Addressing the Limitations of Confirmatory Factor Analysis of Posttraumatic Stress Disorder: An Application of Exploratory Structural Equation Modeling

Confirmatory factor analyses (CFA) of posttraumatic stress disorder (PTSD) provided strong empirical rationale for changes to the PTSD criteria for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Recent statistical critiques suggested the CFA constraint to 0 cross-loadings has biased the findings of PTSD CFAs, leading to complex structural models that lack a priori theoretical justification and yield highly correlated factors. The aim of this study was to evaluate the DSM-5 PTSD factor structure using exploratory structural equation modeling (ESEM), which permits cross-loadings. Participants were trauma-exposed undergraduates (N = 1,139) who completed the PTSD Checklist for DSM-5. We evaluated 4-, 6-, and 7-factor models of PTSD in ESEM and CFA and found the 7-factor hybrid model to be best fitting. Comparisons between ESEM and CFA in the 7-factor model indicated presence of significant cross-loadings, justifying the use of ESEM. Compared to the 7-factor CFA, the 7-factor ESEM model was superior in fit, had lower factor loadings and factor intercorrelations, and exhibited better-differentiated patterns of associations with external correlates. These findings suggest that ESEM may be more appropriate than CFA for future investigations of PTSD factor structure.