title: Elucidating the transdiagnostic dimensional structure of trauma-related psychopathology: Findings from VA cooperative study 504 - risperidone treatment for military service related chronic post traumatic stress disorder.
abstract: BACKGROUND
  Three of the most common trauma-related mental disorders-posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD)-are highly comorbid and share common transdiagnostic symptom dimensions of threat (i.e., fear) and loss (i.e., dysphoria) symptomatology. However, empirical evaluation of the dimensional structure of component aspects of these disorders is lacking.
  
  
  METHODS
  Using structured clinical interview data from U.S. military veterans with chronic military-related PTSD, we evaluated the transdiagnostic dimensional structure of PTSD, MDD, and GAD symptoms. We then examined the relationship between the best-fitting transdiagnostic model of these symptoms, and measures of physical and mental functioning, and life satisfaction and well-being.
  
  
  RESULTS
  Exploratory factor analysis revealed that a 3-factor transdiagnostic model comprised of loss (i.e., dysphoria), threat (i.e., anxious arousal, re-experiencing, and avoidance symptoms), and somatic anxiety (i.e., physiological manifestations of anxiety) symptoms provided the best representation of trauma-related PTSD, MDD, and GAD symptoms. Somatic anxiety symptoms were independently associated with physical functioning, while loss symptoms were independently associated with mental functioning and life satisfaction and well-being.
  
  
  CONCLUSIONS
  Evaluation of study aims in a relatively homogeneous sample of veterans with chronic, military-related PTSD.
  
  
  CONCLUSIONS
  Results of this study suggest that a 3-factor transdiagnostic model best characterizes the dimensional structure of PTSD, MDD, and GAD symptoms in military veterans with chronic military-related PTSD. This model evidenced external validity in demonstrating differential associations with measures of physical and mental functioning, and life satisfaction and well-being. Results provide support for emerging contemporary models of psychopathology, which emphasize transdiagnostic and dimensional conceptualizations of mental disorders. Such models may have utility in understanding the functional status of trauma survivors.
authors.affiliation: United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States. Electronic address: robert.pietrzak@yale.edu.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pietrzak
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; United States Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, United States.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, United States.
authors.forename: Joyce A
authors.initials: JA
authors.lastname: Cramer
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, United States.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Vessichio
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; United States Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, United States.
authors.forename: Jack
authors.initials: J
authors.lastname: Tsai
authors.affiliation: United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Southwick
authors.affiliation: United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; United States Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, United States; Psychiatry Services, Yale-New Haven Hospital, New Haven, CT, United States.
authors.forename: John H
authors.initials: JH
authors.lastname: Krystal
mesh_terms: D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001143:Arousal; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D018967:Risperidone / Q000627:therapeutic use*; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D014481:United States; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data
chemical_list: D014150:Antipsychotic Agents; D018967:Risperidone
keywords: Depression; Exploratory factor analysis; Functioning; Generalized anxiety disorder; Posttraumatic stress disorder; Veterans