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28. Validating Competing Structures of Post-Traumatic Stress Disorder
The underlying structure of posttraumatic stress disorder (PTSD) is far from definitively established. Some have found subtypes. Others argue for dimensional models, while disputing the number and content of factors. In the present study, we compare previously established structural models of PTSD in terms of predictive utility with regard to psychosocial functioning. Competing models were compared in trauma-exposed individuals from the National Epidemiological Study of Alcohol and Related Conditions–III (N=23,936). In DSM-5 and dysphoria confirmatory factor models, only hyperarousal had consistent effects in expected directions. For models separating anxious from dysphoric arousal, anxious arousal was the driving effect in predicting social, psychological, and physical correlates, indicating a need to investigate the utility of combining versus separating these factors. For other factors, significant predictive effects were infrequent and small. The pattern of non-significant or counterintuitive effects for intrusions and avoidance (the only factors shared across models) also indicates a concerning degree of sensitivity in predictive validity to a chosen theoretical structure. Evaluating models’ relative utility in predicting specific outcomes can aid in characterizing different reactions to trauma in terms of their association with impairment, thereby aiding in individualized risk assessment, symptom course prediction, and identification of candidate points of intervention.