Dimensions Of Posttraumatic Stress Disorder Research Articles

BIOLOGICAL MARKERS OF AGING: CHRONIC STRESS AND COGNITIVE IMPAIRMENT IN RESPONDERS FROM THE WORLD TRADE CENTER

Post-traumatic Stress Disorder (PTSD) is a stress related syndrome. Chronic PTSD has increasingly been associated with poor health outcomes, neurodegeneration and risk for cognitive impairment (CI). However, the biological mechanisms underlying the development and maintenance of symptoms and potential associations in accelerating aging are not well understood. The aim of this study was to evaluate whether specific biomarkers influence functional limitations and cognitive impairment in rescue and recovery workers (i.e. responders) from the attacks on the World Trade Center (WTC) in New York. Plasma biomarkers were collected during annual health and wellness visits at the WTC responder clinic between 2012 and 2014. Short Physical Performance Battery (SPPB) and clinical data were examined with prospective PTSD symptom scores collected during participant’s initial enrollment into the parent study as early as 2002. We examined the relationship between cardiovascular (Diastolic Blood Pressure, Systolic Blood Pressure, pulse rate), metabolic (Total Cholesterol, HDL cholesterol, Triglycerides, Glucose, Body Mass Index) and inflammation markers (Albumin, White Blood Count) with Post-traumatic Stress Disorder (PTSD), cognitive functioning (Montreal Cognitive Assessment) and frailty (Short Physical Performance Battery) in responders from the World Trade Center (WTC). We first examined correlations between biomarkers, PTSD symptom severity, PTSD dimensions, cognitive functioning and frailty. We then conducted multivariate regression analyses. In models adjusted for potential confounders, among N=1,045 responders, elevated PTSD was strongly associated with increased frailty, cardiovascular dysregulation and mild cognitive impairment. Current work is ongoing to identify trajectories of change in cognition with frailty and biological factors.

Dimensional structure of posttraumatic stress disorder symptoms after cardiac arrest

BackgroundConsiderable evidence suggests that posttraumatic stress disorder (PTSD) is a heterogeneous construct despite often being treated as a homogeneous diagnostic entity. PTSD in response to cardiac arrest is common and may differ from PTSD following other medical traumas. Most patients are amnesic from the cardiac event, and it is unclear if and how certain PTSD symptoms may manifest. MethodsWe examined the latent structure of PTSD symptoms in 104 consecutive cardiac arrest survivors who were admitted to Columbia University Medical Center. PTSD symptoms were assessed via the PTSD Checklist-Specific at hospital discharge. We performed a confirmatory factor analysis (CFA) to compare 4-factor dysphoria, 4-factor numbing, and 5-factor dysphoric arousal models of PTSD with our data. ResultsThe CFA showed that each of the models had good fit. We chose the 4-factor numbing model (χ2 (113) = 151.59, p < .01, CFI = 0.94, RMSEA = 0.057, 90% CI: [0.032, 0.081]) as most representative of the data, after considering a between-factor correlation of 0.99 in the 5-factor dysphoric arousal model, and greater fit statistics than the 4-factor dysphoria model. LimitationsCertain factors were defined by only two items. Additionally, PTSD was assessed at discharge (median = 21 days); those assessed before 30 days could be displaying symptoms of acute stress disorder. ConclusionsOur findings suggest that PTSD symptoms after cardiac arrest are best represented by a 4-factor numbing model of PTSD. PTSD assessment and intervention efforts for cardiac arrest survivors should consider the underlying dimensions of PTSD.

Post-traumatic stress disorder and coping mechanism among migrant returnees from middle east countries in Amhara region, Ethiopia

Objective: The purpose of this study was to assess risk factors and measure prevalence rates of Post-Traumatic Stress Disorder (PTSD) and Coping Mechanisms of migrant returnees from Middle East countries in Amhara Region, Ethiopia. Methods: Mixed method explanatory research design was employed on 376 randomly selected migrant returnees in six nominated towns of the region. PTSD checklist and Coping Strategy Indicator were employed for assessment. Focus Group Discussion (FGD) and interview were also utilized. Descriptive statistics, independent t-test and MANOVA were utilized to analyze the collected data. Result: The general life time prevalence rate of PTSD was 26.2%. Correspondingly, avoidance, intrusive thought and hyper arousal were reported core symptoms of PTSD in their due order. Likewise, to improve quality of life, failure in educational endeavor, peer and family pressure, unemployment and poverty were the major factors for migration to Middle East. In this study, the independent t-test result shows that there was statistically significant mean difference between male and female respondents in experiencing intrusive thought (t (374)=-2.62, p&lt;0.05), avoidance (t (374)=-3.14, p&lt;0.05) and hyper arousal (t (374)=-2.86, p&lt; 0.05). Besides, current employment status of returnees had statistically significant effect in experiencing intrusive thought (t (374)=2.45, p&lt;0.05), avoidance (t (374)=-2.42, p&lt;0.05) and hyper arousal (t (374) = 2.10, p&lt;0.05). In addition, a MANOVA result revealed that there were statistically significant differences between participants with their respective age (F (6,522)=2.230, p˂0.05), educational status (F (9,665)=3.051, p&lt;0.05), average monthly income (F (6,522)=0.867, p˂0. 05) and types of abuse they faced (F (9,635)=2.113, p˂0. 05) on PTSD dimensions (intrusive thought, avoidance and hyper arousal). Correspondingly, ANOVA result disclosed that age, educational status, types of abuse returnees’ face and monthly income in the Middle East had statistically significant effect on intrusive thought, avoidance and hyper arousal separately. As contributing factors for PTSD, limitations on freedom of movement, enforced cultural isolation, verbal and sexual abuse, excessive working hours, being arrested, confiscation of documents, withholding of wage and life threatening trial were highly reported problems. Finally, problem solving, seeking social support and avoidance coping mechanisms were utilized in their due order. Conclusion: The life time prevalence rate of PTSD were very high. Therefore, mental health service providers shall consider in diagnosing and treating PTSD among migrant returnee

When Did Posttraumatic Stress Disorder Get So Many Factors? Confirmatory Factor Models Since DSM–5

For over three decades confirmatory factor analysis (CFA) has been used to test the construct validity of models of posttraumatic stress disorder (PTSD). The four symptom dimensions of PTSD in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders ( DSM–5) are based on CFA. Since the publication of DSM–5, the number of proposed factors has grown from four to seven. We review these models, focusing on (a) the number of symptoms per factor, indicating how well factors are identified; (b) correlations between factors, indicating how distinct they are; and (c) their external validation. Of the 27 CFAs published since 2013, almost all included factors composed of only two symptoms, and most relied on more than one. High factor correlations were the norm. Two thirds of models provided external validation. Discussion concerns implications for PTSD’s measurement and construct validity and recommendations for improving CFA in the PTSD literature.

Anger as an underlying dimension of posttraumatic stress disorder

In this study, we examined the underlying role of anger in posttraumatic stress disorder (PTSD). Although anger is currently considered within two symptoms of PTSD (i.e., anger/irritability; and negative emotional state), some research has found that anger is more than just a diagnostic symptom of PTSD. The sample consisted of 375 trauma-exposed individuals that completed the PTSD Checklist-5 and Dimensions of Anger Reactions Scale. Confirmatory factor analysis was used to assess PTSD's factor structure based on the four-factor DSM-5 PTSD model. Subsequently, the model was re-tested, statistically controlling for anger by regressing PTSD's items on an observed anger score. Individual factor loading differences were then compared to determine anger's underlying role. Results indicated that a significant amount of variance in PTSD, at both the item level and factor level, was attributable to an underlying dimension of anger. The largest factor attenuation was for the symptom of irritability/anger and the smallest attenuation was recklessness. The results suggest that anger underlies more of PTSD than the two diagnostic symptom criteria.

Effect of workplace bullying on posttraumatic stress disorder in nursing staff

Objective: To investigate the relationship between workplace bullying and posttraumatic stress disorder (PTSD) in nursing staff, and to analyze the role of psychological capital between workplace bullying and PTSD. Methods: From December 2014 to June 2015, convenience sampling was used to collect 496 nurses from 5 grade A tertiary hospitals in a province of China. Their workplace bullying, psychological capital, and PTSD status were assessed using the Negative Acts Questionnaire, Psychological Capital Questionnaire, and Posttraumatic Stress Disorder Self-Rating Scale, respectively. The correlation between variables was analyzed using a structural equation model. Results: Among these nurses, the scores of negative acts, psychological capital, and PTSD were 37.15±12.83, 78.81±16.54, and 34.56±12.52, respectively. The score on each dimension of negative acts was positively correlated with that on each dimension of PTSD (P<0.01) ; the score on each dimension of psychological capital was negatively correlated with that on each dimension of PTSD and negative acts (P<0.01). Negative acts had a positive predictive effect on PTSD (β=0.539, P<0.01) , which was reduced after inclusion of psychological capital (β=0.513, P<0.01). The path coefficient was 0.62 for the effect of negative acts on PTSD, -0.18 for the effect of negative acts on psychological capital, and -0.11 for the effect of psychological capital on PTSD (P<0.05) . Conclusion: Workplace bullying is a predictive factor for PTSD, and psychological capital plays a mediating role between workplace bullying and PTSD. The manager should reduce workplace bullying to improve the psychological capital in nursing staff and to prevent and reduce PTSD.

Hormonal influences on memory dimensions of post-traumatic stress disorder

Hormonal influences on memory dimensions of post-traumatic stress disorder

Cortical thickness reduction in combat exposed U.S. veterans with and without PTSD

We investigated the extent of cortical thinning in U.S. Veterans exposed to combat who varied in the severity of their posttraumatic stress disorder (PTSD) symptoms. In addition, we explored the neural correlates of PTSD symptom dimensions and the interactive effects of combat exposure and PTSD upon cortical thickness. Sixty-nine combat exposed Veterans completed high-resolution magnetic resonance imaging (MRI) scans to estimate cortical thickness. The Clinician Administered PTSD Scale (CAPS) and Combat Exposure Scale (CES) assessments were completed to measure current PTSD and historical combat severity, respectively. PTSD symptom dimensions (numbing, avoidance, reexperiencing, anxious arousal, and dysphoric arousal) were studied. Vertex-wise whole cerebrum analyses were conducted. We found widespread negative correlations between CAPS severity and cortical thickness, particularly within the prefrontal cortex. This prefrontal correlation remained significant after controlling for depression severity, medication status, and other potential confounds. PTSD dimensions, except anxious arousal, negatively correlated with cortical thickness in various unique brain regions. CES negatively correlated with cortical thickness in the left lateral prefrontal, regardless of PTSD diagnosis. A significant interaction between CES and PTSD diagnosis was found, such that CES negatively correlated with cortical thickness in the non-PTSD, but not in the PTSD, participants. The results underscore the severity of cortical thinning in U.S. Veterans suffering from high level of PTSD symptoms, as well as in Veterans with no PTSD diagnosis but severe combat exposure. The latter finding raises considerable concerns about a concealed injury potentially related to combat exposure in the post-9/11 era.

Post-traumatic stress disorder dimensions and asthma morbidity in World Trade Center rescue and recovery workers

ABSTRACTObjective: Using data from a cohort of World Trade Center (WTC) rescue and recovery workers with asthma, we assessed whether meeting criteria for post-traumatic stress disorder (PTSD), sub-threshold PTSD, and for specific PTSD symptom dimensions are associated with increased asthma morbidity. Methods: Participants underwent a Structured Clinical Interview for Diagnostic and Statistical Manual to assess the presence of PTSD following DSM-IV criteria during in-person interviews between December 2013 and April 2015. We defined sub-threshold PTSD as meeting criteria for two of three symptom dimensions: re-experiencing, avoidance, or hyper-arousal. Asthma control, acute asthma-related healthcare utilization, and asthma-related quality of life data were collected using validated scales. Unadjusted and multiple regression analyses were performed to assess the relationship between sub-threshold PTSD and PTSD symptom domains with asthma morbidity measures. Results: Of the 181 WTC workers with asthma recruited into the study, 28% had PTSD and 25% had sub-threshold PTSD. Patients with PTSD showed worse asthma control, higher rates of inpatient healthcare utilization, and poorer asthma quality of life than those with sub-threshold or no PTSD. After adjusting for potential confounders, among patients not meeting the criteria for full PTSD, those presenting symptoms of re-experiencing exhibited poorer quality of life (p = 0.003). Avoidance was associated with increased acute healthcare use (p = 0.05). Sub-threshold PTSD was not associated with asthma morbidity (p > 0.05 for all comparisons). Conclusions: There may be benefit in assessing asthma control in patients with sub-threshold PTSD symptoms as well as those with full PTSD to more effectively identify ongoing asthma symptoms and target management strategies.

Anterior hippocampal dysconnectivity in posttraumatic stress disorder: a dimensional and multimodal approach

The anterior hippocampus (aHPC) has a central role in the regulation of anxiety-related behavior, stress response, emotional memory and fear. However, little is known about the presence and extent of aHPC abnormalities in posttraumatic stress disorder (PTSD). In this study, we used a multimodal approach, along with graph-based measures of global brain connectivity (GBC) termed functional GBC with global signal regression (f-GBCr) and diffusion GBC (d-GBC), in combat-exposed US Veterans with and without PTSD. Seed-based aHPC anatomical connectivity analyses were also performed. A whole-brain voxel-wise data-driven investigation revealed a significant association between elevated PTSD symptoms and reduced medial temporal f-GBCr, particularly in the aHPC. Similarly, aHPC d-GBC negatively correlated with PTSD severity. Both functional and anatomical aHPC dysconnectivity measures remained significant after controlling for hippocampal volume, age, gender, intelligence, education, combat severity, depression, anxiety, medication status, traumatic brain injury and alcohol/substance comorbidities. Depression-like PTSD dimensions were associated with reduced connectivity in the ventromedial and dorsolateral prefrontal cortex. In contrast, hyperarousal symptoms were positively correlated with ventromedial and dorsolateral prefrontal connectivity. We believe the findings provide first evidence of functional and anatomical dysconnectivity in the aHPC of veterans with high PTSD symptomatology. The data support the putative utility of aHPC connectivity as a measure of overall PTSD severity. Moreover, prefrontal global connectivity may be of clinical value as a brain biomarker to potentially distinguish between PTSD subgroups.

DSM-5 Posttraumatic Stress Disorder Symptom Structure in Disaster-Exposed Adolescents: Stability across Gender and Relation to Behavioral Problems.

Given the significant modifications to posttraumatic stress disorder (PTSD) symptom criteria from DSM-IV to DSM-5, a better understanding of the dimensionality underlying DSM-5 PTSD symptoms among adolescents is needed. However, to date, whether gender moderates the latent structure of DSM-5 PTSD symptoms in youth remains unclear. Meanwhile, little is known about how distinct PTSD dimensions relate to adolescent behavioral problems. The aim of this study was to fill these gaps. A sample of 1184 disaster-exposed Chinese adolescents (53.8% girls) with age ranging from 13 to 17years (M=14.3, SD=0.8) completed the PTSD Checklist for DSM-5, and the Withdrawn, Aggressive Behavior, and Delinquent Behavior subscales of the Youth Self-Report. Confirmatory factor analyses revealed that the seven-factor hybrid PTSD model provided the best fit to the data for both girls and boys. Measurement equivalence of this model held across gender, although girls had higher mean scores than boys on some factors. Differential patterns of associations emerged between PTSD dimensions and behavioral problems, with anhedonia symptoms most strongly relating to social withdrawal, and externalizing behavior symptoms most strongly relating to aggression and delinquency. These findings further support the gender invariance and external criterion validity of the newly refined hybrid model that best represents DSM-5 PTSD symptom structure in youth, and carry implications for accurate assessment, diagnosis, and gender comparison of DSM-5 PTSD symptomatology, and potential symptom targets for PTSD intervention among adolescent disaster survivors.

PTSD's Underlying Dimensions in Typhoon Haiyan Survivors: Assessing DSM-5 Symptomatology-Based PTSD Models and Their Relation to Posttraumatic Cognition.

The recent changes in posttraumatic stress disorder (PTSD) symptomatology in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) call for a re-examination of PTSD's latent factor structure. The present study assessed six competing models of PTSD based on DSM-5 symptomatology using confirmatory factor analysis in a sample of young adult Filipino survivors of typhoon Haiyan, one of the strongest typhoons in the world ever recorded at the time of its landfall (N=632). Furthermore, the differential relationships of the factors of the best-fitting model with posttraumatic cognitions were also investigated. Results showed the 7-factor hybrid model of PTSD comprised of intrusion, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal, to be the best fitting model. In addition, the varying degrees of relationship with posttraumatic cognitions support the distinctiveness of each factor. These findings are pertinent in light of the changes in DSM-5 PTSD symptomatology, as well as in understanding the underlying dimensions of PTSD among Asian, particularly Filipino, survivors of a natural disaster.

Support for the 7-factor hybrid model of PTSD in a community sample.

Research suggests that 4-factor models of posttraumatic stress disorder (PTSD) may be improved upon by the addition of novel factors, such as Dysphoric Arousal, Externalizing Behaviors, and Anhedonia. However, a novel 7-factor hybrid model has demonstrated superior fit in veteran and undergraduate samples. The current study sought to replicate this finding in a trauma-exposed community sample and examined relations with positive (PA) and negative affect (NA). Participants included 403 adults (M(age) = 37.75) recruited through Amazon's MTurk. PTSD was measured using the PTSD Checklist-5 (PCL-5). Confirmatory factor analyses were conducted in Mplus. The 7-factor hybrid model demonstrated good fit: CFI = .96, TLI = .95, RMSEA = .06 (90% CI [.05, .07]), SRMR = .03. This model was superior to the 5- and 6-factor models. All factors demonstrated significant relations with PA and NA, the largest of which were the Externalizing Behaviors (with NA) and Anhedonia (with PA) factors. Results provide support for the 7-factor hybrid model of PTSD using the PCL-5 in a community sample. Findings replicate previous research suggesting that PTSD is highly related to NA, which has been purported as an underlying dimension of PTSD. It is recommended that future research use clinical measures to further examine the hybrid model. (PsycINFO Database Record

Latent dimensions of posttraumatic stress disorder and their relations with alcohol use disorder.

The objective of this study was to evaluate the relationship between factors of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) using confirmatory factor analysis (CFA) in order to further our understanding of the substantial comorbidity between these two disorders. CFA was used to examine which factors of PTSD's dysphoria model were most related to AUD in a military sample. Ohio National Guard soldiers with a history of overseas deployment participated in the survey (n = 1215). Participants completed the PTSD Checklist and a 12-item survey from the National Survey on Drug Use used to diagnosis AUD. The results of the CFA indicated that a combined model of PTSD's four factors and a single AUD factor fit the data very well. Correlations between PTSD's factors and a latent AUD factor ranged from correlation coefficients of 0.258-0.285, with PTSD's dysphoria factor demonstrating the strongest correlation. However, Wald tests of parameter constraints revealed that AUD was not more correlated with PTSD's dysphoria than other PTSD factors. All four factors of PTSD's dysphoria model demonstrate comparable correlations with AUD. The role of dysphoria to the construct of PTSD is discussed.

Elucidating dimensions of posttraumatic stress symptoms and their functional correlates in disaster-exposed adolescents

The aim of this study was to elucidate the dimensional structure of posttraumatic stress disorder (PTSD) and potential moderators and functional correlates of this structure in disaster-affected adolescents. A population-based sample of 2000 adolescents aged 12–17 years (M = 14.5 years; 51% female) completed interviews on post-tornado PTSD symptoms, substance use, and parent–adolescent conflict between 4 and 13 months (M = 8.8, SD = 2.6) after tornado exposure. Confirmatory factor analyses revealed that all models fit well but a 5-factor dysphoric arousal model provided a statistically significantly better representation of adolescent PTSD symptoms compared to 4-factor dysphoria and emotional numbing models. There was evidence of measurement invariance of the dysphoric arousal model across gender and age, although girls and older adolescents aged 15–17 years had higher mean scores than boys and younger adolescents aged 12–14 years, respectively, on some PTSD dimensions. Differential magnitudes of association between PTSD symptom dimensions and functional correlates were observed, with emotional numbing symptoms most strongly positively associated with problematic substance use since the tornado, and dysphoric arousal symptoms most strongly positively associated with parent–adolescent conflict; both correlations were significantly larger than the corresponding correlations with anxious arousal. Taken together, these results suggest that the dimensional structure of tornado-related PTSD symptomatology in adolescents is optimally characterized by five separate clusters of re-experiencing, avoidance, numbing, dysphoric arousal, and anxious arousal symptoms, which showed unique associations with functional correlates. Findings emphasize that PTSD in disaster-exposed adolescents is not best conceptualized as a homogenous construct and highlight potential differential targets for post-disaster assessment and intervention.

Association of symptoms following mild traumatic brain injury with posttraumatic stress disorder vs. postconcussion syndrome.

A proportion of patients experience long-lasting symptoms following mild traumatic brain injury (MTBI). The postconcussion syndrome (PCS), included in the DSM-IV, has been proposed to describe this condition. Because these symptoms are subjective and common to other conditions, there is controversy whether PCS deserves to be identified as a diagnostic syndrome. To assess whether persistent symptoms 3 months following head injury are specific to MTBI or whether they are better described as part of posttraumatic stress disorder (PTSD). We conducted a prospective cohort study of injured patients recruited at the adult emergency department of the University Hospital of Bordeaux from December 4, 2007, to February 25, 2009. At 3-month follow-up, we compared the prevalence and risk factors for PCS and PTSD. Multiple correspondence analyses were used to assess clustering of symptoms and their associations with the type of injury. We included 534 patients with head injury and 827 control patients with other nonhead injuries. Three months following the trauma, 21.2% of head-injured and 16.3% of nonhead-injured patients fulfilled the DSM-IV diagnosis of PCS; 8.8% of head-injured patients fulfilled the diagnostic criteria for PTSD compared with 2.2% of control patients. In multivariate analysis, MTBI was a predictor of PTSD (odds ratio, 4.47; 95% CI, 2.38-8.40) but not of PCS (odds ratio, 1.13; 95% CI, 0.82-1.55). Correspondence analysis suggested that symptoms considered part of PCS behave similarly to PTSD symptoms in the hyperarousal dimension. None of these 22 symptoms showed any pattern of clustering, and no clear proximity with head or nonhead injury status could be found. Persistent subjective symptoms frequently reported 3 months after MTBI are not specific enough to be identified as a unique PCS and should be considered part of the hyperarousal dimension of PTSD.

Personality assessment inventory internalizing and externalizing structure in veterans with posttraumatic stress disorder: associations with aggression.

Posttraumatic stress disorder (PTSD) is associated with aggressive behavior in veterans, and difficulty controlling aggressive urges has been identified as a primary postdeployment readjustment concern. Yet only a fraction of veterans with PTSD commit violent acts. The goals of this study were to (1) examine the higher-order factor structure of Personality Assessment Inventory (PAI) scales in a sample of U.S. military veterans seeking treatment for PTSD; and (2) to evaluate the incremental validity of higher-order latent factors of the PAI over PTSD symptom severity in modeling aggression. The study sample included male U.S. Vietnam (n = 433) and Iraq/Afghanistan (n = 165) veterans who were seeking treatment for PTSD at an outpatient Veterans Affairs (VA) clinic. Measures included the Clinician Administered PTSD Scale, the PAI, and the Conflict Tactics Scale. The sample was randomly split into two equal subsamples (n's = 299) to allow for cross-validation of statistically derived factors. Parallel analysis, variable clustering analysis, and confirmatory factor analyses were used to evaluate the factor structure, and regression was used to examine the association of factor scores with self-reports of aggression over the past year. Three factors were identified: internalizing, externalizing, and substance abuse. Externalizing explained unique variance in aggression beyond PTSD symptom severity and demographic factors, while internalizing and substance abuse did not. Service era was unrelated to reports of aggression. The constructs of internalizing versus externalizing dimensions of PTSD may have utility in identifying characteristics of combat veterans in the greatest need of treatment to help manage aggressive urges.

Conditioned fear associated phenotypes as robust, translational indices of trauma-, stressor-, and anxiety-related behaviors.

Post-traumatic stress disorder (PTSD) is a heterogeneous disorder that affects individuals exposed to trauma (e.g., combat, interpersonal violence, and natural disasters). It is characterized by hyperarousal, intrusive reminders of the trauma, avoidance of trauma-related cues, and negative cognition and mood. This heterogeneity indicates the presence of multiple neurobiological mechanisms underlying the development and maintenance of PTSD. Fear conditioning is a robust, translational experimental paradigm that can be employed to elucidate these mechanisms by allowing for the study of fear-related dimensions of PTSD (e.g., fear extinction, fear inhibition, and generalization of fear) across multiple units of analysis. Fear conditioning experiments have identified varying trajectories of the dimensions described, highlighting exciting new avenues of targeted, focused study. Additionally, fear conditioning studies provide a translational platform to develop novel interventions. The current review highlights the versatility of fear conditioning paradigms, the implications for pharmacological and non-pharmacological treatments, the robustness of these paradigms to span an array of neuroscientific measures (e.g., genetic studies), and finally the need to understand the boundary conditions under which these paradigms are effective. Further understanding these paradigms will ultimately allow for optimization of fear conditioning paradigms, a necessary step towards the advancement of PTSD treatment methods.

Measuring dimensions of posttraumatic stress disorder: the Iowa traumatic response inventory.

Researchers have suggested that the symptoms of posttraumatic stress disorder (PTSD) should be divided into the four dimensions of intrusions, avoidance, numbing or dysphoria, and hyperarousal. However, the clinical utility of a dysphoria/general distress symptom dimension is unclear, and measures of the overall structure of PTSD are limited by the small number of avoidance and prototypical hyperarousal symptoms in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The Iowa Traumatic Response Inventory (ITRI) was created as a broader measure of symptoms related to PTSD. The factor analytic method of test construction was used to create the scales from a larger pool of items. The measure was validated in a clinical sample and in a student sample. Analysis of the ITRI symptom dimensions suggests traumatic intrusions and avoidance symptoms are highly associated and are specific to PTSD, whereas dysphoria, hyperarousal, and dissociation are not specific to PTSD. Overall, the ITRI was found to be a reliable and valid measure of PTSD symptoms that better captures the observed structure of the disorder.

Post-traumatic stress and coping factors among search and recovery divers

Irish search and recovery divers dive on a voluntary basis to recover missing persons. During these procedures, they encounter situations not typically part of ordinary human experience and might be expected to experience psychological effects as a result. To investigate the association of post-traumatic stress disorder (PTSD) symptoms with previous experience of missing person recovery among divers, and to investigate the coping mechanisms used. Self-administered questionnaires were distributed to all 206 active search divers in Ireland. A validated questionnaire, the Impact of Event Scale revised (IES-R), was used together with a coping questionnaire to compare the level of symptoms in divers with and without recovery experience, and to describe the main coping factors. One hundred and fifty-five questionnaires were returned, a response rate of 75%. Divers with prior missing person recovery experience scored lower on all three PTSD dimensions (avoidance, intrusion and hyper-arousal) with a significant difference for intrusion (P < 0.001). Coping mechanisms listed by the divers were search and recovery training, support from peers and search unit and sense of duty. The results do not support the hypothesis of an accumulation of traumatic experience in experienced divers but may indicate a survivor bias of the most resilient individuals, or a wearing off of vulnerability to traumatic events with experience.