Emergence Of Posttraumatic Stress Disorder Research Articles

Ameliorating intrusive memories of distressing experiences using computerized reappraisal training.

The types of appraisals that follow traumatic experiences have been linked to the emergence of posttraumatic stress disorder (PTSD). Could changing reappraisals following a stressful event reduce the emergence of PTSD symptoms? The present proof-of-principle study examined whether a nonexplicit, systematic computerized training in reappraisal style following a stressful event (a highly distressing film) could reduce intrusive memories of the film, and symptoms associated with posttraumatic distress over the subsequent week. Participants were trained to adopt a generally positive or negative poststressor appraisal style using a series of scripted vignettes after having been exposed to highly distressing film clips. The training targeted self-efficacy beliefs and reappraisals of secondary emotions (emotions in response to the emotional reactions elicited by the film). Successful appraisal induction was verified using novel vignettes and via change scores on the post traumatic cognitions inventory. Compared with those trained negatively, those trained positively reported in a diary fewer intrusive memories of the film during the subsequent week, and lower scores on the Impact of Event Scale (a widely used measure of posttraumatic stress symptoms). Results support the use of computerized, nonexplicit, reappraisal training after a stressful event has occurred and provide a platform for future translational studies with clinical populations that have experienced significant real-world stress or trauma.

Post-Traumatic Stress Disorder in Turkish Child and Adolescent Survivors Three Years after the Marmara Earthquake.

The study investigated the emergence of post-traumatic stress disorder (PTSD) symptoms in child and adolescent survivors in Turkey three years after the 1999 Marmara Earthquake, with consideration of the severity of exposure and the survivors' gender and age. A representative sample of 293 young earthquake survivors (152 female and 141 male between the ages of 8 and 15) participated in the study. Participants' scores on the Post-Traumatic Stress Disorder Reaction Index for Children indicated that 31.4% reported moderate, 24.2% reported severe, and 3.8% reported very severe traumatic stress reactions. Analysis of the Revised Impact of Events Scale for Children scores revealed that 56% reported severe PTSD symptoms. While severity of exposure and gender were significantly associated with severity of PTSD symptoms, age was not related to PTSD symptoms. The results indicated a high need for addressing the mental health problems of the child and adolescent trauma survivors in Turkey.

The relationship between childhood support and later emergence of PTSD

The authors examine the relationship between three sources of social support (maternal, paternal, and peer) and the development of posttraumatic stress disorder (PTSD). This study utilized data from the National Comorbidity Survey (NCS), a large (N = 5,877) nationally representative population survey. Persons with and without a lifetime history of PTSD and those with and without a history of trauma exposure were compared on levels of social support received prior to age 15. Persons with a history of PTSD reported that they received less maternal, paternal, and peer support as children than those without PTSD. Importantly, persons who developed PTSD after the age of 17 reported lower levels of early childhood support from their fathers.

Natural Course of Posttraumatic Stress Disorder

A 20-month prospective follow-up of survivors of the severe earthquake in Turkey in 1999 examined the natural course of posttraumatic stress disorder (PTSD) and the contribution of different symptom clusters to the emergence of PTSD. Subjects were randomly sampled in a suburb of Istanbul that was severely affected by the earthquake. A total of 464 adults were assessed with a self-report instrument for PTSD symptoms on 3 consecutive surveys that were administered 1 to 3, 6 to 10, and 18 to 20 months following the earthquake. The prevalence of PTSD was 30.2% on the first survey and decreased to 26.9% and 10.6% on the second and third surveys, respectively. Female subjects showed initially higher (34.8%) PTSD rates compared with male subjects (19.1%). However, gender differences disappeared by the time of the third survey due to high spontaneous remission rates in female subjects. Low levels of chronic and delayed-onset PTSD were observed. A major contribution of the avoidance symptoms to PTSD diagnosis was identified by statistical analysis. Initial PTSD following an earthquake may be as prevalent as in other natural disasters, but high rates of spontaneous remission lead to low prevalence 1.5 years following the earthquake. Initial avoidance characteristics play a major role in the emergence of PTSD.

Personality predictors of injury-related posttraumatic stress disorder.

This longitudinal, cohort study examined the effect of personality traits on the emergence of posttraumatic stress disorder (PTSD) in a recently traumatized, civilian, mixed-gender sample with significant injuries. Burn survivors (N = 70) were administered the NEO-Personality Inventory (NEO-PI) and the Structured Clinical Interview for DSM III-R (SCID) at hospital discharge and readministered the SCID 4 and 12 months later. Overall, the sample of burn survivors scored significantly higher on neuroticism and extraversion and lower on openness, agreeableness, and conscientiousness relative to a normative national sample. Furthermore, multivariate analysis of variance revealed that PTSD symptom severity groups (i.e., single symptom, multiple symptoms, subthreshold PTSD, PTSD) were differentially related to neuroticism and extraversion. Planned comparisons indicated that neuroticism was higher and extraversion was lower in those who developed PTSD compared with those who did not develop PTSD.

Healing the Vietnam Wound

Healing the Vietnam Wound Michael Rogin (bio) Echoes of Combat: The Vietnam War in American Memory. By Fred Turner. New York: Doubleday Anchor, 1996. viii + 276 pages. $23.95. The Scar That Binds: American Culture and the Vietnam War. By Keith Beattie. New York: NYU Press, 1998. x + 229 pages. $40.00. In the three decades since the Tet offensive catalyzed the American defeat in Southeast Asia, Vietnam has entered American cultural remembrance, these two books agree, around two dominant intertwined figures—the Vietnam veteran himself, and Vietnam as America’s wound. Fred Turner and Keith Beattie analyze an amnesiac, hallucinatory collective memory that substitutes for the American destruction in Vietnam an investment in what Vietnam did to the United States, America as the victim. Both books chart the shift—with Taxi Driver and the Rambo films as the hinges—from the silent, violent, psychotic veteran of the last years of the war to the healing returned soldiers and therapeutic communities that have dominated the ensuing decades. Both explore the emergence of Post-traumatic Stress Disorder as a diagnostic category in which home front rejection and isolation displace wartime horror, where what the vet suffered and not also what he did produces trauma, and, as Turner puts it, where the warrior is separated from the war. Beattie and Turner both analyze “Bringing the War ‘Home’“ (to cite the title of one of Beattie’s sections; “Bringing It All Back Home,” and “Lost Fathers” are two of Turner’s chapters), the process by which American families and platoons-as-families heal the [End Page 702] veteran’s wounds. Here, the two books share powerful critiques of Platoon, whose split-good-and-evil paternal family romance Oliver Stone and David Halberstam misrecognized as (Turner quoting Halberstam, 135) “historically and politically accurate,” as (Stone to his Oscar-awarders, quoted in Beattie, 88) “really understand[ing] what happened over there.” Beattie adds E.T. as a Vietnam homecoming movie, whereas Turner treats the Star Wars trilogy as Vietnam father/son combat and reconciliation. Echoes of Combat and The Scar That Binds both show how, from major mainstream journalists William Broyles, Jr. and James Fallows to the pulp fiction and paramilitary organizations also analyzed by James Gibson and Susan Jeffords, the war wound was American impotence; male violence, far from defining the war crimes of the United States, became the way to recuperate from the Vietnam syndrome. 1 Noncombatant Fallows’s self-involved concern with the manhood of what he characterized as his elite, draft-evading generation, reported in Echoes of Combat, matches veteran Broyles’s celebration of violence as male birthing ritual. Broyles’s insistence that only the veteran has authority to speak about the war has as its counterpart in The Scar That Binds Fallows’s group narcissist claim that, “The Vietnam War will be important in history only for what it did internally to the United States” (Beattie, 31). Both books, with a wealth of examples, expose the long reach of Vietnam in organizing American cultural life in the quarter-century since the U.S. defeat. 2 Beattie incisively organizes his material into three sections, “The Healed Wound,” “The Vietnam Veteran as Ventriloquist,” and “Bringing the War ‘Home.’” The Scar That Binds begins with “The Healed Wound,” the ubiquitous organic metaphor that folds the national into the personal body. Echoes of Combat also gives pride of place to Vietnam as America’s wound. “Healing as History” and “Scar Tissue” title Turner’s final chapters; his last words are “we must continue to run our fingers along the scars” (195). Sharing so much common ground, however, this deepest commonality of the two volumes is what fundamentally divides them. For Turner (whose book was published shortly before Beattie’s, time enough to appear in the bibliography of The Scar That Binds but not in the text) falls into exactly the pattern that Beattie wants to discredit. By putting returning Vietnam veterans at the center, one can hear Beattie saying, by making their wounds, killings, and psychological traumas synchedochical for the impact of [End Page 703] Vietnam on “American culture at large” (Turner, 13), Turner ends up celebrating the scar tissue that, for Beattie, sutures...

Dissociation, somatization, and affect dysregulation: the complexity of adaptation of trauma.

A century of clinical research has noted a range of trauma-related psychological problems that are not captured in the DSM-IV framework of posttraumatic stress disorder (PTSD). This study investigated the relationships between exposure to extreme stress, the emergence of PTSD, and symptoms traditionally associated with "hysteria," which can be understood as problems with stimulus discrimination, self-regulation, and cognitive integration of experience. The DSM-IV field trial for PTSD studied 395 traumatized treatment-seeking subjects and 125 non-treatment-seeking subjects who had also been exposed to traumatic experiences. Data on age at onset, the nature of the trauma, PTSD, dissociation, somatization, and affect dysregulation were collected. PTSD, dissociation, somatization, and affect dysregulation were highly interrelated. The subjects meeting the criteria for lifetime (but not current) PTSD scored significantly lower on these disorders than those with current PTSD, but significantly higher than those who never had PTSD. Subjects who developed PTSD after interpersonal trauma as adults had significantly fewer symptoms than those with childhood trauma, but significantly more than victims of disasters. PTSD, dissociation, somatization, and affect dysregulation represent a spectrum of adaptations to trauma. They often occur together, but traumatized individuals may suffer from various combinations of symptoms over time. In treating these patients, it is critical to attend to the relative contributions of loss of stimulus discrimination, self-regulation, and cognitive integration of experience to overall impairment and provide systematic treatment that addresses both unbidden intrusive recollections and these other symptoms associated with having been overwhelmed by exposure to traumatic experiences.

Prediction of posttraumatic stress symptoms in children after hurricane Andrew.

The authors used an integrative conceptual model to examine the emergence of posttraumatic stress disorder (PTSD) symptoms in 568 elementary school-age children 3 months after Hurricane Andrew. The model included 4 primary factors: Exposure to Traumatic Events, Child Characteristics, Access to Social Support, and Children's Coping. Overall, 62% of the variance in children's self-reported PTSD symptoms was accounted for by the 4 primary factors, and each factor improved overall prediction of symptoms when entered in the analyses in the order specified by the conceptual model. The findings suggest that the conceptual model may be helpful to organize research and intervention efforts in the wake of natural disasters.

Post-Traumatic Stress Disorder Among Inner City Commuter College Students

Inner city commuter college students differ from their more traditional college student peers in terms of age, backgrounds and life experiences. Embarking on a liberal arts education, however, requires a journey through self discovery which is similar to the experience of traditional students. Because many of our students present histories of traumatic events, and because the inner city campus itself is often surrounded by violence prone city streets, our students represent a population who are particularly likely to have had to deal with traumatic stress. The educational process, which calls into question prior ways of handling and understanding life, may make the emergence of post-traumatic stress disorder more prevalent among these students. Treatment for this disorder by college student counselors, within the context of the college campus, offers a unique opportunity to help our students master past events within the framework of their new college student identity.

Undiagnosed post-traumatic stress disorder following motor vehicle accidents.

To determine the pattern of emergence of post-traumatic stress disorder (PTSD) among motor vehicle accident victims and to examine the influence of PTSD on subsequent levels of disability. A longitudinal study of motor vehicle accident victims one month and 18 months after the accident. Twenty-four motor vehicle accident victims admitted by the trauma team at the Royal Adelaide Hospital. A 52% response rate was achieved. Post-traumatic stress disorder as diagnosed by the Diagnostic Interview Schedule and disability as measured with the Sickness Impact Profile. Eighteen months after their accidents, six of the 24 subjects had clinically significant PTSD and one was considered borderline. None had been previously diagnosed or treated. The group with PTSD had higher scores on all measures of psychological distress one month after the accident and were more likely to use immature psychological defences. There was no association between physical outcome (measured with the modified Glasgow Outcome Scale) at six months and subsequent diagnosis of PTSD. However, the group with PTSD had higher levels of disability on assessment with the Sickness Impact Profile, particularly in the domain of social functioning. The results suggest PTSD was associated with work-related dysfunction equal to that associated with severe physical handicap. The data from this pilot study suggest that PTSD after motor vehicle accidents is an important cause of disability, which may also become the focus for damages in litigation. Thus, there is a need for further investigation of the early patterns of distress and to design preventive programs for victims of road accidents.