Evaluation of the Posttraumatic Stress Disorder Checklist for DSM-5 across United States and India samples: An item response theory analysis using the graded response model.

OBJECTIVES: The Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) is frequently used to assess PTSD symptoms. Extending its psychometric investigations across distinct samples (United States and India), the aims of the present study included investigating the item characteristics, person fit, and differential item functioning (DIF) across the two samples. METHOD: We (a) conducted item analysis using the graded response model to examine item characteristics (thresholds and discrimination parameters) and (b) examined person fit to determine participants' response patterns. The U.S. sample included 176 trauma-exposed individuals seeking mental health treatment, and the Indian sample included 148 trauma-exposed ex-military personnel. RESULTS: Results indicated low discrimination for Item 8 and low but acceptable discrimination for Item 17 for the U.S. and Indian samples, respectively. Across both samples, the most unused response categories were the middle-point or extreme (higher severity) categories (all response categories were better utilized in the Indian sample), and half the participants exhibited person misfit. Supplemental DIF analysis indicated that five items exhibited DIF indicating potential item bias; however, effect sizes for DIF were negligible. CONCLUSIONS: Although the PCL-5 demonstrated strong psychometric properties and showed promise for use across the samples differing on cultural and demographic characteristics, some of the items and the number of categories used to measure them could be revisited to create a more efficient instrument. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Do positive memory characteristics relate to reckless behaviours? an exploratory study in a treatment-seeking traumatised sample.

Reckless and self-destructive behaviours (RSDBs), common among traumatised individuals, are associated with negative health consequences. Gaining a stronger understanding of factors associated with an increased likelihood of RSDBs among traumatised individuals offers potential new avenues for research and treatment. Mounting evidence indicates relations between traumatic experiences and deficits/disturbances in characteristics of positive memories; however, relations between RSDBs and positive memory characteristics has been understudied. Using hierarchical multiple regression, we examined relations between positive memory characteristics (Memory Experiences Questionnaire-Short Form; MEQ-SF) and RSDBs, controlling for PTSD and depression severity, among a sample of treatment-seeking trauma-exposed individuals (N = 77; Mage = 33.96; 57.10% female). Results indicated that MEQ-SF subscales of Accessibility, Coherence, Emotional Intensity, and Sensory Details were significantly associated with engagement in RSDBs, above and beyond PTSD and depressive severity. Those who easily accessed emotionally evocative positive memories tended to engage in elevated RSDBs; those with less coherence and fewer sensory details in their positive memories were also more likely to engage in RSDBs. Theories related to emotion dysregulation and cognitive deficits may explain these obtained relations.

An Exploratory Examination of Client Perspectives on a Positive Memory Technique for PTSD.

Posttraumatic stress disorder (PTSD) treatments primarily address traumatic memories, despite PTSD's association with both traumatic and positive memory difficulties. Addressing this gap, we explored the perspectives of trauma-exposed individuals with mental health treatment experience on therapeutically addressing positive memories. A treatment-seeking sample from a community mental health center (n1 = 60) and a community sample from Amazon's Mechanical Turk (n2 = 123) were queried on the acceptability, feasibility, and delivery/components of a pilot positive memory technique. Results indicated interest or willingness in therapeutically discussing positive memories; most endorsed benefits were improved mood, positive thoughts, and self-esteem. Few barriers were identified (e.g., lack of evidence) compared with feasibility factors (ease/usefulness, improved satisfaction/tolerability, and engagement in PTSD treatment). Preferred treatment components included identifying/discussing positive memories, eliciting associated positive affect, and writing about the positive memory as homework. Results provide formative support for the development and integration of a positive memory technique into PTSD treatments.

PTSD's blame criterion and mental health outcomes in a community mental health treatment-seeking sample.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is a severe psychiatric condition that can manifest as a combination of debilitating symptoms, one of which is a distorted sense of responsibility for the traumatic event. The inclusion of DSM-5's PTSD D3 criterion (blaming self or others for the stressful experience) has received little research attention in regard to its relation to post-trauma mental health outcomes. To address this gap in literature, we examined the relevance of the clinical endorsement of the D3 criterion to PTSD symptomology and other posttrauma mental health outcomes. METHOD: Participants were 123 trauma-exposed, treatment-seeking individuals (Mage = 35.70, 68.3% female) who completed a series of self-report questionnaires assessing PTSD symptomology, depression severity, distress intolerance, rumination, and anger reactions. RESULTS: Independent t tests comparing those that clinically endorsed the D3 criterion (vs. those that did not) revealed that the clinical endorsement of blame was significantly associated with PTSD severity, depression, distress intolerance, and rumination. CONCLUSIONS: Our findings support the significance of PTSD's D3 criterion, and further emphasize the importance of addressing blame in posttrauma mental health outcomes. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

PTSD's risky behavior criterion: Relation with DSM-5 PTSD symptom clusters and psychopathology.

A new symptom criterion of reckless and self-destructive behaviors (E2) was recently added to posttraumatic stress disorder's (PTSD) diagnostic criteria in DSM-5, which is unsurprising given the well-established relation between PTSD and risky behaviors. Researchers have questioned the significance and incremental validity of this symptom criterion within PTSD's symptomatology. Unprecedented to our knowledge, we aim to compare trauma-exposed groups differing on their endorsement status of the risky behavior symptom on several psychopathology constructs (PTSD, depression, distress tolerance, rumination, anger). The sample included 123 trauma-exposed participants seeking mental health treatment (M age=35.70; 68.30% female) who completed self-report questionnaires assessing PTSD symptoms, depression, rumination, distress tolerance, and anger. Results of independent samples t-tests indicated that participants who endorsed the E2 criterion at a clinically significant level reported significantly greater PTSD subscale severity; depression severity; rumination facets of repetitive thoughts, counterfactual thinking, and problem-focused thinking; and anger reactions; and significantly less absorption and regulation (distress tolerance facets) compared to participants who did not endorse the E2 criterion at a clinically significant level. Results indicate the utility of the E2 criterion in identifying trauma-exposed individual with greater posttraumatic distress, and emphasize the importance of targeting such behaviors in treatment.

The relationship between negative expressivity, anger, and PTSD symptom clusters.

More investigation is needed to understand how specific posttraumatic stress disorder (PTSD) symptom clusters relate to the internal experience of anger and overt negative behaviors in response to anger (negative expressivity). We investigated whether anger mediated relations between PTSD symptom clusters and negative expressivity. Multiple regression revealed lower PTSD intrusion symptoms associated with higher levels of negative expressivity. Anger mediated this relationship. Higher avoidance symptoms related to higher negative expressivity. Clinical implications, limitations, and strengths are discussed.

Unique relations between counterfactual thinking and DSM-5 PTSD symptom clusters.

OBJECTIVE: Cognitive models of posttraumatic stress disorder (PTSD) propose that rumination about a trauma may increase particular symptom clusters. One type of rumination, termed counterfactual thinking (CFT), refers to thinking of alternative outcomes for an event. CFT centered on a trauma is thought to increase intrusions, negative alterations in mood and cognitions (NAMC), and marked alterations in arousal and reactivity (AAR). The theorized relations between CFT and specific symptom clusters have not been thoroughly investigated. Also, past work has not evaluated whether the relation is confounded by depressive symptoms, age, gender, or number of traumatic events experienced. METHOD: The current study examined the unique associations between CFT and PTSD symptom clusters according to the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) in 51 trauma-exposed treatment-seeking individuals. RESULTS: As predicted, CFT was associated with all PTSD symptom clusters. After controlling for common predictors of PTSD symptom severity (i.e., age, depressive symptoms, and number of traumatic life events endorsed), we found CFT to be significantly associated with the intrusion and avoidance symptom clusters but not the AAR or NAMC symptom clusters. CONCLUSIONS: Results from the present study provide further support for the role of rumination in specific PTSD symptom clusters above and beyond symptoms of depression, age, and number of traumatic life events endorsed. Future work may consider investigating interventions to reduce rumination in PTSD. (PsycINFO Database Record

The relationship between rumination, PTSD, and depression symptoms.

BACKGROUND: Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are highly comorbid (Elhai et al., 2008. J. Clin. Psychiatry, 69, (4), 597-602). Rumination is a cognitive mechanism found to exacerbate and maintain both PTSD and MDD (Elwood et al., 2009. Clin. Psychol. Rev. 29, (1), 87-100; Olatunji et al., 2013. Clin. Psychol.: Sci. Pract. 20, (3), 225-257). AIMS: Assess whether four rumination subtypes moderate the relationship between comorbid PTSD and MDD symptoms. METHOD: We consecutively sampled patients (N=45) presenting to a mental health clinic using self-report measures of PTSD and MDD symptoms, and rumination in a cross-sectional design. RESULTS: Repetitive rumination moderates the relationship between PTSD and MDD symptoms at one standard deviation above the mean (ß=.044, p=.016), while anticipatory rumination moderates the relationship between PTSD and MDD symptoms at mean levels and higher levels of anticipatory rumination (mean ß=.030, p=.042; higher ß=.060, p=.008). DISCUSSION: Repetitive and anticipatory rumination should be assessed in the context of comorbid PTSD and MDD and interventions should focus on reducing these rumination subtypes. LIMITATIONS: Results should be replicated with other trauma populations because the number and complexity of traumatic events may impact the assessed symptoms. Constructs should also be assessed longitudinally, in order to establish causality. We are unable to confirm why rumination styles moderated the relationship between PTSD and depression or why counterfactual thinking and problem-focused thinking did not moderate the relationship between the two constructs.