The structure of posttraumatic stress symptoms in youth with and without obsessive-compulsive disorder: New insights using factor and network analysis

Abstract

Posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) share ostensibly similar and sometimes overlapping symptoms that complicate diagnostic assessment and conceptualization. While varying models for the symptom structure of PTSD have been proposed – including the presently used 4-factor and a more fine-grained 7-factor model – little research has focused on youth and even less is known about how these symptoms relate to one another when OCD is present. The present study used confirmatory factor analysis (CFA) and network analysis to compare PTSD symptom relations among 2066 trauma-exposed youth aged 8–20 enrolled in the Texas Childhood Trauma Research Network, of which 10.9 % met diagnostic criteria for OCD. CFA model fit was strongest for the 7-factor PTSD model, and multigroup CFA found no evidence that the structure differed as a function of OCD diagnosis, sex, nor age group. Internal consistency in the 7-factor model ranged from poor to good (α = 0.59–0.80), while all clusters of the 4-factor model demonstrated adequate internal consistency (α = 0.75–0.89). Network analysis revealed unique associations between PTSD and OCD. Specifically, having OCD was linked to more Negative Affect (edge = 0.15) and Anhedonia (edge = 0.16), which are both part of the 4-factor Negative Alterations in Cognitions and Mood symptom cluster. While the clinical relevance of the 7-factor model is still unclear, it evidenced mixed empirical support in the present sample and provided greater nuance when examining links between PTSD and OCD.