Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
Clinical Neurosciences Division, Department of Veterans Affairs, National Center for PTSD, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
Psychiatry Res. 2019 Mar;273:266-273. doi: 10.1016/j.psychres.2018.12.094. Epub 2018 Dec 19.
Posttraumatic stress disorder (PTSD) is a heterogeneous condition that can be characterized by unique typologies of symptoms. To date, no study has examined predominant PTSD typologies using DSM-5 criteria. We used latent class analysis (LCA) to identify typologies of DSM-5 PTSD symptoms in 158 U.S. veterans who screened positive for this condition. A three-class solution provided the best fit to the data, described as Dysphoric (36.2%), High Symptom (34.0%) and Threat (29.8%). The Threat class had higher probabilities of intrusions and avoidance compared to the Dysphoric class; the Dysphoric class had higher probabilities of negative affect, anhedonia and externalizing behavior relative to Threat; the High Symptom class had high probabilities of all symptoms. Compared to the Threat class, the Dysphoric class was more likely to have a lifetime history of major depressive, alcohol and drug use disorders; the High Symptom class was more likely to have a lifetime history of alcohol, drug, and nicotine use disorder, current generalized anxiety, or to have attempted or currently contemplated suicide. The High Symptom class reported greater mental, physical and cognitive impairment and lower quality of life. These findings underscore the importance of a personalized approach to the assessment and treatment of DSM-5 PTSD.
创伤后应激障碍(PTSD)是一种异质性疾病,可以通过独特的症状类型来加以描述。迄今为止,尚无研究使用 DSM-5 标准来检查 PTSD 的主要类型。我们使用潜在类别分析(LCA),对 158 名美国退伍军人的 DSM-5 PTSD 症状进行了类型学分析,这些退伍军人都筛查出患有这种疾病。三类别解决方案为数据提供了最佳拟合,可描述为:烦躁不安型(36.2%)、高症状型(34.0%)和威胁型(29.8%)。与烦躁不安型相比,威胁型发生侵入性思维和回避的可能性更高;与威胁型相比,烦躁不安型出现负性情绪、快感缺失和外化行为的可能性更高;高症状型出现所有症状的可能性高。与威胁型相比,烦躁不安型更有可能出现重度抑郁、酒精和药物使用障碍的终生病史;高症状型更有可能出现酒精、药物和尼古丁使用障碍的终生病史、当前广泛性焦虑症病史,或有过自杀未遂或正在考虑自杀。高症状型报告的精神、身体和认知障碍更大,生活质量更低。这些发现强调了对 DSM-5 PTSD 进行个性化评估和治疗的重要性。