Military Service-Related PTSD
Reports from the recent United States-related military conflicts in the Middle East, most notably in Iraq, have increased public awareness of not only the physical wounds, but also the emotional trauma associated with military combat. Historically, a number of terms have evolved to define a psychiatric malady that manifests during or after combat experience. This research Web page addresses research related to one form of psychiatric illness, Post-Traumatic Stress Disorder (PTSD), which results from reaction to harrowing experiences.
As the nature of warfare has evolved, an atypical form of aggressive or terroristic acts, characterized by the element of surprise as opposed to following traditional rules of engagement for which military personnel are trained, has emerged as the normative mode. Life-threatening experiences can occur in the conduct of everyday tasks and in the midst of community activities such as grocery shopping. Large explosive devices that detonate nearby can produce traumatic brain injury, as well as loss of limbs. At the same time, improved medical care provided in close proximity to the conflict has resulted in increased survivorship, albeit survivorship with long-term physical and emotional sequellae for returning military personnel and veterans as well as their loved ones. In recent years, the mental health profession has refined its understanding of the diagnosis and treatment of PTSD as an extreme reaction to traumatic events that occur in military combat or in domestic violence and child abuse.
Historical Discussion on PTSD
According to Parrish (2001), during the early 1800s, military doctors began diagnosing soldiers with “exhaustion” following the stress of battle. This condition was characterized by mental shutdown due to individual or group trauma. Also during this time, in England there was a syndrome known as “railway spine” or “railway hysteria” that bore a resemblance to what we call PTSD today. This syndrome was a reaction to catastrophic railway accidents. During World War I, overwhelming mental fatigue was diagnosed as “soldier’s heart” and “the effort syndrome.” During World War II, the term “shell shock” emerged, followed by the term “combat fatigue.” These terms were used to describe veterans experiencing anxiety and stress as a result of being engaged in combat. The official designation of PTSD did not come about until the publication of the Third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. In the current edition, DSM-IV (1994), PTSD is categorized under a new stress response category and remains in the anxiety disorder category.
Defining the Disorder
PTSD is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat. People with PTSD have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people they were once close to. They may experience sleep problems, poor concentration, irritability/anger, hypervigilance (constantly scanning the environment for danger), extreme physical reactivity, recurrent and distressing nightmares of the traumatic event, feel detached or numb, or be easily startled. (http://www.military.com/opinion/015202,79791,00.html ). Effective treatments for post-traumatic stress disorder are available, and research is yielding new, improved therapies that can help most people with PTSD and other anxiety disorders lead productive, fulfilling lives. http://www.nimh.nih.gov/healthinformation/ptsdmenu.cfm)
Nature and Magnitude of the Problem
A landmark study published in 2006 in the New England Journal of Medicine revealed that approximately 16 percent of those returning from Iraq suffered from mental health problems, the most prominent among them being PTSD. Yet these rates may actually understate the scope of the PTSD problem among American veterans. Army Surgeon General, LT. General Kevin Kiley reported in 2007 that among 1,000 Army soldiers surveyed three to four months after returning from Iraq, a full 30 percent had developed stress-related mental health problems. There is increasing awareness that PTSD sometimes manifests itself months, even years, after the traumatic event. Called “delayed onset” PTSD, this sleeper version of the disorder makes accurate diagnoses at discharge a serious challenge for mental health providers. Service members often refuse to disclose disturbing symptoms common to PTSD, either due to distrust of the mental health establishment or because they are embarrassed to seek help. (http://www.military.com/opinion/0,15202,79791,00.html) written 11/03/2005 and retrieved on 07/17/2007
According to the Veteran’s Administration, more than 9,000 mental health professionals provide mental health services to approximately 1 million veterans per year. Still more veterans of the ongoing war in Iraq and Afghanistan have reported mental health issues, including symptoms of PTSD. A fact sheet, PTSD and Suicide by William Hudenko, PhD, explores the relationship between PTSD and suicide and addresses important questions about understanding and coping with suicide. Available at www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_suicide.html
Social Work Researchers’ Approach
Social work researchers have recently been studying diverse aspects of PTSD, including its relation to co-morbidities such as physical disfigurement, alcoholism and drug abuse, brain injury, and family stress. Researchers are refining assessment tools and scales to measure the incidence and severity of the disorder. Finally, researchers are examining ways to treat this disorder and promote protective factors and minimize negative family impact.
National Institute of Mental Health (NIMH)
Post Traumatic Stress Disorder Information
Post-Traumatic Stress Disorder, PTSD, is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat. People with PTSD have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people they were once close to. They may experience sleep problems, feel detached or numb, or be easily startled. Effective treatments for post-traumatic stress disorder are available, and research is yielding new, improved therapies that can help most people with PTSD and other anxiety disorders lead productive, fulfilling lives.
U.S. Substance Abuse and Mental Health Administration (SAMHSA)
SAMHSA provides a wealth of information relating to PTSD treatment and resources, both governmental and private sector.
U.S. Department of Veterans Affairs (VA)
Federal Benefits for Veterans and Dependents, 2007 Edition http://www1.va.gov/OPA/vadocs/current_benefits.asp
The VA issues an annual summary of benefits that can be an excellent start to understanding the different programs and benefits a veteran may be eligible to receive. The booklet includes other important resources such as a description on how to apply for enrollment into the VA health care system. There are also chapters on Reserve and National Guard; Special Groups of Veterans;
Benefits for Dependents and Survivors; Transition Assistance; and Benefits Provided by Other Federal Agencies. The 170-page publication also has a Facilities Locator & Directory that lists phone numbers and addresses for all 1400+ VA Facilities. The online Facility Locator is searchable by Facility Type or zip code; there is a search feature that allows one to locate facility-related information.
This website provides an array of information on research and treatment related to PTSD.
The International Society for Traumatic Stress Studies (ISTSS)
ISTSS is an international, multidisciplinary professional membership organization that promotes advancement and exchange of knowledge about severe stress and trauma. ISTSS publishes a research journal, Journal of Traumatic Stress, for professionals to share new research in the field. Anonymous experts review the studies, which are considered to be leading research in this field. A quarterly newsletter, Traumatic Stress Points, features organizational news and news and features on various issues.
The following research study abstracts, selected from Social Work Abstracts™ primarily published since 2000, are grouped in categories:
- Symptoms and Co-morbidities
- Scales/Screenings/Assessment Tools
- Treatment Measures and/or Techniques
Symptoms and Co-morbidities
Anhedonia and emotional numbing in combat veterans with PTSD.
AU: Kashdan-T-B; Elhai-J-D; Frueh-B-C
SO: Behaviour-Research-and-Therapy. 44(3): 457-467, March 2006.
Relationships between anhedonia and posttraumatic stress disorder (PTSD) symptom clusters, including their role in predicting psychiatric comorbidity were explored. Measures of anhedonia were derived from an examination of the latent structure of the Beck Depression Inventory. We found evidence for a two-factor solution, leading to anhedonia and undifferentiated, global depressive symptoms scales. In primary analyses, anhedonia had a unique positive relationship with PTSD’s emotional numbing symptoms and minimal relationships with other PTSD symptoms. Upon examining the incremental validity of appetitive functioning (i.e., anhedonia, emotional numbing) over and above aversive functioning (i.e., re-experiencing, avoidance, and hyperarousal PTSD symptoms) variables, greater emotional numbing increased the likelihood of being diagnosed with a major depressive disorder, and greater anhedonia increased the likelihood of being diagnosed with additional anxiety disorders and to a lesser extent, psychotic disorders. Results were consistent with research on the distinction of appetitive and aversive functioning, providing
insight into the nature of PTSD. (Journal abstract)
TI: Social anxiety disorder in veterans affairs primary care clinics.
AU: Kashdan-T-B; Frueh-B-C; Knapp-R-G; Hebert-R; Magruder-K-M
SO: Behaviour-Research-and-Therapy. 44(2): 233-247, January 2006.
AB: To examine the prevalence and correlates of social anxiety disorder (SAD) in veterans, 733 veterans from four VA primary care clinics were evaluated using self-report questionnaires, telephone interview, and a 12-month retrospective review of primary care charts. We also tested the concordance between primary care providers’ detection of anxiety problems and diagnoses of SAD from psychiatric interviews. For the multi-site sample, 3.6% met criteria for SAD. A greater rate of SAD was found in veterans with than without posttraumatic stress disorder (PTSD) (22.0% vs. 1.1%), and primary care providers detected anxiety problems in only 58% of veterans with SAD. The elevated rate of comorbid psychiatric diagnoses and suicidal risk associated with SAD was not attributable to PTSD symptom severity. Moreover, even after controlling for the presence of major depressive disorder, SAD retained unique, adverse effects on PTSD diagnoses and severity, the presence of other psychiatric conditions, and suicidal risk. These results attest to strong relations between SAD and PTSD, the inadequate recognition of SAD in primary care settings, and the significant distress and impairment associated with SAD in veterans. (Journal abstract)
TI: Unwanted memories of assault: What intrusion characteristics are associated with PTSD?
AU: Michael-T; Ehlers-A; Halligan-S-L; Clark-D-M
SO: Behaviour-Research-and-Therapy. 43(5): 613-628, May 2005.
AB: Intrusive memories are common in the immediate aftermath of traumatic events, but neither their presence or frequency are good predictors of the persistence of posttraumatic stress disorder (PTSD). Two studies of assault survivors, a cross-sectional study (N = 81) and a 6-month prospective longitudinal study (N = 73), explored whether characteristics of the intrusive memories improve the prediction. Intrusion characteristics were assessed with an Intrusion Interview and an Intrusion Provocation Task. The distress caused by the intrusions, their “here and now” quality, and their lack of a context predicted PTSD severity. The presence of intrusive memories only explained 9% of the variance of PTSD severity at 6 months after assault. Among survivors with intrusions, intrusion frequency only explained 8% of the variance of PTSD symptom severity at 6 months. Nowness, distress, and lack of context explained an additional 43% of the variance. These intrusion characteristics also predicted PTSD severity at 6 months over and above what could be predicted from PTSD diagnostic status at initial assessment. Further predictors of PTSD severity were rumination about the intrusive memories, and the ease and persistence with which intrusive memories could be triggered by photographs depicting assaults. The results have implications for the early identification of trauma survivors at risk for chronic PTSD. (Journal abstract)
TI: Trauma and health: Physical health consequences of exposure to extreme stress.
BK: Washington, DC: American Psychological Assn. (2004) 311 p.
HC: 41(1), 2005, No. 519
AB: The relationship between stress and physical health has posed many questions for researchers. Most of their queries have focused on stressors such as divorce, bereavement, and job loss. However, more recent work has examined the health effects associated with extreme stressors, including war, sexual victimization, disasters, and serious accidents. This volume continues along that path and summarizes findings on trauma and posttraumatic stress disorder (PTSD) in relation to three domains of outcomes: health status and disease, somatization, and utilization and cost. Contributors examine how trauma and PTSD could lead to poor physical health through correlates such as depression, hostility, and maladaptive coping, and health behaviors. They also present findings on the biology of stress and implications for clinical and health policy. This volume provides a comprehensive summary of existing literature and a critical look at current empirical work. It will stimulate research and support clinical practice by providing clinicians with solid information that can inform their work with patients. This book clearly shows that poor physical health should be recognized, along with mental health problems and impaired psychological functioning, as an outcome of traumatic exposure. (Journal abstract)
TI: Emotion-specific and emotion-non-specific components of posttraumatic stress disorder (PTSD): Implications for a taxonomy of related psychopathology.
AU: Dalgleish-T; Power-M-J
SO: Behaviour-Research-and-Therapy. 42(9): 1069-1088, September 2004.
AB: Many cognitive theories of posttraumatic stress disorder (PTSD), including the authors’ own SPAARS model, propose that one basis of the disorder is the cognitive system’s persistent failure to resolve discrepancies between trauma-related information and the content of pre-existing mental representations, such as schemas. This leads to the characteristic PTSD symptom pattern of re-experiencing and avoidance of trauma-related material. Furthermore, the nature of this unresolved discrepancy revolves around appraisals of threat and the corresponding emotion profile in PTSD is therefore predominantly intense fear and anxiety. This paper argues that this general framework can be extended to discrepancies around other appraisal dimensions such as loss, and consequently to other emotions such as sadness. A localized taxonomy is therefore proposed comprising emotional disorders that resemble PTSD in their basic patterns of re-experiencing and avoidance symptoms–what the authors call their ‘emotion-non-specific component’–but that differ from PTSD in terms of the core emotions involved–’emotion-specific component’. The clinical and nosological implications of this argument are discussed. (Journal abstract)
TI: Stress-induced enhancement of auditory startle: An animal model of
posttraumatic stress disorder.
AU: Garrick-T; Morrow-N; Shalev-A-Y; Eth-S
SO: Psychiatry-Interpersonal-and-Biological-Processes. 64(4): 346-354, Winter 2001.
AB: An innovative animal model of posttraumatic stress disorder (PTS) is proposed in which nonhabituation of the acoustic startle response is developed in rats subsequent to tailshock exposure. Subjects (n = 31) received 30 minutes of intermittent tail shock on 2 days followed by exposure to the tailshock apparatus on the third day. Compared to baseline startle reactions, 9 of 31 tailshock-exposed rats developed nonhabituation of startle response reactions during the subsequent 3 weeks of testing. No control rats developed nonhabituation of startle reactions over a similar time period. These data suggest that this system models useful aspects of clinical PTSD emphasizing nonhabituation of startle reactions as a dependent variable. The method consistently identified a subgroup of rats that developed persistent nonhabituation of startle in response to a tailshock-stress paradigm. (Journal abstract)
TI: Stability of emotions for traumatic memories in acute and chronic PTSD.
AU: Zoellner-L-A; Sacks-M-B; Foa-E-B
SO: Behaviour-Research-and-Therapy. 39(6): 697-711, June 2001.
AB: While memory for central factual information regarding an emotional event is considered to be relatively accurate, memory for emotions seem to be quite inaccurate (Christianson & Safer, 1995). The authors extended this line of research to examine memory for the emotional intensity surrounding a traumatic event (e.g., memory for the fear and horror of the event). The authors conducted a series of two studies. In Study 1, they examined memory for the emotional intensity of the traumatic event in recent sexual or non-sexual assault victims with acute PTSD at 2 and 12 weeks following the assault. In Study 2, they compared memory for emotional intensity in sexual and non-sexual assault victims with either acute or chronic PTSD at initial assessment and 12 weeks later. For both studies, participants were asked to recall general emotional intensity, fear intensity, and dissociative intensity of the traumatic event. Results suggested that memory for the fear of the traumatic event did not fluctuate over time. However, memory for the general emotional and dissociative intensity did fluctuate over time, decreasing for individuals with acute PTSD and increasing for individuals with chronic PTSD. (Journal abstract)
TI: Nocturnal re-experiencing more than forty years after war trauma.
AU: Schreuder-B-J-N; Kleijn-W-C; Rooijmans-H-G-M
SO: Journal-of-Traumatic-Stress. 13(3): 453-463, July 2000.
AB: The aim of this study was the examination of Posttraumatic Nightmares (PTNM) and Posttraumatic Anxiety Dreams (PTAD) in Dutch combat veterans and World War II victims. Participants (outpatients, n = 223) were administered a standardized psychiatric interview, the Impact of Event Scale, the SCL-90, the Clinician Administered PTSD Scale, and an interview on posttraumatic nocturnal re-experiencing. Prevalence of PTNM was 56%. Patients with PTNM, even those who were not diagnosed with PTSD, had significantly more psychiatric complaints than patients with no PTNM. Analysis of PTNM demonstrated that they were often experienced as exact replications of the original traumatic events. Replicative PTNM often implicated dream recurrence. Traumatic experiences before the age of 5 resulted in nonreplicative PTNM only. Unlike nonreplicative PTNM, replicative PTNM seemed to be correlated with several intrusion subscales. (Journal abstract)
TI: Posttraumatic stress symptoms following near-death experiences.
SO: American-Journal-of-Orthopsychiatry. 71(3): 368-373, July 2001.
AB: Persons who report “near-death experiences” (NDEs) acknowledge more intrusive symptoms of posttraumatic stress disorder (PTSD) than those who came close to death without NDEs, but not more avoidance symptoms, suggesting a nonspecific stress response. Although dissociation generally increases vulnerability to PTSD, the positive affect that distinguishes NDEs from other dissociative experiences may mitigate subsequent PTSD symptoms. (Journal abstract)
TI: Fear, helplessness, and horror in posttraumatic stress disorder: Investigating DSM-IV Criterion A2 in victims of violent crime.
AU: Brewin-C-R; Andrews-B; Rose-S
SO: Journal-of-Traumatic-Stress. 13(3): 499-509, July 2000.
AB: A DSM-IV diagnosis of PTSD required for the first time that individuals must report experiencing intense fear, helplessness, or horror at the time of the trauma. In a longitudinal study of 138 victims of violent crime, the authors investigated whether reports of intense trauma-related emotions characterized individuals who, after six months, met criteria for PTSD according to the DSM-III-R. It was found that intense levels of all three emotions strongly predicted later PTSD. However, a small number of those who later met DSM-III-R or ICD criteria for PTSD did not report intense emotions at the time of the trauma. They did, however, report high levels of either anger with others or shame. (Journal abstract)
TI: War experience, PTSD, and sequelae among adult Liberian immigrants who experienced the Civil War as children or adolescents.
DA: New York Univ., PhD, May 2001.
HC: 37(2), 2001, No. 781
AB: A sample of 140 Liberian immigrants to the United States who were in Liberia during the Civil War (1989-1997) and who had experienced war trauma were surveyed on personal loss, intensity of military participation, PTSD, level of acculturation, educational adaptation, and magnitude of family problems. The major findings of this study were: (a) the greater the war participation, the higher the level of PTSD, the higher the level of adhesion to Liberian cultural preferences, the lower the educational adaptation, especially for persons who served as actual combatants in the war, the greater the severity of job problems, and the higher the level of family problems; (b) actual participation in military hostilities was the strongest predictor of PTSD, which contributed to family problems independent of war participation; and (c) educational adaptation was negatively influenced by adhesion to Liberian cultural preferences and war participation, but not by PTSD level. (Journal Abstract)
TI: Interpersonal problems of Vietnam combat veterans with symptoms of
posttraumatic stress disorder.
AU: Roberts-W-R; Penk-W-E; Gearing-M-L; Robinowitz-R; Dolan-M-P; Patterson-E-T
SO: Journal-of-Abnormal-Psychology. 91(6): 444-50, 1982.
AB: A study focused on the interpersonal problems of Vietnam veterans with symptoms of posttraumatic stress disorder (PTSD). A sample of 274 veterans was divided on the basis of their combat experience and how well they met criteria of PTSD, as defined by the third edition of the Diagnostic and Statistical Manual of Mental Disorders. Subjects with symptoms of PTSD were compared with non-PTSD groups of combat veterans and non-combat veterans on measures of specific interpersonal problems, as well as more traditional measures of family and social adjustment. Findings revealed significantly higher scores on clusters of problems regarding intimacy and sociability among subjects with PTSD than among subjects in the comparison groups. Veterans with PTSD also scored higher on a number of scales of a personality inventory but did not differ from non-PTSD subjects on a scale that assessed variables relating to family environment. These findings are compared to those of other studies, and areas in need of additional exploration are discussed. (Journal abstract, edited. Morton S. Perlmutter.)
TI: The Centrality of Event Scale: A measure of integrating a trauma into one’s identity and its relation to post-traumatic stress disorder symptoms.
AU: Berntsen-D; Rubin-D-C
SO: Behaviour-Research-and-Therapy. 44(2): 219-231, January 2006.
AB: A new scale that measures how central an event is to a person’s identity and life story is introduced. For the most stressful or traumatic event in a person’s life, the full 20-item Centrality of Event Scale (CES) and the short 7-item scale are reliable in a sample of 707 undergraduates. The scale correlates .38 with PTSD symptom severity and .23 with depression. The findings are discussed in relation to previous work on individual differences related to PTSD symptoms. Possible connections between the CES and measures of maladaptive attributions and rumination are considered along with suggestions for future research. (Journal abstract)
TI: An abbreviated PTSD checklist for use as a screening instrument in primary care.
AU: Lang-A-J; Stein-M-B
SO: Behaviour-Research-and-Therapy. 43(5): 585-594, May 2005.
AB: Although the importance of recognizing posttraumatic stress disorder (PTSD) in primary care has been well-established, routine screening for PTSD remains unfeasible for many primary care clinics because of the length of the available screening instruments. Thus, the purpose of this work was to develop and validate a brief screening tool for PTSD. In Study 1, four short forms of the PTSD Checklist-civilian version were identified that captured a majority of the variance in the measure. In Study 2, the performance of these short forms was evaluated in a separate sample of primary care patients. It was found that both two-item and six-item versions have adequate psychometric properties for screening purposes and suggest that the selection of one version over the other depends on the specific needs of each primary care clinic. (Journal abstract)
TI: Understanding the pattern of PTSD symptomatology: A comparison of between versus within-group approaches.
AU: Gudmundsdottir-B; Beck-J-G
SO: Behaviour-Research-and-Therapy. 42(11): 1367-1375, November 2004.
AB: This report examines the influence of statistical approach on patterns of Posttraumatic Stress Disorder (PTSD). In this report, 114 women and 51 men were assessed using both the Clinician Administered PTSD scale (CAPS) and the Posttraumatic Symptom Scale-Self Report measure (PSS-SR). Data were examined using both a between-group and a within-group design. In the between-group approach, three subsamples were formed, representing full syndrome PTSD fPTSD), partial PTSD (pPTSD), and no PTSD. The fPTSD and pPTSD groups differed on total scores on both PTSD measures, although differences were noted between clinician and self-report measures in specific symptom clusters. In the within-group approach, curve estimation techniques were used to examine linear versus quadratic fit of the data, using the sample as a whole, ranked according to a separate scale of clinical severity. A linear approach was noted for each measure. Results are discussed in light of current design choices in the literature and its impact on the understanding of posttrauma problems. (Journal abstract)
TI: Distress experienced by participants during an epidemiological survey of posttraumatic stress disorder.
AU: Parslow-R-A; Jorm-A-F; O’Toole-B-I; Marshall-R-P; Grayson-D-A
SO: Journal-of-Traumatic-Stress. 13(3): 465-471, July 2000.
AB: The authors examined the potential for epidemiological studies of mental disorders, specifically of posttraumatic stress disorder (PTSD), to cause further harm to participants involved. Of 1,000 randomly selected Australian Vietnam veterans, 641 agreed to participate in an epidemiological survey. Participants were asked about distress experienced during the interview when traumatic events were raised. Significant distress attributed to the interview was reported by 75.3% of those with current PTSD, 56.5% of those with past PTSD, and 20.6% of those with no PTSD diagnosis. Distress did not affect participants’ use of medical services following the interview nor did it affect their willingness to continue participating in the study. The study concluded that research interviews about PTSD may cause short-term distress, but found no evidence of long-term harm. (Journal abstract)
TI: The effects of extreme early stress in very old age.
AU: Landau-R; Litwin-H
SO: Journal-of-Traumatic-Stress. 13(3): 473-487, July 2000.
AB: This article examined a community-based sample of Holocaust survivors aged 75 and over, in comparison to persons of similar age and sociocultural background who did not personally experience the Holocaust. The analysis compared respondents’ sociodemographic characteristics, interpersonal resources (locus of control and social network), and vulnerability, stratified by gender (n = 194). Assessments of vulnerability (physical health, mental health, and PTSD) were compared across groups. The results revealed almost no differences regarding the sociodemographic and interpersonal variables. Nevertheless, survivors were found to be more vulnerable than the others in the comparison group: (a) male survivors demonstrated a higher prevalence of PTSD, and (b) female survivors indicated greater health-related difficulties and poorer self-rated health. (Journal abstract, edited)
TI: A confirmatory factor analysis of posttraumatic stress symptoms.
AU: Buckley-T-C; Blanchard-E-B; Hickling-E-J
SO: Behavior-Research-and-Therapy. 36(11): 1091-1099, November 1998.
AB: Investigators have recently identified a two-factor structure underlying posttraumatic stress symptoms through the use of exploratory factor analysis [Taylor et al. (1998). The structure of posttraumatic stress symptoms. Journal of Abnormal Psychology, 107, 154-160]. These two factors, which were labeled as Intrusion and Avoidance, and Hyperarousal and Numbing, are consistent with current theoretical models of posttraumatic stress disorder–PTSD [e.g. Foa et al. (1992). Uncontrollability and unpredictability in post-traumatic stress disorder: An animal model. Psychological Bulletin, 112, 218-238]. However, the authors of the Taylor et al. study issued caution in interpreting their findings because there has yet to be a systematic replication of their results. This paper presents a confirmatory factor analysis of the two-factor structure of posttraumatic stress symptoms in 217 survivors of serious motor vehicle accidents with varying degrees of PTSD symptoms. A hierarchical, confirmatory-factor analysis conducted with a structural equation modeling statistics package confirmed that the model proposed by Taylor et al. can adequately account for the presentation of PTSD symptoms in this sample of motor vehicle accident survivors. The implications for the assessment and diagnosis of PTSD are discussed. (Journal abstract)
TI: The role of grief in the delayed reaction of Vietnam Veterans.
DA: Tulane Univ., DSW, December 1996.
AB: This exploratory study, completed in 1996, of 34 Vietnam veteran voluntary respondents was conducted to explore the strength of association between Posttraumatic Stress Disorder (PTSD) and nine specific components of grief. Comparisons were made of the resulting global scores on the Mississippi Scale for Combat-Related PTSD and the scores from each scale of the Grief Experience Inventory (GEI). The nine scales or specific grief components are: Despair, Anger, Guilt, Social Isolation, Loss of Control, Rumination, Depersonalization, Somatization, and Death Anxiety. A nonparametric statistic, the Spearman rank correlation coefficient was used to analyze the comparative rankings of scores. Results suggest that each of the nine comparisons was positively related and significant at the .05 level. Rankings of scores for Despair, Somatization, and Anger/Hostility were the variables indicating the highest agreement with rankings of PTSD scores. The research builds on interactive models of PTSD etiology and contributes to the quantitative exploration of the correlation between the components of grief and PTSD still being manifested. The findings support the stage of grief resolution as an important consideration for assessment and treatment of PTSD. (Dissertation abstract)
TI: Unbidden images: The role of imagery in traumatic stress.
DA: Smith College, PhD, August 1995.
HC: not printed in Sept. 1996 issue, No. 46
AB: This study examined the role of intrusive imagery in the traumatic memories of 21 female individuals suffering from posttraumatic stress disorder (PTSD). The study followed the theoretical models of Horowitz (1986) and Bucci (1982, 1984, 1993), and utilized Bucci’s Referential Activity (RA) Scale to establish levels of translating emotions into words. The participants provided the history of their traumas and four memories for scoring on Bucci’s RA Scale. Also, the subjects were evaluated on a modified Betts’ Scale regarding their general capacity for vivid memories. The results of the study supported the underlying premise that intrusive imagery serves as an alternate pathway in processing traumatic experience. The hypothesized relationship between the presence of traumatic dreams or flashbacks and lowered RA scores was confirmed. The study also found that current intrusive imagery interfered with general ability for clear and vivid recall. The study concludes that the RA theory offers a viable method of investigating the progression of traumatic processing. (Dissertation abstract)
TI: Women after war: Vietnam experiences and post-traumatic stress: Contributions to social adjustment problems of Red Cross workers and military nurses.
DA: Simmons College, PhD, May 1992.
HC: 31(3), 1995, No. 1349
AB: A descriptive study examined the Vietnam experiences, posttraumatic stress disorder (PTSD) symptoms, and later social adjustment of 102 military nurses and 233 Red Cross workers (N = 335). The association of Vietnam experiences to PTSD symptoms and PTSD symptoms to later social adjustment were investigated. Measures for experiences and symptoms were author designed. A social adjustment scale and depressive symptoms scale were included. Denial of emotion, sexual harassment, inadequate preparation for the war zone, and feeling responsible for another’s death were associated with PTSD symptoms. Overall, relationships disrupted by loss provided the strongest associations to PTSD. PTSD symptoms were associated with social adjustment problems with sexual partners, children, family members, friends, and at work. Needed program and policy changes applicable to the American Red Cross, Veterans Administration, and Armed Forces were discussed. Provision of care for civilian volunteers with war-related problems was recommended. (Dissertation abstract)
TI: The relationship of social support to post-traumatic stress disorder among Hispanic and white Vietnam combat veterans.
DA: Catholic Univ. of America, DSW Dissertation, May 1990.
HC: 26(4), 1990, No. 1678
AB: An ex post facto study investigated the relationship between self-perceived social support, exposure to combat, ethnicity, and posttraumatic stress disorder (PTSD). Also examined was the impact of social support on PTSD among Vietnam veterans from two different ethnic groups, Hispanic and white. The study surveyed a random sample of 180 Hispanic and white Vietnam-era veterans seeking services in six different veterans’ agencies during a two-month period. Subjects completed four instruments on social support, PTSD, and combat exposure; the data were analyzed by multiple regression analysis. The study affirmed the impacts of combat exposure and social support on the development of the negative readjustment symptoms of PTSD. For both ethnic groups, combat exposure was positively associated with PTSD, while increased contact and intimacy with friends and relatives was negatively associated with PTSD. The impact of both emotional and tangible crisis support on PTSD was found to be greater among white veterans. (Dissertation abstract)
Treatment Measures and/or Techniques
TI: Cognitive therapy for post-traumatic stress disorder: Development and evaluation.
AU: Ehlers-A; Clark-D-M; Hackmann-A; McManus-F; Fennell-M
SO: Behaviour-Research-and-Therapy. 43(4): 413-431, April 2005.
AB: The paper describes the development of a cognitive therapy (CT) program for posttraumatic stress disorder (PTSD) that is based on a recent cognitive model (Behav. Res. Therapy, 38, 2000, pp. 319). In a consecutive case series, 20 PTSD patients treated with CT showed highly significant improvement in symptoms of PTSD, depression, and anxiety. A subsequent randomized controlled trial compared CT (N = 14) and a 3-month waitlist condition (WL, N = 14). CT led to large reductions in PTSD symptoms, disability, depression, and anxiety, whereas the waitlist group did not improve. In both studies, treatment gains were well maintained at 6-month follow-up. CT was highly acceptable, with an overall dropout rate of only 3%. The intent-to-treat effect sizes for the degree of change in PTSD symptoms from pre to post-treatment were 2.70-2.82 (self-report), and 2.07 (assessor-rated). The controlled effect sizes for CT versus WL post-treatment scores were 2.25 (self-report) and 2.18 (assessor-rated). As predicted by the cognitive model, good treatment outcome was related to greater changes in dysfunctional posttraumatic cognitions. Patient characteristics such as comorbidity, type of trauma, history of previous trauma, or time since the traumatic event did not predict treatment response, however, low educational attainment and low socioeconomic status were related to better outcome. (Journal abstract)
TI: Treatment choice for PTSD.
AU: Zoellner-L-A; Feeny-N-C; Cochran-B; Pruitt-L
SO: Behaviour-Research-and-Therapy. 41(8): 879-886, August 2003.
AB: The impetus for seeking help for assault-related difficulties often rests upon the victims themselves. Yet, we know very little about what factors influence a woman’s decision to seek a particular kind of help after an assault. To learn more about these factors, data from 273 women with varying degrees of trauma history and subsequent PTSD symptoms were collected. All participants read a standard, “if this happened to you, what would you do” scenario describing a traumatic event and subsequent trauma-related psychiatric symptoms. Participants were given the same trauma scenario (i.e., sexual assault) and three treatment options to choose from: sertraline (SER), prolonged exposure (PE), or no treatment. Ratings of treatment credibility, personal reactions to treatment options, and treatment choice were examined. Women were more likely to choose PE than SER for the treatment of chronic PTSD. Perceived credibility of the treatment and personal reactions coincided with women’s choices. By better understanding who would choose which treatments for PTSD and why, the authors suggest ways in which we can improve our ability to tailor how we approach discussing treatment options with these women. (Journal abstract)
TI: Posttraumatic stress disorder symptoms in Korean conflict and World War II combat veterans seeking outpatient treatment.
AU: McCranie-E-W; Hyer-L-A
SO: Journal-of-Traumatic-Stress. 13(3): 427-439, July 2000.
AB: Given important differences in the Korean conflict and World War II, samples of treatment-seeking combat veterans from these wars (30 Korea, 83 World War II) were compared on the prevalence and severity of posttraumatic stress disorder (PTSD). With age, ethnicity, and combat exposure taken into account, the Korean veterans reported significantly more severe symptoms on both interview and self-report PTSD measures. Group differences in the prevalence of current PTSD were in a similar direction but not significant. These results are generally consistent with other studies that have found Korean combat veterans to exhibit higher rates of psychosocial maladjustment than World War II combat veterans. Based on related research with Vietnam veterans, one direction for future investigation is to examine what role stressful post-military homecoming experiences may have played in influencing the development and course of combat-related PTSD in the aging cohort of “forgotten” Korean conflict veterans. (Journal abstract)
TI: The attachment characteristics of combat veterans with posttraumatic stress disorder.
DA: New York Univ, PhD, January 2004.
HC: 40(3), 2004, No. 1481
AB: While the symptom profile and underlying neurobiology of posttraumatic stress disorder (PTSD) have received considerable attention in the literature, less attention has been paid to the interpersonal dynamics, social isolation, and emotional numbing associated with the disorder. The relational dynamics of combat veterans with PTSD are considered through the lens of attachment theory. Fifty combat veterans with a diagnosis of PTSD were administered standardized measures of attachment style, PTSD symptoms, combat exposure, and cognitions associated with PTSD. Correlations between PTSD symptom measures and attachment measure were modest. However, the distribution of attachment classifications in the veteran sample was significantly different from comparison groups. Findings suggest that combat veterans with PTSD endorse characteristically avoidant attachment styles. Theoretical and clinical implications of this finding, with emphasis on the role of the therapeutic alliance, are discussed. (Dissertation abstract)
TI: Cumulative adversity and posttraumatic stress disorder: evidence from a diverse community sample of young adults.
AU: Lloyd-D-A; Turner-R-J
SO: American-Journal-of-Orthopsychiatry. 73(4): 381-391, October 2003.
AB: The authors hypothesized that a history of adversities, whether they were objectively traumatic or not, predicts risk for first onset of PTSD. Survival analysis in a community sample of 1,803 young adults revealed that risk is associated with retrospectively reported adverse experiences that occurred in years prior to the focal traumatic event. Analyses control for clustering of events proximal to onset. Implications for etiology and preventive intervention are noted. (Journal abstract)
TI: Attachment style classification and posttraumatic stress disorder in former prisoners of war.
AU: Dieperink-M; Leskela-J; Thuras-P; Engdahl-B
SO: American-Journal-of-Orthopsychiatry. 71(3): 374-378, July 2001.
AB: Adult attachment style and posttraumatic stress disorder (PTSD)
symptomatology were investigated in 107 former prisoner of war veterans. Those with secure attachment styles scored significantly lower on measures of PTSD than did those with insecure styles, and attachment style was a stronger predictor of PTSD symptom intensity than was trauma severity. The suggested association between attachment style and development and persistence of PTSD are discussed in relation to research and clinical practice. (Journal abstract)