DSM-5 Criterion-A-Based Trauma Types in Service Members and Veterans Seeking Treatment for Posttraumatic Stress Disorder

• Published in: Psychological trauma 2024-10, Vol.16 (7), p.1218-1228
• Main Authors: Benfer, Natasha, Grunthal, Breanna, Dondanville, Katherine A., Young-McCaughan, Stacey, Blankenship, Abby, Abdallah, Chadi G., Back, Sudie E., Flanagan, Julianne, Foa, Edna B., Fox, Peter T., Krystal, John H., Marx, Brian P., McGeary, Donald D., McLean, Carmen P., Pruiksma, Kristi E., Resick, Patricia A., Roache, John D., Shiroma, Paulo, Sloan, Denise M., Taylor, Daniel J., Wachen, Jennifer Schuster, López-Roca, Argelio L., Nicholson, Karin L., Schobitz, Richard P., Schrader, Christian C., Sharrieff, Allah-Fard M., Yarvis, Jeffrey S., Mintz, Jim, Keane, Terence M., Peterson, Alan L., Litz, Brett T.
• Format: Article
• Language: English
• Subjects: Adult; Diagnostic and Statistical Manual; Diagnostic and Statistical Manual of Mental Disorders; Female; Health Care Seeking Behavior; Human; Humans; Male; Middle Aged; Military Personnel; Military Personnel - psychology; Military Veterans; Moral Injury; Posttraumatic Stress Disorder; Reproducibility of Results; Stress Disorders, Post-Traumatic - classification; Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - therapy; Subtypes (Disorders); Trauma; Veterans - psychology
• ISSN: 1942-9681; 1942-969X; 1942-969X
• DOI: 10.1037/tra0001537

Objective: In posttraumatic stress disorder (PTSD), the assumption of the equipotentiality of traumas ignores potentially unique contexts and consequences of different traumas. Accordingly, Stein et al. (2012) developed a reliable typing scheme in which assessors categorized descriptions of traumatic events into six "types": life threat to self (LTS), life threat to other, aftermath of violence (AV), traumatic loss, moral injury by self (MIS), and moral injury by other (MIO). We extended this research by validating the typing scheme using participant endorsements of type, rather than assesor-based types. We examined the concordance of participant and assesor types, frequency, and validity of participant-based trauma types by examining associations with baseline mental and behavioral health problems. Method: Interviewers enrolled military personnel and veterans (N = 1,443) in clinical trials of PTSD and helped them select the most currently distressing Criterion-A trauma. Participants and, archivally, assessors typed the distressing aspect(s) of this experience. Results: AV was the most frequently participant-endorsed type, but LTS was the most frequently rated worst part of an event. Although participants endorsed MIS and MIO the least frequently, these were associated with worse mental and behavioral health problems. The agreement between participants and assessors regarding the worst part of the event was poor. Conclusion: Because of discrepancies between participant and assessor typologies, clinical researchers should use participants' ratings, and these should trump assessor judgment. Differences in pretreatment behavioral and mental health problems across some participant-endorsed trauma types partially support the validity of the participant ratings. Clinical Impact Statement We examined participant and trained assessors' categorization of traumatic events using previously established categories: life threat to self, life threat to others, aftermath of violence (AV), traumatic loss, moral injury by self (MIS), and moral injury by others (MIO). Experiencing AV was the most common, whereas MIS and MIO were the least common. However, moral injuries were associated with worse mental and behavioral health problems. Participants and assessors did not agree on the categorization of traumas, suggesting we should use participant (or patient) interpretations of traumatic events, rather than relying on trained assessor or clinician judgment.