Assessing the application of latent class and latent profile analysis for evaluating the construct validity of complex posttraumatic stress disorder: cautions and limitations

Abstract

Background: The diagnosis of complex posttraumatic stress disorder (CPTSD) has been suggested for inclusion in the 11th version of the International Classification of Diseases (ICD-11), with support for its construct validity coming from studies employing Latent Class Analysis (LCA) and Latent Profile Analysis (LPA).Objective: The current study aimed to critically evaluate the application of the techniques LCA and LPA as applied in previous studies to substantiate the construct validity of CPTSD.Method: Both LCA and LPA were applied systematically in one sample (n = 245), replicating the setup of previous studies as closely as possible. The interpretation of classes was augmented with the use of graphical visualization.Results: The LCA and LPA analyses indicated divergent results in the same dataset. LCA and LPA partially supported the existence of classes of patients endorsing different PTSD and CPTSD symptom patterns. However, further inspection of the results with scatterplots did not support a clear distinction between PTSD and CPTSD, but rather suggested that there is much greater variability in clinical presentations amongst adult PTSD patients than can be fully accounted for by either PTSD or CPTSD.Discussion: We argue that LCA and LPA may not be sufficient methods to decide on the construct validity of CPTSD, as different subgroups of patients are identified, depending on the statistical exact method used and the interpretation of the fit of different models. Additional methods, including graphical inspection should be employed in future studies.

New findings questioning the construct validity of complex posttraumatic stress disorder (cPTSD): let’s take a closer look

“…Complex posttraumatic stress disorder (cPTSD) has been the subject of controversy since it was first proposed almost three decades ago (Herman, 1992). In this commentary, I will concur with the conclusion of a recent study by Achterhof et al (2019) that demonstrating construct validity for CPTSD requires more evidence than can be provided by latent class (LCA) and latent profile (LPA) analyses alone. However, I will challenge their assertion that their LCA and LPA results cast doubt on the construct validity of CPTSD, and suggest that instead their findings actually provide consistent evidence of distinct PTSD, CPTSD, and also Disorders of Self Organization (DSO) sub-groups even in a sample of patients diagnosed with PTSD.…”

“…In the midst of this rapidly evolving controversy, Achterhof et al (2019) have reported a timely empirical examination of the construct validity of cPTSD in a sample of adult patients diagnosed with PTSD. Using both latent class (LCA) and latent profile (LPA) analytic procedures, sub-groups were identified with symptom profiles consistent with PTSD and cPTSD.…”

Validation of posttraumatic stress disorder (PTSD) and complex PTSD in Chinese children as per the ICD-11 proposals using the International trauma questionnaire

“…Also, two studies reported a 2-class solution (CPTSD, PTSD) (Karatzias et al, 2017 ; Sachser, Keller, & Goldbeck, 2017 ). Although these divergent findings may be due to the limitations of latent class analysis (LCA) and latent profile analysis (LPA) in the application, these studies were mostly supportive of the results for distinguishing CPTSD and PTSD symptoms (Achterhof, Huntjens, Meewisse, & Kiers, 2019 ). Only one study called this into question, as it showed a 4-class solution with classes differing in severity (Wolf et al, 2015b ).…”

Does Science Literacy Guarantee Resistance to Health Rumors? The Moderating Effect of Self-Efficacy of Science Literacy in the Relationship between Science Literacy and Rumor Belief

“…The participants were asked to rate the extent of their belief in those rumors (1 = extreme doubt, 5 = extreme belief) (e.g., “drinking overnight boiled water causes cancer”). To better identify those participants who were more likely believe health rumors, responses were dichotomized following the methodology of previous studies [ 38 ]. Only participants who disbelieved the health rumors and answered 1 (extreme doubt) or 2 (doubt) in response to either of the five rumors were identified as not-believing (0), being immune to health rumors; otherwise, those who answered 3 (maybe), 4 (believe), or 5 (extreme belief) in any of the five rumors were identified as believing (1), misbelieving in health rumors.…”