Exploring the factor structure of the PTSD checklist for DSM-5 in psychotic disorders

Psychol Trauma. 2021 Sep 30. doi: 10.1037/tra0001146. Online ahead of print.


Objective: The PTSD Checklist for DSM (PCL) is the most widely used screener to assess posttraumatic stress disorder (PTSD) in those with psychotic disorders (psychosis), though previous research has questioned its validity in psychosis. Considerable symptom overlap between the 2 disorders (e.g., concentration difficulties, avoidance, etc.) along with the general underdiagnosing of PTSD in psychosis speaks to the need for consensus regarding brief screeners. This hypothesis-generating study is the first to explore the PCL-5 (its most recent iteration) factor structure in psychosis to assess if a more valid underlying structure may exist.

Method: Sixty-5 individuals who met the DSM-5 PTSD criterion A traumatic event following an interview subsequently completed the PCL-5. Exploratory factor analysis was conducted to explore the latent structure of the PCL-5 in psychotic disorders.

Results: A 4-factor solution differing from the DSM-5 4-factor model emerged as the best fitting model. Resulting PCL-5 dimensions in psychosis were identified as (1) Reexperiencing/Negative Affect; (2) Depressive; (3) Externalizing Anxious Behaviors; and (4) Avoidance/Physiological Reactivity.

Conclusions: Results guide the hypothesis that the latent structure of the PCL-5 may be unique in psychosis, which will have important clinical implications. Research is now needed to confirm the proposed model in larger samples of individuals with psychosis. (PsycInfo Database Record (c) 2021 APA, all rights reserved).