Vietnam Combat Veterans Research Articles

Compensation seeking, comorbidity, and apparent exaggeration of PTSD symptoms among Vietnam combat veterans.

We evaluated whether veterans who apparently exaggerate their symptoms are more likely to be (a) seeking disability compensation or (b) suffering from more comorbid pathology than nonexaggerating veterans. Fifty-four of 145 (37%) veterans with posttraumatic stress disorder who completed the Minnesota Multiphasic Personality Inventory-2 (J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 1989) were identified as apparent exaggerators, with F (Frequency) - K (Correction ) >13. These participants scored higher than nonexaggerators on self-report measures of various psychological symptoms but were no more likely to be seeking compensation or to have comorbid substance use or other anxiety disorders. Affective disorder was overrepresented among apparent exaggerators, however. Findings support the hypothesis of increased comorbidity among symptom exaggerators as measured by the F - K index but not the commonly held belief that symptom exaggerators are more likely to seek compensation.

Life-Course Timing and Sequencing of Marriage and Military Service and Their Effects on Marital Stability

We examine the life-course sequencing hypothesis that marriage before military service has a greater disruptive effect on marital stability than marriage during or after military service. Using event-history data from a I3-year panel study of 2,857 White males from Washington State high schools in 1966, we found that Vietnam combat veterans (n = 610) and Vietnam-era veterans (n = 581) married at the same rate as nonveterans (n = 1,666). Marriages initiated before or during military service in Vietnam did not have a significant negative impact on long-term marital stability. Marrying for the first time after military service, however, increased marital stability. Major historic events create diversity in the life course by altering role choices available to birth cohorts and by influencing role transitions that young people make (Gade, 1991). Compulsory military service during times of war is one of the most pervasive historic events that has altered young people's life-course pathways and outcomes over the last century (Elder, 1986). Because of World War II, many young men married before their military service (Pavalko & Elder, 1990). At the end of World War II, divorce rates rose to a record high. Soldiers who married before their military service had higher divorce rates than those who married after military service (Modell, 1989; Pavalko & Elder, 1990). Research on the effects of Vietnam military service on marriage yields conflicting findings. Some studies based on limited post-war samples of Vietnam veterans suggest that war-related separations and intense combat experiences increased marital instability (Frey-Wouters & Laufer, 1986; Gimbel & Booth, 1994; Laufer & Gallops, 1985; Stellman, Stellman, & Sommer, 1988). Other research that used longitudinal data on large samples of high school students from the Vietnam era found no difference in long-term divorce rates between veterans and nonveterans (Call Teachman, 1991; Card, 1983). Pavalko and Elder (1990) suggested that the limited effect of the Vietnam War on divorce rates was due to soldiers entering the military at a younger age than soldiers during World War II. They argued that the majority of marriages occurred after Vietnam military service, thereby eliminating the strain of war separation on the marriage and reducing the likelihood of divorce. This explanation makes assumptions about marriage patterns during the Vietnam era that have received little attention in the literature. In this article, we compare the marriage patterns of Vietnam combat veterans to Vietnam-era veterans and nonveterans, and we test the hypothesis that the sequencing of marriage before military service increased the probability of divorce for Vietnam veterans. BACKGROUND The transition to adulthood presents adolescents with a complex set of interrelated choices about roles in education, employment, and family that are more or less structured by age-related norms and institutional requirements (Featherman, Hogan, & Sorensen, 1984; Hogan & Astone, 1986). The modal life-course pattern is for young people to complete their education, enter the labor force, and marry (Call & Teachman, 1991; Hogan, 1978; Marini, 1984). Divergence from modal patterns of role-taking negatively affects subsequent life-course outcomes through a reduction in fit between personal behavior and the structure of schools and employment that are organized to process birth cohorts (Hogan, 1980; Rindfuss, Swicegood, & Rosenfeld, 1987; Spenner, Otto, & Call, 1982). During World War II, younger men who hoped to avoid the draft through a family deferment rushed to marry (Modell, 1989). Modell also found that soldiers married in surprisingly large numbers during military service. Soldiers who delayed marriage until their military duty was completed married shortly after they left the military. At all ages, World War II veterans were more likely to marry than their nonveteran peers (Modell & Steffey, 1988). …

Compensation seeking, comorbidity, and apparent exaggeration of PTSD symptoms among Vietnam combat veterans.

Compensation seeking, comorbidity, and apparent exaggeration of PTSD symptoms among Vietnam combat veterans.

Smoking withdrawal symptoms in response to a trauma-related stressor among vietnam combat veterans with posttraumatic stress disorder

This study investigated the relationship between a trauma-related stressor and smoking withdrawal symptoms in 25 male Vietnam combat veterans with posttraumatic stress disorder (PTSD) using a within-subjects design. All subjects were smokers. The stressor involved a modified Stroop task, in which the veterans color-named either anxietyrelated or neutral control words. Anxiety-related words produced more withdrawal symptoms than neutral control words, including increased craving, negative affect symptoms, somatic symptoms, and lack of alertness.

Subjective versus objective sleep in Vietnam combat veterans hospitalized for PTSD

AbstractTwenty‐five Vietnam combat veterans with chronic severe posttraumatic stress disorder (PTSD) completed a sleep self‐report questionnaire on admission to an inpatient treatment program. Between 1 and 2 months later each spent 3 or more nights in the sleep laboratory. When self‐report and laboratory findings were compared, significant relationships were observed between sleep schedule items such as time‐to‐bed/time‐out‐of‐bed and polysomnographic measures of sleep. In contrast, global ratings of sleep quality were generally unrelated to polysomnographic measures. These findings may have implications for survey research assessing sleep quality in traumatized populations.

The Keane PTSD scale extracted from the MMPI: Sensitivity and specificity with Vietnam veterans

AbstractA study was conducted to further investigate whether the Keane Posttraumatic Stress Disorder (PTSD) Scale of the Minnesota Multiphasic Personality Inventory (MMPI) can be employed as a separate instrument administered outside the context of the full MMPI. A group of Vietnam combat veterans with diagnosed PTSD and two comparison groups of veterans without PTSD (Vietnam combat and era veterans) were diagnosed by clinical interviews. Over 84% of the 64 veterans in the study were accurately classified by the Keane PTSD Scale into their original diagnostic groups. Excellent test sensitivity was demonstrated, with 90% of combat veterans with PTSD being properly classified by the Keane PTSD Scale when the recommended cutoff score of 30 was utilized. The clinical and research implications are discussed.

Social phobia and PTSD in Vietnam veterans

AbstractPosttraumatic stress disorder (PTSD) is the most prevalent psychological disorder experienced by Vietnam veterans. However, there are many other disorders and problems of adjustment, like social anxiety and social phobia, that have not been fully investigated in this population. This study examined the prevalence of social phobia and the comorbidity of social phobia and PTSD, and tested out a theory of the etiology of social anxiety in trauma victims. Forty one Vietnam combat veterans were interviewed and completed self‐report measures assessing PTSD and social phobia. Adversity of homecoming was also assessed. Using a conservative multi‐method assessment approach, 32% of the sample were found to be positive for both social phobia and PTSD. Veterans with PTSD were significantly more likely to cany an additional diagnosis of social phobia as compared to veterans without PTSD. Adversity of homecoming and shame about one's experience in Vietnam were significant predictors of current level of social anxiety over and above the effects of pre‐military anxiety and severity of combat exposure. These observations suggest that social anxiety and social phobia may be significant problems among individuals with PTSD. Further, these findings offer preliminary support for the theory that posttrauma environment may impact upon the later development of social anxiety.

Subjective versus objective sleep in Vietnam combat veterans hospitalized for PTSD.

Twenty-five Vietnam combat veterans with chronic severe posttraumatic stress disorder (PTSD) completed a sleep self-report questionnaire on admission to an inpatient treatment program. Between 1 and 2 months later each spent 3 or more nights in the sleep laboratory. When self-report and laboratory findings were compared, significant relationships were observed between sleep schedule items such as time-to-bed/time-out-of-bed and polysomnographic measures of sleep. In contrast, global ratings of sleep quality were generally unrelated to polysomnographic measures. These findings may have implications for survey research assessing sleep quality in traumatized populations.

Interpersonal and self‐reported hostility among combat veterans with and without posttraumatic stress disorder

AbstractThe present study investigated self‐reported and interpersonal hostility in 70 Vietnam combat veterans with and without posttraumatic stress disorder (PTSD) and 60 comparison community volunteer subjects. Veterans were 50 help‐seeking, male Vietnam combat veterans with PTSD and 20 non‐help‐seeking male combat veterans without PTSD. Vietnam veterans with PTSD not only reported more hostility than non‐PTSD veterans and healthy community volunteers, but also reacted behaviorally with more hostility during an interpersonal interaction. Compared to veterans without PTSD, veterans with PTSD reported significantly higher levels of hostility and demonstrated significantly greater non‐verbal expressions of hostility during an interpersonal task. These results suggest that the level of hostility in PTSD combat veterans may be high as compared to comparison groups. The implications of these results and possible research directions are presented.

Modes of long‐term coping with trauma memories: Relative use and associations with personality among Vietnam veterans with chronic PTSD

AbstractLittle is known about how individuals who develop chronic posttraumatic stress disorder (PTSD) cope with recurring trauma memories, or how enduring personality characteristics influence such coping. Focusing on 110 hospitalized Vietnam combat veterans with chronic PTSD, this exploratory study assessed the relative frequency of using eight ways of coping with war memories, and associations between relative use of these strategies and eight dysfunctional personality styles. As a secondary issue, associations between coping strategies, combat exposure, and PTSD severity were also examined. Consistent with prior findings, these veterans predominantly used emotion‐focused and avoidant strategies to cope with war memories. Differing personality styles and relative use or nonuse of particular coping strategies were also associated in psychologically coherent ways. These preliminary findings are discussed in relation to methodologic and future research issues.

Childhood factors and war zone stress in chronic PTSD

AbstractThis study assessed the predictive validity of combat factors and selected premilitary variables (i.e., childhood physical abuse, substance abuse in the family of origin, or being raised in a nonadaptive or noncohesive family) on posttraumatic stress disorder (PTSD) group membership. In addition, it assessed the correlation of combat exposure and selected premilitary variables with the severity of PTSD symptomology. Ninety‐three male Vietnam combat veterans with PTSD were compared to 82 male Vietnam combat veterans without the disorder. The results of two hierarchical logit analyses identified combat exposure as the best predictor of PTSD‐group membership. However, physical punishment was also found to significantly predict group membership when entered first in the analyses. Furthermore, multiple regression analyses conducted with the PTSD group alone found that both combat exposure and physical abuse predicted greater PTSD symptomology. These findings suggest that childhood physical abuse as well as military trauma should be addressed in the assessment and treatment of chronic PTSD patients.

Plasma norepinephrine kinetics in patients with posttraumatic stress disorder

To determine whether basal sympathetic nervous system (SNS) function is increased in patients with posttraumatic stress disorder (PTSD), we used a radioisotope dilution technique to assess basal arterialized plasma norepinephrine (NE) kinetics in 12 men who were Viet Nam combat veterans with PTSD and six normal controls. In addition to determining the rates of appearance of NE into, and clearance of NE from, plasma, we measured basal arterialized plasma levels of epinephrine (EPI), and also vital signs, in both groups. Patients with PTSD actually manifested lower arterialized plasma levels of NE, and had lower rates of appearance of NE into plasma, than did controls. The rate of NE clearance from plasma was unaltered in PTSD patients. Patients with PTSD also showed a trend toward lower arterialized EPI levels than controls, but manifested a trend toward higher diastolic blood pressure. Our data indicate that basal SNS activity is not increased in patients with PTSD and that previous reports of increased resting SNS activity in this population may instead reflect SNS reactivity.

Memory and anxiety disorders

Experimental psychopathologists have identified varying patterns in memory bias in people with depressive and anxiety disorders. Individuals suffering from depression tend to exhibit explicit memory deficits for positively-valanced material, and sometimes exhibit biases for retrieving negative self-relevant information as well. Most studies, however, provide scant evidence for implicit memory biases in depression. In contrast to depression, anxiety disorders are rarely associated with enhanced explicit memory for threat-related information (with the exception of panic disorder). Evidence for implicit memory biases for threat in these syndromes is mixed. After providing an overview of findings on memory abnormalities in depressive and anxiety disorders, data from several new studies bearing on posttraumatic stress disorder (PTSD) in Vietnam combat veterans and in women with histories of childhood sexual abuse are presented. Involving directed forgetting, implicit memory and autobiographical cueing paradigms, these experiments point to a pattern of abnormalities linked to PTSD rather than to trauma per se.

Selective processing of trauma-relevant words in posttraumatic stress disorder

This study investigated Stroop color-naming of trauma-related words in male Vietnam combat veterans with ( n = 42) and without ( n = 15) posttraumatic stress disorder (PTSD). The anxiety connotations of the words were either very specific to the Vietnam experience ( point, lead), general but still Vietnam-related ( medevac, bodybags), or general and not specifically related to Vietnam ( crash, grief). All three categories of words slowed color-naming compared to neutral control words. This was true for all subjects, but the effect was more pronounced in veterans with PTSD. The generally negative but still Vietnam-related words caused more interference in colornaming than did the other categories of words, which was attributed to their ability to access Vietnam combat memories more efficiently. There was a free recall and recognition memory advantage for the emotion words, suggesting that the Stroop interference effect was mediated by an attentional bias towards the anxiety-related material rather than avoidance of it. Veterans with PTSD were slower in color-naming overall, an effect that could not be attributed to group differences in psychiatric medication, depression, or anxiety.

Effects of the benzodiazepine antagonist flumazenil in PTSD

Evidence from preclinical and clinical studies suggests a role for alterations in the benzodiazepine/GABAA receptor complex in stress and anxiety. Flumazenil is a relatively pure benzodiazepine/GABAA antagonist with limited intrinsic activity. In panic disorder patients, but not healthy controls, flumazenil has been demonstrated to provoke panic attacks. Vietnam combat veterans with PTSD (n = 14) received 90-second intravenous infusions of flumazenil 2 mg or placebo in a double-blind, crossover study design. PTSD symptomology was assessed using the PTSD Symptom Scale, and anxiety symptoms were measured with visual analogue rating scales. There was no significant difference in PTSD and anxiety symptoms between administration of flumazenil and placebo. Flumazenil administration does not produce an increase in anxiety and PTSD symptoms in patients with PTSD. This suggests that PTSD and panic disorder are dissimilar in terms of benzodiazepine/GABAA system function.

The Assessment of Post-traumatic Stress Disorder with an Australian Vietnam Veteran Population: Preliminary Findings with Two New Instruments

Preliminary data are provided on two new instruments in the field of traumatic stress, namely the Penn Inventory and the post-traumatic stress disorder (PTSD) module of the Composite International Diagnostic Interview (CIDI). The Penn Inventory is a 26-item self-report scale developed for use with a range of trauma populations. The CIDI-PTSD is a draft module currently being trialed and eventually to be included in the full version of the CIDI interview. Participants comprised 30 Australian Vietnam combat veterans, who also completed the Impact of Event Scale and the Mississippi Scale for PTSD (M-PTSD). The Penn Inventory demonstrated good congruent validity and was comparable to the M-PTSD in diagnostic accuracy. Both scales tended to overdiagnose. The CIDI-PTSD performed disappointingly, showing relatively low sensitivity and specificity. Implications for the appropriate use of these instruments are discussed.

Cognitive processing of emotional information in posttraumatic stress disorder

Vietnam combat veterans either with or without posttraumatic stress disorder (PTSD) participated in a computerized Stroop color-naming experiment in which they named the colors of neutral, positive, negative, and combat words. Idiographic stimulus selection established the personal emotional significance of the stimuli. Words appeared either randomly or blocked by type. Results indicated that PTSD patients exhibited more interference for combat words than for other words, whereas control subjects exhibited similar, but less pronounced, patterns of interference. Positive words produced no more interference than neutral words, and much less than combat words. This paradigm may provide a nonintrospective index of intrusive cognition in traumatized people.

Smoking in Vietnam combat veterans with post‐traumatic stress disorder

AbstractThe present study investigated smoking prevalence, smoking motives, demographic variables and psychological symptoms in 124 help‐seeking, male Vietnam combat veterans with post‐traumatic stress disorder (PTSD). A high percentage of these veterans smoked (60%). Vietnam veterans with PTSD who smoked were more likely than those who did not smoke to report higher levels of PTSD symptoms, depression and trait anxiety. Increased depression was associated with increased automatic smoking. Smokers reported a high frequency of smoking in response to military memories. Implications for smoking interventions, cessation, and relapse prevention efforts are discussed.

Autobiographical memory disturbance in combat-related posttraumatic stress disorder

Vietnam combat veterans with (n = 19) and without (n = 13) posttraumatic stress disorder (PTSD) participated in an autobiographical memory experiment in which they attempted to retrieve specific personal memories exemplifying traits denoted by positive (e.g. loyal) and negative (e.g. guilty) cue words. Veterans with PTSD exhibited difficulties retrieving specific autobiographical memories, especially in response to positive trait cue words. These deficits were especially pronounced in PTSD Ss who wore Vietnam War regalia (e.g. medals, fatigues) to the laboratory. Regalia-wearing PTSD Ss disproportionately retrieved memories from the Vietnam War, unlike other Ss who retrieved relatively recent memories. Wearing regalia in daily life may be emblematic of psychological fixation to a war fought more than two decades ago. Difficulties remembering one's past may underlie difficulties envisioning one's future, as reflected in the PTSD symptom of ‘future foreshortening’, and difficulties using memory specifically may also hamper efforts to solve personal problems.

Smoking in vietnam combat veterans with post-traumatic stress disorder

The present study investigated smoking prevalence, smoking motives, demographic variables and psychological symptoms in 124 help-seeking, male Vietnam combat veterans with post-traumatic stress disorder (PTSD). A high percentage of these veterans smoked (60%). Vietnam veterans with PTSD who smoked were more likely than those who did not smoke to report higher levels of PTSD symptoms, depression and trait anxiety. Increased depression was associated with increased automatic smoking. Smokers reported a high frequency of smoking in response to military memories. Implications for smoking interventions, cessation, and relapse prevention efforts are discussed.