Description Of Posttraumatic Stress Disorder Research Articles

Measuring post-traumatic stress disorder and complex post-traumatic stress disorder using the International Trauma Questionnaire: results from a Hungarian clinical and non-clinical sample

ABSTRACT Background: The 11th revision of the International Classification of Diseases (ICD-11) simplified the description of post-traumatic stress disorder (PTSD) and also introduced a new trauma-related diagnosis called complex post-traumatic stress disorder (CPTSD). CPTSD is linked to earlier, prolonged interpersonal trauma, and is characterized by a broader range of symptoms, in addition to the core PTSD symptoms. The International Trauma Questionnaire (ITQ) has been developed to assess the new diagnostic criteria. Objectives: The primary aim of our study was to test the factor structure of the ITQ in a clinical and a non-clinical Hungarian sample. We also examined whether the degree of traumatization or the type of trauma experienced was associated with meeting the criteria for PTSD or CPTSD, or with the severity of PTSD or disturbances in self-organization (DSO) symptoms, in both samples. Method: A trauma-exposed heterogeneous clinical sample (N = 176) and a non-clinical sample (N = 229) filled out the ITQ and a modified version of the Life Events Checklist (LEC-5). The factor structure of the ITQ was tested by examining the model fit of seven competing confirmatory factor analysis models. Results: A two-factor second-order model with a second-order PTSD factor (measured by three first-order factors) and a DSO factor (measured directly by six symptoms) had the best fit to the data in both samples if an error correlation was allowed between negative self-concept items. Those in the clinical group who reported more interpersonal and childhood trauma experienced more PTSD and DSO symptoms. Also, there were significant, positive, and weak associations between the total number of different traumas and PTSD and DSO factor scores in both samples. Conclusion: ITQ was found to be a reliable tool to differentiate between PTSD and CPTSD, two related but distinct constructs in a clinical and a non-clinical trauma-exposed sample in Hungary.

The Network Structure of ICD-11 Disorders Specifically Associated with Stress: Adjustment Disorder, Prolonged Grief Disorder, Posttraumatic Stress Disorder, and Complex Posttraumatic Stress Disorder

Introduction: The ICD-11 includes a new grouping for “disorders specifically associated with stress” that contains revised descriptions of posttraumatic stress disorder (PTSD) and adjustment disorder (AjD) and new diagnoses in the form of complex PTSD (CPTSD) and prolonged grief disorder (PGD). These disorders are similar in that they each require a life event for the diagnosis; however, they have not yet been assessed together for validity within the same sample. We set out to test the distinctiveness of the four main ICD-11 stress disorders using a network analysis approach. Methods: A population-based, cross-sectional design. A nationally representative sample of adults from the Republic of Ireland aged 18 years and older (N = 1,020) completed standardized measures of PTSD, CPTSD, AjD, and PGD. A network analysis was conducted at the symptom level. Outcome measures included the International Trauma Questionnaire, the Inventory of Complicated Grief, and the International Adjustment Disorder Questionnaire. Results: Consistent with the taxonomic structure of the ICD-11, our results showed that although the four conditions clustered independently at the disorder level, the specific symptoms of PTSD, CPTSD, PGD, and AjD clustered together very strongly but more strongly than with symptoms of the other disorders. The majority (61%) of the variation in each symptom could be explained by its neighboring symptoms. The strongest transdiagnostically connecting symptom was “startle response.” Discussion/Conclusion: Mental health professionals caring for people who have experienced a range of stressors and traumatic life events can be confident in diagnosing these conditions that have clear diagnostic boundaries. Interventions addressing stress-associated disorders should be based on diagnostic assessment to ensure close fit between symptoms and treatment.

Investigating centrality in PTSD symptoms across diagnostic systems using network analysis*

ABSTRACT Background: The posttraumatic stress disorder (PTSD) diagnosis has been widely debated since it was introduced into the diagnostic nomenclature four decades ago. Recently, the debate has focused on consequences of having two different descriptions of PTSD: 20 symptoms belonging to four symptom clusters in the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5), and three symptoms clusters in the 11th edition of the International Classification of Diseases (ICD-11) most often operationalized by six symptoms in the International Trauma Questionnaire (ITQ) (2017) and Hansen, Hyland, Armour, Shevlin, & Elklit (2015). Research has provided support for both models of PTSD, but at the same time indicates differences in estimated prevalence rates of PTSD (Hansen et al., 2015, 2017). A growing body of research has modelled PTSD both theoretically and statistically as a network of interacting symptoms (Birkeland, Greene, & Spiller, 2020), yet it remains more unclear how the two diagnostic systems perform regarding which symptoms are more central/interconnected. Objectives and methods: We estimated two 23-item Gaussian Graphical Models to investigate whether ICD-11 or DSM-5 PTSD symptoms are more central in two trauma-exposed samples: a community sample (N = 2,367) and a military veteran sample (N = 657). PTSD DSM-5 was measured with the PTSD checklist-5 (PCL-5) and the PTSD ICD-11 was measure by the ITQ PTSD subscale. Results: Five of the six most central symptoms estimated via the expected influence centrality metric across the two samples were identical and represented symptoms from both diagnostic systems operationalized by the PCL-5 and the ITQ. Conclusions: The results of the present study underline that symptoms from both diagnostic systems hold central positions. The implications of the results are discussed from the perspectives of an indexical (i.e. the diagnostic systems reflect both shared and different aspects of PTSD) and a constitutive view (i.e., the diagnostic systems represent different disorders and the results cannot be reconciled per se) of mental health diagnoses (Kendler, 2017).

Patterns of comorbidity associated with ICD-11 PTSD among older adults in the United States

Little research has been conducted on posttraumatic stress disorder (PTSD) comorbidity among older adults regarding the description of PTSD in the 11th version of the International Classification of Diseases (ICD-11). This study sought to provide evidence of a dimensional model of psychopathology using the ‘Hierarchical Taxonomy of Psychopathology’ (HiTOP) model as a theoretical framework to explain patterns of ICD-11 PTSD comorbidity. Distinct patterns of ICD-11 PTSD comorbidity among a nationally representative sample (n = 530) of adults aged 60 years and older from the United States were examined using latent class analysis (LCA). Covariates associated with comorbidity classes were assessed through multinomial logistic regression. ICD-11 PTSD was highly comorbid with other psychopathologies. LCA results favoured a two-class solution. Class 1 (71.7%) was characterised by moderate probabilities for major depressive disorder and alcohol use disorder; Class 2 (28.3%) was characterised by a moderate-high probability of general psychopathology and was associated with lower social support, spousal/partner physical abuse, and history of attempted suicide. PTSD was highly comorbid with other disorders among older adults. Distinct patterns of PTSD comorbidity exist among this cohort and these findings can aid clinicians and researchers in understanding and predicting maladaptive responses to trauma and associated psychopathology.

A cross-country psychiatric screening of ICD-11 disorders specifically associated with stress in Kenya, Nigeria and Ghana

ABSTRACT Background: The Global Forum for Health Research, with the support of the World Health Organization, highlighted the need to prioritize mental health research in Africa. The introduction of revised descriptions of Posttraumatic Stress Disorder (PTSD) and Adjustment Disorder, along with new diagnoses of Complex PTSD and Prolonged Grief Disorder, in the ICD-11 creates a need for additional national-level epidemiological studies on the prevalence of stress-related disorders. Methods: The prevalence rates of these four ICD-11 stress disorders were assessed in three African countries including Nigeria (N = 1006), Kenya (N = 1018), and Ghana (N = 500). Participants completed disorder-specific measures for each disorder. Findings: Across the entire sample, the current prevalence rate of probable Adjustment Disorder was 8.4% (95% C.I. = 7.4%, 9.6%), probable PTSD was 18.6% (95% C.I. = 17.2, 20.2%), probable Complex PTSD was 15.9% (95% C.I. = 14.5%, 17.4%) and probable Prolonged Grief Disorder was 3.7% (95% C.I. = 3.1%, 4.5%). Interpretation: The results are applicable primarily to well-educated urban and suburban adults in these African countries. Results indicated that Adjustment Disorder, PTSD, and CPTSD are highly prevalent in these three African countries. There is now a pressing need to develop culturally sensitive interventions to enable recovery from these conditions.

Le développement de paradigmes psycholinguistiques devient nécessaire à l’espace de la psychotraumatologie. Analyse critique de la littérature anglophone et des premiers travaux francophones. Vers un nouveau modèle du traumatisme psychique

Resume Objectifs Si l’interet pour la psychotraumatologie s’est progressivement generalise au cours de la derniere decennie, faute de reperage diagnostique, de nombreux patients restent sans soins tandis que parallelement, l’offre de psychotherapies differenciees s’est majoree. Notons egalement que si les recherches en neurosciences ont explose en nombre, leurs applications concretes utiles a la pratique quotidienne semblent plus tenues, notamment au plan pharmacologique. De tels achoppements seraient-ils causes par une preeminence de la reference au « stress » au detriment de la consideration du « trauma » ? Au-dela des picrocholines querelles d’ecoles, il apparait aujourd’hui necessaire de construire une nouvelle phase d’analyse. Methodes Nous exposons une revue critique de la litterature de langue anglaise avant de focaliser sur les quelques etudes francophones existantes. Resultats La majorite des etudes anglophones referencees se rattachent aux protocoles de deux travaux princeps sans que les paradigmes linguistiques en soutenant le design apparaissent tres structures. L’analyse linguistique s’y avere en fait limitee, sans mention des richesses apportees par les ecoles de semantique et de pragmatique. Il apparait toutefois une lente complexification des methodes d’analyse textuelle dans le temps. Pour l’espace francophone, seules deux etudes existent : l’une de Louis Crocq datant des annees 1960, et une autre de Ribeton & Auxemery mettant en evidence le syndrome psycholinguistique post-traumatique (anomie traumatique, repetitions linguistiques et desorganisation discursive). Conclusion Les troubles psychiques post-traumatiques beneficient d’un renouveau d’interet pour la psychiatrie et la psychologie contemporaines. La densification de la description du trouble de stress post-traumatique dans le DSM-5 pourrait encore se completer des differentes formes cliniques specifiques constituant les troubles psychiques post-traumatiques. Aussi, a l’heure ou differents protocoles psychotherapeutiques apparaissent concurrents (protocoles comportementaux et cognitifs, traitements par l’hypnose, therapies par mouvements oculaires, therapies psychodynamiques, therapies narratives, etc.), l’analyse de la restauration du langage pourrait permettre d’unifier une conception specifique du traumatisme psychique et de ses consequences cliniques. Le paradigme que nous proposons developpe la recherche clinique a l’aide de marqueurs psycholinguistiques offrant d’evaluer l’efficacite des psychotherapies.

Does size really matter? A multisite study assessing the latent structure of the proposed ICD-11 and DSM-5 diagnostic criteria for PTSD

ABSTRACTBackground: Researchers and clinicians within the field of trauma have to choose between different diagnostic descriptions of posttraumatic stress disorder (PTSD) in the DSM-5 and the proposed ICD-11. Several studies support different competing models of the PTSD structure according to both diagnostic systems; however, findings show that the choice of diagnostic systems can affect the estimated prevalence rates.Objectives: The present study aimed to investigate the potential impact of using a large (i.e. the DSM-5) compared to a small (i.e. the ICD-11) diagnostic description of PTSD. In other words, does the size of PTSD really matter?Methods: The aim was investigated by examining differences in diagnostic rates between the two diagnostic systems and independently examining the model fit of the competing DSM-5 and ICD-11 models of PTSD across three trauma samples: university students (N = 4213), chronic pain patients (N = 573), and military personnel (N = 118).Results: Diagnostic rates of PTSD were significantly lower according to the proposed ICD-11 criteria in the university sample, but no significant differences were found for chronic pain patients and military personnel. The proposed ICD-11 three-factor model provided the best fit of the tested ICD-11 models across all samples, whereas the DSM-5 seven-factor Hybrid model provided the best fit in the university and pain samples, and the DSM-5 six-factor Anhedonia model provided the best fit in the military sample of the tested DSM-5 models.Conclusions: The advantages and disadvantages of using a broad or narrow set of symptoms for PTSD can be debated, however, this study demonstrated that choice of diagnostic system may influence the estimated PTSD rates both qualitatively and quantitatively. In the current described diagnostic criteria only the ICD-11 model can reflect the configuration of symptoms satisfactorily. Thus, size does matter when assessing PTSD.

Trauma, Shame, and Men's Tears in The Manchurian Candidate

Charles S. Young and Susan L. Carruthers describe John Frankenheimer's The Manchurian Candidate (US, 1962) as a prisoner-of-war film. This article argues that, as such, it stages the responses of its male protagonists to trauma. Focusing on weeping, the article examines the representation of masculine traumatic symptoms in both Richard Condon's 1959 novel and Frankenheimer's cinematic adaptation of it. In a period of national shame about the unwon Korean conflict, Frankenheimer first feminizes his protagonists by rendering them hysterical, and then allows them to redeem themselves through heroic deeds of masculine role fulfillment. Drawing on the modeling of masculine hysteria by both Mark S. Micale and Elaine Showalter, the article is also informed not only by Bessel van der Kolk's descriptions of post-traumatic stress disorder but also by theorizations of tears in the writings of Tom Lutz, Steve Neale, and Linda Williams. Peter Brooks and Geoffrey Nowell-Smith mobilized ideas expressed here about melodrama. As a melodramatic enactment of masculine roles in the late 1950s and early 1960s, The Manchurian Candidate is both a trauma film and a “male weepy.”

Psychotraumatology : Differentiation, extension and public discourse

The first description of posttraumatic stress disorder (PTSD) in the 1980s marked the origin of psychotraumatology. Based on the variety of developments in the meantime and being relevant for basic research and clinical application, a differentiation of diagnoses according to the new International Classification of Diseases (ICD-11) are presented including PTSD, complex PTSD, prolonged grief disorder and adjustment disorder. In addition, extension towards traumatic and adverse childhood experiences and their significance for lifetime mental and somatic morbidity are described. Concerning these childhood traumata and adversities, distinct biological and epigenetic factors have been extensivelyinvestigated. Also, research groups have postulated that important psychological disorders should be differentiated according to those with and those without reference to pathogenetic trauma. Lastly, regarding relevant public discourses, societal dimensions of victimhood and compensation are discussed as well as aglobal perspective with respect to continuous and historical traumatization.

Commentary: The evolving conception of posttraumatic stress disorder - reflections on Danzi and La Greca (2016).

As first formulated in 1980, the description of posttraumatic stress disorder (PTSD) was based on people exposed to severe and repeated traumatic events. Although the conceptualisation of PTSD in successive versions of the DSM has changed, the symptom picture remains complex and there have been concerns over whether the threshold is too high. In contrast, ICD-11 proposes a simpler diagnosis based on six symptoms and a distinction between PTSD and Complex PTSD. This approach may be more clinically useful and easier to employ for children in younger age groups. Danzi and La Greca's data are valuable in suggesting that PTSD in preadolescent as well as preschool children should be diagnosed using different criteria to adults. They also identify a lack of overlap between diagnostic systems that suggests PTSD may not be optimally identified using current methods.

The Various Care Requirements of Psychotraumatized Subjects: From Linguistic Desert to Therapeutic Perspectives

Background: The cardinal symptoms of posttraumatic stress disorder, which is exhibited as intrusions, avoidance strategies and hypervigilance, are rarely highlighted by psycho traumatized patients when they seek care. Furthermore, the clinical features of posttraumatic stress disorder (PTSD) change over time and vary between patients; thus, a classical description of PTSD that can apply to all patients is more of the exception than the rule. Clinical findings: Many comorbidities affect both the clinical presentation and the development of PTSD. The demand for care is generally expressed via addictive and somatic comorbidities in psycho traumatized subjects: physical bodily injuries are more socially acceptable than psychological injuries. Indeed, the multifaceted nature of PTSD can often mislead clinicians because they tend to focus on the somatic complaints. Psychological comorbidities can also be present, such as depressive and anxiety disorders, dissociative disorders, psychoactive substance use and suicidal behavior. Literature findings: PTSD is favored by a polygenic vulnerability, and a preponderance of susceptibility to neuromodulation implicates various endophenotypes, which explain the different clinical dimensions that are encountered. But no neurobiological study has revealed a biological marker which would apparently and inevitably destine a subject to structure a PTSD in reaction to a stress. In contrast, the psychopathological study discovers afterwards that a particular subject has necessarily built a traumatic repetition syndrome according to the concordance of significant data relating to their history. Conclusion: Although the only FDA-approved drugs for the treatment of PTSD are sertraline and paroxetine, numerous studies have evaluated the use of Serotonin-norepinephrine reuptake inhibitors and atypical antipsychotics. The psychotherapy will thus require active commitment of the subject who far from clearing themselves of the traumatic scene will produce meaning by breaking away from a purely passive position taken at the heart of the tragedy. If the trauma is in essence nonsense, the psychotherapeutic reconstruction will promote this search for a meaning enabling the subject to continue to produce rather than again returning to real death.

Traumatismes et traces : données expérimentales

BackgroundsWhether traumatic events and history enhance the risk of later psychopathology is no longer controversial since early description of posttraumatic stress disorder by psychoanalysts after World War I. However, whether the best model is the so-called vulnerability one (meaning genetically predetermined development) or the probabilistic epigenetic one (meaning that trauma can impact biological levels in a permanent manner as well) is still debated. ObjectiveTo critically review the literature to explore supporting data on how “trauma gets under the skin” leaving measurable consequences at a biological and/or psychological level. MethodsI critically reviewed the literature and selected studies investigating impact of early trauma (e.g. severe deprivation, maltreatment and/or abuse) at biological and/or psychological levels. I will also summarize experimental data from recent work of the Salpétrière group focusing on the impact of traumatic experience on early interaction or psychoanalytic listening. ResultsThere is now a consistent amount of data supporting the probabilistic epigenetic model of development. We found studies showing how traumatic experience can impact development from: (1) animal models of early separation; (2) human longitudinal studies controlling for confounding variables such as genetic ones; (3) human studies with different neurobiological correlates (e.g. neuro-imaging data; electro-encephalographic parameters; epigenetic markers). Furthermore, we were able to show in three different experiments that: (1) psychoanalysts are able to identify, without explicit knowledge and above the level of chance, healthy adults whose siblings had experienced cancer during childhood; (2) false positive ultrasound screening for soft markers may impact mother-infant interaction negatively; (3) caregivers of infants who will later develop autism adapt their interaction dynamic unconsciously before being aware of child psychopathology. ConclusionTrauma should not anymore be regarded only as an “outside” event as impact can be evidenced at biological levels that have long lasting effects during development and even in next generations.

Mothers with post-traumatic stress disorder after traumatic childbirth struggled to survive and experienced nightmares, flashbacks, anger, anxiety, depression, and isolation

Beck CT. Post-traumatic stress disorder due to childbirth: the aftermath. Nurs Res 2004;53:216–24. [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Q What is the essence of mothers’ experiences of post-traumatic stress disorder (PTSD) after...

Interventions for post-traumatic stress disorder

In recent years the media has reported on many major disasters, both internationally and nationally. Whether a trauma is of national or personal significance, there are common features in all of them. Disasters remind people of their own vulnerability and mortality. Disruptions in personal coping mechanisms may require professional intervention. This article gives a description of post-traumatic stress disorder and discusses interventions which health-care professionals are currently using in the clinical setting.

Assessing and Treating Victims of Violence

This slim, edited volume brings together information on diagnostic and symptom-assessment instruments useful in research on victims of violence, descriptive information on childhood sexual abuse and its sequelae, and descriptions of posttraumatic stress disorder (PTSD), rape victims, and battered women. Key clinical assessment and treatment issues are provided for patients exposed to these particular types of violence. The book succeeds in providing a competent account of PTSD symptoms and available psychometric instruments for studying PTSD and, to a lesser extent, other sequelae of violence. In both chapters about childhood violence, Assessing Children for the Effects of Sexual Victimization and Long-Term Correlates of Childhood Sexual Abuse in Adult Survivors, the authors are effective in conveying the multiple adverse outcomes of childhood abuse, particularly with respect to disturbances in function and effects on life course. Too often clinicians have attempted to squeeze the clinical sequelae of violence in children into single diagnoses

Cognitive Therapy and Posttraumatic Stress

Cognitive Therapy and Posttraumatic Stress Treating PTSD: Cognitive-Behavioral Strategies Foy, David W. New York: Guilford Press. 1992. (172 pp.) Over the past decade, the construct of post-traumatic stress disorder (PTSD) has demonstrated increasing utility as a framework for understanding clinical phenomena. Findings that roughly 25% of all women have had experiences that meet the legal definition of rape (Koss, Gidycz, & Wisniewski, 1987) and sexual abuse (Finkelhor, Hotaling, Lewis, & Smith, 1984) have moved the notion of PTSD from a disorder limited to war veterans to a more general syndrome affecting victims of all violence. David Foy's edited volume is an attempt to bring the diverse strands of PTSD treatment toghether by highlighting cognitive- behavioral applications to war veterans, battered women, survivors of sexual assault, and child victims of abuse. As David Barlow, the Guilford "Treatment Manuals for Practitioners" series editor, notes, "the goal is to provide therapists with a cross-trauma perspective on PTSD derived from treatment protocols in use at established centers." Cognitive approaches to the treatment of PTSD tend to fall into one of two camps. A constructivist line of theorizing hypothesizes that traumatic incidents of violence shatter core schemata of safety and predictability, leaving victims with a fragmented sense of identity (Janoff-Bulman, 1985; McCann & Pearlman, 1990). Therapy, from this vantage point, must create an accepting, safe relationship context for the exploration of traumatic events and repair of damaged schemata. Cognitive-behavioral conceptualizations, alternatively, stress that PTSD symptoms are conditioned responses to traumatic stimuli, in which avoidance of trauma-related cues is central to the maintenance of distress (Jones & Barlow, 1990). Treatment, therefore, necessarily involves controlled exposure to threatening stimuli, as in flooding or desensitization, as a means of deconditioning. Foy's volume is firmly rooted in the second perspective, offering a wealth of guidance regarding cognitive-behavioral assessment and treatment. In the initial chapter, Foy offers a conceptual model of PTSD in which symptoms are mediated by the severity of the stressor(s) and vulnerabilities of the individual. PTSD symptoms are hypothesized as the result of "an immediate conditioned emotional re-action" (p. 7) to overwhelming stressors. Accordingly, an assessment of PTSD must include an understanding of the nature and extent of the trauma as well as an account of the accompanying physical and psychological responses. As the author notes, For many trauma survivors, avoidance of traumatic cues - external cues, as well as physiological or cognitive ones - becomes a guiding principle for maintaining psychological safety. Paradoxically, re-exposure and desensitization to traumatic cues or memories are vital if self-determination is to be regained (p. 10). The remainder of the text can be thought of as clinical guides for operationalizing this model with a variety of populations. A worthwhile aspect of the volume is that its chapters assume a parallel organization, beginning with a description of PTSD in the relevant population and a theoretical statement that guides treatment planning and ending with guidelines for assessment and treatment. The literature cited is (within the text's orientation) comprehensive and current, offering useful references for those interested in researching particular assessment tools or outcome studies. Chapters Two ("A Vet Center Experience: Multievent Trauma, Delayed Treatment Type"; R. Carl Sipprelle) and Three ("Assessment and Treatment of Combat-Related Post-Traumatic Stress Disorder in a Medical Center Setting," Edward M. Carroll and David W. Foy) cover the treatment of veterans in outpatient and inpatient settings respectively. Sipprelle divides the treatment process into three phases - crisis intervention, trauma, and integration - highlighting the goals of group therapy at each juncture. …

Concurrent Validation of the Millon Clinical Multiaxial Inventory among Vietnam Veterans with Posttraumatic Stress Disorder

A carefully derived group of 60 Posttraumatic Stress Disorder (PTSD) inpatient Vietnam veterans was identified and given two psychometric inventories, the Millon Clinical Multiaxial Inventory and the Sixteen Personality Factor Test to identify a profile for this disorder among Vietnam veterans. A profile of the Passive-Aggressive and Avoidant personality patterns (8–2) resulted. The personality patterns of Schizoid and Borderline were present as influencing styles, as were the symptom disorders of Dysthymia and Anxiety. The 16 PF pattern of this group was low on Warmth, Emotional Stability, Happy-Go-Lucky, Boldness, Self-discipline, and Extraversion, and high on Suspiciousness, Insecurity, Self-sufficiency, and Anxiety. Also, using the method developed by Krug for the 16 PF, a 1322 (or 2322) style resulted. This style is noted for its anxiety and introversion components. Both scales are useful in identification and description of PTSD.

Proving cause and effect in traumatic stress: The draft lottery as a natural experiment

A dozen years after the end of U.S. involvement in the Vietnam war, considerable evidence suggests that some Vietnam veterans have suffered longterm mental health problems as a result of their experiences while in the military. Published reports began with the first descriptions of post-traumatic stress disorder, which is now a recognized psychiatric diagnosis. Recently, we have added to this literature by using a new technique based on the military draft lottery of 1970–1972. This article discusses the rationale behind the approach that we used, summarizes our results, which have been published in detail elsewhere, discusses how our results complement those of previous studies, and suggests ways in which similar techniques might be used to further investigate delayed effects of the Vietnam-era military draft.