, A., Petukhova, M., Shahly, V., van Ommeren, M., et al. (2014) · Depression and Anxiety · doi:10.1002/da.22279 · Cited by 221 · see citing works
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Elklit, A., Hyland, P., & Shevlin, M. (2014) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v5.24221 · Cited by 172 · see citing works
Psychometric properties of the Turkish version of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5)
Boysan, M., Guzel Ozdemir, P., Ozdemir, O., Selvi, Y., Yilmaz, E., & Kaya, N. (2017) · Psychiatry and Clinical Psychopharmacology · doi:10.1080/24750573.2017.1342769 · Cited by 170 · see citing works
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Kumpula, M. J., Orcutt, H. K., Bardeen, J. R., & Varkovitzky, R. L. (2011) · Journal of Abnormal Psychology · doi:10.1037/a0023927 · Cited by 162 · see citing works
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Tursich, M., Ros, T., Frewen, P. A., Kluetsch, R. C., Calhoun, V. D., & Lanius, R. A. (2015) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12387 · Cited by 148 · see citing works
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Disorders specifically associated with stress: a case-controlled field study for ICD-11 Mental and Behavioural Disorders
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“Empirical evience for the specified essential features of PTSD was rimarily drawn from studies investigating the symptom tructure of previous PTSD definitions (e.g., Elklit & Shevlin, 007; Gootzeit & Markon, 2011; Yufik & Simms, 2010).”
Method
DSM-5: a collection of psychiatrist views on the changes, controversies, and future directions
Nemeroff, C. B., Weinberger, D., Rutter, M., MacMillan, H. L., Bryant, R. A., Wessely, S., Stein, D. J., Pariante, C. M., Seemüller, F., Berk, M., et al. (2013) · BMC Medicine · doi:10.1186/1741-7015-11-202 · Cited by 128 · see citing works
COVID-19 pandemic as a traumatic event and its associations with fear and mental health: a cognitive-activation approach
Sanchez-Gomez, M., Giorgi, G., Finstad, G. L., Urbini, F., Foti, G., Mucci, N., Zaffina, S., & León-Perez, J. M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18147422 · Cited by 75 · see citing works
Temporal stability of DSM–5 posttraumatic stress disorder criteria in a problem-drinking sample.
Keane, T. M., Rubin, A., Lachowicz, M., Brief, D., Enggasser, J. L., Roy, M., Hermos, J., Helmuth, E., & Rosenbloom, D. (2014) · Psychological Assessment · doi:10.1037/a0037133 · Cited by 74 · see citing works
Posttraumatic stress disorder symptom structure in Chinese adolescents exposed to a deadly earthquake.
Wang, L., Long, D., Li, Z., & Armour, C. (2011) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-011-9508-4 · Cited by 65 · see citing works
Elucidating Posttraumatic Stress Symptom Profiles and Their Correlates Among Women Experiencing Bidirectional Intimate Partner Violence: PTSD Symptom Profiles Among IPV-Exposed Women
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The impact of changes in distress tolerance on PTSD symptom severity post-treatment among veterans in residential trauma treatment
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Psychological Intimate Partner Violence and Sexual Risk Behavior: Examining the Role of Distinct Posttraumatic Stress Disorder Symptoms in the Partner Violence–Sexual Risk Link
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PTSD’s Underlying Dimensions in Typhoon Haiyan Survivors: Assessing DSM-5 Symptomatology-Based PTSD Models and Their Relation to Posttraumatic Cognition
Mordeno, I. G., Carpio, J. G. E., Nalipay, M. J. N., & Saavedra, R. L. J. (2017) · Psychiatric Quarterly · doi:10.1007/s11126-016-9429-z · Cited by 46 · see citing works
The influence of victimization history on PTSD symptom expression in women exposed to intimate partner violence.
Matlow, R. B., & DePrince, A. P. (2013) · Psychological Trauma: Theory, Research, Practice, and Policy · doi:10.1037/a0027655 · Cited by 38 · see citing works
Neural indices of emotional reactivity and regulation predict course of PTSD symptoms in combat-exposed veterans
Fitzgerald, J. M., Gorka, S. M., Kujawa, A., DiGangi, J. A., Proescher, E., Greenstein, J. E., Aase, D. M., Schroth, C., Afshar, K., Kennedy, A. E., et al. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2017.11.005 · Cited by 37 · see citing works
Impact of posttraumatic stress symptom dimensions on psychophysiological reactivity to threat and reward
Lieberman, L., Gorka, S. M., Funkhouser, C. J., Shankman, S. A., & Phan, K. L. (2017) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2017.04.002 · Cited by 30 · see citing works
Impact of comorbid depression on quality of life in male combat Veterans with posttraumatic stress disorder
Raab, P. A., Mackintosh, M.-A., Gros, D. F., & Morland, L. A. (2015) · Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2014.05.0130 · Cited by 29 · see citing works

Authors: Yufik, T., & Simms, L. J.
Affiliations: University at Buffalo, State University of New York (US)
ORCID: Simms, Leonard J.
Venue: Journal of Abnormal Psychology
Publisher: American Psychological Association (APA)
Published: 2010-11
Volume: 119
Issue: 4
Pages: 764-776
ISSN: 0021-843X (ISSN-L)
1939-1846
DOI: 10.1037/a0020981
PMC: PMC4229035
OpenAlex: W1995856212
Cited by: 323
References: 90
Citations by year: 2026: 7 · 2025: 10 · 2024: 6 · 2023: 5 · 2022: 7 · 2021: 10 · 2020: 15 · 2019: 22 · 2018: 18 · 2017: 24 · 2016: 24 · 2015: 45 · 2014: 40 · 2013: 36 · 2012: 36
FWCI: 31.24
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Journal of Abnormal Psychology (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Mental Health (R01MH080086)
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords: post-traumatic stress disorder, PTSD symptom structure, intrusion symptoms, avoidance symptoms, hyperarousal, dysphoria
MeSH terms: Factor Analysis, Statistical, Humans, Models, Psychological, Psychometrics, Severity of Illness Index, Stress Disorders, Post-Traumatic, Reproducibility of Results, Diagnostic and Statistical Manual of Mental Disorders

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A meta-analytic investigation of the structure of posttraumatic stress disorder symptoms.

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