DSM-5 Four-Cluster PTSD Model
Friedman, M. J.; Resick, P. A.; Bryant, R. A.; Brewin, C. R. · 2011
別名: DSM-5 PTSD · 4-cluster PTSD
The DSM-5 four-cluster PTSD model reorganized PTSD symptoms from three clusters (DSM-IV) into four: intrusion/re-experiencing, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. This restructuring was based on confirmatory factor analyses showing that the DSM-IV avoidance/numbing cluster was better represented as two distinct factors. The model also expanded PTSD from 17 to 20 symptoms and relocated it from anxiety disorders to a new trauma- and stressor-related disorders category.
Four-cluster model of post-traumatic stress disorder as defined in DSM-5: intrusion (Cluster B), avoidance (Cluster C), negative alterations in cognition and mood (Cluster D), and alterations in arousal and reactivity (Cluster E).
- 出典:
- Friedman, M. J. (2014). Literature on DSM-5 and ICD-11. PTSD Research Quarterly, 25(2), 1-10.
- デジタルオブジェクト識別子 — ジャーナル記事への直接リンク。:
- 10.1002/da.20767
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エビデンス概要
- 実証的サポート
- 中程度のエビデンス
- 再現性
- 部分的に再現
- 異文化
- ほぼ普遍的
- メタ分析
- 8件索引済み
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歴史的背景
Friedman, Resick, Bryant, and Brewin (2011) proposed the four-cluster reorganization based on a comprehensive review of empirical literature on PTSD's latent structure, which consistently showed that avoidance and emotional numbing loaded on separate factors. The DSM-5 PTSD criteria were finalized in 2013 after extensive field testing, representing one of the most evidence-based revisions in the DSM-5. PTSD became the first syndrome in psychiatry to have its diagnostic criteria substantially revised based on factor-analytic findings.
構成概念
侵入
Criterion B of the DSM-5 four-cluster PTSD model encompasses re-experiencing symptoms in which the traumatic event is involuntarily relived through recurrent intrusive memories, distressing nightmares, dissociative flashback reactions, intense psychological distress upon exposure to trauma-related cues, and marked physiological reactions to reminders of the event (APA, 2013). At least one intrusion symptom must be present for PTSD diagnosis.
回避
Criterion C of the DSM-5 four-cluster PTSD model reflects persistent effortful avoidance of trauma-related stimuli, manifesting as either avoidance of distressing internal reminders (thoughts, feelings, or memories) or avoidance of external reminders (people, places, conversations, activities) that arouse recollections of the traumatic event (APA, 2013). At least one avoidance symptom must be present for diagnosis.
認知と気分の否定的変化
Criterion D of the DSM-5 four-cluster PTSD model captures persistent negative changes in thinking and emotional experience that began or worsened after trauma, including inability to recall key features of the event, exaggerated negative beliefs, distorted blame, persistent negative emotional states, diminished interest, feelings of detachment, and inability to experience positive emotions (APA, 2013). Two or more symptoms must be present.
覚醒と反応性の変化
Criterion E of the DSM-5 four-cluster PTSD model captures marked changes in arousal and reactivity associated with the traumatic event, manifesting as irritable or aggressive behavior, reckless or self-destructive behavior, hypervigilance, exaggerated startle response, concentration difficulties, and sleep disturbance (APA, 2013). Two or more symptoms must be present, reflecting a state of heightened physiological alertness.
機器
- PTSD Checklist for DSM-5(PCL-5)Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P.2013
この理論に基づくテスト
実践的応用
The four-cluster model directly shapes clinical assessment through instruments like the CAPS-5 (Clinician-Administered PTSD Scale) and PCL-5 (PTSD Checklist), which are structured around the four symptom clusters. It guides treatment planning by allowing clinicians to identify which symptom clusters are most prominent. The expanded symptom set better captures negative cognitive changes and externalizing behaviors (e.g., reckless behavior) that were absent from DSM-IV.
測定方法
The four-cluster structure was derived primarily from confirmatory factor analyses across diverse trauma-exposed populations. Armour et al. (2016) systematically reviewed 112 CFA studies of PTSD's latent structure from DSM-IV through DSM-5.
批評と制限事項
Multiple confirmatory factor analytic studies have found that alternative models, particularly six- and seven-factor models (separating dysphoric arousal from anxious arousal, and anhedonia from negative affect), demonstrate significantly better fit than the official four-factor model. Cross-cultural studies with refugee and non-Western populations have found inconsistencies in the four-cluster structure, with the Anhedonia model often showing superior fit. The expansion to 20 symptoms has been criticized for reducing diagnostic specificity and potentially over-pathologizing normative stress responses.
主要文献
- Friedman, M. J., Resick, P. A., Bryant, R. A., & Brewin, C. R.. (2011). Considering PTSD for DSM-5. 10.1002/da.20767
- Friedman, M. J.. (2013). Finalizing PTSD in DSM-5: Getting here from there and where to go next. 10.1002/jts.21840
- Armour, C., Mullerova, J., & Elhai, J. D.. (2016). A systematic literature review of PTSD's latent structure in the Diagnostic and Statistical Manual of Mental Disorders: DSM-IV to DSM-5. 10.1016/j.cpr.2015.12.003
- Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L.. (2015). The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. 10.1002/jts.22059
- Weathers, F. W., Bovin, M. J., Lee, D. J., Sloan, D. M., Schnurr, P. P., Kaloupek, D. G., Keane, T. M., & Marx, B. P.. (2018). The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and initial psychometric evaluation in military veterans. 10.1037/pas0000486