Objective: Evidence has suggested there are sex differences in posttraumatic stress disorder (PTSD) symptom expression; however, few studies have assessed whether these differences are due to measurement invariance. This study aimed to examine sex differences in PTSD symptoms based on the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) using differential item functioning (DIF). Method: Confirmatory factor analysis was conducted on the DSM-5 model of PTSD, followed by a

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... tiple indicators multiple causes (MIMIC) model to examine possible DIF using the PTSD Checklist for DSM-5. Data were analyzed from a Malaysian adolescent sample (n ϭ 481) of which 61.7% were female, with a mean age of 17.03 years. Results: The results indicated the presence of DIF for 2 of 20 PTSD criteria. Females scored significantly higher on emotional cue reactivity (B4), and males reported significantly higher rates of reckless or self-destructive behavior (E2) while statistically controlling for the latent variables in the model. However, the magnitude of these item-level differences was small. Conclusion: These findings indicate that despite the presence of DIF for 2 DSM-5 symptoms, this does not provide firm support for nonequivalence across sex. Clinical Impact Statement This study suggests that although sex differences were observed in 2 out of 20 posttraumatic stress disorder (PTSD) symptom criteria, the magnitude of these effects was small and may be the result of gender role stereotypes rather than a bias in diagnostic criteria. Given the paucity of studies examining sex differences in PTSD symptom expression based on the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), more research is needed across different cultures and types of traumatic exposure before firm conclusions can be made.