The structure of PTSD. Development of the Post Traumatic Symptom scale from a clinician-based perspective

Figures & data

Table 1. Item content of PTSs and corresponding DSM-5 criteria for PTSD.

No.	Content	DSM – 5 Criterion
1	All kinds of memories come to my mind about the event, and I can’t seem to control them. Îmi vin în minte diverse amintiri despre eveniment pe care nu le pot controla.	B1 – Intrusive memory
2	I relive the event, as if it were happening all over again. Retrăiesc evenimentul ca și cum s-ar întâmpla din nou.	B1 – Re-experience
3	I feel restlessness and internal struggle when I encounter stimuli that remind me of what happened. Am o stare de neliniște și zbucium intern când întâlnesc stimuli care-mi amintesc de ce mi s-a întâmplat.	B4 – Cued distress
4	I have very intense sensations in my body when something reminds me of the traumatic event. Am senzații intense și neplăcute în corp atunci când ceva îmi amintește de evenimentul traumatic.	B5 – Cued physical reaction
5	I strive to forget what happened. Mă străduiesc să uit ceea ce s-a întâmplat.	C1 – Avoidance – memory
6	I avoid coming into contact with something that can remind me of the event. Evit să intru în contact cu ceva ce îmi poate aminti de acel eveniment.	C2 – Avoidance – external
7	I don’t like talking about things that remind me of the event. Nu-mi place să stau de vorbă despre lucruri care-mi amintesc de acel eveniment.	C2 – Avoidance – external
8	I have difficulty remembering important parts of the traumatic event. Am dificultăți să-mi amintesc părți importante ale evenimentului traumatic.	D1 – Amnesia
9	I lost my confidence in myself and others. Mi-am pierdut sentimentul încrederii în mine și în ceilalți.	D2 – Distortion – self & others
10	I think I am to blame for what’s happening to me. Cred că sunt de vină pentru ceea ce mi se întâmplă.	D3 – Guilt
11	I can hardly enjoy the things that used to give me pleasure. Mi-e greu să mă mai bucur de lucrurile care înainte îmi făceau plăcere.	D5 – Loss of interest
12	I feel disconnected from the world. Mă simt rupt de lume.	D6 – Detachment / Estrangement
13	I feel like I lost my joy of living. Parcă mi-am pierdut bucuria de viață.	D7 – Dysphoria / Anhedonia
14	I get easily annoyed because of small things. Pot fi scos ușor din sărite de lucruri de nimic.	E1 – Irritability
15	I feel the urge to hurt myself or others. Îmi vine să-mi fac rău mie sau altora.	E2 – Auto- & hetero-aggression
16	I find it difficult to concentrate on my tasks. Mi-e greu să mă concentrez pe ceea ce am de făcut.	E5 – Concentration
17	I sleep very little and I can’t really rest. Dorm puțin și nu mă pot odihni cu adevărat.	E6 – Sleep disturbance /Restlessness
18	I am almost always on my toes because I need to protect myself. Stau aproape permanent în gardă, ca să mă pot proteja.	E3 – Hypervigilance
19	I noticed I startle at unexpected sounds. Am observat că tresar puternic la unele sunete care vin pe neașteptate.	E4 – Startle response
20	I jump out of my skin sometimes. Uneori sar ca un arc.	E4 – Startle response

Note: Original Romanian items are presented in italics.

Table 2. Percentage of trauma-specific exposures within samples 1 and 3.

Traumatic experience	Students	Clients
Accident	18.68%	24.4%
Fire	10.55%	8.0%
Explosion	2.25%	1.1%
Disaster	21.97%	12.1%
Physical abuse	0.0%	8.3%
Psychological abuse	0.0%	15.0%
Attack	0.0%	9.1%
Sexual aggression	17.99%	0.8%
War	1.55%	0.5%
Incarceration	3.81%	2.9%
Torture	2.76%	0.0%
Terrorism	0.0%	0.0%
Injury	22.32%	9.9%
Threats	37.89%	7.8%
Abduction	2.59%	0.5%
Illness	28.37%	26.6%
Medical accident	14.36%	5.9%
Death of a close person	77.68%	37.6%
Other	22.31%	4.8%

Table 3. Item scalability coefficients (SE) and output of monotonicity assessment for the PTSs.

Item	Hi (item scalability)	Active comparisons	Violations	Significant violations
1	.494 (.021)	225	0	0
2	.464 (.022)	178	7	0
3	.526 (.019)	180	2	0
4	.491 (.021)	181	6	0
5	.465 (.023)	208	0	0
6	.439 (.023)	288	1	0
7	.439 (.024)	257	4	0
8	.302 (.029)	251	3	0
9	.491 (.021)	188	4	0
10	.410 (.026)	248	2	0
11	.468 (.023)	174	10	0
12	.490 (.021)	175	2	0
13	.500 (.021)	130	4	0
14	.446 (.023)	194	6	0
15	.422 (.028)	115	1	0
16	.428 (.026)	246	2	0
17	.422 (.024)	22	1	0
18	.400 (.026)	183	1	0
19	.452 (.023)	224	0	0
20	.418 (.024)	250	6	0

Table 4. Competing factor structures, factor loadings and fit indices for PTSs.

Item	DSM-5 (4 factors)		Dysphoric Arousal (5 factors)		Anhedonia (6 factors)		External Behaviours (6 factors)		Hybrid (7 factors)
	Subscale	Loadings	Subscale	Loadings	Subscale	Loadings	Subscale	Loadings	Subscale	Loadings
1. B1	Rexp	.762	Rexp	.763	Rexp	.763	Rexp	.764	Rexp	.764
2. B1	Rexp	.747	Rexp	.747	Rexp	.748	Rexp	.747	Rexp	.748
3. B4	Rexp	.888	Rexp	.888	Rexp	.888	Rexp	.888	Rexp	.888
4. B5	Rexp	.849	Rexp	.848	Rexp	.848	Rexp	.848	Rexp	.847
6. C2	Avoid	.846	Avoid	.850	Avoid	.851	Avoid	.851	Avoid	.852
5. C1	Avoid	.661	Avoid	.658	Avoid	.658	Avoid	.657	Avoid	.657
7. C2	Avoid	.653	Avoid	.652	Avoid	.651	Avoid	.652	Avoid	.651
8. D1	NACM	.499	NACM	.496	NACM	.552	NACM	.493	NACM	.551
9. D2	NACM	.731	NACM	.728	NACM	.831	NACM	.725	NACM	.833
10. D3	NACM	.447	NACM	.442	NACM	.505	NACM	.439	NACM	.504
11. D5	NACM	.761	NACM	.765	Anhed	.783	NACM	.767	Anhed	.783
12. D6	NACM	.765	NACM	.764	Anhed	.759	NACM	.765	Anhed	.758
13. D7	NACM	.821	NACM	.822	Anhed	.835	NACM	.824	Anhed	.835
14. E1	HypA	.496	DysphA	.485	DysphA	.484	ExtB	.534	ExtB	.532
15. E2	HypA	.442	DysphA	.455	DysphA	.456	ExtB	.504	ExtB	.505
16. E5	HypA	.795	DysphA	.828	DysphA	.829	DysphA	.807	DysphA	.807
17. E6	HypA	.679	DysphA	.687	DysphA	.687	DysphA	.676	DysphA	.676
18. E3	HypA	.594	AnxA	.685	AnxA	.685	AnxA	.685	AnxA	.685
19. E4	HypA	.636	AnxA	.777	AnxA	.778	AnxA	.778	AnxA	.778
20. E4	HypA	.575	AnxA	.677	AnxA	.677	AnxA	.677	AnxA	.677
Second order model fit	χ2 (166)= 499.12, p < .001 TLI = .896, CFI = .909, RMSEA = .073 with 95%CI = [.066, .081], SRMR = .055		χ2 (165) = 423.80, p < .001 TLI = .919, CFI = .930, RMSEA = .065 with 95%CI = [.057, .072], SRMR = .051		χ2 (164) = 398.95, p <.001 TLI = .926, CFI = .936, RMSEA = .062 with 95%CI = [.054, .070], SRMR = .051		χ2 (164) = 425.96, p <.001 TLI = .917, CFI = .929, RMSEA = .065 with 95%CI = [.058, .073], SRMR = .052		χ2 (163) = 401.13, p <.001 TLI = .924, CFI = .935, RMSEA = .063 with 95%CI = [.055, .070], SRMR = .052
Bifactor model fit	χ2 (150) = 360.75, p < .001 TLI = .927, CFI = .943, RMSEA = .061 with 95%CI = [.053, .069], SRMR = .051		χ2 (150) = 362.18, p < .001 TLI = .927, CFI = .930, RMSEA = .062 with 95%CI = [.054, .070], SRMR = .050		χ2 (150) = 366.34, p <.001 TLI = .925, CFI = .941, RMSEA = .062 with 95%CI = [.054, .070], SRMR = .048		χ2 (152) = 370.63, p <.001 TLI = .926, CFI = .941, RMSEA = .062 with 95%CI = [.054, .070], SRMR = .051		χ2 (152) = 375.12, p <.001 TLI = .924, CFI = .939, RMSEA = .063 with 95%CI = [.055, .071], SRMR = .049

Note: Rexp, re-experiencing; Avoid, avoidance; NACM, negative alterations in cognitions and mood; HypA, hyperarousal; DysphA, dysphoric arousal; AnxA, anxious arousal; Anhed, anhedonia; ExtB, externalizing behaviours; Th, threat.

Figure 1. Correlations between PTSs’ items in the first responders sample versus the student sample.

Figure 2. Correlations between subscales of PTSs, PCL-5, and DASS.

Figure 3. ROC Curve of the PCL-5 compared to SCID-5 diagnoses (N = 95).

Data availability statement

The data that support the findings of the current study are openly available in OSF at https://osf.io/mptxv/, with identifier: Doi:10.17605/OSF.IO/MPTXV.