The latent factor structure of acute stress disorder following bank robbery: Testing alternative models in light of the pending DSM-5
Correspondence should be addressed to Maj Hansen, Institute of Psychology, National Centre for Psychotraumatology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark (e-mail: firstname.lastname@example.org).
Acute stress disorder (ASD) was introduced into the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) to identify posttraumatic stress reactions occurring within the first month after a trauma and thus help to identify victims at risk of developing posttraumatic stress disorder (PTSD). Since its introduction, research into ASD has focused on the prediction of PTSD, whereas only a few studies have investigated the latent structure of ASD. Results of the latter have been mixed. In light of the current proposal for the ASD diagnosis in the pending DSM-5, there is a profound need for empirical studies that investigate the latent structure of ASD prior to the DSM-5 being finalized.
Based on previous factor analytic research, the DSM-IV, and the proposed DSM-5 formulation of ASD, four different models of the latent structure of ASD were specified and estimated.
The analyses were based on a national study of bank robbery victims (N = 450) using the acute stress disorder scale.
The results of the confirmatory factor analyses showed that the DSM-IV model provided the best fit to the data. Thus, the present study suggests that the latent structure of ASD may best be characterized according to the four-factor DSM-IV model of ASD (i.e., dissociation, re-experiencing, avoidance, and arousal) following exposure to bank robbery.
The results are pertinent in light of the pending DSM-5 and add to the debate about the conceptualization of ASD.
- The present study supports the DSM-IV conceptualization of ASD and thus underlines the need of further research into the ASD structure before the launching of the DSM-5.
- Clinical theory and practice may be affected in several ways if future research, such as this study, fails to support the proposed structure of ASD in the DSM-5 and new proposals of ASD in the DSM-5 are not set forward and tested.
- Treatment of acute posttraumatic symptoms will likely become less effective if it focuses on an imprecise conceptualization of ASD.
- Although possible, it seems unlikely that the results of the present study may simply reflect properties of the ASDS rather than the ASD diagnosis, because the DSM-IV model has been supported in prior studies using both a diagnostic interview and the ASDS.
- The results of the present study are based on bank robbery victims and thus should be generalized to other trauma populations with caution.