Posttraumatic Stress Disorder Profile Research Articles

Cognitive profiles of Post-traumatic Stress Disorder and depression in children and adolescents

Background/Objective: Several diagnostic criteria of Post-traumatic Stress Disorder (PTSD) are remarkably similar to symptoms reported by individuals with depression, particularly as they manifest as cognitive processing deficits in children. Because of this overlap in profile and the high rate of comorbidity of PTSD and depression (48% to 69%), pinpointing similarities/differences in cognitive processes related to each of these disorders is essential to accurate diagnosis. This study aims to examine cognitive performance profiles of 23 children who have been victims of PTSD and to compare their results with 23 children with depression and 24 controls. Method: Empirical study, observational and descriptive methodologies were performed using several neuropsychological tests to assess IQ, attention, memory and executive function. Statistical comparisons between groups were made using the non-parametric Kruskall-Wallis test and post-hoc analyses were conducted using a Mann Whitney U test, as well as Quade's co-variance analysis. Results: Data show different profiles of cognitive performance in those with PTSD compared to those with depression and controls. Conclusions: The findings suggests that PTSD and depressed children differ somewhat in their cognitive profiles, and the differences in IQ found between those with PTSD and those without are not necessarily a confounding variable, but may rather be a consequence of their traumatic experience.

The role of guilt in Posttraumatic Stress Disorder

ABSTRACTBackground: A growing body of evidence supports the notion that the emotional profile of Posttraumatic Stress Disorder (PTSD) may be more diverse than traditional accounts presume. PTSD’s image as an anxiety-based disorder is undergoing change as the significance of other emotions in its development becomes more evident. Experimental research is needed in order to expand the understanding of underlying processes driving the development of PTSD.Objective: Experimentally test the influence of stressor-related guilt on the occurrence of PTSD symptomatology.Method: A non-clinical student sample faced an analogue trauma, a stressor in the form of a computer crash and related loss of data. We either personally blamed participants for causing the incident (blame group) or told them that it was a technical failure and therefore not their fault (no-blame group). Levels of guilt before and after the incident as well as number and associated distress of incident-related intrusions were assessed using a one-day diary and compared between groups.Results: The guilt manipulation was successful: feelings of guilt significantly increased in the blame group but not in the no-blame group. Furthermore, the blame group showed a significantly higher number of intrusions and associated distress compared to the no-blame group at one-day follow-up.Conclusions: These laboratory findings indicate that feelings of guilt may lead to increased PTSD symptomatology, supporting the view that guilt experienced in reaction to a traumatic event may be part of a causal mechanism driving the development of PTSD.

Homogeneity of Severe Posttraumatic Stress Disorder Symptom Profiles in Children and Adolescents Across Gender, Age, and Traumatic Experiences Related to 9/11.

Patients with a posttraumatic stress disorder (PTSD) diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV; American Psychiatric Association, 1994) will very likely not share all of the same symptoms, a consequence of the polythetic approach used in the DSM. We examined heterogeneity in the latent structure of PTSD symptoms using data from a previously published sample of 8,236 youth a subset of which had been exposed to the September 11, 2001 attacks (N = 6,670; Hoven etal., 2005). Latent class analysis was applied (a) to PTSD symptoms alone, (b) to symptoms in combination with impairment indicators, and (c) to PTSD symptoms when stratified by age and gender, as well as by empirically defined classes of exposure. We identified 4 symptom classes: no disturbance (49.4%), intermediate disturbance (2 classes; 21.5% and 18.6%, respectively), and severe disturbance (10.5%). These classes varied not only in the severity of symptoms, but also in the configuration of symptoms. We observed a high probability of endorsing both PTSD symptoms and indicators of impairment only in the severe disturbance class. A similar 4-class structure was found when the data were stratified by age, gender, and exposure classes. There were no significant differences as a function of age, gender, or exposure in the presence of severe PTSD. Heterogeneity was observed at intermediate levels of PTSD symptom severity. The specific PTSD symptoms that defined the severe PTSD profile could constitute the pathogenic aspects of a largely invariant and clinically meaningful PTSD syndrome.

Evidence of distinct profiles of Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) based on the new ICD-11 Trauma Questionnaire (ICD-TQ)

BackgroundThe WHO International Classification of Diseases, 11th version (ICD-11), has proposed two related diagnoses following exposure to traumatic events; Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). We set out to explore whether the newly developed ICD-11 Trauma Questionnaire (ICD-TQ) can distinguish between classes of individuals according to the PTSD and CPTSD symptom profiles as per ICD-11 proposals based on latent class analysis. We also hypothesized that the CPTSD class would report more frequent and a greater number of different types of childhood trauma as well as higher levels of functional impairment. Methods Participants in this study were a sample of individuals who were referred for psychological therapy to a National Health Service (NHS) trauma centre in Scotland (N=193). Participants completed the ICD-TQ as well as measures of life events and functioning. ResultsOverall, results indicate that using the newly developed ICD-TQ, two subgroups of treatment-seeking individuals could be empirically distinguished based on different patterns of symptom endorsement; a small group high in PTSD symptoms only and a larger group high in CPTSD symptoms. In addition, CPTSD was more strongly associated with more frequent and a greater accumulation of different types of childhood traumatic experiences and poorer functional impairment. LimitationsSample predominantly consisted of people who had experienced childhood psychological trauma or been multiply traumatised in childhood and adulthood. ConclusionsCPTSD is highly prevalent in treatment seeking populations who have been multiply traumatised in childhood and adulthood and appropriate interventions should now be developed to aid recovery from this debilitating condition.

Dissociative features in posttraumatic stress disorder: A latent profile analysis.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) characterizes the dissociative subtype of posttraumatic stress disorder (PTSD) in terms of the individual meeting the criteria for PTSD and additionally reporting symptoms of depersonalization and/or derealization. The current study aimed to examine whether a dissociative PTSD profile may include alternative features of dissociation and whether it could be differentiated from a nondissociative PTSD profile on certain psychopathologies and demographics. Data from 309 trauma-exposed participants, collected through Amazon Mechanical Turk, were subjected to latent profile analysis. Regression analyses were used to examine the predictors of latent classes. Three discrete profiles named Baseline, PTSD, and Dissociative profile were uncovered. All examined features of dissociation were significantly elevated in the Dissociative profile. Anxiety, male sex, being employed, and having a minority racial background significantly predicted the Dissociative profile relative to the PTSD profile. The study points to the importance of alternative symptoms of dissociation in the dissociative PTSD subtype beyond the symptoms of depersonalization and derealization. (PsycINFO Database Record

Can the dissociative PTSD subtype be identified across two distinct trauma samples meeting caseness for PTSD?

For over a century, the occurrence of dissociative symptoms in connection to traumatic exposure has been acknowledged in the scientific literature. Recently, the importance of dissociation has also been recognized in the long-term traumatic response within the DSM-5 nomenclature. Several studies have confirmed the existence of the dissociative posttraumatic stress disorder (PTSD) subtype. However, there is a lack of studies investigating latent profiles of PTSD solely in victims with PTSD. This study investigates the possible presence of PTSD subtypes using latent class analysis (LCA) across two distinct trauma samples meeting caseness for DSM-5 PTSD based on self-reports (N=787). Moreover, we assessed if a number of risk factors resulted in an increased probability of membership in a dissociative compared with a non-dissociative PTSD class. The results of LCA revealed a two-class solution with two highly symptomatic classes: a dissociative class and a non-dissociative class across both samples. Increased emotion-focused coping increased the probability of individuals being grouped into the dissociative class across both samples. Social support reduced the probability of individuals being grouped into the dissociative class but only in the victims of motor vehicle accidents (MVAs) suffering from whiplash. The results are discussed in light of their clinical implications and suggest that the dissociative subtype can be identified in victims of incest and victims of MVA suffering from whiplash meeting caseness for DSM-5 PTSD.

Post-Traumatic Stress Disorder Across the Adult Lifespan: Findings From a Nationally Representative Survey.

There is a dearth of community-based epidemiologic literature that examines post-traumatic stress disorder (PTSD) across the adult lifespan. In the current study the authors address this gap by examining the ways in which PTSD differs among young (ages 20-34), middle-aged (ages 35-64), and older (age 65+) adults with respect to past-year prevalence, nature of "worst" stressful experience ever experienced before the onset of PTSD, all traumatic experiences, symptom expression, psychiatric comorbidities, and mental health-related quality of life. We analyzed Wave 2 data from the National Epidemiologic Survey on Alcohol and Related Conditions, including adults with past-year diagnoses of PTSD (N = 1,715). The prevalence of past-year PTSD was significantly higher for young (4.3% [SE: 0.3]) and middle-aged (5.2% [SE: 0.2]) adults compared with older adults (2.6% [SE: 0.2]). Respondents in the three age groups differed with regard to their "worst" stressful experience ever experienced before the onset of PTSD and to all traumatic experiences. Older adults experienced significantly fewer traumatic experiences (mean: 5.2; SE: 0.2) compared with young (mean: 5.7; SE: 0.2) and middle-aged adults (mean: 6.4; SE: 0.1). Young and middle-aged adults had significantly greater symptom counts and greater odds of comorbid psychiatric disorders when compared with older adults. PTSD had similar effects on mental health-related quality of life across the adult lifespan. Results highlight key differences in the characteristics of PTSD across the adult lifespan. The overall pattern of findings indicates that increasing age is associated with less severe PTSD profiles, including lower prevalence, fewer traumatic experiences, lower symptom counts, and lower odds of psychiatric comorbidity.

Less is more? Assessing the validity of the ICD-11 model of PTSD across multiple trauma samples

BackgroundIn the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the symptom profile of posttraumatic stress disorder (PTSD) was expanded to include 20 symptoms. An alternative model of PTSD is outlined in the proposed 11th edition of the International Classification of Diseases (ICD-11) that includes just six symptoms.Objectives and methodThe objectives of the current study are: 1) to independently investigate the fit of the ICD-11 model of PTSD, and three DSM-5-based models of PTSD, across seven different trauma samples (N=3,746) using confirmatory factor analysis; 2) to assess the concurrent validity of the ICD-11 model of PTSD; and 3) to determine if there are significant differences in diagnostic rates between the ICD-11 guidelines and the DSM-5 criteria.ResultsThe ICD-11 model of PTSD was found to provide excellent model fit in six of the seven trauma samples, and tests of factorial invariance showed that the model performs equally well for males and females. DSM-5 models provided poor fit of the data. Concurrent validity was established as the ICD-11 PTSD factors were all moderately to strongly correlated with scores of depression, anxiety, dissociation, and aggression. Levels of association were similar for ICD-11 and DSM-5 suggesting that explanatory power is not affected due to the limited number of items included in the ICD-11 model. Diagnostic rates were significantly lower according to ICD-11 guidelines compared to the DSM-5 criteria.ConclusionsThe proposed factor structure of the ICD-11 model of PTSD appears valid across multiple trauma types, possesses good concurrent validity, and is more stringent in terms of diagnosis compared to the DSM-5 criteria.

The Evolution of Post-Traumatic Stress Disorder following Moderate-to-Severe Traumatic Brain Injury.

Increasing evidence indicates that post-traumatic stress disorder (PTSD) may develop following traumatic brain injury (TBI), despite most patients having no conscious memory of their accident. This prospective study examined the frequency, timing of onset, symptom profile, and trajectory of PTSD and its psychiatric comorbidities during the first 4 years following moderate-to-severe TBI. Participants were 85 individuals (78.8% male) with moderate or severe TBI recruited following admission to acute rehabilitation between 2005 and 2010. Using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Disorders (SCID-I), participants were evaluated for pre- and post-injury PTSD soon after injury and reassessed at 6 months, 12 months, 2 years, 3 years, and 4 years post-injury. Over the first 4 years post-injury, 17.6% developed injury-related PTSD, none of whom had PTSD prior to injury. PTSD onset peaked between 6 and 12 months post-injury. The majority of PTSD cases (66.7%) had a delayed-onset, which for a third was preceded by subsyndromal symptoms in the first 6 months post-injury. PTSD frequency increased over the first year post-injury, remained stable during the second year, and gradually declined thereafter. The majority of subjects with PTSD experienced a chronic symptom course and all developed one or more than one comorbid psychiatric disorder, with mood, other anxiety, and substance-use disorders being the most common. Despite event-related amnesia, post-traumatic stress symptoms, including vivid re-experiencing phenomena, may develop following moderate-to-severe TBI. Onset is typically delayed and symptoms may persist for several years post-injury.

Longitudinal epigenetic variation of DNA methyltransferase genes is associated with vulnerability to post-traumatic stress disorder.

Epigenetic differences exist between trauma-exposed individuals with and without post-traumatic stress disorder (PTSD). It is unclear whether these epigenetic differences pre-exist, or arise following, trauma and PTSD onset. In pre- and post-trauma samples from a subset of Detroit Neighborhood Health Study participants, DNA methylation (DNAm) was measured at DNA methyltransferase 1 (DNMT1), DNMT3A, DNMT3B and DNMT3L. Pre-trauma DNAm differences and changes in DNAm from pre- to post-trauma were assessed between and within PTSD cases (n = 30) and age-, gender- and trauma exposure-matched controls (n = 30). Pre-trauma DNAm was tested for association with post-trauma symptom severity (PTSS) change. Potential functional consequences of DNAm differences were explored via bioinformatic search for putative transcription factor binding sites (TFBS). DNMT1 DNAm increased following trauma in PTSD cases (p = 0.001), but not controls (p = 0.067). DNMT3A and DNMT3B DNAm increased following trauma in both cases (DNMT3A: p = 0.009; DNMT3B: p < 0.001) and controls (DNMT3A: p = 0.002; DNMT3B: p < 0.001). In cases only, pre-trauma DNAm was lower at a DNMT3B CpG site that overlaps with a TFBS involved in epigenetic regulation (p = 0.001); lower pre-trauma DNMT3B DNAm at this site was predictive of worsening of PTSS post-trauma (p = 0.034). Some effects were attenuated following correction for multiple hypothesis testing. DNAm among trauma-exposed individuals shows both longitudinal changes and pre-existing epigenetic states that differentiate individuals who are resilient versus susceptible to PTSD. These distinctive DNAm differences within DNMT loci may contribute to genome-wide epigenetic profiles of PTSD.

Posttraumatic stress disorder and prolonged grief in refugees exposed to trauma and loss

BackgroundWhile a large proportion of conflict-affected populations have been dually exposed to trauma and loss, there is inadequate research identifying differential symptom profiles related to bereavement and trauma exposure in these groups. The objective of this study were to (1) determine whether there are distinct classes of posttraumatic stress disorder (PTSD) and prolonged grief disorder (PGD) symptoms in bereaved trauma survivors exposed to conflict and persecution, and (2) examine whether particular types of refugee experiences and stressors differentially predict symptom profiles.MethodsParticipants were 248 Mandaean adult refugees who were assessed at an average of 4.3 years since entering Australia following persecution in Iraq. PTSD, PGD, trauma exposure, adjustment difficulties since relocation, and English proficiency were measured. Latent class analysis was used to elucidate symptom profiles of PTSD and PGD in this sample.ResultsLatent class analysis revealed four classes of participants: a combined PTSD/PGD class (16%), a predominantly PTSD class (25%), a predominantly PGD class (16%), and a resilient class (43%). Whereas membership in the PTSD/PGD class was predicted by exposure to traumatic loss, those in the PGD class were more likely to have experienced adaptation difficulties since relocation, and individuals in the PTSD class were more likely to have experienced difficulties related to loss of culture and support.ConclusionsThis study provides evidence that specific symptom patterns emerge following exposure to mass trauma and loss. These profiles are associated with distinct types of traumatic experiences and post-migration living difficulties. These results have substantial public health implications for assessment and intervention following mass trauma.

Faking it: incentives and malingered PTSD

Purpose – The purpose of this paper is to address how context for malingering and the provision of incentives influence malingered symptom profiles of post-traumatic stress disorder (PTSD). Design/methodology/approach – A 2 (case context)×3 (incentive) factorial design was utilized. Participants (n=298) were given an incentive (positive, negative, or no incentive), randomly assigned to a criminal or civil context, and asked to provide a fake claim of child abuse with corresponding malingered symptoms of PTSD. Under these conditions, participants completed several questionnaires pertaining to symptoms of trauma and PTSD. Findings – Results indicated that negative incentives were primarily associated with lower symptom scores. Therefore, “having something to lose” may result in more constrained (and realistic) symptom reports relative to exaggeration evidenced with positive incentives. Originality/value – These results have implications for forensic settings where malingered claims of PTSD are common and incentives for such claims (e.g. having something to gain or lose) frequently exist. Previous studies have failed to address incentives (positive and negative) in relation to a crime (i.e. abuse) that can span both criminal and civil contexts.

Heterogeneity of posttraumatic stress symptoms in a highly traumatized low income, urban, African American sample

Trauma is associated with a range of outcomes; identification of homogeneous profiles of posttrauma symptoms may inform theory, diagnostic refinement, and intervention. The present investigation applies a novel analytic technique to the identification of homogeneous subgroups of post-traumatic symptomatology in a large sample of African American adults reporting high levels of trauma. Latent profiles of posttraumatic stress disorder (PTSD) symptom severity were tested using latent profile analysis. Pseudo-class draws were used to characterize class differences across types of trauma, diagnostic comorbidities, and clinically-relevant features. Participants consisted of 2915 highly traumatized African Americans living in low income, urban setting and recruited from medical clinics in Atlanta, GA. Findings supported the presence of six distinct subgroups of posttraumatic stress symptom profiles described as resilient, moderate with amnesia, moderate with diminished interest, moderate without diminished interest and amnesia severe without amnesia, and severe overall. Observed subgroups differed across numerous historical and concurrent factors including childhood trauma, current and lifetime diagnoses of PTSD and major depression, lifetime substance use diagnosis, dissociation, depressive symptoms, emotional dysregulation, negative and positive affect, and history of hospitalization and suicidality. Posttraumatic stress disorder as currently defined is comprised of homogeneous subgroups with important differences in posttraumatic stress symptom endorsement as well as concomitant differentiation of associated diagnoses and clinically-relevant associated features.

Memorie traumatiche precoci e disturbo post traumatico da stress. Uno studio sperimentale

[ Early traumatic memories and Post Traumatic Stress Disorder (PTSD). An experimental study] INTRODUCTION. This paper has analyzed the Post-Traumatic Stress Disorder (PTSD) in order to address clinical and psychopathogenetic aspects of the disorder. An extensive literature supports the presence of a strong link between childhood trauma and dissociative symptoms, indicating this link as the primary or predominant source of PTSD. In addiction, several studies have shown that – exposed to the same traumatic conditions – not all people develop a Post Traumatic Stress Disorder, a problem not addressed by clinical research. METHODS. The study aimed at verifying the existence of a correlation between childhood traumatic memories (sexual, psychological, and emotional abuse, exposure to family violence), and the further development of this anxiety disorder. Moreover, the research wanted to obtain a psychopathology profile of PTSD. Subjects were required to fill the Minnesota Multiphasic Personality Inventory (MMPI), including the PTSD-Keane scale, and some MMPI special scales. RESULTS. This research has verified a statistical relationship (logistic regression) between traumatic childhood events and the development of the Post Traumatic Stress Disorder. In addition, the results obtained from the sample of psychiatric patients indicate a strong disorganization of the personality of patients with PTSD symptomatology. DISCUSSION. The data show that childhood trauma organize a basic vulnerability which increases 10 times the risk to develop this pathology after a traumatic experience.

Trauma amid ‘culture of avoidance’: Symptom profile of PTSD in Bedouin members of the Israel Defense Forces

The appropriateness and cultural relevance of the construct of posttraumatic stress disorder (PTSD) has been questioned by previous studies of non-Western populations. The current study examined the symptom profile of PTSD in an ethnic minority group of Bedouin members of the Israel Defense Forces (N=317). Comparing individuals with PTSD to traumatized individuals without PTSD, we identified a pattern of symptoms that differed between the groups: while symptoms from the re-experiencing cluster were those most frequently reported by the PTSD group, avoidance symptoms were the most frequently reported by the traumatized group without PTSD. Our findings highlight the role of sociocultural considerations in the development of trauma-related problems and the special meaning of avoidant strategies for traumatized individuals from non-Western backgrounds.

The Posttraumatic Stress Disorder Checklist as a Screening Measure for Posttraumatic Stress Disorder in Rehabilitation After Burn Injuries

Gardner PJ, Knittel-Keren D, Gomez M. The posttraumatic stress disorder checklist as a screening measure for posttraumatic stress disorder in rehabilitation after burn injuries. ObjectivesTo determine the profile of posttraumatic stress disorder (PTSD) among outpatients with burn injuries referred to psychology in a rehabilitation hospital, and the utility of the Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C) as a screening measure for PTSD. DesignRetrospective psychological chart review. SettingOutpatient burn clinic of a rehabilitation hospital. ParticipantsOutpatients (N=132) with burns referred to psychology between December 1999 and January 2010. InterventionsPsychological evaluation and self-report questionnaires measuring PTSD and depression. Main Outcome MeasuresThe Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition to assess clinical diagnosis of disorders, PCL-C to measure PTSD, and the Beck Depression Inventory-II to measure depression. ResultsOf 132 outpatients, 127 (96%) had work-related injuries, 116 (88%) were men, and 16 (12%) were women. Mean age ± SD at injury was 39.0±11.1 years. Mean time from injury to assessment was 15.7±42.7 months. Burn etiology included: electrical (46.2%), scald (28.0%), flame (16.7%), chemical (5.3%), and contact (3.8%). Most patients (75%) were diagnosed with PTSD, either clinical (39.4%) or subclinical (35.6%). PTSD (clinical or subclinical) was frequently diagnosed in the following etiology groups: scald (85.7%), flame (77.3%), and electrical (74.6%). There were significant relationships between PTSD and depression (P<.001), and between subclinical PTSD and adjustment disorder (P<.03). PCL-C mean scores ± SD in the clinical and subclinical PTSD groups were 59.7±8.9 and 43.5±15.6, respectively. A PCL-C total score of 50 or higher had a sensitivity of 90% and specificity of 79% for PTSD diagnosis. ConclusionsThere was a high prevalence of PTSD (clinical or subclinical) among outpatients with burns referred to psychology. Prospective screening of psychological symptoms, clinical assessment, and intervention is warranted, especially for patients with work-related burn injuries. Our results suggest that PCL-C is a useful screening measure for PTSD in patients with burns.

Investigating the MMPI–2 Trauma Profile in Treatment-Seeking Peacekeepers

Most available research on MMPI–2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) scores in combat veterans suffering from posttraumatic stress disorder (PTSD) has focused on Vietnam veterans. No data are available from peacekeepers suffering from PTSD. The aim of this study was to investigate the relationship between PTSD and the MMPI–2 in a sample of 120 treatment seeking peacekeeping veterans. Results show that relative to a non-PTSD reference group, veterans who screened positive for PTSD scored higher on Scales F, 2 (D), 4 (Pd), 6 (Pa), 7 (Pt), 8 (Sc), and 0 (Si) of the MMPI–2. Scales 2 (D), 7 (Pt), and 8 (Sc) were highest in the mean PTSD profile but no 2- or 3-point code type could be defined. Moderate correlations were found between a self-report measure for PTSD symptoms and scores on MMPI–2 clinical scales 1 (Hs), 2 (D), 6 (Pa), 7 (Pt), and 8 (Sc). The MMPI–2 proved to be useful in assessing the broad range of symptoms typically present in trauma populations as well as the severity of posttraumatic morbidity.

'Traumatisers or traumatised': Trauma experiences and personality characteristics of Australian prisoners.

Post-traumatic stress disorder (PTSD) is over represented in the prisoner population and is predictive of violence and suicide. This raises issues in relation to prisoner management, as well as theoretical issues such as why there is a range of vulnerability for PTSD. The current study examines the relationship between PTSD and personality profiles of prisoners. Data from 1305 participants in the NSW survey of health in prisoners are examined to identify relationships between personality profiles derived from the Temperament and Character Inventory (TCI) and PTSD. Participants are grouped as experiencing no trauma; with a trauma history but no PTSD; and being diagnosed with PTSD. A logistic regression modelled significant predictors of PTSD. These data indicated that women prisoners report PTSD at twice the rate of males. An increased risk for PTSD is associated with high Harm Avoidance, low Self-Directedness, high Persistence and high Self-Transcendence. A combination of both temperament and character traits influences the trajectory towards PTSD development. Targeted treatment of these traits is needed in addressing the problems of prisoners with PTSD and managing the associated risks of violence and suicide.

MMPI-2 Profiles in Civilian PTSD

The authors studied MMPI-2 profiles of workers (N = 83) diagnosed with posttraumatic stress disorder (PTSD) and a control group comprising workers with chronic pain (N = 40). Significant differences were seen in profiles between the PTSD groups and the control group, and the authors compared the PTSD profiles according to exposure to two different kinds of traumatic incidents: industrial accidents or criminal events. They found differences in profile elevations based on the type of event: The level of distress and fear is greater in PTSD victims of crime, and the results also suggest that victims of crime are more suspicious and guarded compared with accident victims. Theoretically based reasons for the differences in profile elevations between the two PTSD groups are discussed.

Posttraumatic stress disorder (PTSD), actual pathology, and the question of representability: A reply to "Attachment deficits, personality structure, and PTSD" (J. Mills).

Reading a reaction to one’s publication is usually a good thing for one’s narcissism. In the best of cases, it is a good thing for one’s thinking as well, as it obliges us to reconsider critically a number of our ideas. This is the case with the paper published by J. Mills, as a reaction to our “Actual Neurosis and PTSD” (Verhaeghe & Vanheule, 2005). In the first part of our answer, we will clarify certain of our ideas in the light of Mills’s critical remarks. In the second part, we want to address what we consider to be the main problem in matters of posttraumatic stress disorder (PTSD), that is, the question of representability. The title of Mills’s paper gives a good summary of his central objection to our reasoning. In his clinical experience, the predisposition to future PTSD profiles is predicated “on earlier deficits in personality structure due to developmental traumas.” In his latest book (Mills, 2005) he has generalized the idea of “structural deficits in personality organization due to attachment pathology constituted as a disorder of the self and maintained on unconscious representational levels.” At first sight, this seems to be a major difference with our reasoning, where the actual-neurotic structure, based on a failure of the Other during the early child–parent interactions, is put forward as the predisposition to future PTSD. Nevertheless, there are more similarities than divergences. Indeed, in our reasoning, the failed interactions between child and Other determine what we have called here the original trauma (Verhaeghe & Vanheule, 2005, p. 502) and elsewhere even the “structural trauma” (Verhaeghe, 2004, p. 317). When writing our paper and even right now, we are very much aware of the semantic difficulties. Stating that a disorder caused by a trauma is based upon a preceding trauma sounds too circular. That is why we considered it more important to elaborate the—indeed—structural context of this original trauma, based upon a reinterpretation and enlargement of Freud’s actual neurosis. The idea of “structure” is hereby quite important. There are at least two actors involved—the infant and the Other—around one central issue: the drive arousal, experi