History Of Posttraumatic Stress Disorder Research Articles

Panic following trauma: the etiology of acute posttraumatic arousal

Two studies examined the contributing factors for panic symptoms following trauma. In Study 1, survivors of sexual and nonsexual assaults ( N=105) were assessed at 2 weeks postcrime. Prior trauma, psychiatric history, crime characteristics, and peritraumatic dissociation were assessed. Posttraumatic panic was modestly predicted by childhood sexual abuse (CSA) experiences, a history of Anxiety and Depression, and peritraumatic dissociation. Childhood physical abuse (CPA), Adult Victimization, crime variables, and a prior history of Substance Use disorders and posttraumatic stress disorder (PTSD) were not implicated. In Study 2, the role of peritraumatic panic in predicting later arousal was also examined in a similar sample who were assessed within 6 weeks of their trauma ( N=93). Presence of significant arousal during trauma predicted frequency of posttrauma panic attacks, but not its severity. In contrast to Study 1, prior history of PTSD, perception of life threat, and the index trauma being a sexual assault all predicted posttrauma panic, whereas prior trauma exposure and depression did not. These findings are discussed in terms of cognitive and arousal factors that may influence posttrauma panic.

Relationship between distressing cancer-related recollections and hippocampal volume in cancer survivors.

Having cancer is extremely stressful, and distressing cancer-related recollections are frequently reported by cancer survivors. Smaller hippocampal volume has been observed in stress-related neuropsychiatric disorders, such as posttraumatic stress disorder (PTSD) and major depression. The aim of this study was to determine whether there is a similar association between distressing cancer-related recollections and hippocampal volume. The subjects were 67 women who had had breast cancer surgery 3 or more years earlier and had no history of PTSD or major depression before the cancer. Each woman was evaluated with a semistructured interview to determine whether she had a history of distressing cancer-related recollections. Hippocampal volume was measured by three-dimensional magnetic resonance imaging, and memory function was assessed by the Wechsler Memory Scale-Revised. The volume of the left hippocampus was significantly smaller (5%) in the subjects with a history of distressing cancer-related recollections (N=28) than in those without any such history (N=39). There was no significant difference in right hippocampal volume or whole brain volume measured as a control. There were no significant differences in delayed memory or percentage retention. However, significantly worse immediate visual memory, but not verbal memory, was observed in the subjects with a history of distressing cancer-related recollections. Having distressing cancer-related recollections is associated with smaller left hippocampal volume in survivors of breast cancer.

Is the spatial distribution of brain lesions associated with closed-head injury in children predictive of subsequent development of posttraumatic stress disorder?

To determine whether there is an association between the spatial distributions of lesions detected at magnetic resonance (MR) imaging of the brain in children, adolescents, and young adults after closed-head injury (CHI) and development of the reexperiencing symptoms of posttraumatic stress disorder (PTSD). Data obtained in 94 subjects without a history of PTSD as determined by parental interview were analyzed. MR images were obtained 3 months after CHI. Lesions were manually delineated and registered to the Talairach coordinate system. Mann-Whitney analysis of lesion distribution and PTSD status at 1 year (again, as determined by parental interview) was performed, consisting of an analysis of lesion distribution versus the major symptoms of PTSD: reexperiencing, hyperarousal, and avoidance. Of the 94 subjects, 41 met the PTSD reexperiencing criterion and nine met all three PTSD criteria. Subjects who met the reexperiencing criterion had fewer lesions in limbic system structures (eg, the cingulum) on the right than did subjects who did not meet this criterion (Mann-Whitney, P =.003). Lesions induced by CHI in the limbic system on the right may inhibit subsequent manifestation of PTSD reexperiencing symptoms in children, adolescents, and young adults.

Neuropsychological Findings in Combat-Related Posttraumatic Stress Disorder

Previous research investigating whether combat-related Posttraumatic Stress Disorder (PTSD) is associated with impaired neuropsychological functioning has yielded inconsistent findings. The present study addressed many methodological limitations of previous research. Neuropsychological measures of intellectual ability, learning, memory, attention, visuospatial ability, executive functioning, language, and psychomotor speed were compared in four groups of early middle-aged community dwelling veterans. The four demographically comparable groups were: (a) those with current PTSD symptoms (n =80); (b) those with a prior history of PTSD but not currently experiencing active PTSD symptoms (n =80); (c) a non-PTSD psychiatrically matched control group (n =80); and (d) a normal control group (n =80). Results indicated that the four groups did not statistically differ on the neuropsychological measures and that veterans with PTSD perform similarly to demographically matched controls. Results further suggested that the cognitive difficulties previously linked to PTSD may actually have been secondary to preexisting individual differences or other clinical conditions coexisting with PTSD.

The stressor criterion in DSM-IV posttraumatic stress disorder: an empirical investigation

Background: The DSM-IV two-part definition of posttraumatic stress disorder (PTSD) widened the variety of stressors (A1) and added a subjective component (A2). The effects of the revised stressor criterion on estimates of exposure and PTSD in a community sample are evaluated. Methods: A representative sample of 2181 persons in southeast Michigan were interviewed about lifetime history of traumatic events and PTSD. The evaluation of the revised two-part definition is based on a randomly selected sample of events that represents the total pool of traumatic events experienced in the community. Results: The enlarged definition of stressors in A1 increased the total number of events that can be used to diagnose PTSD by 59%. The majority of A1 events (76.6%) involved the emotional response in A2. Females were more likely than males to endorse A2 (adjusted odds ratio = 2.66; 95% confidence interval 1.92, 3.71). Of all PTSD cases resulting from the representative sample of events, 38% were attributable to the expansion of qualifying events in A1. The identification of exposures that lead to PTSD were not improved materially by A2 however, events that did not involve A2 rarely resulted in PTSD. Conclusions: Compared to previous definitions, the wider variety of stressors in A1 markedly increased the number of events experienced in the community that can be used to diagnose PTSD. Furthermore, A2 might be useful as a separate criterion, an acute response necessary for the emergence of PTSD, and might serve as an early screen for identifying a subset of recently exposed persons at virtually no risk for PTSD. The utility of A2 as a screen must be tested prospectively.

Suppression of cellular immunity in men with a past history of posttraumatic stress disorder.

High rates of medical morbidity have been reported in subjects with posttraumatic stress disorder (PTSD). The authors examined immune function in subjects in remission from past PTSD. The initial study group was composed of 1,550 Japanese male workers. Japanese versions of the Events Check List, the Impact of Event Scale-Revised, and the Diagnostic Interview Schedule for DSM-IV were used to identify subjects who had a past history of PTSD. Twelve of the workers were identified as having such a history. These men were matched in age and smoking habits, which affect immunity, to 48 comparison subjects who had similar stressful life experiences but no current or past history of PTSD. Natural killer (NK) cell activity, lymphocyte subset counts, and production of interferon gamma (IFN-gamma) and interleukin-4 (IL-4) were measured in the 60 men by means of phytohemagglutinin stimulation. The number of lymphocytes, number of T cells, NK cell activity, and total amounts of IFN-gamma and IL-4 were significantly lower in the 12 men with a past history of PTSD. PTSD leaves a long-lasting immunosuppression and has long-term implications for health.

Worsening of Post-Traumatic Stress Disorder Symptoms with Cognitive Decline: Case Series

We present three cases of post-traumatic stress disorder (PTSD) symptoms associated with cognitive decline. Patient age ranged from 57 to 70 years old and all patients had war-related PTSD. In each case, the patient had a history of PTSD that was under fairly good control until the onset of cognitive impairment due to Alzheimer's disease or vascular or alcohol-related dementia. These cases suggest that neurodegeneration of memory pathways may disinhibit symptoms of PTSD.

Personality disorders, history of trauma, and posttraumatic stress disorder in subjects with anxiety disorders

The purpose of the study was to examine the association of personality disorders, history of trauma, and posttraumatic stress disorder (PTSD) in a large sample of subjects with anxiety disorders. Categorical and continuous indices of personality disorders were compared in three groups from the Harvard/Brown Anxiety Disorders Research Project (HARP): subjects with no history of trauma (n = 403), subjects with a history of trauma but no history of PTSD (n = 151), and subjects with a current or past diagnosis of PTSD (n 68). Subjects with PTSD were more likely to meet criteria for borderline or self-defeating personality disorder than subjects in the other two groups. PTSD subjects also had higher scores on the continuous measures (total number of criteria met) for borderline and self-defeating personality disorder than the other two groups. The findings suggest that a diagnosis of PTSD rather than a history of trauma is associated with borderline and self-defeating personality disorder features. Alternative conceptualizations of axis II features in individuals with PTSD are discussed.

Childhood Maltreatment and College Drop-Out Rates

This study, which followed 210 freshmen through 4 years of college, found that by their second semester in college, students who reported experiencing more than one form of childhood abuse (physical, sexual, or emotional) and those who were sexually assaulted but not otherwise maltreated were significantly less likely to be enrolled than nonvictims. By the end of their senior years, only 35% of multiple victims, 50% of those sexually abused only, and 60% of nonvictims were enrolled. Symptoms of post-traumatic stress disorder (PTSD) at the 2nd week of the freshman year were significantly related to college attendance at the 4th year, with a significant interaction between PTSD and abuse history as they related to remaining in or dropping out of college. Unless researchers studying the impact of childhood trauma in college samples are examining first-semester freshmen, it is likely that the research is being conducted with only the healthiest of survivors, which could lead to inaccurate conclusions about the abuse population as a whole.

Gabapentin in the Treatment of Posttraumatic Stress Disorder.

Sir: Gabapentin is a newer anticonvulsant approved for use as an adjunct agent in the treatment of partial seizures with or without secondary generalization.1 Recent publications indicate that gabapentin has been useful in a wide array of psychiatric conditions including anxiety disorders,2 alcohol withdrawal,3 bipolar disorder,4 behavioral disorders,5,6 and even antidepressant-induced bruxism.7 Although its exact mechanism of action is not known,1 it is structurally related to γ-aminobutyric acid (GABA), but does not interact with GABA receptors.8 A case is presented in which a patient diagnosed with posttraumatic stress disorder (PTSD) who had been taking multiple medications with little clinical response was placed on gabapentin treatment with beneficial results. To date, there has been 1 report describing its use in treating PTSD.9 Case report. Mr. A, a 48-year-old man, had a chronic history of PTSD (DSM-IV criteria) and opioid abuse dating back to his military service in Vietnam. He had been treated over the years with numerous medications for his PTSD, most recently fluoxetine, 40 mg/day; trazodone, 150 mg at night; and clonidine, 0.1 mg p.o. t.i.d., all for at least 1 year. He was admitted for an exacerbation of his symptoms including increasing nightmares, flashbacks, intrusive thoughts, and suicidal ideation. His medical history was significant for hepatitis C and mildly increased hepatic enzymes. Mr. A requested a change in medication to alleviate his worsening presenting symptoms, especially the nightmares and flashbacks. He agreed to a trial of gabapentin initiated at 300 mg at bedtime in addition to his current medication regimen. Over the next several days, he noted decreased nightmares, no flashbacks, and less anxiety and irritability overall. On day 3, the gabapentin was increased to 300 mg b.i.d., which further reduced his irritability. His sleep increased to 6 hours a night without awakenings. Over the course of 3 months, Mr. A noted a distinct reduction in nightmares and flashbacks, and his depression improved. He continues to participate in an outpatient treatment group and has begun a 12-step program to work on his opioid abuse. Gabapentin is an anticonvulsant that is eliminated by the kidneys and is not protein bound.8 By virtue of these properties as well as lack of hepatic enzyme induction, gabapentin has little potential for drug interactions with psychotropic medications,8 which is of great importance in treating a complicated psychiatric disorder such as PTSD. Although the exact neurobiology of gabapentin is not fully understood, Nutt10 reviews the current understanding of the role of certain neurotransmitters such as glutamate, GABA, serotonin, and norepinephrine as well as hypothalamic peptides in PTSD. Gabapentin may exert its effects through its structural relationship to GABA, playing an important role in decreasing excitatory input (glutamate) at the N-methyl-d-aspartate (NMDA) and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, thought to play a role in sensory transmission important in the psychobiology of PTSD.10 Gabapentin may be an important adjunct in a complicated psychiatric disorder; however, further studies in a controlled fashion are needed. Conclusions and opinions expressed are those of the author and do not necessarily reflect the position or policy of the U.S. Government, Department of Defense, Department of the Army, or the U.S. Army Medical Command.

Predictors of acute stress following motor vehicle accidents.

The aim of this study was to investigate the predictors of acute stress following motor vehicle accidents (MVA). Sixty-two consecutive adult admissions to a hospital were assessed between two days and four weeks following a MVA. Participants were assessed for acute stress disorder (ASD) with a structured clinical interview and administered the Beck Depression Inventory (BDI), Coping Style Questionnaire, Dissociative Experiences Scale, and the Eysenck Personality Inventory. The prevalences of full and sub-syndromal ASD were 16.1% and 14.5%, respectively. BDI, history of psychiatric treatment, history of posttraumatic stress disorder (PTSD), and history of previous MVA accounted for 61% of the variance of acute stress severity. The findings indicate that predictors of acute stress severity are comparable to the predictors of PTSD and highlight the possibility of identifying those who may benefit from early treatment.

Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma.

The study estimates the relative importance of specific types of traumas experienced in the community in terms of their prevalence and risk of leading to posttraumatic stress disorder (PTSD). A representative sample of 2181 persons in the Detroit area aged 18 to 45 years were interviewed by telephone to assess the lifetime history of traumatic events and PTSD, according to DSM-IV. Posttraumatic stress disorder was assessed with respect to a randomly selected trauma from the list of traumas reported by each respondent, using a modified version of the Diagnostic Interview Schedule, Version IV, and the World Health Organization Composite International Diagnostic Interview. The conditional risk of PTSD following exposure to trauma was 9.2%. The highest risk of PTSD was associated with assaultive violence (20.9%). The trauma most often reported as the precipitating event among persons with PTSD (31% of all PTSD cases) was sudden unexpected death of a loved one, an event experienced by 60% of the sample, and with a moderate risk of PTSD (14.3%). Women were at higher risk of PTSD than men, controlling for type of trauma. The risk of PTSD associated with a representative sample of traumas is less than previously estimated. Previous studies have overestimated the conditional risk of PTSD by focusing on the worst events the respondents had ever experienced. Although recent research has focused on combat, rape, and other assaultive violence as causes of PTSD, sudden unexpected death of a loved one is a far more important cause of PTSD in the community, accounting for nearly one third of PTSD cases.

Post-traumatic stress disorder and somatization symptoms: a prospective study

The objective of this study is to determine whether persons with a history of post-traumatic stress disorder (PTSD) are at increased risk for somatization symptoms. Using the NIMH Diagnostic Interview Schedule, 1007 21–30-year-old members of a large health maintenance organization in south-east Michigan were interviewed initially in 1989, with follow-up interviews conducted in 1992 and 1994. Prevalence of somatization syndrome and number of somatization symptoms in the 5-year follow-up period were compared in relation to PTSD status at baseline, using logistic regression. History of PTSD was associated with significantly more symptoms in each of the somatic symptom groups, except pain. In addition, persons with PTSD were more likely to report each of the symptoms of somatization, compared to those with other psychiatric disorders. Prospectively, baseline history of PTSD signaled an increased risk of pain (OR = 2.1) and conversion symptoms (OR = 2.3) in the follow-up interval, relative to those with no disorder. PTSD increased the risk of somatization symptoms beyond that expected by the presence of comorbid psychiatric disorders. The excess of somatization symptoms in persons with history of PTSD might be attributable to PTSD per se, or to the greater severity of the associated comorbidity, compared to persons with disorders other than PTSD.

Assessing Post-Traumatic Stress Disorder in Children: Diagnostic and Measurement Strategies

This article summarizes contemporary diagnostic and measurement approaches for assessing post-traumatic stress disorder (PTSD) in children. A brief history of PTSD in children is pre sented, and current research concerning prevalence rates is briefly summarized. Diagnostic classifications used in assessing PTSD in children are further reviewed including the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (Diagnostic Classifica tion : 0-3). Five standardized measures and one global assessment measure that have been used in screening and diagnosing children at risk for PTSD are examined in relationship to their psy chometric properties and clinical utility. Finally, the authors provide guidelines for which meas ures to use in social work practice and make suggestions for additional strategies andfurther de veloping assessment protocols in this area.

The Trauma Response of Children and Adolescents: Future Directions in Research

Although trauma research in children lags behind that of adults and is often preliminary or unreplicated, current work promises rich understanding of the neurobiologic and psychologic mechanisms underlying the trauma response of the young. Epidemiologic and longitudinal, prospective, controlled studies sensitive to cultural and developmental differences are needed to illuminate the natural history of posttraumatic stress disorder and to show how trauma and its response interact with family, school, and community factors. Promising profound implications for society, such data would enable mental health professionals, educators, and policy makers to develop standards for prevention, detection, and intervention to optimize children's developmental trajectory.

One-year follow-up of survivors of a mass shooting.

This report describes a 1-year follow-up study of survivors of a mass shooting incident. Acute-phase data from this incident were previously reported in this journal. The Diagnostic Interview Schedule/Disaster Supplement was used to assess 136 survivors at 1-2 months and again a year later, with a 91% reinterview rate. In the acute postdisaster period, 28% of subjects met criteria for posttraumatic stress disorder (PTSD), and 18% of subjects qualified for another active psychiatric diagnosis. At follow-up, 24% of subjects reported a history of postdisaster PTSD (17% were currently symptomatic), and 12% another current psychiatric disorder. Half (54%) of all 46 individuals identified as having had PTSD at either interview were recovered at follow-up, and no index predictors of recovery were identified. There were no cases of delayed-onset PTSD (beyond 6 months). Considerable discrepancy in identified PTSD cases was apparent between index and follow-up. Inconsistency in reporting, rather than report of true delayed-onset, was responsible for all PTSD cases newly identified at 1 year. The majority of subjects with PTSD at index who were recovered at follow-up reported no history of postdisaster PTSD at follow-up, suggesting considerable influence of fading memory. This study's findings suggest that disaster research that conducts single interviews at index or a year later may overlook a significant portion of PTSD. The considerable diagnostic comorbidity found in this study was the one robust predictor of PTSD at any time after the disaster. Disaster survivors with a psychiatric history, especially depression, may be most vulnerable to developing PTSD and therefore may deserve special attention from disaster mental health workers.

The prevalence of post-traumatic stress disorder and its relation to childhood adversity in subjects with eating disorders

The prevalence of post-traumatic stress disorder (PTSD) and its relation to childhood adversity and Axis I psychiatric disorders was assessed in a clinical population of 164 eating disorders patients. Eleven per cent (18/164) had a lifetime history of PTSD. There was no difference in the prevalence of PTSD between the subgroups of eating disorders. Higher prevalences of PTSD symptoms were found in those who had a history of childhood sexual abuse (23 per cent versus 9 per cent; p<0.05), discord in the home (16 per cent versus 6 per cent; p<0.05) and high parental control (44 per cent versus 6 per cent; p<0.001). Higher rates of life-time comorbidity of other Axis I disorders in PTSD sufferers was only found for anxiety disorders (67 per cent versus 39 per cent, p<0.03). Possible mechanisms linking childhood experiences to PTSD are discussed. © 1997 John Wiley & Sons, Ltd and Eating Disorders Association.

The National Women's Study: relationship of victimization and posttraumatic stress disorder to bulimia nervosa.

In recent years there has been increased interest regarding the role of crime victimization in the development and/or maintenance of eating disorders, particularly bulimia nervosa. To examine the relationship among assault, bulimia nervosa, and binge eating disorder, a national, representative sample of 3,006 women completed structured telephone interviews. Lifetime prevalence of completed, forcible rape for respondents with bulimia nervosa was 26.6%, as compared with 11.5% for respondents with binge eating disorder and 13.3% for respondents without bulimia nervosa or binge eating disorder. Compared to respondents without bulimia nervosa or binge eating disorder, aggravated assault history was significantly more prevalent in women with bulimia nervosa (26.8%), as was a lifetime history of posttraumatic stress disorder (36.9%). Characteristics of sexual assault experiences were not associated with dysfunctional eating patterns. Specific types of disordered eating such as compensatory behaviors in bulimia nervosa were associated with higher rates of victimization. In sum, the significantly higher rates of both sexual and aggravated assault among women with bulimia nervosa compared with women without such a diagnosis support the hypothesis that victimization may contribute to the development and/or maintenance of bulimia nervosa.

Psychiatric Symptomatology and Psychological Functioning in HIV-Infected Mothers

The present study examines psychiatric and psychological functioning in HIV-infected mothers with young children. Reflecting the epidemiology of HIV disease in women, the majority were African American and Latina, socioeconomically disadvantaged single parents with histories of substance use. Women were recruited from primary care HIV clinics. They were administered a structured psychiatric interview (SCID-R-Nonpatient form), as well as a psychological symptom questionnaire (Demoralization Scale). Prevalence rates of lifetime psychiatric diagnoses (88%), particularly lifetime histories of Major Depression (58%) and Post-Traumatic Stress Disorder (38%), were considerably higher than in other comparable samples in the literature. History of substance use was associated with history of Post-Traumatic Stress Disorder and the number of traumas experienced was associated with psychiatric and psychological functioning.

Prevalence of Somatoform Disorders in a Large Sample of Patients With Anxiety Disorders

The authors investigated the prevalence and characteristics of somatoform (SOM) disorders among 654 subjects with anxiety disorders who were part of the larger Harvard/Brown Anxiety Disorders Research Project. Thirty-six (5.5%) of the subjects had past or current SOM disorders. The subjects with SOM disorders were significantly more likely to have histories of posttraumatic stress disorder (22% vs. 8%, P = 0.01). The subjects with generalized anxiety disorder had significantly higher rates of SOM disorder (9.2% vs. 4.0%, P = 0.01). These results add support to the observation that SOM disorders are frequently comorbid with anxiety and depressive disorders.