{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:47:43Z","timestamp":1787237263351,"version":"build-2736575974"},"reference-count":49,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,12,16]],"date-time":"2024-12-16T00:00:00Z","timestamp":1734307200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["F31 MH126528"],"award-info":[{"award-number":["F31 MH126528"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Traumatic Stress"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Traumatic stress reactions (TSRs) exist on a continuum that includes posttraumatic stress disorder (PTSD), highly comorbid psychopathology, and resilience, highlighting the need for comprehensive and integrative approaches capable of capturing the full spectrum of heterogeneous reactions. Here, we used a transdiagnostic and multidimensional method to characterize clinical phenotypes of TSRs in a nationally representative sample of U.S. military veterans. The Middle\u2010Out Approach was used to evaluate self\u2010reported PTSD, generalized anxiety, major depressive symptoms, and physical and mental functioning to identify discrete latent classes of TSRs and their demographic, military and trauma history, and psychosocial correlates. Cross\u2010sectional data were analyzed from 3,727 U.S. veterans who participated in the National Health and Resilience in Veterans Study. Latent class analysis identified five classes of veterans: low TSR (61.3%), anxious\/depressive (16.6%), avoidant arousal (9.2%), dysphoric arousal (8.2%), and high TSR (4.7%). Veterans in the dysphoric arousal and high TSR classes demonstrated lower functioning than other classes, which showed similar levels of moderate\u2010to\u2010high functioning despite symptom differences. Classes distinguished between resilience to PTSD symptoms versus resilience to all symptoms and functioning domains and were differentially associated with demographic characteristics, trauma and military histories, and psychosocial characteristics. The results suggest that veterans exhibit different clinical phenotypes of TSRs, which may help inform etiology, diagnostic subtypes, and personalized treatment. Further, although most veterans with psychopathology experience functional impairment, a sizable subset demonstrates high functioning despite psychopathology symptoms.<\/jats:p>","DOI":"10.1002\/jts.23119","type":"journal-article","created":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T00:34:52Z","timestamp":1734395692000},"page":"259-271","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Identifying transdiagnostic traumatic stress reactions in U.S. military veterans: A nationally representative study"],"prefix":"10.1002","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8185-2982","authenticated-orcid":false,"given":"Cameron P.","family":"Pugach","sequence":"first","affiliation":[{"name":"Department of Psychology University of North Carolina at Greensboro  Greensboro North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9799-669X","authenticated-orcid":false,"given":"Shane W.","family":"Adams","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Stanford University School of Medicine  Palo Alto California USA"},{"name":"Polytrauma System of Care VA Palo Alto Health Care System  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2412-9012","authenticated-orcid":false,"given":"Blair E.","family":"Wisco","sequence":"additional","affiliation":[{"name":"Department of Psychology University of North Carolina at Greensboro  Greensboro North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert H.","family":"Pietrzak","sequence":"additional","affiliation":[{"name":"National Center for PTSD, Clinical Neurosciences Division VA Connecticut Healthcare System  Orange Connecticut USA"},{"name":"Department of Psychiatry Yale School of Medicine  West Haven Connecticut USA"},{"name":"Department of Social and Behavioral Sciences Yale School of Public Health  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,12,16]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1037\/hea0001347"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/jts.22357"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jts.23005"},{"key":"e_1_2_11_5_1","volume-title":"Psychological Trauma: Theory, Research, Practice, & Policy. 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