Psychological Medicine

Original Articles

Diagnostic alterations for post-traumatic stress disorder: examining data from the National Comorbidity Survey Replication and National Survey of Adolescents

Jon D. Elhaia1 c1, Julian D. Forda2, Kenneth J. Ruggieroa3 and B. Christopher Frueha4

a1 University of South Dakota, Vermillion, SD, USA

a2 University of Connecticut Medical School, Farmington, CT, USA

a3 Medical University of South Carolina, Charleston, SC, USA

a4 Baylor College of Medicine and the Menninger Clinic, Houston, TX, USA


Background Two alternative models of post-traumatic stress disorder (PTSD) appear to represent the disorder's latent structure better than the traditional Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) three-factor PTSD model. The present study examines the impact of using these structural models for the diagnosis of lifetime PTSD while retaining the DSM-IV PTSD's six-symptom diagnostic requirement.

Method Data were gathered from large-scale, epidemiological datasets collected with adults (National Comorbidity Survey Replication) and adolescents (National Survey of Adolescents). Two alternative, empirically supported four-factor models of PTSD were compared with the DSM-IV three-factor PTSD diagnostic model.

Results Results indicated that the diagnostic alterations resulted in substantially improved structural validity, downward adjustments of PTSD's lifetime prevalence (roughly 1 percentage point decreases in adults, 1–2.5 percentage point decreases in adolescents), and equivalent psychiatric co-morbidity and sociodemographic associations.

Conclusions Implications for modifying PTSD diagnostic criteria in future editions of DSM are discussed.

(Received October 13 2008)

(Revised March 09 2009)

(Accepted March 14 2009)

(Online publication April 20 2009)


c1 Address for correspondence: J. D. Elhai, Ph.D., Disaster Mental Health Institute, The University of South Dakota, 414 East Clark Street – SDU 114, Vermillion, South Dakota 57069-2390, USA. (Email: