What Does the PCL-5 Measure? A Conjoint Hierarchical Analysis Using the MMPI-3

The PTSD Checklist for DSM-5 (PCL-5) is a widely used screening instrument for posttraumatic stress disorder (PTSD) symptoms. There is active debate about what the PCL-5 actually measures (i.e., PTSD specific symptoms vs general distress or other transdiagnostic factors), especially when positive screenings are observed using total sum scores. The Minnesota Multiphasic Personality Inventory-3 (MMPI-3) is a broadband clinical instrument used to assess a wide array of self-reported psychological and behavioral difficulties within an established hierarchical structure. Examining the PCL-5 together with the MMPI-3 may clarify the nature of the factors underlying the PCL-5, which can separately contribute to elevated total scores on the instrument. Using a previously well-studied sample of United States veterans and their romantic partners (n = 386), we subjected the PCL-5 items and MMPI-3 scales to a series of conjoint exploratory factor analyses. In this sample, PCL-5 items could be largely explained by three correlated but relatively distinctive factors (affect/cognitions, traumatic intrusion/avoidance, and hyperarousal). Conjoint analysis with the MMPI-3 showed that the PCL-5 affective/cognitive items were differentially saturated with a nonspecific demoralization/distress factor. The PCL-5 hyperarousal factor cross-loaded primarily with MMPI-3 somatic and cognitive scales. The PCL-5 intrusions/avoidance factor cross-loaded minimally with any MMPI-3 scales, identifying that factor’s content as relatively distinctive among the present indicators. We contextualize these findings within recent research and clinical trends that reconsider PTSD through a multidimensional lens. We also discuss clinical implications of these findings; in particular, examining individual PCL-5 symptom groupings may reveal insight into psychological and behavioral processes with greater specificity to posttraumatic symptomatology.