Network models of DSM–5 posttraumatic stress disorder: Implications for ICD–11.

Abstract

Recent proposals for revisions to the 11th edition of the International Classification of Diseases (ICD-11) posttraumatic stress disorder (PTSD) diagnostic criteria have argued that the current symptom constellation under the Diagnostic and Statistical Manual of Mental Disorders-5 is unwieldy and includes many symptoms that overlap with other disorders. The newly proposed criteria for the ICD-11 include only six symptoms. However, restricting the symptoms to those included in the ICD-11 has implications for PTSD diagnosis prevalence estimates, and it remains unclear whether these six symptoms are most strongly associated with a diagnosis of PTSD. Network analytic methods, which assume that psychiatric disorders are networks of interrelated symptoms, provide information regarding which symptoms are most central to a network. We estimated network models of PTSD in a national sample of veterans of the Iraq and Afghanistan wars. In the full sample, the most central symptoms were persistent negative emotional state, efforts to avoid external reminders, efforts to avoid thoughts or memories, inability to experience positive emotions, distressing dreams, and intrusive distressing thoughts or memories; i.e., three of the six most central items to the network would be eliminated from the diagnosis under the current proposal for ICD-11. An empirically-defined index summarizing the most central symptoms in the network performed comparably to an index reflecting the proposed ICD-11 PTSD criteria at identifying individuals with an independently-assessed DSM-5 defined PTSD diagnosis. Our results highlight the symptoms most central to PTSD in this sample, which may inform future diagnostic systems and treatment.

A Bayesian network analysis of posttraumatic stress disorder symptoms in adults reporting childhood sexual abuse

“…In a study where most participants score very low (or high) on a symptom measure, such skewness can compress variability for a symptom, rendering it difficult to detect a correlation between it and other symptoms in the network. For example, the PTSD symptom referring to difficulty recalling important aspects of the trauma (‘amnesia’) was characterized by very low centrality metrics in our study as well as in other PTSD studies (Armour et al, 2017; Bryant et al, 2017; McNally et al, 2015; Mitchell et al, 2017). In our data, this symptom did exhibit a notably positive skew, potentially contributing to its low centrality.…”

“…Indeed, intrusive memories may prompt intense feelings of shame and guilt that may foster perceived social disconnection and trauma-related avoidance (Lee, Scragg, & Turner, 2001), especially among adult survivors of CSA (Clancy, 2009). In fact, two recent network studies on DSM-5 PTSD revealed that persistent negative emotional states had markedly high centrality (Armour et al, 2017; Mitchell et al, 2017). Yet this symptom was missing from our DSM-IV-based study.…”

“…By using data from adults reporting histories of CSA, we applied network analysis to a new traumatized group beyond the earthquake survivors (McNally et al, 2015), war veterans (Armour, Fried, Deserno, Tsai, & Pietrzak, 2017; Mitchell et al, 2017), and civilian accident and assault survivors (Bryant et al, 2017) that have been the focus of prior studies. Hence, in contrast to previous PTSD studies, our current study involved participants whose stressors were always interpersonal, sexual, and occurred many years earlier.…”

PTSD symptomics: network analyses in the field of psychotraumatology

“…Symptomics research in the area of PTSD has been scarce so far, although several studies have focused on investigating the network structures of PTSD symptoms (Afzali et al, 2017; Armour, Fried, Deserno, Tsai, & Pietrzak, 2017; Bryant et al, 2017; Fried et al, 2017; McNally et al, 2015; Mitchell et al, 2017). The present special issue of EJPT adds to the literature by curating four additional PTSD network studies, each looking at a different aspect of PTSD.…”

Replicability and generalizability of PTSD networks: A cross-cultural multisite study of PTSD symptoms in four trauma patient samples

“…Network models were implemented only recently in the field of PTSD research (McNally et al, 2015), and have been used in at least 11 papers since (Afzali et al, 2016(Afzali et al, , 2017Armour et al, 2016;Birkeland & Heir, 2017;Bryant et al, 2016;Frewen, Schmittmann, Bringmann, & Borsboom, 2013;Knefel, Tran, & Lueger-Schuster, 2016;Mitchell et al, 2017;Spiller et al, 2017;Sullivan, Smith, Lewis, & Jones, 2016). Overall, we identify three specific challenges in the prior literature of PTSD symptom networks that we aim to address in the present paper.…”