Abstract
Vulnerability factors for posttraumatic stress disorder (PTSD) development are still controversial. Our aim was to study the vulnerability factors for the development of war-related PTSD over a period of 40 years after exposure. A cross-sectional, observational study was carried out on 61 male traumatized war veterans, taking into consideration adverse childhood experiences (ACE), attachment orientations, number of non-war-related traumatic events, and war experiences. Lifetime PTSD was assessed by using the Clinician-Administered PTSD Scale. Insecure attachment styles were significantly associated with lifetime PTSD and even after adjustment for war exposure this was still significant. Non-war-related traumatic events were not associated with lifetime PTSD, whereas ACE were associated with lifetime PTSD. War-related experiences were also associated with lifetime PTSD, except for injury or disease. The results for our sample show that, 40 years after war, the intensity of war-related experiences and ACE were significantly and independently associated with the development of lifetime PTSD. Insecure attachment was significantly associated with lifetime PTSD, which, in turn, are both positively associated with war exposure. These findings may have implications for patient care, as they constitute a strong argument that attachment-focused therapies could well be necessary 40 years after trauma.
Highlights
Posttraumatic stress disorder (PTSD) diagnostic criteria have recently been reviewed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [1]
Lifetime posttraumatic stress disorder (PTSD) for the sample of war veterans studied is significantly associated with insecure attachment, war-related experiences, and childhood adversities
This study cannot conclude on the causality of the association between insecure attachment and lifetime PTSD
Summary
Posttraumatic stress disorder (PTSD) diagnostic criteria have recently been reviewed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [1]. PTSD diagnosis requires the experience of a traumatic event (TE) to bring on its development. The TE definition has changed from DSM-IV to DSM-5 criteria, with the latter not requiring the person to feel intense fear, helplessness, or horror—as DSM-IV does. It has been estimated that 9.2% of those exposed to a TE will have PTSD [2]. The reason why only a minority of exposed people come to develop PTSD is the focus of much research. Vulnerability factors have been described and can be grouped into three clusters. Pre-traumatic vulnerability factors have been found, such as: arousal, negative affect, hostility, Healthcare 2020, 8, 359; doi:10.3390/healthcare8040359 www.mdpi.com/journal/healthcare
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