Posttraumatic Stress Disorder Near and Far: Symptom Networks From 2 to 12 Months After the Virginia Tech Campus Shootings

Posttraumatic stress disorder (PTSD) is unique in its longitudinal focus. To better understand how PTSD develops, we used network analysis in a longitudinal sample of survivors of the 2008 Virginia Tech campus shootings. Participants were 212 women who completed surveys at both 2 and 12 months after the shooting. Using within-group permutation tests, we found that overall network strength significantly increased and overall network structure significantly changed. Several symptoms saw marked alterations in their network centrality and relations to other symptoms. Psychological reactivity at reminders was the most central symptom at 2 months but among the least central at 12 months. By contrast, reliving, anhedonia, and physiological reactivity had low centrality at 2 months but high centrality at 12 months. Findings broadly support memory-based and fear-conditioning accounts of PTSD and suggest that automatic situationally cued symptoms, including reliving, thought avoidance, and physiological reactions, become more central to the network over time.