Predicting PTSD in Women with a History of Childhood Rape

The impact of factors that predispose childhood rape victims to develop posttraumatic stress disorder (PTSD) is important in understanding both the impact of childhood rape and the development of PTSD as a psychological disorder. The present study attempted to determine which crime, perpetrator, victim, and aftermath characteristics are related to PTSD status. A national representative sample of women (N = 3,220) were interviewed about their history of rape, trauma-related variables, and PTSD status. Consistent with research on crime victims, life threat and physical injury discriminated PTSD status in a sample of childhood rape victims. In addition, two other domains were related to PTSD development: (1) testification about rape and (2) rape types. The present findings are discussed in relation to previous research.     

Acute Intrusive and Avoidant PTSD Symptoms as Predictors of Chronic PTSD Following Burn Injury

Several studies have endeavored to learn if acute PTSD symptoms are predictive of chronic PTSD, with equivocal results. In the present study, acute intrusive and avoidant PTSD symptoms were analyzed as possible predictors of chronic PTSD following burn injury. Results showed that baseline IES scores, within one week of injury, were significantly different for those who were later diagnosed with chronic PTSD. Additional analyses, undertaken to assess the relative importance of each symptom group in predicting chronic PTSD, indicated that both the presence, per se, and severity of acute avoidant symptoms predicted chronic PTSD.     

MMPI Scales for Diagnosing Acute and Chronic PTSD in Civilians

To develop new Minnesota Multiphasic Personality Inventory (MMPI) scales for diagnosing acute and chronic posttraumatic stress disorder (PTSD), 237 civilians with PTSD or panic disorder (controls) completed the MMPI-R. All 399 items were submitted to chi-square analysis to select those differentiating acute or chronic PTSD from controls. The analyses yielded an MMPI Acute PTSD scale (32 items) and a MMPI Chronic PTSD scale (41 items). Discriminating between acute PTSD and controls, the MMPI Acute PTSD scale had a hit rate of 83% and the MMPI Chronic PTSD scale produced a hit rate of 75% to 80%. Cross-validation produced similar hit rates. These scales scores were not substantially influenced by gender or types of traumatic events, and only the MMPI Acute PTSD scale seemed to not be sensitive to co-morbidity.     

Preliminary Evaluation of Sexual Problems in Combat Veterans with PTSD

This study evaluated the potential relationship between posttraumatic stress disorder (PTSD) and sexual problems. The Golombok Rust Inventory of Sexual Satisfaction was mailed to combat veterans currently in treatment at an outpatient PTSD clinic. Completed questionnaires were received from 90 patients. Results indicated that over 80% of subjects were experiencing clinically relevant sexual difficulties. Impotence and premature ejaculation were the most frequently reported problems that have corresponding psychological diagnoses. The rates of sexual problems for this sample of veterans with PTSD was similar to those reported in other studies and exceeded rates of similar problems found in samples from community samples. These data suggest mat PTSD may be a risk factor for sexual problems.     

Screening for PTSD in a Substance Abuse Sample: Psychometric Properties of a Modified Version of the PTSD Symptom Scale Self-Report

The high rate of posttraumatic stress disorder (PTSD) among substance use disorder (SUD) patients has been documented in research protocols, but there is evidence that it is markedly under-diagnosed in clinical settings. To address the need for a brief self-report measure to identify SUD patients who may benefit from further assessment and/or treatment for PTSD, the psychometric properties of a modified version of the PTSD Symptom Scale Self-Report (PSSSR) were examined in a treatment-seeking SUD sample (N = 118). The modified version of the PSS-SR, which measures both frequency and severity of PTSD symptoms, demonstrated good internal consistency reliability and was correlated with other self-report measures of trauma-related symptomatology. Comparisons between a structured PTSD diagnostic interview and the modified PSS-SR indicated that 89% of the PTSD positive patients were correctly classified by the modified PSS-SR. The clinical relevance of these findings was discussed.     

PTSD and Comorbid Psychotic Disorder: Comparison with Veterans Diagnosed with PTSD or Psychotic Disorder

Symptoms of posttraumatic stress disorder (PTSD), psychosis, general psychopathology, role functioning, violence potential, and cognitive and emotional aspects of psychotic states were compared in three groups of veterans. Groups were defined on the basis of their DSM-IV diagnoses: Psychotic disorder and war-related PTSD, war-related PTSD without psychotic symptoms, and psychotic disorder without PTSD. Veterans with PTSD and a comorbid psychotic disorder showed significantly higher levels of positive symptoms of psychosis, general psychopathology, paranoia, and violent thoughts, feelings, and behaviors than the other two groups. These data show that patients with comorbid PTSD and psychotic disorder show levels of cognitive, emotional, and behavioral disturbance that far exceed the levels of disturbance seen in patients with PTSD without psychosis or in patients with psychotic disorder.     

PTSD Severity and Health Perceptions in Female Victims of Sexual Assault

In women with chronic posttraumatic stress disorder (PTSD), poor physical health may be related to their PTSD symptoms through an underlying negative affect or distress that accompanies the disorder, through the PTSD symptoms in general, or specifically through the chronic hyperarousal present in the disorder. The current study examined the relative contribution of these factors to reported physical symptoms in female victims of sexual assault. Seventy-six women with chronic PTSD were assessed, using measures of stressful life events, psychological difficulties, and perceived health. Negative life events, anger, depression, and PTSD severity were all related to self-reported physical symptoms; however, PTSD severity predicted self-reported physical symptoms beyond these other variables. Contrary to our hypothesis, the reexperiencing cluster of PTSD, and not the hyperarousal cluster, was related to self-reported physical symptoms.     

The Course and Correlates of Combat‐Related PTSD in Australian Vietnam Veterans in the Three Decades After the War

Australian male Vietnam veterans (N = 388) were assessed 22 and 36 years after their return to Australia using standardized diagnostic interviews, with added data from Army records and self‐report questionnaires. Among veterans who ever had posttraumatic stress disorder (PTSD), 50.3% had a current diagnosis at the second assessment; of those who had a current diagnosis at Wave 1, 46.9% were also current at Wave 2. Late onset occurred for 19.0% of veterans, of whom 60.8% were current at Wave 2. Multivariate analysis compared veterans with no history of PTSD (n = 231) with veterans who had ever had PTSD (n = 157) to assess risk factors for PTSD incidence; and veterans with a history, but not current PTSD (n = 78) with veterans who had current PTSD at the second assessment (n = 79) to assess risk factors for failure to remit. Incidence was associated with lower education, shorter Army training predeployment, higher combat, excess drinking, and help‐seeking after return to Australia. Prevalence was associated with having a father who saw combat in World War II, being injured in battle, having a lower intelligence test score, experiencing higher combat, and having a diagnosis of phobia at the first assessment. Only combat was common to incidence and prevalence.     

Thematic Resolution, PTSD, and Complex PTSD: The Relationship Between Meaning and Trauma-Related Diagnoses

The role of modifying schemas in trauma-focused psychotherapy has received theoretical and clinical attention. However, the relationship of schematic processing to posttraumatic stress disorder (PTSD) diagnosis has not been examined empirically. The current study compared measures of thematic disruption among individuals with PTSD alone, PTSD with concurrent complex PTSD, and no PTSD. Eighty two participants were interviewed to assess PTSD status, complex PTSD status, traumatic life events, and trauma-related thematic processing. Results indicated that variables quantifying thematic disruption and thematic resolution significantly distinguished those individuals with concurrent PTSD plus complex PTSD from the other two groups. Exploratory analyses indicated that PTSD symptom severity and the interpersonal nature of the trauma were related to thematic disruption.     

Posttraumatic stress disorder and traumatic brain injury: Are they mutually exclusive?

It has been suggested that posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) must be mutually incompatible disorders. However, growing empirical evidence has begun to question this. Evidence suggests that although PTSD may be relatively rare among the TBI population, some TBI patients seem to develop PTSD. We suggest two theoretical routes through which PTSD might develop in TBI patients: through nonconscious processes in individuals who are subsequently amnesic, but who were conscious at the time of the traumatic episode and through subsequent appraisal processes in individuals who were unconscious during the traumatic episode.     

Effects of Varying Scoring Rules of the Clinician Administered PTSD Scale (CAPS) for the Diagnosis of PTSD After Acute Burn Injury

The Clinician Administered Posttraumatic Stress Disorder Scale (CAPS) enables quantification of the seventy of each of the 17 posttraumatic stress disorder (PTSD) symptoms. Blanchard and colleagues (1995) have documented variation in rates of PTSD among survivors of motor vehicle accidents depending on the CAPS scoring rule used. This report examines the effects of varying the scoring rules of the CAPS on rates of acute PTSD symptoms in hospitalized burn patients. Changing from the most liberal to the most conservative scoring rule resulted in a change in diagnosis of acute PTSD from 25% to 32% of the sample. The variation documented in this study and others has implications for a range of issues, including rates of PTSD in epidemiological studies, treatment outcome research, and forensic evaluations.     

An Examination of Antecedent Traumas and Psychiatric Comorbidity Among Male Inmates with PTSD

Despite substantially higher rates of posttraumatic stress disorder (PTSD) among male inmates than among men in the general population, there is a dearth of research on PTSD among incarcerated men. The current study addresses traumatic events that precede PTSD and psychiatric disorders that are comorbid with PTSD in an inmate sample. Seeing someone seriously injured or killed, being sexually abused, and being physically assaulted were the three most commonly reported antecedent traumas to PTSD. Lifetime and current rates of mood disorders, anxiety disorders, and antisocial personality disorder were elevated among inmates with a diagnosis of PTSD. Two hundred and thirteen inmates participated in the study. Sixty-nine participants (33%) met lifetime DSM–III–R criteria for PTSD, and 45 (21%) met current criteria. The findings are compared with general population samples, and implications of the findings are discussed.     

Consistency of retrospective reports of peritraumatic responses and their relation to PTSD diagnostic status

Few studies have examined whether trauma‐exposed individuals are consistent in their retrospective reports of how they reacted at the time of trauma exposure, and whether this phenomenon has any implications at the diagnostic level. In a series of three longitudinal studies (N = 113) with different timeframes, the authors prospectively investigated the consistency of peritraumatic response scores as a function of posttraumatic stress disorder (PTSD) diagnostic status. Across the three studies, consistency of scores was better among individuals who either did not develop PTSD or who remitted from it than among those whose PTSD did not remit. These results are consistent with the literature suggesting that compromised memory processes are related to sustained PTSD.     

PTSD and ADHD: underlying factors in many cases of burnout

Objective: To analyse the extent to which traumatic life events, post‐traumatic stress disorder (PTSD) and the neuropsychiatric disorder attention deficit hyperactivity disorder (ADHD) can be contributors associated with burnout and the long‐term sick leave that results from it. Subjects: Sixty‐two individuals on long‐term sick leave due to stress‐related poor health and burnout, and 83 working individuals were screened for the presence of traumatic life events, PTSD and ADHD. Potential background factors involved in burnout were analysed using a multiple logistic regression. Results: Fifty‐two per cent of those on long‐term sick leave were judged to have PTSD and 24 per cent to have ADHD. The number of suspected/possible cases was even higher—71 per cent and 56 per cent, respectively. Nineteen per cent were judged to have both PTSD and ADHD; 56 per cent were judged to have PTSD and/or ADHD. PTSD, ADHD and traumatic life events in the form of sexual assault and severe human suffering were all strongly associated with both burnout and long‐term sick leave. Conclusions: Since ADHD is almost never discussed and PTSD rarely so in the occupational rehabilitation of individuals with burnout, these results should act as a warning signal. Further studies are needed, however, including clinical examinations in order to establish with certainty if PTSD and ADHD can predict burnout followed by long‐term sick leave. Copyright © 2006 John Wiley & Sons, Ltd.     

PTSD Among Bereaved Parents Following the Violent Deaths of Their 12- to 28-Year-Old Children: A Longitudinal Prospective Analysis

This study examined the prevalence ofposttraumatic stress disorder (PTSD) among parents bereaved by the violent deaths of their 12- to 28-year-old children. A community-based sample of 171 bereaved mothers and 90 fathers was recruited by a review of Medical Examiner records and followed for 2 years. Four important findings emerged: Both parents' gender and children's causes of death significantly affected the prevalence of PTSD symptoms. Twice as many mothers and fathers whose children were murdered met PTSD caseness (full diagnostic) criteria compared with accident and suicide bereavement. Symptoms in the reexperiencing domain were the most commonly reported. PTSD symptoms persisted over time, with 21% of the mothers and 14% of the fathers who provided longitudinal data still meeting caseness criteria 2 years after the deaths. Parents who met caseness criteria for PTSD, compared with those who did not, were significantly different on multiple study variables. Both theoretical and clinical implications for the findings are discussed.     

Factors Associated with PTSD Symptoms Following Treatment for Breast Cancer: Test of the Andersen Model

The utility of Andersen's (1993, 1994) model of psychologic morbidity following cancer treatment for predicting PTSD symptoms in breast cancer survivors (N = 82) was examined. PTSD symptoms, physical comorbidity, social support, depression history, and pre-cancer traumatic stressors were assessed in a structured telephone interview. Multiple regression analysis indicated that Andersen model variables (physical comorbidity, education, disease stage, cancer treatment, depression history, social support) accounted for 39% of variance in PTSD symptom reports ( p < .001). Addition to the model of time since treatment completion, pre-cancer traumatic stressors, age at diagnosis, and tamoxifen usage accounted for an additional 16% of variance (p < .001). Higher levels of PTSD symptoms were associated with less social support, greater pre-cancer trauma history, less time since treatment completion, and more advanced disease.     

Effects of Psychotherapeutic Treatments for PTSD: A Meta-Analysis of Controlled Clinical Trials

This meta-analysis synthesized the results from controlled, clinical trials of psychotherapeutic treatments for posttraumatic stress disorder (PTSD). Psychotherapeutic modalities included behavioral, cognitive, and psychodynamic treatments, in group and individual settings. Participants in the studies included combat veterans from the Vietnam and Lebanon Wars, crime-related victims, and severe bereavement sufferers. The impact of psychotherapy on PTSD and psychiatric symptomatology was significant, d = .52, r = .25, when measured immediately after treatments were administered. Similarly, there was no decay in the effect of treatment at follow-up, d = .64, r = .31. Moreover, for target symptoms of PTSD and general psychological symptoms (intrusion, avoidance, hyperarousal, anxiety, and depression), effect sizes were significant, ranging from r's of .2–.49. Results suggest substantial promise for improving psychological health and decreasing related symptoms for those suffering from PTSD.     

Visuoconstructional ability in PTSD patients compared to a control group with the same ethnic background

Background. Studies on problem of visuoconstructional ability in post‐traumatic stress disorder (PTSD) are scarce. Aim. (1) Visuoconstructional ability in subjects with chronic PTSD, compared to an ethnically matched control group; (2) to investigate which factors independent of other factors would predict Block Design Test (BDT) scores in the PTSD group. Methods. Thirty male subjects with chronic PTSD, and 20 male without PTSD were included in the study. The non‐verbal memory and intelligence tests used were the BDT, and the Benton Visual Retention Test (BVRT). Main results. The PTSD group showed significantly lower scores in BDT compared to controls. Duration of PTSD, and sum of errors in the BVRT, predicted the BDT score. Severity of PTSD, age, and number of years of education were incorporated in the model but they were not significant predictor of the BDT scores in the PTSD group. Conclusion. These results strengthen the previous conclusions that the PTSD patients' weakness on BDT associated with duration of the disease derives from exacerbation of part‐by‐part cognitive and emotional processing and from more generally defected limbic system coherence. Copyright © 2006 John Wiley & Sons, Ltd.     

Female Partners' Estimations of Male Veterans' Combat-Related PTSD Severity

This study investigated concordance between male Vietnam veterans' and their female partners' reports of veterans' posttraumatic stress disorder (PTSD) symptoms. Fifty male Vietnam combat veterans and their partners rated the severity of their own PTSD symptoms. Also, partners rated the severity of veterans' symptoms. Results indicated modest levels of agreement in reports of symptom presence/absence. Partner ratings of veterans' PTSD severity were positively correlated with veteran reports and partners' own self-reported PTSD symptoms. After controlling for veterans' self-reported symptoms, partners' symptoms significantly predicted their estimates of veterans' avoidance symptoms, but not veterans' reexperiencing or hyperarousal symptoms. Theoretical and practical implications of these findings are discussed.     

MMPI, MMPI-2 and PTSD: Overview of Scores, Scales, and Profiles

A number of issues should be considered when applying profile interpretations and subscales derived from the original MMPI. These issues and the overall utility of the MMPI-2 for posttraumatic stress disorder (PTSD) evaluations are summarized. The Keane PTSD scale is found to be an effective tool for differential diagnosis when a cut-off score of 28 is used. The Schlenger PTSD scale warrants additional study. Various MMPI-2 validity scales are useful in detecting malingering, but concurrence regarding cut-off scores is lacking. The 2-8/8-2 MMPI PTSD profile does not emerge as consistently on the MMPI-2 as it did on the MMPI, due to the frequent elevation of scale 7 on the MMPI-2.