Posttraumatic Stress Symptom Profiles in Individuals Exposed to Criterion A Traumas versus Non-Criterion A Stressors

Abstract

Variable methods for assessing trauma exposure and mixed findings on the development of posttraumatic stress disorder (PTSD) following traumatic and non-traumatic events have fueled debate regarding the necessity of the traumatic stressor criterion (Criterion A) for a PTSD diagnosis. The current study replicated and expanded previous research by examining the impact of an increasingly rigorous Criterion A rating methodology and several participant characteristics on endorsement of PTSD symptoms in a sample of undergraduate students (N = 1872) who completed a written trauma narrative and self-report measures of trauma exposure, PTSD, and other psychopathology. Profiles of self-rated symptoms of PTSD and co-morbid psychopathology between Criterion A and Non-Criterion A groups were examined with profile analysis (a type of multivariate ANOVA) following the identification of Criterion A groups through three methods: self-report checklist, trauma narrative review, and trauma narrative review with confidence ratings. Possible reasons for endorsement of PTSD symptoms by non-traumatized participants were also explored using profile analysis, including negative impression management, presence of comorbid psychopathology, and exposure to a high magnitude stressor that just missed the definition of a DSM-5 Criterion A trauma. Results indicated that Criterion A groups generally endorsed higher levels of PTSD symptoms than Non-Criterion A groups, especially for the most rigorous Criterion A coding methodology. This supports the Criterion A requirement for a PTSD diagnosis, and highlights the benefits of using narratives and confidence ratings when assessing Criterion A. Further, group profiles departed from parallelism, indicating larger differences between symptoms of reexperiencing, avoidance, and arousal and reactivity compared to negative alterations in cognitions and mood symptoms. The High Magnitude Stressors group responded more similarly to the Criterion A group across self-rated measures of PTSD symptoms and psychopathology. Non-Criterion A participants who endorsed higher levels of PTSD symptoms also endorsed higher depression and anxiety compared to those who endorsed lower levels of PTSD symptoms. Lastly, as part of an exploratory analysis, the removal of sexually violent events from the analysis attenuated the difference between Criterion A and Non-Criterion A groups. The current findings have implications for the accurate identification of trauma exposure, definition of DSM-5 Criterion A, potential differential trauma-relatedness of PTSD symptoms, and the impact of event type and co-occurring psychopathology on the assessment of PTSD.