Latent profile analysis and principal axis factoring of the DSM-5 dissociative subtype

Figures & data

Table 1 Principal axis factor analysis with direct oblimin rotation of the 20-item PCL-5 plus depersonalization and derealization items

	Communalities		Factor Matrix						Pattern Matrix						Structure Matrix
Items/variables	Init	Extr	1	2	3	4	5	6	1	2	3	4	5	6	1	2	3	4	5	6
1. Intrusive memories	0.41	0.50	0.53	−0.19	−0.28	−0.19	−0.26	0.01	0.69	0.04	0.00	0.05	0.07	0.12	0.69	0.12	0.16	0.15	0.27	−0.13
2. Nightmares	0.32	0.33	0.47	−0.28	−0.03	−0.18	−0.06	0.03	0.45	0.00	0.14	−0.14	0.14	−0.03	0.53	0.08	0.28	−0.10	0.28	−0.24
3. Flashbacks	0.35	0.45	0.50	−0.26	−0.09	−0.13	−0.32	−0.10	0.66	−0.03	0.12	−0.01	−0.11	0.00	0.65	0.08	0.28	0.05	0.10	−0.21
4. Upset at reminder	0.41	0.51	0.52	−0.16	−0.38	−0.15	−0.18	−0.14	0.68	0.03	−0.16	0.11	0.06	−0.04	0.69	0.12	0.03	0.21	0.28	−0.22
5. Phys. reaction at reminder	0.36	0.41	0.50	−0.24	−0.19	0.00	−0.06	−0.14	0.50	−0.10	0.01	0.10	0.07	−0.22	0.60	0.10	0.20	0.16	0.29	−0.37
6. Av. Int. R.	0.34	0.49	0.38	−0.16	−0.27	−0.05	0.37	0.32	0.05	0.01	0.05	0.02	0.68	0.01	0.27	0.05	0.11	0.10	0.69	−0.17
7. Av. Ext. R.	0.38	0.57	0.46	−0.17	−0.26	−0.06	0.39	0.33	0.70	0.03	0.09	0.01	0.71	−0.01	0.32	0.09	0.16	0.11	0.74	−0.22
8. Amnesia	0.19	0.20	0.29	−0.14	0.20	0.13	0.04	0.20	−0.02	−0.06	0.42	0.03	0.16	−0.02	0.14	0.03	0.42	0.03	0.19	−0.17
9. Negative beliefs	0.33	0.53	0.31	0.37	−0.19	0.48	−0.15	0.07	−0.04	0.08	0.15	0.71	−0.03	−0.01	0.09	0.21	0.13	0.71	0.05	−0.06
10. Blaming	0.30	0.41	0.28	0.22	−0.36	0.37	−0.13	0.01	0.12	−0.03	−0.03	0.61	0.02	−0.01	0.19	0.08	−0.02	0.63	0.13	−0.04
11. Neg. emotions	0.34	0.39	0.37	0.35	−0.28	0.22	0.04	−0.05	0.05	0.20	−0.10	0.50	0.09	−0.14	0.19	0.31	−0.02	0.55	0.20	−0.20
12. Loss of interest	0.38	0.53	0.32	0.57	0.05	−0.30	0.08	0.03	−0.03	0.74	−0.07	0.01	0.09	0.05	0.07	0.72	0.04	0.13	0.10	−0.12
13. F. distant/cut−off	0.42	0.55	0.29	0.67	0.00	−0.14	0.03	0.05	−0.10	0.70	−0.05	0.21	0.03	0.07	0.00	0.70	0.02	0.31	0.05	−0.06
14. Anhedonia	0.32	0.39	0.34	0.44	0.13	−0.20	−0.14	0.05	0.10	0.59	0.11	0.07	−0.08	0.12	0.16	0.60	0.20	0.16	−0.03	−0.07
15. Irritable/Anger	0.22	0.25	0.34	0.28	0.21	−0.09	−0.00	−0.09	0.02	0.40	0.12	0.03	−0.09	−0.14	0.13	0.46	0.23	0.08	−0.02	−0.26
16. Risk taking	0.24	0.26	0.29	0.00	0.39	−0.04	−0.14	−0.01	0.09	0.16	0.37	−0.09	−0.17	−0.07	0.16	0.23	0.44	−0.09	−0.11	−0.21
17. Hypervigilance	0.31	0.43	0.42	−0.13	0.12	0.19	0.28	−0.34	0.02	−0.10	0.05	0.08	0.02	−0.65	0.23	0.08	0.23	0.07	0.17	−0.64
18. Startle reactivity	0.36	0.59	0.50	−0.09	0.21	0.14	0.30	−0.42	0.02	−0.00	0.05	0.04	−0.03	−0.75	0.26	0.19	0.29	0.04	0.15	−0.76
19. Diff. concentrating	0.21	0.21	0.31	0.16	0.19	−0.12	0.18	−0.11	−0.04	0.31	0.06	−0.08	0.05	−0.25	0.10	0.36	0.18	−0.03	0.10	−0.34
20. Insomnia	0.12	0.10	0.23	0.03	0.03	−0.15	0.11	−0.07	0.09	0.18	−0.03	−0.10	0.08	−0.14	0.16	0.21	0.07	−0.05	0.14	−0.22
Depersonalization	0.49	0.71	0.50	−0.21	0.56	0.17	−0.17	0.22	0.07	−0.03	0.82	−0.01	−0.06	−0.03	0.26	0.11	0.83	0.28	0.04	0.01
Derealization	0.42	0.49	0.50	−0.07	0.38	0.16	−0.05	0.25	0.01	0.07	0.66	0.08	0.09	−0.02	0.22	0.18	0.68	0.26	−0.07	0.15

Factors were interpreted as follows: 1) Reexperiencing, 2) Emotional Numbing/Anhedonia, 3) Dissociation, 4) Negative Alterations in Cognition & Mood, 5) Avoidance, and 6) Hyperarousal.

Table 2 Six factor correlation matrix identified in principal axis factor analysis of the 20-item PCL-5 plus depersonalization and derealization items

	1	2	3	4	5	6
1) Reexperiencing	1.00
2) Emotional numbing/anhedonia	0.14	1.00
3) Dissociation	0.26	0.17	1.00
4) Negative alterations in cognition & mood	0.12	0.16	−0.03	1.00
5) Avoidance	0.31	0.05	0.07	0.12	1.00
6) Hyperarousal	−0.31	−0.24	−0.31	−0.01	−0.22	1.00

Table 3 Fit indices for different latent class solutions (PCL-5 ≥38)

Model	Loglikelihood	BIC	Entropy	LMR-A p-value	BLRT p-value
Two classes	−18561.07	37545.76	0.849	<0.001	<0.001
Three classes	−18326.61	37222.25	0.826	0.002	<0.001
Four classes	−18202.34	37119.14	0.816	0.475	<0.001^a
Five classes	−18051.67	36963.21	0.872	0.041	<0.001
Six classes	−17961.87^a	36929.03	0.886	0.469	<0.001

BIC=Bayesian information criterion; LMR-A=Lo-Mendell-Rubin adjusted likelihood ratio test; BLRT=bootstrap likelihood ratio test.

^aThe best loglikelihood value was not replicated. As we used a high number of starts, this indicates that too many classes were extracted with a six-class solution.

Fig. 1 PTSD and dissociation symptom severity across five latent classes. EN-M=Emotional Numbing—Moderate. HYP-M=Hyperarousal—Moderate. DISS-M=Dissociation—Moderate. DISS-S=Dissociation—Severe. ND-S=Non-Dissociative—Severe. LC=Latent Class. Statistically significant between class differences are reported in Table 4.

Table 4 Differences between latent classes in PTSD and depersonalization and derealization symptom frequency

	a. Emotional numbing	b. Hyperarousal	c. Moderate D-PTSD	d. Severe D-PTSD	e. Severe ND-PTSD
1. Intrusive memories	1.90 (1.00)^b,c,d,e	2.35 (0.84)^a,d,e	2.26 (0.96)^a,d,e	3.43 (0.76)^a,b,c,e	3.03 (0.81)^a,b,c,d
2. Nightmares	1.13 (1.11)^b,c,d,e	1.98 (1.23)^a,d	2.05 (1.04)^a,d	3.32 (0.71)^a,b,c,e	2.37 (1.33)^a,d
3. Flashbacks	1.22 (1.06)^b,c,d,e	1.75 (1.09)^a,d,e	2.10 (0.99)^a,d	3.21 (0.84)^a,b,c,e	2.34 (1.17)^a,b,d
4. Upset at reminder	2.35 (0.94)^b,d,e	2.65 (0.87)^a,d,e	2.51 (0.90)^d,e	3.60 (0.59)^a,b,c	3.57 (0.65)^a,b,d
5. Phys. React. at Reminder	1.60 (0.93)^b,c,d,e	2.33 (1.05)^a,d,e	2.28 (0.93)^a,d,e	3.74 (0.52)^a,b,c,e	3.10 (0.91)^a,b,c,d
6. Avoid. Int. Reminders	2.25 (1.07)^d,e	2.56 (0.95)^d,e	2.37 (0.96)^d,e	3.25 (0.99)^a,b,c	3.26 (0.83)^a,b,c
7. Avoid. Ext. Reminders	2.11 (1.14)^b,d,e	2.48 (1.00)^a,d,e	2.39 (0.95)^d,e	3.39 (0.84)^a,b,c	3.27 (0.87)^a,b,c
8. Amnesia	1.12 (1.24)^b,c,d,e	1.63 (1.21)^a,d	2.09 (1.25)^a,d	2.75 (1.46)^a,b,c,e	1.69 (1.49)^a,d
9. Negative beliefs	3.04 (1.14)^b,d	2.43 (1.04)^a,d,e	2.70 (0.99)^d,e	3.75 (0.47)^a,b,c,e	3.28 (1.11)^b,c,d
10. Blaming	2.83 (1.19)^d,e	2.82 (0.92)^d,e	2.48 (1.08)^d,e	3.54 (0.76)^a,b,c,e	3.37 (1.00)^a,b,c
11. Negative emotions	3.06 (0.84)^b,c,d,e	2.64 (0.94)^a,d,e	2.64 (0.89)^a,d,e	3.81 (0.40)^a,b,c	3.52 (0.77)^a,b,c
12. Loss of interest	3.19 (0.82)^b,c	1.60 (0.95)^a,c,d,e	2.36 (0.97)^a,b,d,e	3.49 (0.66)^b,c	3.33 (0.78)^b,c
13. Feeling distant/cut-off	3.61 (0.57)^b,c	1.96 (0.90)^a,c,d,e	2.76 (0.88)^a,b,d,e	3.63 (0.62)^b,c	3.48 (0.72)^b,c
14. Anhedonia	2.90 (1.03)^b,c,d	1.42 (0.87)^a,c,d,e	2.53 (0.94)^a,b,d,e	3.46 (0.73)^a,b,c	3.04 (1.13)^b,c
15. Irritability/anger	2.46 (1.19)^b,d,e	1.92 (1.02)^a,c,d,e	2.40 (1.00)^b,d,e	3.39 (0.96)^a,b,c,e	2.85 (1.16)^a
16. Risk taking	0.90 (1.13)^c,d	0.92 (1.06)^c,d	1.96 (1.19)^a,b,d,e	2.81 (1.37)^a,b,c,e	1.23 (1.36)^c,d
17. Hypervigilance	1.76 (1.22)^b,c,d,e	2.43 (1.15)^a,d	2.29 (1.07)^a,d	3.46 (0.76)^a,b,c,e	2.63 (1.16)^a,d
18. Startle reactivity	1.58 (1.20)^b,c,d,e	2.08 (1.01)^a,d,e	2.38 (1.06)^a,d,e	3.49 (0.73)^a,b,c,e	2.81 (1.13)^a,b,c,d
19. Difficulty concentrating	2.63 (1.08)^b,d	2.22 (1.10)^a,d,e	2.60 (0.99)^d	3.40 (0.75)^a,b,c,e	2.89 (1.16)^b,d
20. Insomnia	2.74 (1.32)^d	2.71 (1.21)^c	2.57 (1.12)^d	3.68 (1.21)^a,b,c,e	2.94 (1.21)^d
Depersonalization	0.26 (0.52)^c,d,e	0.30 (0.54)^c,d	2.56 (0.83)^a,b,d,e	3.19 (0.77)^a,b,c,e	0.51 (0.68)^a,c,d
Derealization	1.01 (1.11)^c,d,e	1.01 (0.98)^c,d,e	2.57 (0.96)^a,b,d,e	3.33 (0.93)^a,b,c,e	1.62 (1.33)^a,b,c,d

D=Dissociative, ND=Non-Dissociative. ^aStatistically significantly different from EN-M class; ^bStatistically significantly different from HYP-M class; ^cStatistically significantly different from DISS-M class; ^dStatistically significantly different from DISS-S class; ^eStatistically significantly different from ND-S class.

Table 5 Differences between latent classes on latent factors identified by principal axis factor analysis

	a. Emotional numbing	b. Hyperarousal	c. Moderate D-PTSD	d. Severe D-PTSD	e. Severe ND-PTSD
1. Reexperiencing	−0.73 (0.41)^c,d,e	−0.74 (0.38)^c,d,e	−0.02 (0.52)^a,b,d,e	1.83 (0.51)^a,b,c,e	0.62 (0.46)^a,b,c,d
2. Emotional numbing/Anhedonia	0.82 (0.60)^b,c,d,e	−0.88 (0.66)^a,c,d,e	−0.44 (0.72)^a,b,d,e	0.01 (0.49)^a,b,c	0.25 (0.63)^a,b,c
3. Dissociation	−0.08 (0.70)^b,c,d,e	−0.37 (0.71)^a,c,d,e	0.91 (0.60)^a,b,d,e	0.46 (0.46)^a,b,c,e	−0.70 (0.62)^a,b,c,d
4. Negative alterations in cognition and mood	−0.17 (0.77)^b,c,d	0.20 (0.79)^a,e	0.20 (0.81)^a,e	0.18 (0.45)^a,e	−0.26 (0.79)^b,c,d
5. Avoidance	0.01 (0.91)	0.14 (0.71)	−0.29 (0.74)	−0.21 (0.59)	0.24 (0.73)
6. Hyperarousal	0.06 (0.82)	−0.25 (0.73)	0.30 (0.73)	0.09 (0.63)	−0.19 (0.78)

D=Dissociative, ND=Non-Dissociative. ^aStatistically significantly different from EN-M class; ^bStatistically significantly different from HYP-M class; ^cStatistically significantly different from DISS-M class; ^dStatistically significantly different from DISS-S class; ^eStatistically significantly different from ND-S class. All p's<0.05 Bonferroni corrected.

Table 6 Differences between latent classes in other measures of dissociative experience

	a. Emotional numbing	b. Hyperarousal	c. Moderate D-PTSD	d. Severe D-PTSD	e. Severe ND-PTSD	F	η ^2
CDS anomalous body experience (n=167)	2.27 (3.10)^d	3.03 (4.21)^d	5.74 (9.19)	9.04 (12.21)^a,b,e	2.95 (5.42)^d	4.69	0.10
CDS emotional numbing (n=167)	3.51 (3.69)^d	3.50 (4.04)^d	4.11 (5.71)	7.15 (7.05)^a,e	3.09 (4.08)^d	3.31	0.08
CDS anomalous subjective recall (n=167)	3.76 (3.06)^d	3.50 (3.25)^d	4.93 (4.77)	7.81 (6.54)^a,b,e	3.81 (3.30)^d	5.24	0.12
CDS alienation from surroundings (n=167)	3.46 (2.98)	2.63 (2.33)^d	3.26 (3.80)	5.88 (5.12)^b,e	3.28 (3.38)^d	3.41	0.08
MDI depersonalization (n=82)	8.13 (3.95)^c,d	9.72 (3.99)^d	13.74 (5.58)^a,d	20.38 (5.80)^a,b,c,e	10.15 (4.79)^d	12.17	0.39
MDI derealization (n=82)	10.88 (5.80)^d	10.94 (3.92)^d	14.47 (5.76)^d	21.75 (5.70)^a,b,c,e	11.76 (4.80)^d	8.71	0.31
MDI emotional constriction (n=82)	11.67 (5.53)^d	11.39 (4.43)^d	14.47 (5.76)	19.50 (5.76)^a,b	13.23 (6.07)	3.67	0.16
MDI disengagement (n=82)	14.62 (4.19)^d	14.67 (4.61)	15.32 (6.06)	20.88 (5.74)^a,e	12.85 (5.43)^d	3.28	0.15
MDI memory disturbance (n=82)	9.83 (4.72)^d	10.06 (4.57)^d	14.00 (5.02)	17.50 (8.65)^a,b,e	9.69 (4.70)^d	5.05	0.21
MDI identity dissociation (n=82)	6.54 (3.66)^c,d	7.50 (4.20)^c,d	12.58 (6.12)^a,b	16.75 (7.96)^a,b,e	8.15 (4.77)^d	8.71	0.31
MID depersonalization (n=169)	22.02 (16.63)^c,d	26.94 (25.16)^c,d	58.32 (22.30)^a,b,d,e	83.33 (19.61)^a,b,c,e	31.14 (24.24)^c,d	34.29	0.46
MID derealization (n=169)	16.19 (14.84)^c,d	22.67 (25.15)^c,d	50.15 (19.40)^a,b,d,e	67.80 (19.08)^a,b,c,d	21.83 (23.40)^d,e	30.72	0.43
MID trance (n=169)	23.44 (19.63)^c,d	26.12 (24.26)^c,d	50.37 (22.40)^a,b,e	59.60 (30.71)^a,b,c,e	32.00 (24.77)^c,d	12.40	0.23
MID time loss (n=169)	5.60 (7.45)^c,d	7.93 (7.65)^c,d	14.66 (8.39)^a,b,e	20.13 (12.69)^a,b,e	8.89 (8.90)^c,d	11.84	0.22

Class sizes per wave: EN-M (n _{Wave 1}=41; n _{Wave 2}=24; n _{Wave 3}=48), HYP-M (n _{Wave 1}=30; n _{Wave 2}=18; n _{Wave 3}=33), DISS-M (n _{Wave 1}=27; n _{Wave 2}=19; n _{Wave 3}=38), DISS-S (n _{Wave 1}=26; n _{Wave 2}=8; n _{Wave 3}=15), ND-S (n _{Wave 1}=43; n _{Wave 2}=13; n _{Wave 3}=35). D=Dissociative, ND=Non-Dissociative. ^aStatistically significantly different from EN-M class; ^bStatistically significantly different from HYP-M class; ^cStatistically significantly different from DISS-M class; ^dStatistically significantly different from DISS-S class; ^eStatistically significantly different from ND-S class. CDS=Cambridge Depersonalization Scale, MDI=Multiscale Dissociation Inventory, MID=Multidimensional Inventory of Dissociation.

Table 7 Differences between latent classes in measures of presumed non-dissociative distress

	a. Emotional numbing	b. Hyperarousal	c. Moderate D-PTSD	d. Severe D-PTSD	e. Severe ND-PTSD	F	η ^2
DERS (n=167)	88.37 (27.37)	85.73 (28.67)	87.70 (25.47)	88.33 (26.63)	99.81 (15.19)	1.16	0.03
IIP (n=82)	60.71 (22.20)^d	55.61 (23.05)^d	64.95 (27.68)	61.46 (13.76)^a,b	91.13 (26.48)	3.50	0.15
MID-emotional suffering (n=169)	69.54 (25.78)^b	50.64 (25.30)	67.55 (23.21)^b	79.37 ( 21.43)^b	87.47 (20.49)^b	8.85	0.18

Class sizes per wave: EN-M (n _{Wave 1}=41; n _{Wave 2}=24; n _{Wave 3}=48), HYP-M (n _{Wave 1}=30; n _{Wave 2}=18; n _{Wave 3}=33), DISS-M (n _{Wave 1}=27; n _{Wave 2}=19; n _{Wave 3}=38), DISS-S (n _{Wave 1}=26; n _{Wave 2}=8; n _{Wave 3}=15), ND-S (n _{Wave 1}=43; n _{Wave 2}=13; n _{Wave 3}=35). D=Dissociative, ND=Non-Dissociative. ^aStatistically significantly different from EN-M class; ^bStatistically significantly different from HYP-M class; ^cStatistically significantly different from DISS-M class; ^dStatistically significantly different from DISS-S class; ^eStatistically significantly different from ND-S class. DERS=Difficulty in Emotion Regulation Scale, IIP=Inventory of Interpersonal Problems, MID=Multidimensional Inventory of Dissociation.

Table 8 Differences between latent classes in measures of childhood trauma history

	a. Emotional numbing	b. Hyperarousal	c. Moderate D-PTSD	d. Severe D-PTSD	e. Severe ND-PTSD	F	η ^2
CTQ emotional neglect (n=167)	12.41 (5.18)	13.03 (4.92)	13.30 (5.52)	14.42 (6.05)	13.86 (5.72)	0.67	0.02
CTQ emotional abuse (n=167)	12.24 (6.22)	13.27 (5.98)	13.89 (5.91)	15.23 (7.10)	13.30 (6.49)	0.93	0.02
CTQ sexual abuse (n=167)	8.49 (5.75)	7.00 (4.68)^d	10.44 (6.70)	11.84 (7.88)^b,e	7.14 (4.97)^d	3.78	0.09
CTQ physical abuse (n=167)	7.88 (4.26)^d	7.80 (3.70)	9.96 (4.81)	11.54 (7.03)^a	9.09 (5.31)	2.80	0.07
CTQ physical neglect (n=167)	7.59 (3.88)^d	8.73 (3.36)	10.19 (4.18)	10.88 (5.60)^a	8.79 (4.05)	2.91	0.07
JVQ conventional crime (n=82)	13.63 (10.15)	12.61 (8.84)	15.37 (11.00)	22.75 (12.91)	11.77 (7.42)	1.84	0.09
JVQ child maltreatment (n=82)	6.17 (5.88)	6.50 (5.16)	6.47 (6.14)	11.50 (7.29)	7.00 (4.38)	1.43	0.07
JVQ peer-sibling victimization (n=82)	9.17 (7.23)	11.17 (6.84)	9.32 (9.35)	17.75 (9.56)	8.92 (7.05)	2.12	0.10
JVQ sexual victimization (n=82)	7.67 (7.88)	7.06 (9.12)	8.05 (9.73)	10.63 (12.68)	7.85 (7.84)	0.22	0.01
JVQ witnessing violence (n=82)	7.54 (8.77)	10.11 (9.80)	10.11 (9.55)	15.88 (15.59)	8.00 (6.90)	1.21	0.06
CTQ-S emotional abuse (n=169)	3.40 (1.53)^d	3.24 (1.54)^d	3.63 (1.26)	4.67 (0.81)^a,b	3.97 (1.38)	3.57	0.08
CTQ-S physical abuse (n=169)	1.96 (1.32)^d	2.09 (1.37)^d	2.82 (1.33)	4.00 (1.46)^a,b,e	2.69 (1.53)^d	7.52	0.16
CTQ-S sexual abuse (n=169)	2.42 (1.63)^d	2.12 (1.29)^d	2.45 (1.54)^d	4.13 (1.41)^a,b,c,e	2.77 (1.66)^d	4.89	0.11

Class sizes per wave: EN-M (n _{Wave 1}=41; n _{Wave 2}=24; n _{Wave 3}=48), HYP-M (n _{Wave 1}=30; n _{Wave 2}=18; n _{Wave 3}=33), DISS-M (n _{Wave 1}=27; n _{Wave 2}=19; n _{Wave 3}=38), DISS-S (n _{Wave 1}=26; n _{Wave 2}=8; n _{Wave 3}=15), ND-S (n _{Wave 1}=43; n _{Wave 2}=13; n _{Wave 3}=35). D=Dissociative, ND=Non-Dissociative. ^aStatistically significantly different from EN-M class; ^bStatistically significantly different from HYP-M class; ^cStatistically significantly different from DISS-M class; ^dStatistically significantly different from DISS-S class; ^eStatistically significantly different from ND-S class. CTQ=Childhood Trauma Questionnaire, JVQ=Juvenile Victimization Questionnaire, CTQ-S=Childhood Trauma Questionnaire-Screen.