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. 2024 Oct;16(7):1218-1228.
doi: 10.1037/tra0001537. Epub 2023 Jul 6.

DSM-5 criterion-a-based trauma types in service members and veterans seeking treatment for posttraumatic stress disorder

Natasha Benfer  1 , Breanna Grunthal  1 , Katherine A Dondanville  2 , Stacey Young-McCaughan  2 , Abby Blankenship  2 , Chadi G Abdallah  3 , Sudie E Back  4 , Julianne Flanagan  4 , Edna B Foa  5 , Peter T Fox  6 , John H Krystal  7 , Brian P Marx  8 , Donald D McGeary  2 , Carmen P McLean  9 , Kristi E Pruiksma  2 , Patricia A Resick  10 , John D Roache  2 , Paulo Shiroma  11 , Denise M Sloan  8 , Daniel J Taylor  12 , Jennifer Schuster Wachen  13 , Argelio L López-Roca  14 , Karin L Nicholson  15 , Richard P Schobitz  14 , Christian C Schrader  16 , Allah-Fard M Sharrieff  16 , Jeffrey S Yarvis  16 , Jim Mintz  2 , Terence M Keane  8 , Alan L Peterson  2 , Brett T Litz  1
Affiliations

DSM-5 criterion-a-based trauma types in service members and veterans seeking treatment for posttraumatic stress disorder

Natasha Benfer et al. Psychol Trauma. 2024 Oct.

Abstract

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. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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Conflict of interest statement

Conflict of Interest Disclosures

Natasha Benfer reports research funding from the Department of Veterans Affairs (VA).

Breanna Grunthal reports research funding from the Department of Defense (DoD) and VA.

Stacey Young-McCaughan reports research funding from the DoD, VA, and the National Institutes of Health (NIH).

Katherine A. Dondanville reports research funding from the DoD, the Bob Woodruff Foundation (BWF), Texas Veterans + Family Alliance (TV+FA), Boeing, and the United States Automobile Association (USAA).

Abby E. Blankenship reports research funding from the DoD, the American Psychological Foundation, the American Psychological Association, and the National Institute for Food and Agriculture.

Chadi G. Abdallah reports research funding from the DoD, VA, and NIH. He has served as a consultant, speaker and/or on advisory boards for Aptinyx, Genentech, Janssen, Psilocybin Labs, Lundbeck, Guidepoint, and FSV7, and as editor of Chronic Stress for Sage Publications, Inc. He also filed a patent for using mTORC1 inhibitors to augment the effects of antidepressants (Aug 20, 2018).

Sudie E. Back reports research funding from the DoD, VA, and NIH.

Julianne Flanagan reports research funding from the DoD, VA, and NIH.

Edna B. Foa reports research funding from DoD and NIH and receiving royalties from publishing books on PTSD treatment and honoraria for lectures and workshops on prolonged exposure.

Peter T. Fox reports research funding from the DoD, VA, and NIH.

John H. Krystal reports research funding from the DoD, VA, and NIH.

Brian P. Marx reports research funding from the DoD, VA, and NIH and receiving royalties from publishing books on PTSD treatment and honoraria for lectures and workshops on written exposure therapy.

Donald D. McGeary reports research funding from the DoD, VA, and NIH.

Carmen P. McLean reports research funding from the DoD, the Patient-Centered Outcomes Research Institute (PCORI), the Federal Emergency Management Agency (FEMA).

Kristi E. Pruiksma reports research funding from the DoDand the American Sleep Medicine Foundation.

Patricia A. Resick reports research funding from the DoD, VA, and NIH and receiving royalties from publishing books on PTSD treatment and honoraria for lectures and workshops on cognitive processing therapy.

John D. Roache reports research funding from the DoD, VA, and NIH.

Paulo Shiroma reports research funding from the DoD, VA, and NIH.

Denise M. Sloan reports research funding from the DoD, VA, and NIH and receiving royalties from publishing books on PTSD treatment and honoraria for lectures and workshops on written exposure therapy.

Daniel J. Taylor reports research funding from the DoD, VA, and NIH.

Jennifer Schuster Wachen reports research funding from the DoD and VA.

Jim Mintz reports research funding from the DoD, VA, and NIH.

Terence M. Keane reports research funding from the DoD, VA, and NIH.

Alan Peterson reports research funding from the DoD, VA, NIH, BWF, and TV+FA.

Brett T. Litz reports research funding from the DoD, VA, and NIH.

All other authors report no conflict of interest.

Figures

Figure 1a.
Figure 1a.
Trauma Type Prevalence as Reported by Participants.
Figure 1b.
Figure 1b.
Trauma Type Prevalence as Reported by Independent Coders. Note. LTS = life threat-self. LTO = life threat-other. AV = aftermath of violence. TL = traumatic loss. MIS = moral injury-self. MIO = moral injury-other.
See this image and copyright information in PMC

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