Journal of Anxiety Disorders 37 (2016) 10–20

Contents lists available at ScienceDirect

Journal of Anxiety Disorders

Latent profiles of DSM-5 PTSD symptoms and the “Big Five”

personality traits
Ateka A. Contractor a,b,g,∗ , Cherie Armour c , M. Tracie Shea b,d , Natalie Mota e,f ,
Robert H. Pietrzak e,f
a
Department of Psychology, University of Toledo, 2801 West Bancroft St., Toledo, OH 43606-3390, USA
b
Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Box Box G-BH, Providence, RI 02912, USA
c
School of Psychology, Ulster University, Cromore Road, Coleraine, Northern Ireland, UK
d
Veterans Affairs Medical Center, 830 Chalkstone Avenue, Providence, RI 02908, USA
e
United States Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut
Healthcare System, West Haven, CT, USA
f
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
g
VA Boston Healthcare System (Massachusetts Veterans Epidemiology Research and Information Center), Boston, MA 02130, USA

a r t i c l e i n f o a b s t r a c t

Article history: Typologies of DSM-5 PTSD symptoms and personality traits were evaluated in regard to coping styles and
Received 2 June 2015 treatment preferences using data from 1266 trauma-exposed military veterans of which the majority
Received in revised form 1 October 2015 were male (n = 1097; weighted 89.6%). Latent profile analyses indicated a best-fitting 5-class solution;
Accepted 15 October 2015
PTSD asymptomatic and emotionally stable (C1); predominant re-experiencing and avoidance symp-
Available online 20 October 2015
toms and less emotionally stable (C2); subsyndromal PTSD (C3); predominant negative alterations
in mood/cognitions and combined internalizing–externalizing traits (C4); and high PTSD severity and
Keywords:
combined internalizing–externalizing traits (C5). Compared to C5, C1 members were less likely to use
DSM-5 PTSD
Big-five personality dimensions
self-distraction, denial, and substance use and more likely to use active coping; C2 and C4 members were
Latent profile analyses less likely to use denial and more likely to use behavioral disengagement; C3 members were less likely
Coping to use denial and instrumental coping and more likely to use active coping; most classes were less likely
Mental health treatment to seek mental health treatment. Compared to C1, C2 members were more likely to use self-distraction,
substance use, behavioral disengagement and less likely to use active coping; C3 members were more
likely to use self-distraction, and substance use, and less likely to use positive reframing, and acceptance;
and C4 members were more likely to use denial, substance use, emotional support, and behavioral disen-
gagement, and less likely to use active coping, positive reframing, and acceptance; all classes were more
likely to seek mental health treatment. Emotional stability was most distinguishing of the typologies.
Other implications are discussed.
© 2015 Elsevier Ltd. All rights reserved.

1. Introduction emotionality and high negative emotionality), externalizers (high

Research has demonstrated a link between posttraumatic stress
disorder (PTSD) symptoms and pre-trauma/post-trauma personal-
ity traits (reviewed in Jakšić, Brajković, Ivezić, Topić, & Jakovljević,
2012). An important line of research evaluating personality-PTSD
typologies post-trauma exposure has consistently found sup-
port for three personality typologies: internalizers (low positive
∗ Correspondence author at: Department of Psychiatry and Human Behavior, War-
ren Alpert Medical School of Brown University, Box Box G-BH, Providence, RI 02912,
USA.
E-mail address: ateka.c@gmail.com (A.A. Contractor).
negative emotionality and low constraint), and those with simple
PTSD and low pathology (Carleton, Mulvogue, & Duranceau, 2015;
Castillo et al., 2014; McDevitt-Murphy et al., 2012; Miller, Greif, &
Smith, 2003; Miller, Kaloupek, Dillon, & Keane, 2004; Rielage, Hoyt,
& Renshw, 2010; Thomas et al., 2014). To date, however, no known
study has assessed how DSM-5 PTSD symptoms may co-occur with
personality traits to create PTSD-personality typologies or how
these typologies relate to coping styles and treatment options. Con-
sideration of PTSD-personality heterogeneity may inform clinical
practice, specifically matching treatment to individuals with dif-
ferent PTSD and personality trait profiles (Miller, 2003).
Personality traits refer to a tendency to demonstrate thoughts,
feelings, and behaviors consistently in a developmental and con-

http://dx.doi.org/10.1016/j.janxdis.2015.10.005
0887-6185/© 2015 Elsevier Ltd. All rights reserved.
 A.A. Contractor et al. / Journal of Anxiety Disorders 37 (2016) 10–20
textual framework (McCrae & Costa, 2003). Research indicates
that personality traits influence four aspects of posttraumatic
stress disorder (PTSD) symptoms: (1) vulnerability, (2) resilience,
(3) posttraumatic growth (PTG), and (4) behavioral expressions
(reviewed in Jakšić et al., 2012). Regarding vulnerability and pro-
tective factors, PTSD symptoms positively related to negative
emotionality, neuroticism, harm avoidance, novelty-seeking, self-
transcendence, hostility/anger, and anxiety; and negatively relate
to extraversion, conscientiousness, self-directedness, the combina-
tion of high positive and low negative emotionality, hardiness, and
optimism (reviewed in Jakšić et al., 2012).
Regarding the behavioral expression of personality traits asso-
ciated with PTSD, cluster and latent class analytic (LCA) studies
have found evidence of three distinct personality typologies among
trauma-exposed individuals (Carleton et al., 2015; Castillo et al.,
2014; Jakšić et al., 2012; McDevitt-Murphy et al., 2012; Miller,
2003; Miller et al., 2003; Miller et al., 2004; Rielage et al., 2010;
Sellbom & Bagby, 2009; Thomas et al., 2014; Wolf, Miller, &
Harrington, 2012). Internalizers who are more likely to express dis-
tress inwards are characterized by low positive emotionality (less
tendency to experience positive emotions and fewer healthy inter-
personal engagements) and high negative emotionality (greater
tendency to experience negative emotions such as anger, and
more problematic interpersonal interactions). Externalizers, who
are more likely to express distress outwards, are characterized by
lower constraint (less tendency to minimize risk, avoid harm, and
be cautious), and higher negative emotionality. Those with simple
PTSD generally have low personality pathology.
The three personality typologies have differing comorbidities,
patterns of PTSD symptoms, and PTSD severity. Internalizers are
more likely to have posttraumatic depression and anxiety (e.g.,
Castillo et al., 2014; Forbes, Elhai, Miller, & Creamer, 2010; Miller,
2003), while externalizers are more likely to have posttraumatic
aggression and substance use (e.g., Castillo et al., 2014; Flood et al.,
2010; Forbes et al., 2010; Miller et al., 2004; Sellbom & Bagby, 2009).
While some studies have found significantly greater PTSD sever-
ity among internalizers (Castillo et al., 2014; Flood et al., 2010;
Miller & Resick, 2007), others have documented no significant dif-
ferences across personality typologies in PTSD severity (Sellbom &
Bagby, 2009; Wolf et al., 2012). Miller and Resnick (2007) found
that internalizers endorsed significantly more severe hyperarousal
symptoms than other personality type groups whereas Carleton
et al. (2015) found that externalizers and those with simple PTSD
had significantly more severe hyperarousal symptoms.
Existing studies on personality typologies have some limita-
tions. First, most studies have used cluster analytic techniques (e.g.,
Castillo et al., 2014; McDevitt-Murphy et al., 2012; Miller et al.,
2003; Miller & Resick, 2007; Rielage et al., 2010); fewer studies
have used latent profile analyses (LPA) or latent class analyses (LCA;
Forbes et al., 2010; Thomas et al., 2014; Wolf et al., 2012). Compar-
atively, LPA and LCA approaches use more objective determinants,
such as Bayesian information criteria (BIC) values and Lo-Mendell
Rubin test (LMR) values to determine the appropriate number of
classes, and do not assume equal class sizes (Nylund, Asparouhov
et al., 2007). Second, no known study has combined DSM-5 PTSD
symptoms and personality traits to determine class membership;
this has important implications for treatment matching (Miller,
2003) and in predicting resiliency post-trauma exposure (Wilson
& Agaibi, 2006). Third, personality typologies have rarely been
compared in PTSD symptom cluster severity (Carleton et al.,
2015; Miller & Resick, 2007), and no known study has looked
at PTSD-personality typologies in relation to coping and mental
health treatment. Research indicates that personality traits differ-
entially relate to coping styles (Brebner, 2001; Watson & Hubbard,
1996). For example, neuroticism is associated with passive and
emotion-focused coping such as denial; distraction by daydream-
11
ing, fantasizing or involvement in substitute activities; expressing
negative feelings: and self-pre-occupation (Brebner, 2001; Watson
& Hubbard, 1996). Lastly, unique to our study is the evaluation
of study aims in a contemporary, nationally representative sam-
ple of trauma-exposed veterans. Thus, our aims were to: (1) assess
PTSD-personality typologies using DSM-5 PTSD symptoms and the
Big-Five personality traits; (2) evaluate class differences in severity
of DSM-5 PTSD symptom clusters, number of traumatic experi-
ences, and personality traits; and (3) determine class differences
in coping styles and mental health treatment utilization.
2. Method
2.1. Participants and procedure
The National Health and Resilience in Veterans Study (NHRVS) is
a contemporary, nationally representative survey of 1484 U.S. vet-
erans drawn from a research panel of more than 50,000 households
maintained by GfK Knowledge Networks, Inc. GfK Knowledge Net-
works is a survey research firm which utilizes a probability-based,
online non-volunteer access survey panel called KnowledgePanel® ,
a nationally representative sample of U.S. adults covering approxi-
mately 98% of U.S. households. The study was conducted between
September and October 2013. A total of 1602 adults responded
“Yes” to an initial screening question confirming veteran status and
1484 participated in the NHRVS; response rate was 92.6%. The high
response rate is likely accounted for the survey panelists having
agreed to participate in the survey panel prior to the current study
being initiated. Participants were reimbursed $15 for completing
the survey.
To permit generalizability of study results to the entire
population of U.S. veterans, poststratification weights, which
were computed by GfK Knowledge Networks statisticians, were
applied based on demographic distributions (i.e., age, gender,
race/ethnicity, education, Census region, metropolitan area) from
the most contemporaneous U.S. Census Bureau Current Popu-
lation Survey. All participants provided informed consent prior
to participation. Questionnaires were completed online via a
secure web-based system maintained by GfK Knowledge Networks.
Anonymity was protected; none of the NHRVS investigators had
access to any identifying information nor did they have any contact
with participants.The NHRVS study was approved by the Human
Subjects Committee of the VA Connecticut Healthcare System, and
the VA Office of Research and Development.
2.2. Assessments
2.2.1. The Trauma History Screen
(THS; Carlson et al., 2011) is a self-report measure assessing the
lifetime occurrence of 13 potentially traumatic events (e.g., motor
vehicle accidents, military combat, unexpected loss of a loved one).
For the purposes of the NHRVS, an additional traumatic experi-
ence of ‘life-threatening illness or injury’ was added. Participants
responded by indicating ‘yes’—this kind of thing happened to me
or ‘no’—this kind of thing did not happen to me. Excellent psy-
chometric properties of this measure have been shown across four
independent studies (Carlson et al., 2011).
2.2.2. The Posttraumatic Stress Disorder-Checklist version 5
(PCL-5) is a 20-item self-report assessment of DSM-5 PTSD
symptom severity (Weathers et al., 2013). In the current study,
the PCL-5 was modified to assess lifetime PTSD symptoms on
a five-point Likert-type scale (0 = Not at all to 4 = Extremely) in
relation to each respondent’s self-nominated ‘worst’ traumatic
event. The original PCL version has high test-retest reliability
12 A.A. Contractor et al. / Journal of Anxiety Disorders 37 (2016) 10–20

Table 1
Demographic characteristics for the full sample and each of the latent classes.

Demographics Total AsPTSDEs1 ReAvEs2 SubPTSD3 NAMCInEx4 PTSD InEx5

Sample N (wt%) (wt%) (wt%) (wt%) (wt%)
(wt%)

Total N 1,226 719 60 309 88 50

(100) (54.7) (7.3) (25.1) (7.0) (5.9)
Mean Mean Mean Mean Mean Mean
(SD) (SD) (SD) (SD) (SD) (SD)
Age 60.6 (15.3) 66.47 57.45 60.04 54.52 47.10
(13.17) (13.59) (14.94) (13.43) (15.90)
Years of Military Service 7.24 7.45 6.33 6.99 7.11 7.08
(7.55) (7.95) (6.25) (7.27) (6.92) (5.67)
n n n n n n
(wt%) (wt%) (wt%) (wt%) (wt%) (wt%)
Male gender 1097 (89.6) 672 52 269 71 33
(92.6) (84.5) (88.8) (84.7) (76.9)

Marital status
Married 835 521 38 200 48 28
(63.8) (67.5) (60.6) (63.0) (54.3) (48.1)
Not currently married 391 198 22 109 40 22
(36.2) (32.5) (39.4) (37.0) (45.7) (51.9)

Race
White (non-hispanic) 1001 610 45 247 68 31
(76.1) (80.6) (66.0) (72.6) (73.4) (65.6)
Racial/ethnic minority 225 109 15 62 20 19
(23.9) (19.4) (34.0) (27.4) (26.6) (34.4)

Enlistment status
Drafted 177 118 5 45 7 2
(12.4) (14.7) (13.7) (10.8) (7.2) (2.0)
Enlisted 1039 595 55 260 81 48
(87.1) (84.6) (86.3) (88.4) (92.8) (98.0)
Refused 10 6 / 4 / /
(0.6) (0.7) / (0.8) / /

Note: % are weighted values thus representative of the US veteran population. AsPTSDEs1 = PTSD asymptomatic and emotionally stable, ReAvEs2 = predominant re-experiencing
and avoidance symptoms and less emotional stability, SubPTSD3 = subsyndromal PTSD, NAMCInEx4 = predominant NAMC and combined internalizing–externalizing traits,
PTSDInEx5 = high PTSD symptom severity and combined internalizing–externalizing traits.

(r = .96), and is strongly correlated with other PTSD self-report mea-
sures (Mississippi Scale for Combat Related PTSD; r = .85–.93) and
clinician-administered interviews (Clinician-Administered PTSD
Scale; r = .79; reviewed in McDonald & Calhoun, 2010). In the
current study, the PCL-5 demonstrated good internal consistency
(Cronbach’s alpha = .95). To evaluate the DSM-5 PTSD dimensions,
we used the four DSM-5 PTSD symptom clusters of re-experiencing,
avoidance, negative alterations in mood and cognitions (NAMC),
and alterations in arousal and reactivity (AAR; American Psychiatric
Association, 2013). Probable PTSD was operationalized as a score
of 38 or higher (Hoge, Riviere, Wilk, Herrell, & Weathers, 2014).
2.2.3. Ten-Item Personality Inventory
(TIPI; Gosling, Rentfrow, & Swann, 2003) is a 10—item self-
report brief measure of the “Big Five” personality traits of emotional
stability (anxious versus confident and calm), extraversion (out-
going versus reserved), openness to experience (imaginative and
inventive versus cautious and routine-like), agreeableness (friendly
and cooperative versus detached), and conscientiousness (efficient
and organized versus careless). Respondents rate these items on a
seven-point Likert scale (1 = disagree strongly to 7 = agree strongly).
Items are paired into 5 sets of 2 items. The scale is scored by
taking the average of the item pairs after the reversal of the
appropriate items. The subscale scores were utilized in the anal-
yses in this study. In the current study, the TIPI demonstrated
good consistency (Cronbach’s alpha = .75) for the total measure.
The subscales reliability alphas were as follows: Emotional Stabil-
ity (Cronbach’s alpha = .69), Extraversion (Cronbach’s alpha = .55),
Conscientiousness (Cronbach’s alpha = .54), and Openness to Expe-
riences (Cronbach’s alpha = .48), and Agreeableness (Cronbach’s
alpha = .43).
2.2.4. Brief COPE
Individuals were given a list of 14 coping styles selected from
the Brief-COPE which assesses coping reactions (Carver, 1997) and
were asked to rank the three that they “most commonly use” to
deal with their PTSD symptoms. These coping styles include active
coping (active steps to deal with the stressor or its effects), use
of emotional support (moral support, sympathy or empathy from
others), use of instrumental support (advice, information and help
from others), planning, positive reframing (interpreting a stress-
ful situation in positive terms), acceptance of the reality of the
stressor, humor, tendency to turn to religion in times of stress,
self-distraction, denial, substance use, behavioral disengagement
(reducing effort and giving up), venting of feelings, and self-blame
(Carver, 1997; Carver, Scheier, & Weintraub, 1989; Meyer, 2001).
There is evidence of good convergent and discriminant validity
for the scales, and adequate internal consistency for most scales
(Carver, 1997; Carver et al., 1989).
2.2.5. Utilization of psychotropic medications and psychotherapy
Individuals were asked to give a yes/no response to the follow-
ing questions: “Are you currently taking prescription medication
for a psychiatric or emotional problem?” and “Are you currently
receiving psychotherapy or counseling for a psychiatric or emo-
tional problem?”
2.3. Exclusions and missing data
Participants who did not disclose a traumatic experience on the
THS (n = 216) and who were missing >30% of the PCL-5 items (n = 42)
were excluded, leaving an effective sample size of 1226. All remain-
ing missing data in the 1226 cases on the PCL items was estimated
 A.A. Contractor et al. / Journal of Anxiety Disorders 37 (2016) 10–20
Table 2
Frequencies of reported potentially traumatic events.
Potentially traumatic events (n = 1226)
Life-threatening illness or injury
A really bad car, boat, train, or airplane accident
A really bad accident at work or home
A hurricane, flood, earthquake, tornado, or fire
Hit or kicked hard enough to injure—as a child
Hit or kicked hard enough to injure—as an adult
Forced or made to have sexual contact—as a child
Forced or made to have sexual contact—as an adult
Attacked with a gun, knife, or weapon
During military service—saw something horrible or was badly scared
Sudden death of close family member or friend
Seeing someone die suddenly or get badly hurt or killed
Sudden move or loss of home and possessions
Suddenly abandoned by spouse, partner, parent, or family
Some other sudden event that made you feel very scared, helpless, or horrified
Note: categories are not mutually exclusive. These are all reported potentially traumatic events and not the ‘worst event.’ Wt = weighted%
using maximum likelihood (ML). There were no missing data across
the TIPI or Brief COPE items.
2.4. Effective sample characteristics
The effective sample (n = 1226) had a mean age of 60.6
(SD = 15.3; range = 20–94). The majority were male (n = 1097;
weighted 89.6%) and Caucasian (n = 1001; weighted 76.1%).
Approximately a third had a bachelors or higher degree (n = 511;
weighted 30.7%). Combat exposure was reported by 473 partici-
pants (weighted = 41.0%). The percentage of participants who met
the criteria for probable PTSD based on a PCL-5 score of 38 was
101 (weighted 9.7%). Demographic information for the total sample
and for each latent class is presented in Table 1. Trauma exposures
are reported in Table 2.
2.5. Data analysis
First, LPAs were conducted (McLachlan & Peel, 2000) using
Mplus version 6.12. ML estimation procedures with robust stan-
dard errors were utilized to profile participants into distinct latent
classes based on their responses to the 20 lifetime PCL-5 items and
the Big Five personality dimensions assessed by the TIPI. Prior to
running the LPAs, an assessment of the normality of the data (latent
model indicators) was conducted. Based on the recommended nor-
mality assessment benchmarks of skewness values <2 and kurtosis
values <7 (Curran, West, & Finch, 1996), it was revealed that most
PTSD indicators and all personality indicators were normally dis-
tributed. Few PTSD items violated the assumption of normality with
skewness values >2 (feeling or acting if the traumatic experience
was reoccurring; physiological reactions to trauma reminders; dif-
ficulty recalling all aspects of the traumatic event; and engaging in
reckless behaviors).
Models comprising 2–6 latent profiles were estimated. The
use of weights in the estimation of latent models prevented
the implementation of a bootstrapped Lo–Mendel–Rubin-adjusted
likelihood ratio (LMR-A) test. In terms of fit statistics, to determine
the optimal latent class solution, guidelines recommend that lower
Akaike information criteria (AIC), Bayesian information criterion
(BIC) values, and sample-size adjusted BIC values (SSABIC) are pref-
erential (Nylund, Asparouhov et al., 2007; Nylund, Bellmore et al.,
2007; Yang, 2006). According to Raftery (1995), a model with a
10-point lower BIC value has a 150:1 likelihood to be the better fit-
ting model. In addition, a significant LMR test (Nylund, Asparouhov
et al., 2007) indicates that the model with one less class is optimal.
In the second step of the analyses, we compared all classes for
the best-fitting class solution on severity of DSM-5 PTSD symp-
13
Endorsements n (wt%)
401 (32.7)
316 (27.9)
156 (14.0)
485 (39.3)
210 (19.2)
214 (19.5)
95 (9.4)
58 (4.5)
302 (27.7)
414 (35.7)
856 (71.7)
525 (44.7)
238 (22.8)
256 (24.2)
150 (12.8)
tom clusters, number of potentially traumatic experiences, and
personality dimensions using analyses of variance (ANOVAs) with
post-hoc comparisons. Such analyses enabled us to identify the pat-
tern of significant differences on these constructs across classes;
this information is not obtained by LPA. We further compared all
classes to the most severe PTSD class and least severe PTSD class
on variables of the coping styles and utilization of psychotropic
medication and psychotherapy with chi-square analyses.
3. Results
3.1. Latent profile analyses
Table 3 shows the fit indices of the latent profile models. The
model comprising 6 latent classes failed to converge, suggest-
ing the extraction of too many classes. Therefore, in comparing
model fit, comparisons were based on the fit indices which rep-
resented models comprising 2–5 latent classes. Using established
guidelines (Nylund, Asparouhov et al., 2007; Nylund, Bellmore
et al., 2007; Yang, 2006), a 5-class solution was deemed opti-
mal. Of note, the LMR-A value was non-significant across all
models. In assessing entropy values, all values exceeded 0.80,
suggesting clear classification across all solutions. The entropy
value for the 5-class model was 0.95. Based on the composi-
tion of symptoms within classes (see Fig. 1), classes were termed
PTSD asymptomatic and emotionally stable (AsPTSDEs1 ; n = 719;
54.7%); predominant re-experiencing and avoidance symptoms
and less emotional stability (ReAvEs2 ; n = 60; 7.3%); subsyndro-
mal PTSD (SubPTSD3 ; n = 309; 25.1%); predominant NAMC and
combined internalizing–externalizing traits (high negative emo-
tionality and lower constraint (NAMCInEx4 ; n = 88; 7.0%); and high
PTSD symptom severity and combined internalizing–externalizing
traits (PTSDInEx5 ; n = 50; 5.9%). The prevalence of lifetime probable
PTSD, across classes AsPTSDEs1 , ReAvEs2 , SubPTSD3 , NAMCInEx4 ,
and PTSDInEx5 was 0%, 6%, 0%, 48.5%, and 100% respectively as
assessed by the modified PCL-5 for lifetime administration.
3.2. Class differences in PTSD symptom cluster severity, number
of potentially traumatic experiences, personality indices, coping
styles, and mental health treatment
Results of the ANOVAs and subsequent post-hoc comparisons
indicated that all classes differed significantly on re-experiencing,
avoidance, NAMC, and AAR symptom cluster severity (see Table 4).
Further, most class comparisons on endorsed potentially trau-
matic experiences were significant (see Table 4). Comparatively,
not all ANOVA and subsequent post-hoc comparison results for
14 A.A. Contractor et al. / Journal of Anxiety Disorders 37 (2016) 10–20

Table 3
Fit indices for the PTSD-personality typologies.

Cl Log-likelihood AIC BIC SSABIC Entropy LMR-A LMR-A p value

2 −40480.466 81112.931 81501.406 81259.998 0.984 11169.339 0.1447

3 −38768.559 77741.118 78262.492 77938.497 0.973 3405.396 0.2331
4 −38227.823 76711.646 77365.919 76959.337 0.930 1075.655 0.8409
5 −37731.707 75771.414 76558.586 76069.417 0.946 986.895 0.7768
6 – – – – – – –

Note: AIC: akaike information criterion; BIC: Bayesian information criterion; SSABIC: sample size adjusted Bayesian information criterion; LMR-A (p-value):
Lo–Mendell–Rubin-adjusted likelihood ratio test value and associated significance level. Class 6 failed to converge suggesting the extraction of too many classes.

3 AsPTSDEs1 (54.7%)
Mean Scores

ReAvEs2 (7.3%)

2 SubPTSD3 (25.1%)
NAMCInEx4 (7.0%)

1 PTSDInEx5 (5.9%)

Fig. 1. Latent profile plot of the 5 class PTSD and personality model.

Table 4
Results of ANOVAs using class membership as the independent variable and each DSM-5 PTSD symptom cluster, and number of traumatic experiences as dependent variables
(weighted sample).

PTSD cluster Full Sample AsPTSDEs1 ReAvEs2 SubPTSD3 NAMCInEx4 PTSD InEx5 F Partial 2
M (SD) M (SD) M (SD) M (SD) M (SD) M (SD)

Reexp 3.88 (4.43) 1.3 (1.48) <2,3,4,5 9.97 (2.43)>3,4;<5 3.97 (1.76) <4,5 7.04 (2.70) <5 15.79 (2.41) 71434.30* .82
Avoid 1.69 (2.09) .48 (.8) <2,3,4,5 4.55 (1.7) >3,4;<5 1.83 (1.4) <4,5 3.67 (1.69) <5 6.39 (1.4) 662.34* .68
NAMC 4.9 (5.9) 1.19 (1.4) <2,3,4,5 7.03 (3.55)>3;<4,5 6.04 (2.97) <4,5 15.54 (4.38) <5 19.44 (3.63) 1353.66* .82
AAR 4.56 (4.73) 1.59 (1.57) <2,3,4,5 7.39 (2.86)>3;<4,5 5.42 (2.38) <4,5 11.61 (4.34) <5 16.17 (3.07) 983.64* .76
No. of Traumas 4.08 (2.85) 3.06 (2.17)<2,3,4,5 6.48 (3.13) >3 4.31 (2.60) <4,5 5.94 (2.80) <5 7.44 (3.67) 92.53 .23

Note: post-hoc class comparisons with significant differences (p < .05) are indicated by superscripts that include Class numbers to indicate pattern of differences; *p < .001;
**p < .05; Reexp is re-experiencing; avoid is avoidance; NACM is negative alterations in mood and cognitions; AAR is alterations in arousal and reactivity; AsPTSDEs1 :
PTSD asymptomatic and emotionally stable; ReAvEs2 : predominant re-experiencing and avoidance symptoms and less emotional stability; SubPTSD3 : subsyndromal PTSD;
NAMCInEx4 : predominant NAMC and combined internalizing–externalizing traits; PTSDInEx5 : high PTSD symptom severity and combined internalizing–externalizing traits.

Table 5
Results of ANOVAs using class membership as the independent variable and each personality dimensions as dependent variables.

Personality dimensions Full Sample AsPTSDEs1 ReAvEs2 SubPTSD3 NAMC InEx4 PTSD InEx5 F Partial 2
M (SD) M (SD) M (SD) M (SD) M (SD)

Extra 3.97 (1.51) 4.25 (1.42) >2,3,4,5 3.77 (1.52) 3.74 (1.5) 3.32 (1.91) 3.61 (1.48) 12.89* .04
Agree 5.02 (1.28) 5.34 (1.17) >3,4,5 5.03 (1.23) >4,5 4.81 (1.21) >4,5 4.10 (1.13) 4.13 (1.57) 35.46* .10
Cons 5.68 (1.19) 5.95 (1.08) >3,4,5 5.77 (1.03) >4,5 5.49 (1.1) >4,5 4.81 (1.41) 4.91 (1.39) 32.46* .10
Emot Stab 5.11 (1.39) 5.63 (1.11) >2,3,4,5 4.8 (1.09) >4,5 4.82 (1.29) >4,5 4.12 (1.54) >5 3.08 (1.56) 98.64* .24
Open 4.94 (1.28) 5.15 (1.16) >3,4,5 5.10 (1.43) >4,5 4.80 (1.25) >5 4.50 (1.46) 4.01 (1.44) 18.90 * .06

Note: post-hoc class comparisons with significant differences (p < .05) are indicated by superscripts that include Class numbers to indicate pattern of differences; *p < .001;
**p < .05; Reexp is re-experiencing; avoid is avoidance; NAMC is negative alterations in mood and cognitions; AAR is alterations in arousal and reactivity; AsPTSDEs1 :
PTSD asymptomatic and emotionally stable; ReAvEs2 : predominant re-experiencing and avoidance symptoms and less emotional stability; SubPTSD3 : subsyndromal PTSD;
NAMCInEx4 : predominant NAMC and combined internalizing–externalizing traits; PTSDInEx5 : high PTSD symptom severity and combined internalizing–externalizing traits.
 A.A. Contractor et al. / Journal of Anxiety Disorders 37 (2016) 10–20
class differences in personality dimension scores were significant
(see Table 5). Emotional stability as a personality dimension was
the most distinguishing when comparing across classes. Regard-
ing number of potentially traumatic experiences, the AsPTSDEs1
class reported the lowest number compared to other classes, and
the PTSDInEx5 class reported the highest number compared to all
classes excluding the SubPTSD3 class.
Further, chi-square analyses focused on comparing classes to
the highest PTSD severity class for differences in coping styles and
treatment options.1 See Tables 6 and 7 for detailed results. Com-
pared to the PTSDInEx5 class, the AsPTSDEs1 class was less likely to
prefer the use of self-distraction, denial, substance use, instrumen-
tal support, psychotherapy, and medication use; and more likely to
prefer the use of active coping. Compared to the PTSDInEx5 class,
the ReAvEs2 class was less likely to prefer denial, psychotherapy,
and medication use; and was more likely to prefer behavioral dis-
engagement. Compared to the PTSDInEx5 class, the SubPTSD3 class
was less likely to prefer denial, instrumental coping, psychother-
apy, and medication use, and more likely to prefer active coping.
Additionally, compared to the PTSDInEx5 class, the NAMCInEx4
class was more likely to prefer emotional support and behavioral
disengagement; and less likely to prefer instrumental support and
psychotherapy.
Additionally, we compared classes to the lowest PTSD severity
class for differences in coping styles and treatment options. Com-
pared to the AsPTSDEs1 class, the ReAvEs2 class was more likely to
prefer self-distraction, substance use, behavioral disengagement,
and mental health treatment; and less likely to prefer active cop-
ing. Compared to the AsPTSDEs1 class, the SubPTSD3 class was
more likely to prefer self-distraction, substance use, and mental
health treatment; and less likely to prefer acceptance and positive
reframing. Lastly, compared to the AsPTSDEs1 class, the NAMCInEx4
class was less likely to use active coping, positive reframing, and
acceptance; and more likely to use denial, substance use, emotional
support, behavioral disengagement, and mental health treatment.
4. Discussion
Using a nationally representative sample of trauma-exposed
U.S. military veterans, the current study found a best-fitting 5 PTSD-
personality typology solution, which differed with respect to DSM-5
PTSD symptom cluster severity and some of the “Big Five” person-
ality dimensions. Comparing all classes to the most severe PTSD
class, most differences were found for utilization of mental health
treatment; and the preferred use of self-distraction, denial, active
coping, emotional and instrumental support, and behavioral dis-
engagement coping strategies. Comparing all classes to the least
severe PTSD class, most differences were found for utilization of
mental health treatment; and the preferred use of self-distraction,
active coping, substance use, and positive reframing coping strate-
gies.
4.1. Nature of the PTSD-personality class typologies
The class with the largest sample size, AsPTSDEs1 (54.7%)
included PTSD asymptomatic and emotionally stable veterans. Veter-
ans in this class reported the lowest severity of PTSD symptoms,
fewer potentially traumatic experiences, had no members with
a probable PTSD diagnosis, and scored higher on all personality
dimensions compared to most classes (excluding ReAvEs2 ). As indi-
cated in the literature, the majority of individuals who experience
a traumatic event do not develop clinically significant PTSD symp-
toms; and a large number of people post trauma exposure are
emotionally stable (Breslau et al., 1998).
15
On the other end of the severity spectrum (PTSDInEx5 ; 5.9%)
participants were characterized by high PTSD symptom severity
and combined internalizing–externalizing traits (low emotional sta-
bility, conscientiousness and extraversion; Rielage et al., 2010).
In addition to having the highest PTSD symptom severity and
the largest proportion of veterans with a probable PTSD diagno-
sis (100%), veterans in this group had significantly lower scores
on all personality dimensions compared to AsPTSDEs1 , on all
personality dimensions excluding extraversion compared to the
ReAvEs2 and SubPTSD3 classes, and on emotional stability com-
pared to the NAMCInEx4 class. The PTSDInEx5 class additionally
endorsed more potentially traumatic experiences compared to
most classes (excluding ReAvEs2 ). We found another combined
internalizing–externalizing traits class (NAMCInEx4 ; 7.0%) which
had a significant proportion of veterans with a probable PTSD
diagnosis (48.5%); however this class differed from the PTSDInEx5
class on three aspects: (1) lower PTSD symptom severity, (2) pre-
dominant NAMC symptoms, and (3) greater emotional stability.
These veterans had significantly lower scores on all personality
dimensions compared to the AsPTSDEs1 class; on all personality
dimensions excluding extraversion compared to the ReAvEs2 class;
and on agreeableness, conscientiousness, and emotional stability
compared to the SubPTSD3 class.
The ReAvEs2 and SubPTSD3 classes were comparable with
respect to personality dimensions (average personality overall and
low emotional stability); however, they differed in PTSD symp-
tom profiles (symptom severity and predominant symptoms), and
number of potentially traumatic experiences endorsed. ReAvEs2
veterans had predominant re-experiencing and avoidance symp-
toms and less emotional stability. This class also scored lower on
extraversion and emotional stability compared to the AsPTSDEs1
class, did not differ significantly than SubPTSD3 on all personality
dimensions, and had significantly higher scores on agreeableness,
conscientiousness, emotional stability, and openness to experience
compared to the NAMCInEx4 and PTSDInEx5 classes. Further, the
ReAvEs2 class endorsed significantly greater number of potentially
traumatic experiences compared to the SubPTSD3 veterans, and
6% of veterans in this class had a probable PTSD diagnosis. The
last class—subsyndromal PTSD (SubPTSD3 ; 25.1%) was characterized
by moderate PTSD symptom severity, and they scored lower than
group average on all personality dimensions assessed. Further, the
SubPTSD3 class had significantly lower scores on all personality
dimensions than the AsPTSDEs1 class, significantly higher scores
on agreeableness, conscientiousness, and emotional stability com-
pared to the NAMCInEx4 class, and significantly higher scores on
agreeableness, conscientiousness, emotional stability, and open-
ness to experience compared to the PTSDInEx5 class.
Some similar PTSD-personality typologies differed in PTSD
symptom severity and patterns. Similarly, Forbes et al. (2010)
found two internalizing personality classes (moderate and high
internalizing), which differed with respect to severity and ele-
vations on a measure of psychoticism. These findings, coupled
with results of the current study, suggest that when assess-
ing symptom heterogeneity, solely classifying people into low,
moderate, and high PTSD symptom severity or according to the
internalizing–externalizing personality dichotomy may be insuf-
ficient. In comparing the personality profiles of the ReAvEs2 and
SubPTSD3 classes, there were no differences on the Big-Five per-
sonality dimensions. However, both classes differed significantly
in severity of all PTSD symptom clusters and the SubPTSD3 class
had predominant re-experiencing and avoidance symptoms. Simi-
larly, the NAMCInEx4 and PTSDInEx5 classes had similar personality
patterns, with the PTSDInEx5 class scoring higher on emotional
stability; however these classes differed in PTSD severity and symp-
tom patterns. The PTSDInEx5 class scored higher in severity on all
16 A.A. Contractor et al. / Journal of Anxiety Disorders 37 (2016) 10–20

Table 6
Frequencies and weighted percentages of coping styles and mental health treatment utilization in the total effective sample and by class.

Coping style/treatment Total Sample N AsPTSDEs1 ReAvEs2 SubPTSD3 NAMCInEx4 PTSD InEx5
(wt%) (wt%) (wt%) (wt%) (wt%) (wt%)

Total N for each class 1226 719 (54.7) 60 (7.3) 309 (25.1) 88 (7.0) 50 (5.9)

Coping strategies
Self-distraction 495 (39.7) 234 (33.2) 28 (51.3) 163 (48.4) 47 (41.2) 23 (46.7)
Active coping 211 (17.2) 139 (19.8) 6 (9.9) 54 (19.0) 7 (5.6) 5 (7.5)
Substance use 54 (5.5) 12 (2.2) 8 (12.2) 19 (7.5) 8 (9.3) 7 (13.7)
Emotional support 83 (7.6) 47 (7.1) 3 (3.9) 24 (8.3) 6 (15.8) 3 (3.7)
Instrumental support 17 (1.9) 7 (1.0) 3 (3.6) 3 (1.6) 1 (1.2) 3 (10.3)
Behavioral disengagement 14 (1.2) 2 (0.2) 3 (6.9) 4 (0.7) 5 (6.5) 0 (0.0)
Venting 27 (2.4) 14 (2.2) 2 (1.8) 7 (2.7) 4 (5.2) 0 (0.0)
Denial 21 (2.2) 5 (0.7) 0 (0.0) 5 (1.6) 5 (8.4) 6 (14.4)
Positive reinforcement 82 (6.1) 63 (7.7) 4 (8.0) 13 (4.2) 1 (1.6) 1 (1.6)
Planning 25 (1.9) 18 (2.5) 0 (0.0) 5 (1.6) 2 (1.4) 0 (0.0)
Humor 22 (1.3) 15 (1.6) 2 (1.5) 5 (1.3) 0 (0.0) 0 (0.0)
Accept 39 (3.1) 34 (5.1) 1 (1.0) 3 (0.6) 0 (0.0) 1 (1.3)
Religion 8 (0.4) 7 (0.7) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.8)
Self-blame 4 (0.6) 1 (0.1) 0 (0.0) 3 (2.4) 0 (0.0) 0 (0.0)
Refused for coping style 7 (0.7) 6 (1.3) 0 (0.0) 1 (0.1) 0 (0.0) 0 (0.0)
Other coping 18 (1.1) 16 (1.5) 0 (0.0) 0 (0.0) 2 (3.8) 0 (0.0)

Mental health treatment utilization

Medication 109 (9.7) 21 (2.3) 8 (11.3) 27 (8.8) 30 (36.6) 23 (56.4)
Psychotherapy 68 (6.7) 8 (0.9) 4 (3.7) 17 (6.2) 21 (26.1) 18 (43.6)

Note: all percentages reported are weighted estimates; wt% is weighted percentage;
AsPTSDEs1 : PTSD asymptomatic and emotionally stable; ReAvEs2 : predominant re-experiencing and avoidance symptoms and less emotional stability; SubPTSD3 :
subsyndromal PTSD; NAMCInEx4 : predominant NAMC and combined internalizing–externalizing traits; PTSDInEx5 : high PTSD symptom severity and combined
internalizing–externalizing traits.

PTSD symptom clusters and the NAMCInEx4 class had predominant
NAMC symptoms. These differences may, at least in part, influence
the PTSD symptom course, clinical treatment choice and outcomes,
and co-occurring symptoms. Further, symptomatic trauma sur-
vivors may express distress inwards and outwards depending on
environmental variables and reinforcement obtained for the dif-
ferent coping strategies, and may not completely adhere to an
internalizing–externalizing dichotomy. Personality traits may thus
influence PTSD symptom presentation (Miller, 2003). Results also
raise further questions on the interaction of personality variables
and other socio-demographic and biological factors that may influ-
ence PTSD symptom profiles.
The five class PTSD-personality typology found in the current
study did not entirely replicate the known three-class personality
typology among trauma-exposed samples (Carleton et al., 2015;
Castillo et al., 2014; McDevitt-Murphy et al., 2012; Miller et al.,
2003; Miller et al., 2004; Rielage et al., 2010; Thomas et al., 2014)
or the three-class solution for PTSD symptoms (Ayer et al., 2011;
Breslau, Reboussin, Anthony, & Storr, 2005; Elhai, Naifeh, Forbes,
Ractliffe, & Tamburrino, 2011; Steenkamp et al., 2012). The use of
LPA as a statistical technique which has been rarer in the literature
(Forbes et al., 2010; Thomas et al., 2014; Wolf et al., 2012) and the
consideration of PTSD symptoms in combination with personality
traits to determine latent classes may explain differences in find-
ings between the current study and prior studies. Further, we used
a trauma-exposed sample rather than restricting it to one with a
PTSD diagnosis which has been the sample characteristics of sev-
eral prior studies (e.g., Castillo et al., 2014; Wolf et al., 2012). In
fact, the PTSD asymptomatic and emotionally stable class included
more than half of the current study participants and none of them
had a probable PTSD diagnosis. Compared to such people without
a PTSD diagnosis, people with a PTSD diagnosis have more severe
emotional concerns including depression and anxiety (Shalev, Peri,
Canetti, & Schreiber, 1996); and more physical health problems
(Beckham et al., 1998). Thus, using a sample restricted to those
with a PTSD diagnosis to replicate this study’s research questions
would be a relevant pursuit. Additionally, PTSD-personality typolo-
gies may depend on the nature of the personality framework used.
Thomas et al. (2014) found three personality typologies with a tem-
peramental trait framework; however four personality typologies
with an interpersonal trait framework. It may also be important to
consider the transitional nature of personality typologies over time
in trauma-exposed samples (McDevitt-Murphy et al., 2012). Addi-
tionally, our study used DSM-5 PTSD symptoms in contrast to prior
studies that used DSM-IV PTSD symptoms. The DSM-5 PTSD con-
ceptualization distinguishes between the DSM-IV avoidance and
numbing symptoms with the new numbing symptom cluster rela-
beled as NAMC in DSM-5. Further, the DSM-IV arousal symptom
cluster is relabeled as AAR in DSM-5 and includes an additional
symptom of reckless and self-destructive behaviors.
4.2. Relation of class typologies with coping styles and mental
health treatment utilization
Overall, increasing PTSD symptom severity and less emotional
stability, less extraversion, and less agreeableness were more asso-
ciated with maladaptive forms of coping such as denial, substance
use, and self-distraction; and were less associated with adaptive
forms of coping such as active coping and emotional support. Fur-
ther, decreasing PTSD severity and more emotional stability, more
extraversion, and more agreeableness were associated with more
adaptive coping preferences, such as active coping, positive refram-
ing, and acceptance; and were less associated with maladaptive
forms of coping such as substance use, self-distraction and behav-
ioral disengagement. These findings are consistent with prior work
(Meyer, 2001; Oni, Harville, Xiong, & Buekens, 2012; Watson &
Hubbard, 1996). As expected, use of mental health treatment was
related to increasing PTSD symptom cluster severity and less emo-
tional stability.
Coping styles helped further differentiate classes
with similar PTSD-personality profiles. For example, the
NAMCInEx4 and PTSDInEx5 classes, who had similar combined
internalizing–externalizing personality patterns, differed not only
in overall PTSD symptom severity and PTSD symptom patterns,
 A.A. Contractor et al. / Journal of Anxiety Disorders 37 (2016) 10–20 17

Table 7
Chi-square values with significance levels and phi coefficients for different coping strategies across class comparisons.a

Class comparisons Self-distraction Active coping

Chi-square values (df) p value Phi coefficients Chi-square values (df) p value Phi coefficients

AsPTSDEs1 vs PTSDInEx5 5.02 (1) .03 .08 6.92 (1) .01 −.10
ReAvEs2 vs PTSDInEx5 .34 (1) .56 −.05 .44 (1) .51 −.05
SubPTSD3 vs PTSDInEx5 .08 (1) .77 −.02 5.99 (1) .01 −.3
NAMCInEx4 vs PTSDInEx5 .47 (1) .49 .06 .08 (1) .78 .02
ReAvEs2 vs AsPTSDEs1 11.14 (1) .001 .12 5.04 (1) .03 −.08
SubPTSD3 vs AsPTSDEs1 20.58 (1) <.001 .15 .07 (1) .79 −.01
NAMCInEx4 vs AsPTSDEs1 1.99 (1) .16 .05 9.6 (1) .002 −.11

Denial Substance use

AsPTSDEs1 vs PTSDInEx5 61.99 (1) <.001 .29 26.61 (1) <.001 .19
ReAvEs2 vs PTSDInEx5 13.37 (1) <.001 .29 .08 (1) .78 .02
SubPTSD3 vs PTSDInEx5 23.66 (1) <.001 .25 3.07 (1) .08 .09
NAMCInEx4 vs PTSDInEx5 1.24 (1) .27 .09 .72 (1) .40 .07
ReAvEs2 vs AsPTSDEs1 .54 (1) .46 −.03 23.86 (1) <.001 .18
SubPTSD3 vs AsPTSDEs1 2.34 (1) .13 .05 14.98 (1) <.001 .12
NAMCInEx4 vs AsPTSDEs1 30.97 (1) <.001 .2 13.11 (1) <.001 .13

Emotional support Instrumental support

AsPTSDEs1 vs PTSDInEx5 .89 (1) .35 −.04 26.47 (1) <.001 .19
ReAvEs2 vs PTSDInEx5 .07 (1) .79 .02 2.84 (1) .09 .13
SubPTSD3 vs PTSDInEx5 1.5 (1) .22 −.06 12.82 (1) <.001 .18
NAMCInEx4 vs PTSDInEx5 5.5 (1) .02 −.19 5.82 (1) .02 .19
ReAvEs2 vs AsPTSDEs1 1.76 (1) .18 −.05 3.19 (1) .07 .07
SubPTSD3 vs AsPTSDEs1 .51 (1) .47 .02 .54 (1) .46 .02
NAMCInEx4 vs AsPTSDEs1 7.27 (1) .007 .1 .02 (1) .90 .004

Behavioral disengagement Venting

AsPTSDEs1 vs PTSDInEx5 .11 (1) .74 −.01 1.56 (1) .21 −.05
ReAvEs2 vs PTSDInEx5 5.04 (1) .03 −.18 1.62 (1) .20 −.1
SubPTSD3 vs PTSDInEx5 .47 (1) .49 −.04 1.91 (1) .17 −.07
NAMCInEx4 vs PTSDInEx5 4.48 (1) .03 −.17 3.56 (1) .06 −.16
ReAvEs2 vs AsPTSDEs1 36.79 (1) <.001 .22 .004 (1) .95 .002
SubPTSD3 vs AsPTSDEs1 1.68 (1) .20 .04 .21 (1) .64 .02
NAMCInEx4 vs AsPTSDEs1 31.74 (1) <.001 .21 2.27 (1) .13 .06

Positive reframing Acceptance

AsPTSDEs1 vs PTSDInEx5 3.87 (1) .05 −.07 2.01 (1) .16 −.05
ReAvEs2 vs PTSDInEx5 3.47 (1) .06 .15 .02 (1) .88 .01
SubPTSD3 vs PTSDInEx5 1.27 (1) .26 −.06 .41 (1) .52 .03
NAMCInEx4 vs PTSDInEx5 .01 (1) .91 .01 1.16 (1) .28 .09
ReAvEs2 vs AsPTSDEs1 .002 (1) .96 .002 2.85 (1) .09 −.06
SubPTSD3 vs AsPTSDEs1 4.23 (1) .04 −.07 11.91 (1) .001 −.11
NAMCInEx4 vs AsPTSDEs1 4.82 (1) .03 −.08 4.47 (1) .03 −.08

Psychotherapy Medication
AsPTSDEs1 vs PTSDInEx5 244.2 (1) <.001 .58 210 (1) <.001 .54
ReAvEs2 vs PTSDInEx5 38.13 <.001 .49 25.95 (1) <.001 .40
SubPTSD3 vs PTSDInEx5 71.10 (1) <.001 .43 64.31 (1) <.001 .41
NAMCInEx4 vs PTSDInEx5 5.22 (1) .02 .18 1.7 (1) .19 .10
ReAvEs2 vs AsPTSDEs1 4.01 .05 .07 19.53 (1) <.001 .16
SubPTSD3 vs AsPTSDEs1 23.04 (1) <.001 .15 21.22 (1) <.001 .15
NAMCInEx4 vs AsPTSDEs1 131.71 (1) <.001 .42 154.08 (1) <.001 .46

Note: Results in bold are significant; AsPTSDEs1 : PTSD asymptomatic and emotionally stable, ReAvEs2 : predominant re-experiencing and avoidance symptoms and less
emotional stability; SubPTSD3 : subsyndromal PTSD; NAMCInEx4 : predominant NAMC and combined internalizing–externalizing traits; PTSDInEx5 : high PTSD symptom
severity and combined internalizing–externalizing traits.
a
Some classes that were compared had an n = 0 for coping styles of religion, planning, humor, and self-blame; the chi-square values could not be computed and hence are
not reported.

but also in certain coping styles. For example, the NAMCInEx4
class was more likely than the PTSDInEx5 class to prefer emotional
support and behavioral disengagement, but less likely to prefer
instrumental support. This finding suggests that PTSD symptom
heterogeneity may be differentially linked to coping styles.
Two main trends were contrary to what we had expected. One
trend indicates that problem-focused and adaptive forms of cop-
ing – instrumental coping and seeking emotional support – were
associated with increasing PTSD symptom severity and less emo-
tional stability. Compared to the PTSDInEx5 class, the SubPTSD3
class was less likely to prefer instrumental coping. Further, com-
pared to the AsPTSDEs1 class, the NAMCInEx4 class was more likely
to prefer seeking emotional support. These findings are consistent
with the results of a study by Doron et al. (2014) who found a pos-
itive association between trait anxiety and seeking instrumental
support in a college student sample, which they attributed to the
nature of college students: the greater the anxiety the more they
seek support from others. Thus, one might hypothesize that, with
increasing PTSD symptom severity and possible distress, trauma-
exposed individuals may be more inclined to use adaptive coping
styles such as seeking instrumental and emotional support whereas
with non-clinical PTSD symptoms, there is minimal need to focus
on coping styles. The other unexpected trend is related to maladap-
tive form of coping—behavioral disengagement (giving up attempts
to reach goals when stressed) as being more common in classes
with lower PTSD severity and more emotional stability, which is
18 A.A. Contractor et al. / Journal of Anxiety Disorders 37 (2016) 10–20
contrary to prior findings (Carver et al., 1989; Watson & Hubbard,
1996). For example, compared to the PTSDInEx5 class, the ReAvEs2
class was more likely to report using behavioral disengagement as
their preferred coping strategy.
There are possible explanations for these unexpected findings.
First, other factors influencing coping styles including availability
of instrumental support, prior life experiences, and psychiatric his-
tory were not assessed in the current study. Second, we did not
assess temporal causal relations between coping styles and PTSD
symptom severity. Consequently, we are not able to assess if use
of effective coping styles is causally related to less PTSD symptom
severity. One example references the comparison of the AsPTSDEs1
and PTSDInEx5 classes wherein compared to the PTSDInEx5 class,
the AsPTSDEs1 class were less likely to use in effective coping strate-
gies such as self-distraction, denial, and substance use, and more
likely to use an effective coping strategy such as active coping. We
are unsure if this coping pattern could be actually causing or be the
result of a more healthy emotional profile for the AsPTSDEs1 class;
understanding such cause-effect relations is an important avenue
for future research. Lastly, we did not look at other refined and
differentiated personality characteristics, such as hardiness and
optimism, or more multifarious aspects of personality, as assessed
using more comprehensive personality assessments (e.g., Multidi-
mensional Personality Questionnaire-Brief Form (MPQ-BF; Patrick,
Curtin, & Tellegen, 2002).
4.3. Implications and limitations
The current study has several clinical and theoretical implica-
tions. First, results confirm the clinical utility of combining PTSD
symptoms and personality traits in characterizing the heterogene-
ity of PTSD symptom presentation in trauma-exposed veterans
(Horowitz & Stinson, 1994). We found five different classes of
people differentially relating to some coping styles and treatment
utilization; this adds to the importance of addressing personality
styles and coping post-trauma in the resiliency literature (Wilson
& Agaibi, 2006). Understanding PTSD-personality subtypes post-
trauma may also aid in personalization of treatment (Miller, 2003).
Second, results add to the importance of considering PTSD-
personality heterogeneity using a person-centered approach
(Galatzer-Levy & Bryant, 2013). Although two people may have
combined internalizing–externalizing traits, they may differ in
their predominant PTSD symptoms, PTSD symptom cluster sever-
ity, certain personality indices, and coping styles. Trauma-based
treatment could consider such differences when individualiz-
ing treatment; this informs clinical decision-making as well. For
example, treatment approaches for the ReAvEs2 PTSD-personality
typology could capitalize on the individual’s tendency to be orga-
nized and open to new experiences. Another example is that people
in the NAMCInEx4 class preferred use of emotional support and
behavioral disengagement but not instrumental support compared
to the PTSDInEx5 class. Thus, treatment for the former class can
target NAMC symptom severity, emotional stability, decreasing
coping styles of behavioral disengagement, capitalizing on use of
emotional support, and increasing use of instrumental support
compared to the PTSDInEx5 class members.
Third, emotional stability as a personality trait was central
in distinguishing PTSD-personality typologies consistent with the
literature (reviewed in Jakšić et al., 2012; Vollrath & Torgersen,
2000), followed by conscientiousness (Vollrath & Torgersen, 2000),
and agreeableness; extraversion was least distinguishing between
these PTSD-personality typologies. In fact, the combination of low
neuroticism and high conscientiousness has been found to be most
related to effective coping (Vollrath & Torgersen, 2000) as also
supported by the current study. It raises the question of whether
an initial screening of emotional stability when assessing PTSD
symptoms can provide incremental information related to treat-
ment. Results add to the importance of considering treatments
focusing on emotional regulation skills such as Dialectical Behav-
ioral Therapy for people with trauma-exposure (Steil, Dyser, Priebe,
Kleindienst, & Bohus, 2011).
Fourth, we found a trend of more adaptive coping (e.g., active
coping) and less maladaptive coping (e.g., denial) with decreasing
PTSD severity and more emotional stability. These results accord
with prior literature highlighting the importance of considering
coping styles in a larger dispositional context. For example, Watson
and Hubbard (1996) found that the Big Five personality traits jointly
accounted for approximately 20% of the variance in the COPE scales.
Thus, accounting for heterogeneous PTSD-personality typologies
can help inform coping-focused interventions for symptomatic
trauma survivors. In the current study, coping styles of denial,
substance use, self-distraction, active coping, instrumental cop-
ing, positive reframing, acceptance, and behavioral disengagement
were the most distinguishing of the PTSD-personality typologies,
suggesting that it may be clinically useful to assess for these spe-
cific coping styles with a briefer measure (e.g., Brief COPE) to target
them in treatment.
Fifth, as expected, the trend of increasing use of psychotropic
medications and psychotherapy with increasing PTSD severity and
decreasing emotional stability added to the validity of the PTSD-
personality typologies. Lastly, we saw a pattern of increasing PTSD
symptom severity and decreasing emotional stability with higher
number of endorsed potentially traumatic experiences further
adding to the established typology categorization.
Limitations of the current study must be noted. First, the self-
report measures may be affected by possible response biases and it
is unclear whether clinician-administered measures would yield
comparable results. Second, while results of this study are gen-
eralizable to the broader population of US Veterans with civilian
and combat-related potentially traumatic experiences, they may
not necessarily generalize to combat veterans specifically or other
trauma-exposed populations. Third, given the modified version of
the Brief-COPE used in the current study, factor analyses for coping
dimensions was statistically inappropriate; this is a consideration
for future research. Fourth, the cross-sectional design of this study
precluded evaluation of causal pathways among PTSD symptoms,
personality traits, and coping styles. Thus, we were not able to
assess the interaction of premorbid personality traits and traumatic
event exposure to understand vulnerabilities to the development
and maintenance of PTSD symptoms. Longitudinal studies are
needed to evaluate this possibility. Fifth, we did not use alterna-
tive personality conceptualizations such as the HEXACO model of
personality structure, which yields six factors of Honesty-Humility,
Emotionality, Extraversion, Agreeableness, Conscientiousness, and
Openness to Experience. It is suggested that this model is an
empirical and theoretical improvement over the Big-Five model
of personality. Relevant to our study findings is HEXACO’s theoret-
ically refined conceptualization of Emotionality; this is described
as altruistic tendencies toward kin, excludes anger that defines the
emotional stability factor and includes sentimentality that defines
the agreeableness factor of the Big-Five personality model (Ashton
& Lee, 2007). It would be helpful to consider this model, as well
as other more nuanced models of personality structure, in future
work on latent PTSD-personality pathology. Lastly, we used two
items to assess for each personality dimension which may have
contributed to the low reliability coefficients for some of the the
personality subscales; it will be helpful for future research to use
more comprehensive and reliable alternative personality measures.
Notwithstanding these limitations, results of the current study
suggest that we can expect heterogeneity as 5 class typologies
differing in symptom severity and type when considering PTSD
symptoms and personality traits, and the typologies differentially
 A.A. Contractor et al. / Journal of Anxiety Disorders 37 (2016) 10–20
relate to some coping styles and treatment options. These findings
underscore the importance of considering personality pathology
in examining the heterogeneity of DSM-5 PTSD symptom presen-
tation. Further research is needed to replicate these findings in
other trauma-exposed populations; to evaluate causal associations
between personality traits, PTSD symptoms, and coping styles; and
to examine how more nuanced personality models may influence
‘person-based’ typologies of DSM-5 PTSD symptoms.
Acknowledgement
The NHRVS was funded by the U.S. Department of Veteran
Affairs National Center for Posttraumatic Stress Disorder.
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