Exposure to atrocities and severity of chronic posttraumatic stress disorder in Vietnam combat veterans

The purpose of this study was to examine factors predicting the development of posttraumatic stress symptoms after a traumatic event, the 1991 Oakland/Berkeley firestorm. The major predictive factors of interest were dissociative, anxiety, and loss of personal autonomy symptoms reported in the immediate aftermath of the fire; contact with the fire; and life stressors before and after the fire. Subjects were recruited from several sources so that they would vary in their extent of contact with the fire. Of 187 participants who completed self-report measures about their experiences in the aftermath of the firestorm, 154 completed a follow-up assessment. Of these 154 subjects, 97% completed the follow-up questionnaires 7-9 months after the fire. The questionnaires included measures of posttraumatic stress and life events since the fire. Dissociative and loss of personal autonomy symptoms experienced in the fire's immediate aftermath, as well as stressful life experiences occurring later, significantly predicted posttraumatic stress symptoms measured 7-9 months after the firestorm by a civilian version of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder and the Impact of Event Scale. Dissociative symptoms more strongly predicted posttraumatic symptoms than did anxiety and loss of personal autonomy symptoms. Intrusive thinking differs from other kinds of posttraumatic symptoms in being related directly to the trauma and previous stressful life events. These findings suggest that dissociative symptoms experienced in the immediate aftermath of a traumatic experience and subsequent stressful experiences are indicative of risk for the later development of posttraumatic stress symptoms. Such measures may be useful as screening procedures for identifying those most likely to need clinical care to help them work through their reactions to the traumatic event and to subsequent stressful experiences.

Alexithymia refers to a specific disturbance in psychic functioning characterized by difficulties in the capacity to verbalize affect and to elaborate fantasies. Although initially described in the context of psychosomatic illness, alexithymic characteristics may be observed in patients with a wide range of medical and psychiatric disorders. The author reviews the concept of alexithymia, including its historical background, clinical and demographic features, and possible etiology. He critically evaluates the different methods used to measure alexithymia and discusses the important implications it has for medical and psychiatric treatment.

This review of the descriptive literature on borderline patients indicates that accounts of such patients vary depending upon who is describing them, in what context, how the samples are selected, and what data are collected. The authors identify six features that provide a rational means for diagnosing borderline patients during an initial interview: the presence of intense affect, usually depressive or hostile; a history of impulsive behavior; a certain social adaptiveness; brief psychotic experiences; loose thinking in unstructured situations; and relationships that vacillate between transient superficiality and intense dependency. Reliable identification of these patients will permit better treatment planning and clinical research.

The authors examined the effect of patients' style of clinical presentation on primary care physicians' recognition of depression and anxiety. The subjects were 685 patients attending family medicine clinics on self-initiated visits. They completed structured interviews assessing presenting complaints, self-report measures of symptoms and hypochondriacal worry, the Diagnostic Interview Schedule (DIS), and the Center for Epidemiologic Studies Depression Scale (CES-D). Physician recognition was determined by notation of any psychiatric condition in the medical chart over the ensuing 12 months. The authors identified three progressively more persistent forms of somatic presentations, labeled "initial," "facultative," and "true" somatization. Of 215 patients with CES-D scores of 16 or higher, 80% made somatized presentations; of 75 patients with DIS-diagnosed major depression or anxiety disorder, 76% made somatic presentations. Among patients with DIS major depression or anxiety disorder, somatization reduced physician recognition from 77%, for psychosocial presenters, to 22%, for true somatizers. The same pattern was found for patients with high CES-D scores. In logistic regression models education, seriousness of concurrent medical illness, hypochondriacal worry, and number of lifetime medically unexplained symptoms each increased the likelihood of recognition, while somatized presentations decreased the rate of recognition. While physician recognition of psychiatric distress in primary care varied widely with different criteria for recognition, the same pattern of reduction of recognition with increasing level of somatization was found for all criteria. In contrast, hypochondriacal worry and medically unexplained somatic symptoms increased the rate of recognition.

Distressing and intrusive reexperiencing of the trauma is a hallmark symptom of posttraumatic stress disorder (PTSD; American Psychiatric Association, 1994). However, unwanted memories of trauma are not a sign of pathology per se. In the initial weeks after a traumatic experience, intrusive memories are common. For most trauma survivors, intrusions become less frequent and distressing over time. A central question for understanding and treating patients with PTSD is therefore what maintains distressing intrusive reexperiencing in these people. Three factors appear to be important: (1) memory processes responsible for the easy triggering of intrusive memories, (2) the individuals’ interpretations of their trauma memories, and (3) their cognitive and behavioral responses to trauma memories.

The authors propose that oscillations of attachment in borderline personality disorder stem from a central problem with regulation of interpersonal distance. This problem derives from borderline patients' conflicts between fears of abandonment and domination. When they move closer to others, they fear that they will be dominated; when they move away, they fear that they will be abandoned. Whichever direction they move, they experience negative feedback. This gives rise to recurrent oscillations between attachment to and detachment from others. Because the oscillations are reinforced by the ambivalent reactions of significant others and the involvement of third parties, family therapy is often indicated.

The current study examined the relationships among combat exposure, presence of and search for meaning in life, general and social self-efficacy, and both posttraumatic stress disorder (PTSD) and depression symptom severity for a Veteran sample (N = 93). Participants completed an online survey comprising the Combat Exposure Scale, Meaning in Life Questionnaire, Self-Efficacy Scale, Depression subscale of the Depression, Anxiety, Stress Scales-21, and PTSD Checklist-Specific Stressor version. The majority of participants were male and Caucasian. Participants served in various service eras To determine factors that predicted PTSD and depression severity, separate hierarchical linear regressions were performed. In the final PTSD model, rank, combat exposure, and general self-efficacy were significant predictors, with officer rank, lower combat exposure, and higher general self-efficacy associated with lower PTSD severity. The interaction between combat exposure and general self-efficacy was also significant, with self-efficacy moderating the relationship between combat exposure and PTSD severity. For depression, rank, presence of meaning in life, and general self-efficacy were significant predictors in the model, with officer rank, higher presence of meaning in life, and general self-efficacy associated with lower depression severity. A focus on strengthening self-efficacy may assist with lower levels of PTSD and depression symptomatology after combat trauma.

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The authors compared the hypnotizability of 65 Vietnam veteran patients with posttraumatic stress disorder (PTSD) to that of a normal control group and four patient samples using the Hypnotic Induction Profile. The patients with PTSD had significantly higher hypnotizability scores than patients with diagnoses of schizophrenia (N = 23); major depression, bipolar disorder--depressed, and dysthymic disorder (N = 56); and generalized anxiety disorder (N = 18) and the control sample (N = 83). This finding supports the hypothesis that dissociative phenomena are mobilized as defenses both during and after traumatic experiences. The literature suggests that spontaneous dissociation, imagery, and hypnotizability are important components of PTSD symptoms.

Following the 1980 Mount St. Helens volcanic eruption, psychiatric reactions were studied in the disaster area and in a control community. Using the new criterion-based diagnostic method for psychiatric epidemiologic research, the Diagnostic Interview Schedule, the authors found a significant prevalence of disaster-related psychiatric disorders. These Mount St. Helens disorders included depression, generalized anxiety, and posttraumatic stress reaction. There was a progressive "dose-response" relationship in the comparison of control, low-exposure, and high-exposure groups. The dose-response pattern occurred among both the bereaved and the property-loss victims.

Background: Childhood maltreatment is associated with various psychiatric disorders, including post-traumatic stress disorder (PTSD) and personality disorders (PDs). Previous research has suggested that PTSD and PD are highly comorbid. However, the impact of different types of childhood maltreatment on the severity of PTSD and PD symptoms in a clinical population with PTSD/PD symptoms remains unclear. Objective: We aimed to clarify the role of (a) the overall severity and (b) the severity of subtypes of childhood maltreatment on the severity of (a) PTSD and (b) comorbid PD symptoms. Methods: Data was collected from participants (N = 197) seeking treatment for PTSD with comorbid PD symptoms at a trauma expertise centre in the Netherlands. We assessed childhood maltreatment using the Childhood Trauma Questionnaire-short form (CTQ-sf), PTSD severity with the Clinician-administered PTSD Scale for DSM-5 (CAPS-5), and PD severity with the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD). Data were analyzed using linear and Poisson regression. Results: We found that emotional neglect was the most prevalent form of childhood maltreatment (80.7%), followed by emotional abuse (72.6%). Sexual and emotional abuse shared independent associations with the severity of PTSD. The overall maltreatment severity and emotional abuse were significantly associated with the severity of comorbid borderline PD symptoms. Sexual abuse was significantly associated with the severity of comorbid avoidant PD symptoms. None of the childhood maltreatment types were significantly associated with the severity of comorbid obsessive-compulsive PD symptoms. Conclusions: We demonstrated the relationship between childhood sexual and emotional abuse and PTSD severity in people with PTSD and comorbid PD symptoms. This has important implications since emotional abuse usually does not fulfil the A-criterion required for the diagnosis of PTSD. We recommend routinely assessing emotional abuse in trauma- and PD treatment, and investigating the effectiveness of adapting trauma treatment for emotional abuse. Trial registration: ClinicalTrials.gov identifier: NCT03833453.

The Health Care for Reentry Veterans (HCRV) program provides Veterans Health Administration outreach services to veterans incarcerated in state and federal prisons. This study used HCRV data to compare risk of incarceration of veterans of Operations Enduring Freedom (OEF), Iraqi Freedom (OIF), and New Dawn (OND) and other veterans and to identify sociodemographic and clinical characteristics of incarcerated veterans of OEF/OIF/OND. Administrative national data were analyzed for 30,968 incarcerated veterans, including 1,201 OEF/OIF/OND veterans, contacted from October 2007 to April 2011. Odds ratios were calculated comparing the risk of incarceration among OEF/OIF/OND and other veterans in the HCRV sample and in a weighted sample of nonincarcerated veterans from the 2010 National Survey of Veterans. Stepwise logistic regressions of HCRV data examined characteristics of incarcerated veterans independently associated with OEF/OIF/OND service. Regardless of ethnicity or age, OEF/OIF/OND veterans were less than half as likely as other veterans to be incarcerated and constituted only 3.9% of the incarcerated veterans. Compared with other incarcerated veterans, OEF/OIF/OND veterans were younger, were more likely to be married, were more likely to report combat exposure, expected a shorter incarceration, were 26% less likely to have a diagnosis of drug abuse or dependence, and were three times more likely to have combat-related posttraumatic stress disorder (PTSD). OEF/OIF/OND veterans appeared to be at lower risk of incarceration than veterans of other service eras, but those who were incarcerated had higher rates of PTSD. Efforts to link these veterans to mental health services upon their release are warranted.

Using objective measures, the authors found a high rate of childhood sexual and physical abuse in a sample of 66 female psychiatric inpatients. Childhood abuse experiences were correlated with severity of adult psychiatric symptoms. The authors explore the usefulness of adult psychological symptoms, diagnoses, and prescribed medications as factors in the identification of patients who have histories of early sexual and physical abuse.

Observational research has consistently reported an inverse relationship between exercise and posttraumatic stress disorder (PTSD). However, the majority of these studies have compared individuals with and without PTSD, and very few have measured the symptoms of PTSD or its severity. In fact, no study has examined the relationship between exercise and PTSD symptoms in a sample of individuals diagnosed with PTSD. As such, further investigation is needed. PURPOSE: To elucidate the cross-sectional relationship between self-reported exercise and PTSD symptoms and symptom severity in a sample of individuals diagnosed with PTSD. METHODS: Baseline data collected from a longitudinal study of PTSD and lifestyle behaviors were used for this study. Participants were 18 males, 61 females, and 2 transgender males ages 19-59 (34.6±11.6). To be eligible, participants had to have a prior diagnosis of PTSD. Exercise was assessed using the Godin Leisure-Time Exercise Questionnaire, and participants were divided into two groups using recommended cutoffs: <14 Insufficiently Active (n=38, 46.9%); and ≥14 Active/Moderately Active (n=43, 53.1%). PTSD symptoms and severity were measured with the PTSD Checklist (PCL)-Civilian, Pittsburgh Sleep Quality Index (PSQI), and Kessler Psychological Distress Scale (K10). Group differences were analyzed using independent samples t-tests. RESULTS: PTSD severity and related symptoms were significantly worse in the Insufficiently Active group. Specifically, when compared to the Active/Moderately Active group, the mean scores of the Insufficiently Active group were significantly higher for the PCL (66.7±12.2 vs. 59.8±12.2; t=2.45, p=.01), PSQI (14.0±3.6 vs. 10.4±3.9; t=4.29, p<.01) and K10 (34.4±8.2 vs. 29.8±8.8; t=2.40, p=.02). CONCLUSIONS: The results of this study suggest that there is an inverse relationship between exercise level and PTSD symptoms and PTSD symptom severity among individuals diagnosed with PTSD. While inferences about the direction of causality cannot be made from these data, this is the first study to reveal such a relationship in this population. Future studies will be needed to further investigate how varying levels of exercise impact PTSD and its related symptoms.

The authors gave the CES-D, a self-report depression symptom scale, to 515 people drawn from a longitudinal community survey. The subjects were also interviewed using the Schedule for Affective Disorders and Schizophrenia (SADS). From the information collected on the SADS, the subjects were given diagnoses based on Research Diagnostic Criteria. The results indicate a modest relationship between self-reported symptoms of depression and the diagnosis of a major or minor depression. However, the groups defined as "cases" by such reports also include many people with other diagnoses or with no diagnoses at all. Thus, symptom scales are useful for the screening of depressed persons in research studies but are only rough indicators of clinical depression in the community.