Examining the disconnect between psychometric models and clinical reality of posttraumatic stress disorder

There have been many factor analytic studies aimed at testing alternative latent structures of DSM-IV and DSM-5 posttraumatic stress disorder (PTSD) symptoms. The primary rationale for such studies is that determining the 'best' factor analytic model will result in better diagnoses if that structure is the basis for diagnostic decisions. However, there appears to be a disconnect between the factor analytic modelling and the diagnostic implications. In this study, we derived prevalence rates based on commonly reported models of PTSD, based on data from two clinical samples (N=434), and also assessed if the different models generated consistent risk estimates in relation to the effects of childhood maltreatment. We found that the different models produced different prevalence rates, ranging from 64.5% to 83.9%. Furthermore, we found that the relationship between childhood maltreatment and 'diagnosis' varied considerably depending upon which latent symptom profile was adopted. It is argued that, given the maturity of this area of research, factor analytic studies of PTSD should now include information on the diagnostic implications of their findings.