Empirical data have challenged chronic posttraumatic stress disorder (PTSD) consisting of three dimensions. In the present study we aimed to determine the factor structure of acute posttraumatic symptoms in two recently traumatized samples.
In sample 1, 203 civilian trauma survivors were administered the Davidson Trauma Scale (DTS) approximately 1 week posttrauma. In sample 2, 182 civilian treatment seeking trauma survivors completed the DTS at an average of 41.4 days posttrauma.
Our confirmatory factor analyses indicated that a 4-factor intercorrelated model provided the best representation of the data in both samples. The four factors are best described as reexperiencing, active avoidance, dysphoria, and hyperarousal.
For acute posttraumatic symptoms, the empirical data suggest to split the avoidance cluster into ‘Active avoidance’ and ‘Dysphoria’—confirming findings in studies on chronic PTSD. In future revisions of the DSM, the diagnostic criteria for PTSD may need to be adapted to fit the research findings.
According to the Diagnostic and Statistical Manual of Mental Disorders, fourth version (American Psychiatric Association, 1994), posttraumatic stress disorder (PTSD) consists of the following three symptom clusters: reexperiencing, avoidance, and hyperarousal. Recently, several studies have challenged this three-dimensional conceptualization of PTSD which is based on expert consensus instead of empirical data. A growing body of evidence from factor analytic studies suggests that the current conceptualization of PTSD may not accurately capture the basic underlying dimensions of PTSD. In particular, there has been discussion on the avoidance cluster, which would consist of two separate mechanisms namely active avoidance and numbing (Buckley, Blanchard, & Hickling, 1998; Foa, Riggs, & Gershuny, 1995; Taylor, Kuch, Koch, Crockett, & Passey, 1998). More recent and sophisticated studies support the position that active avoidance and numbing are distinct symptom clusters (Asmundson et al., 2000; King, Leskin, King, & Weathers, 1998; Marshall, 2004; McWilliams, Cox, & Asmundson, 2005). These studies point into the direction of four dimensions: ‘Reexperiencing,’ ‘Avoidance,’ ‘Numbing,’ and ‘Hyperarousal’ either subsumed by a higher order general factor (Asmundson et al., 2000) or consisting of four distinct but first order factors (Asmundson et al., 2000, King et al., 1998 and Marshall, 2004). In a study by Simms, Watson, and Doebbeling (2002), four dimensions described as reexperiencing, avoidance, dysphoria and hyperarousal were found. The dysphoria factor was a combination of symptoms of numbing and hyperarousal.
In the present study, we aimed to determine the factor structure of acute posttraumatic stress symptoms in two different recently trauma-exposed Dutch samples assessed with the Davidson Trauma Scale (DTS; Davidson, 1996). The DTS was developed to address the need for a standardized self-rating instrument in the field of PTSD. It was specifically designed to evaluate symptoms of PTSD in individuals with a broad range of trauma and consists of 17 items corresponding to the DSM IV PTSD symptoms (American Psychiatric Association, 1994). In accordance with the previous findings, we expect to the 4-factor model (with the avoidance cluster split into two) to best fit these samples.
