The factor structure of Posttraumatic Stress Disorder -A confirmatory factor analysis and an exploration of the influence of trauma type on the symptom presentation-
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There is considerable debate about the legitimacy of the PTSD diagnosis. Therefore there is an urge to supplement the diagnostic system with scientific observations, preliminary to the construction of the fifth version of the DSM. This master study investigated the diagnosis of PTSD. Specifically, the current (DSM-IV-TR) factor structure and three alternative factor structures were analyzed and tested on a ‘heterogeneous trauma-exposed population’. The alternative models consisted of a nested six-factor model, the King et al. (1998) model and the Simms et al. (2002) model. The six factor model was designed by Ebberink et al. (2009) and it distinguishes PTSD specific symptoms from dysphoria symptoms and a ‘PTSD a specific’ symptom. To investigate the fit of the factor models on the trauma population, and to compare it to each other, a confirmative factor analysis (CFA) was performed. The second aim of this study was to explore the relation between trauma type and PTSD, since studies indicate that the symptom presentation of PTSD is related to trauma type. To explore this relation, a multivariate analysis of variance (MANOVA) was performed. The current study used data from the Dutch translation of the Clinician-Administered PTSD Scale (CAPS) that was acquired from 170 clients of two Mental Healthcare Centres: ‘Overwaal, Centre of Anxiety Disorders’ and ‘Hendriks & Rooseboom, specialists in psychological health’. All clients were clinically diagnosed with PTSD. Comparison of the proposed factor models showed that he DSM-IV-TR model had the worst fit, and the Simms model provided the best fit. These findings are not consistent with the study of Ebberink et al. (2009), and do not support the assumption that the six factor model shows superior fit to the other models. On the contrary, the findings are concordant with the broad acknowledgement that the PTSD symptomatology of re-experiencing is typical for PTSD (Horowitz, 1997; King et al., 1998; Simms et al., 2002; Brewin, 2003). Obvious is that avoidance could be best defined by two symptoms of active avoidance (C1, C2). Furthermore, there was no statistically significant difference among trauma groups on the symptom representation of PTSD. The present findings suggest that there are many reactions to extreme trauma, but that the Simms model includes a core set of symptoms that applies for all trauma types. The findings support the weighty body of literature that challenges the current DSM-IV-TR PTSD factor structure and support the view that it involves four clusters of symptoms as opposed to three.