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      The German version of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): psychometric properties and diagnostic utility

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          Abstract

          Background

          The Posttraumatic Stress Disorder (PTSD) Checklist (PCL, now PCL-5) has recently been revised to reflect the new diagnostic criteria of the disorder.

          Methods

          A clinical sample of trauma-exposed individuals ( N = 352) was assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and the PCL-5. Internal consistencies and test-retest reliability were computed. To investigate diagnostic accuracy, we calculated receiver operating curves. Confirmatory factor analyses (CFA) were performed to analyze the structural validity.

          Results

          Results showed high internal consistency (α = .95), high test-retest reliability ( r = .91) and a high correlation with the total severity score of the CAPS-5, r = .77. In addition, the recommended cutoff of 33 on the PCL-5 showed high diagnostic accuracy when compared to the diagnosis established by the CAPS-5. CFAs comparing the DSM-5 model with alternative models (the three-factor solution, the dysphoria, anhedonia, externalizing behavior and hybrid model) to account for the structural validity of the PCL-5 remained inconclusive.

          Conclusions

          Overall, the findings show that the German PCL-5 is a reliable instrument with good diagnostic accuracy. However, more research evaluating the underlying factor structure is needed.

          Electronic supplementary material

          The online version of this article (10.1186/s12888-017-1541-6) contains supplementary material, which is available to authorized users.

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          Most cited references26

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          Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans.

          This study examined the psychometric properties of the posttraumatic stress disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5; Weathers, Litz, et al., 2013b) in 2 independent samples of veterans receiving care at a Veterans Affairs Medical Center (N = 468). A subsample of these participants (n = 140) was used to define a valid diagnostic cutoff score for the instrument using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers, Blake, et al., 2013) as the reference standard. The PCL-5 test scores demonstrated good internal consistency (α = .96), test-retest reliability (r = .84), and convergent and discriminant validity. Consistent with previous studies (Armour et al., 2015; Liu et al., 2014), confirmatory factor analysis revealed that the data were best explained by a 6-factor anhedonia model and a 7-factor hybrid model. Signal detection analyses using the CAPS-5 revealed that PCL-5 scores of 31 to 33 were optimally efficient for diagnosing PTSD (κ(.5) = .58). Overall, the findings suggest that the PCL-5 is a psychometrically sound instrument that can be used effectively with veterans. Further, by determining a valid cutoff score using the CAPS-5, the PCL-5 can now be used to identify veterans with probable PTSD. However, findings also suggest the need for research to evaluate cluster structure of DSM-5. (PsycINFO Database Record
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            Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War.

            Confirmatory factor analysis was used to compare 6 models of posttraumatic stress disorder (PTSD) symptoms, ranging from 1 to 4 factors, in a sample of 3,695 deployed Gulf War veterans (N = 1,896) and nondeployed controls (N = 1,799). The 4 correlated factors-intrusions, avoidance, hyperarousal, and dysphoria-provided the best fit. The dysphoria factor combined traditional markers of numbing and hyperarousal. Model superiority was cross-validated in multiple subsamples, including a subset of deployed participants who were exposed to traumatic combat stressors. Moreover, convergent and discriminant validity correlations suggested that intrusions may be relatively specific to PTSD, whereas dysphoria may represent a nonspecific component of many disorders. Results are discussed in the context of hierarchical models of anxiety and depression.
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              Finalizing PTSD in DSM-5: getting here from there and where to go next.

              The process that resulted in the diagnostic criteria for posttraumatic stress disorder (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association; ) was empirically based and rigorous. There was a high threshold for any changes in any DSM-IV diagnostic criterion. The process is described in this article. The rationale is presented that led to the creation of the new chapter, "Trauma- and Stressor-Related Disorders," within the DSM-5 metastructure. Specific issues discussed about the DSM-5 PTSD criteria themselves include a broad versus narrow PTSD construct, the decisions regarding Criterion A, the evidence supporting other PTSD symptom clusters and specifiers, the addition of the dissociative and preschool subtypes, research on the new criteria from both Internet surveys and the DSM-5 field trials, the addition of PTSD subtypes, the noninclusion of complex PTSD, and comparisons between DSM-5 versus the World Health Association's forthcoming International Classification of Diseases (ICD-11) criteria for PTSD. The PTSD construct continues to evolve. In DSM-5, it has moved beyond a narrow fear-based anxiety disorder to include dysphoric/anhedonic and externalizing PTSD phenotypes. The dissociative subtype may open the way to a fresh approach to complex PTSD. The preschool subtype incorporates important developmental factors affecting the expression of PTSD in young children. Finally, the very different approaches taken by DSM-5 and ICD-11 should have a profound effect on future research and practice. Published 2013. This article is a US Government work and is in the public domain in the USA.
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                Author and article information

                Contributors
                antje.krueger@uni-muenster.de
                christine.knaevelsrud@fu-berlin.de
                hr@ptzbw.org
                anne.dyer@zi-mannheim.de
                i.schaefer@uke.de
                julia.schellong@uniklinikum-dresden.de
                thomas.ehring@lmu.de
                Journal
                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                1471-244X
                28 November 2017
                28 November 2017
                2017
                : 17
                : 379
                Affiliations
                [1 ]ISNI 0000 0001 2172 9288, GRID grid.5949.1, Institute of Psychology, , University of Münster, ; Fliednerstrasse 21, 48149 Münster, Germany
                [2 ]ISNI 0000 0000 9116 4836, GRID grid.14095.39, Department of Clinical Psychology and Psychotherapy, , Free University Berlin, ; 14195 Berlin, Germany
                [3 ]Psychotrauma Centre, German Armed Forces Hospital Berlin, 10179 Berlin, Germany
                [4 ]ISNI 0000 0001 2190 4373, GRID grid.7700.0, Central Institute of Mental Health, , Medical Faculty Mannheim/Heidelberg University, ; 68159 Mannheim, Germany
                [5 ]ISNI 0000 0001 2287 2617, GRID grid.9026.d, Centre for Interdisciplinary Addiction Research, , University of Hamburg, ; 20246 Hamburg, Germany
                [6 ]ISNI 0000 0001 2180 3484, GRID grid.13648.38, Department of Psychiatry and Psychotherapy, , University Medical Centre Hamburg-Eppendorf, ; 20246 Hamburg, Germany
                [7 ]ISNI 0000 0001 2111 7257, GRID grid.4488.0, Department of Psychotherapy and Psychosomatic Medicine, , Technical University Dresden, ; 01307 Dresden, Germany
                [8 ]ISNI 0000 0004 1936 973X, GRID grid.5252.0, Department of Psychology, LMU, ; 80802 Munich, Germany
                Author information
                http://orcid.org/0000-0002-3095-4732
                Article
                1541
                10.1186/s12888-017-1541-6
                5704375
                29183285
                29685b92-d155-4de4-b22f-c2a69bae7550
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 17 May 2017
                : 13 November 2017
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Clinical Psychology & Psychiatry
                posttraumatic stress disorder,dsm-5,pcl-5,self-report questionnaire

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