Beyond posttraumatic stress disorder diagnosis: How specific trauma symptoms drive long-term disability in veterans.
Abstract
The link between trauma-related symptomatology and psychosocial disability is well-established. However, the extent to which specific PTSD symptom clusters differentially contribute to distinct psychosocial disability domains remains unclear. This study examined these associations, hypothesizing that negative alterations in mood and cognition and hyperarousal symptoms would be the strongest predictors of concurrent and future psychosocial disability. We conducted a secondary analysis of longitudinal data from 332 veterans (30% female) with a range of trauma-related symptom severity, as measured by the PTSD Checklist for DSM-5 (PCL-5; M = 27.6, SD = 20.8). Linear mixed-effects models were used to assess the unique contributions of PTSD symptom clusters to psychosocial disability across six domains-understanding/communication, mobility, self-care, interpersonal relationships, life activities, and social participation-measured four times over 24 months. Across domains, negative alterations in mood and cognition and hyperarousal symptoms emerged as the most consistent predictors of psychosocial disability, with effect sizes ranging from small (β = 0.14) to large (β = 0.53). Avoidance symptoms showed more domain-specific associations, particularly for mobility and social participation. Time effects indicated improvement in several domains, though self-care disability remained stable. PTSD symptoms explained more variance in interpersonal and social functioning than in domains related to physical functioning and self-care. Negative alterations in mood and cognition and hyperarousal symptoms exert disproportionate influence on psychosocial disability, underscoring their importance as treatment targets. Avoidance may contribute to disability in specific life domains, highlighting the need for rehabilitation strategies tailored to both broad and domain-specific impairments in veterans with trauma-related symptomatology. (PsycInfo Database Record (c) 2026 APA, all rights reserved).