The underlying dimensionality of PTSD in the diagnostic and statistical manual of mental disorders: where are we going?

There has been a substantial body of literature devoted to answering one question: Which latent model of posttraumatic stress disorder (PTSD) best represents PTSD's underlying dimensionality? This research summary will, therefore, focus on the literature pertaining to PTSD's latent structure as represented in the fourth (DSM-IV, 1994) to the fifth (DSM-5, 2013) edition of the DSM. This article will begin by providing a clear rationale as to why this is a pertinent research area, then the body of literature pertaining to the DSM-IV and DSM-IV-TR will be summarised, and this will be followed by a summary of the literature pertaining to the recently published DSM-5. To conclude, there will be a discussion with recommendations for future research directions, namely that researchers must investigate the applicability of the new DSM-5 criteria and the newly created DSM-5 symptom sets to trauma survivors. In addition, researchers must continue to endeavour to identify the “correct” constellations of symptoms within symptom sets to ensure that diagnostic algorithms are appropriate and aid in the development of targeted treatment approaches and interventions. In particular, the newly proposed DSM-5 anhedonia model, externalising behaviours model, and hybrid models must be further investigated. It is also important that researchers follow up on the idea that a more parsimonious latent structure of PTSD may exist.

已有大量学术文献致力于解答一个核心议题：哪一种创伤后应激障碍（Posttraumatic Stress Disorder, PTSD）潜在模型能够最贴切地反映该障碍的潜在维度结构？因此本研究综述将聚焦于《精神障碍诊断与统计手册（Diagnostic and Statistical Manual of Mental Disorders, DSM）》第四版（DSM-IV，1994）至第五版（DSM-5，2013）中所呈现的PTSD潜在结构相关研究文献。本文将首先阐明该研究领域的必要性与合理性，随后梳理总结与DSM-IV及DSM-IV-TR（DSM-IV文本修订版）相关的研究文献，之后再对新近发布的DSM-5相关研究成果进行综述。最后，本文将展开讨论并提出未来研究方向的建议：其一，研究者需探索新版DSM-5诊断标准及新增的DSM-5症状群在创伤幸存者中的适用性；其二，研究者应持续致力于明确症状群内的"恰当"症状组合，以确保诊断算法的合理性，助力靶向治疗方案与干预手段的开发。尤为关键的是，需进一步探究新近提出的DSM-5快感缺失模型、外化行为模型以及混合模型。此外，研究者还应跟进探索"PTSD或许存在更为简约的潜在结构"这一研究思路。