Posttraumatic stress disorder symptom clusters and trauma-related coping among college students: A structural equation modeling analysis

Trauma-exposed individuals frequently employ substance use and eating behaviors as coping strategies for managing posttraumatic stress disorder (PTSD) symptoms. Yet, research examining differential associations between specific PTSD symptom clusters and distinct coping mechanisms remains limited. This study used structural equation modeling to examine differential associations among the four DSM-5 PTSD symptom clusters (intrusions, avoidance, negative alterations in cognition and mood [NACM], alterations in arousal and reactivity [arousal]) and three common trauma-related coping behaviors: drinking to cope, cannabis use to cope, and eating to cope. Participants were 238 trauma-exposed undergraduate students with probable PTSD (78.6% women; M_age = 22.84 years, SD = 6.8) from a diverse (50.4% White) university in the southeastern United States. Factor scores derived from confirmatory factor analyses modeling the four-factor PTSD structure and each trauma-related coping behavior were entered into a path model, with each of the three coping scores simultaneously regressed on the four PTSD symptom cluster scores. Arousal symptoms were positively and uniquely associated with all three trauma-related coping behaviors, drinking: β = .302; eating: β = .391; cannabis: β = .263. ps = .007-.045. Intrusion symptoms were positively associated with trauma-related eating, β = .225, p = .035. The avoidance and NACM symptom clusters were not uniquely associated with any of the coping behaviors in the full model. These findings elucidate the unique pathways through which distinct PTSD symptom clusters drive specific coping behaviors and support the development of symptom-targeted interventions to reduce reliance on potentially harmful coping strategies.