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Abstract
Debates about posttraumatic stress disorder (PTSD) often turn on whether it is a timeless, cross-culturally valid natural phenomenon or a socially constructed idiom of distress. Most clinicians seem to favor the first view, differing only in whether they conceptualize PTSD as a discrete category or the upper end of a dimension of stress responsiveness. Yet both categorical and dimensional construals presuppose that PTSD symptoms are fallible indicators reflective of an underlying, latent variable. This presupposition has governed psychopathology research for decades, but it rests on problematic psychometric premises. In this article, we review an alternative, network perspective for conceptualizing mental disorders as causal systems of interacting symptoms, and we illustrate this perspective via analyses of PTSD symptoms reported by survivors of the Wenchuan earthquake in China. Finally, we foreshadow emerging computational methods that may disclose the causal structure of mental disorders. Ever since its diagnostic debut more than 30 years ago (American Psychiatric Association [APA], 1980), posttraumatic stress disorder (PTSD) has been among the most controversial syndromes in our nosology (Brewin, 2003; McNally, 2003; Rosen, 2004). One abiding controversy concerns its ontological status (McNally, 2012). Is PTSD a timeless, universal psychobiological entity emerging whenever people encounter overwhelming trauma (e.g., Osterman & de Jong, 2007; Yehuda & McFarlane, 1987)?Or is it a socially constructed idiom of distress arising in the wake of the Vietnam War and confined chiefly to contemporary Western culture (e.g., Summerfield, 2001; Young, 1995)? Even some who never doubt the natural status of PTSD question whether it qualifies as a categorical entity, as implied by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA, 2013). For example, after applying Meehl’s (1995) taxometric methods to PTSD symptoms reported by Vietnam veterans, Ruscio, Ruscio, and Keane (2002) concluded that symptoms reflect the high end of a continuum of stress responsiveness rather than a discrete clinical entity. These differences notwithstanding, traumatologists on both sides of the categorical versus dimensional divide agree that PTSD symptoms should be psychometrically construed as reflective indicators of an underlying latent variable. According to this view, the construct of PTSD denotes a latent variable that functions as the common cause of each of the PTSD symptoms (Bollen & Lennox, 1991; Edwards & Bagozzi, 2000). Thus, PTSD symptoms cohere syndromically because they share a common determinant, just as headaches.
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