Complex posttraumatic sStress disorder: An exploratory investigation of PTSD and DES NOS among Dutch war veterans

The recently developed concept Disorder of Extreme Stress Not Otherwise Specified (DES NOS) or complex posttraumatic stress disorder (complex PTSD) is designed to encompass long-standing symptoms not present in PTSD. An exploratory investigation of PTSD and DES NOS was performed with the Structured Clinical Interview for PTSD and for DES NOS in a small sample of Dutch war veterans with combat experience. Both PTSD and DES NOS symptoms were frequently reported. About 67% of the veterans met criteria for PTSD and 38% met criteria for DES NOS. DES NOS appeared to be associated with PTSD. Several DES NOS subcategories proved more important than others for distinguishing simple PTSD from complex PTSD.     

Effects of Varying Diagnostic Criteria for Posttraumatic Stress Disorder Are Endorsing the Concept of Partial PTSD

The purpose of the present study was to investigate the appropriateness of different diagnostic criteria sets for posttraumatic stress disorder (PTSD). This was done by varying diagnostic criteria on the diagnosis of PTSD in a study group of N = 146 former political prisoners, and comparing the resulting diagnostic groups with a study group of N = 75 nontraumatized controls with regard to mean scores on measures of subjective distress (i.e., IES-R, BDI, BAI, SCL-90-R). The findings did not support the diagnostic boundaries as defined by the DSM-IV or the lowering of the avoidance criterion from three to two symptoms. The concept of partial PTSD appeared to be the most appropriate way to provide diagnostic coverage for those who did not meet full DSM IV criteria.     

Evaluation of Dream Content in Combat-Related PTSD

Nightmares that replicate traumatic events are among the criteria that define posttraumatic stress disorder (PTSD); however, there has been limited systematic assessment of the content of dreams in PTSD. A PTSD dream rating instrument was developed to ope rationalize features attributed to dreams associated with combat-related PTSD that incorporated dimensions from the dream content analysis literature, and its reliability was assessed. Then the instrument was used to characterize dream reports in 18 Vietnam combat veterans diagnosed with PTSD. Approximately half of the group's target dreams contained features characteristic of combat, and all but 3 (17%) were moderately to highly threatening. Fifty-three percent were set at least partially in the present and 79% contained distorted elements. We therefore conclude that target dreams of combat veterans with PTSD vary with regard to replication of trauma and elements normally associated with dreaming, but typically are threatening.     

A Relational Perspective on PTSD in Early Childhood

This paper describes the clinical and research evidence for the importance of the relational context of posttraumatic stress disorder in young children. We review 17 studies that simultaneously assessed parental and child functioning following trauma. In many studies, despite limitations, an association between undesirable parental/family variables and maladaptive child outcomes has been consistently found. We present a model of the parental/family variables as moderators and vicarious traumatic agents for symptoms in young children. Also, a Compound Model is proposed, with three distinctive patterns of the parent–child relationship that impact on posttraumatic symptomatology in young children. Implications for clinical practice and research directions are discussed.     

Emergency room vital signs and PTSD in a treatment seeking sample of motor vehicle accident survivors

Seeking to replicate earlier reports by Shalev et al. (1998) and R. A. Bryant, A. G. Harvey, R. M. Guthrie, and M. L. Moulds (2000) that elevated heart rate (HR) shortly after a trauma was predictive of later posttraumatic stress disorder (PTSD), we examined vital sign data on 74 treatment-seeking motor vehicle accident (MVA) survivors, taken in the Emergency Department (ED) following their MVAs. Contrary to expectations, we found that those with elevated HRs in the ED were significantly less likely to meet criteria for PTSD 13 months post-MVA and that those with elevated HRs had lower levels of posttraumatic stress symptoms. Likewise, those with current PTSD had lower ED values of HR and DBP than did those who did not currently meet criteria for PTSD.     

Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients

Background: Although rates vary across studies, research in recent years shows that prevalence of post-traumatic stress disorder (PTSD) following intensive care unit (ICU) can be high. Presently no screening tool assessing all three PTSD symptom categories has been validated in ICU patients. The aim of the study was to conduct a preliminary validation of such a measure, the UK- Post-Traumatic Stress Syndrome 14-Questions Inventory (UK-PTSS-14).
Methods: A case series cohort study performed at two ICUs in two UK district general hospitals. The UK-PTSS-14 was administered at three time-points (4–14 days, 2 months and 3 months post-ICU discharge). At time-point three participants also completed the Post-traumatic Stress Diagnostic Scale (PDS) and the Impact of Events Scale (IES).
Results: Forty-four patients completed the 3-month follow up. The UK-PTSS-14 was internally reliable at all three time-points (Cronbach's α=0.89, 0.86 and 0.84, respectively). Test–retest reliability was highest between time-points two and three (ICC=0.90). Concurrent validity at time-point three was high against the PDS ( r =0.86) and the IES ( r =0.71). Predictive validity was highest at time-point two ( r =0.85 with the PDS and r =0.71 with the IES). Receiver operator characteristic curve analysis suggested the highest levels of sensitivity (86%) and specificity (97%) for diagnosis of PTSD were at time-point two, with an optimum decision threshold of 45 points.
Conclusion: This preliminary validation study suggests that the UK-PTSS-14 could be reliably used as a screening instrument at 2 months post-discharge from the ICU to identify those patients in need of referral to specialist psychological services.     

German version of Clinician-Administered PTSD Scale

This study assessed the reliability of a German translation of the Clinician-Administered PTSD Scale (CAPS) by using data from 45 survivors of accidents who were hospitalized at the department of traumatology of a university hospital. Assessments were carried out 5 days (Time 1) and 6 months (Time 2) after the accident. Internal consistency proved to be comparable to that of the original English version: Cronbach's alpha was .88 at T1 and .92 at T2 for the CAPS total score. The CAPS correlated significantly with the validated German version of the Impact of Event Scale (IES) (T1: r = .56, T2: r = .78). The data suggest that the German version of the CAPS is a reliable instrument for the assessment of posttraumatic stress disorder symptomatology in accident victims. Further studies are necessary to validate further the questionnaire.     

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

A 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.     

Revictimization and Interpersonal Resource Loss Predicts PTSD Among Women in Substance-Use Treatment

Child physical abuse (CPA) and child sexual abuse (CSA) were hypothesized to be associated with revictimization and interpersonal resource loss in adulthood. These adulthood experiences were, in turn, hypothesized to increase risk for current posttraumatic stress disorder (PTSD). High-risk women were recruited from an innercity drug and alcohol treatment center (N = 105). Interpersonal resource losses, partner-produced physical assault, adulthood rape, CPA, and CSA had direct effects on PTSD. CPA and CSA also had indirect effects on PTSD through rape, which, in turn, predicted PTSD. Results suggest that the traumatic origins of current PTSD among substance-using women are multifaceted and support the importance of considering interpersonal coping resources in evaluating and treating female substance users.     

The prevalence of posttraumatic stress disorder among American Indian Vietnam veterans: disparities and context

This study employed data from two Congressionally mandated efforts (the American Indian Vietnam Veterans Project and the National Vietnam Veterans Readjustment Study) to examine differential prevalence of posttraumatic stress disorder (PTSD) among 5 ethnically defined samples of male Vietnam theater veterans. Lay interviews assessed individual experiences before, during, and after the war from 1,798 male Vietnam theater veterans. Clinical reinterviews using the SCID were conducted with subsamples (N = 487). The prevalence of both 1-month and lifetime PTSD was higher for the 2 American Indian samples than for Whites. Once logistic regressions controlled for differential exposure to war-zone stress, ethnicity was no longer a significant predictor of PTSD.     

Alexithymia in Holocaust Survivors with and Without PTSD

Alexithymia was measured in non-treatment seeking, community-dwelling Holocaust survivors using the Toronto Alexithymia Scale—Twenty Item Version (TAS-20). Scores of survivors with (n = 30) and without (n = 26) posttraumatic stress disorder (PTSD) were compared, and associations among alexithymia, severity of trauma, and severity of PTSD symptoms were determined. Survivors with PTSD had significantly higher scores on the TAS-20 compared to survivors without PTSD. TAS-20 scores were significantly associated with severity of PTSD symptoms, but not with severity of trauma. This study adds to our knowledge of the relationship between alexithymia and trauma by demonstrating that this characteristic is related to the presence of posttraumatic symptoms and not simply exposure to trauma.     

Ambulatory monitoring and physical health report in Vietnam veterans with and without chronic posttraumatic stress disorder

This study investigated the associations among PTSD, ambulatory cardiovascular monitoring, and physical health self-reports in 117 male Vietnam combat veterans (61 with PTSD and 56 without PTSD). PTSD was associated with health symptoms and number of current health conditions beyond the influence of several covariates. PTSD was associated with greater systolic blood pressure variability, and an elevated percentage of heart rate and systolic blood pressure readings above baseline. Higher mean heart rate and an elevated percentage of heart rate above baseline were associated with physical health symptoms. None of the ambulatory monitoring variables mediated the association between PTSD and physical health outcomes. Findings suggest that the interrelationships among ambulatory autonomic responses, PTSD, and physical health deserve more research attention.     

Service utilization and outcomes in medically ill veterans with posttraumatic stress and depressive disorders

This study examined behavioral health service utilization, health-related quality of life, and psychological distress in medically hospitalized male veterans (N = 743) with and without current or lifetime comorbid posttraumatic stress disorder (PTSD) and depressive disorder. Participants completed psychiatric and psychosocial self-report measures at baseline and follow-up. Clinical/functional status and service utilization rates were compared for patients with PTSD only, depressive disorder only, comorbid PTSD/depressive disorder, and neither disorder. Patients with PTSD/depressive disorder were more likely to use mental health/substance abuse services, have longer lengths of stay, and report more psychological distress than others. Results indicate that screening, early detection, and referral are critical in treating these comorbid patients because of increased psychological distress and high service-use rates.     

Integration of psychological and biological approaches to trauma memory: implications for pharmacological prevention of PTSD

Although memory processes play a central role in both psychological and neurobiological accounts of the development of posttraumatic stress disorder (PTSD), there has been little integration of the two literatures. This paper aims to consider the implications of an integrated account of trauma memory for pharmacological treatments that have been proposed for the prevention of PTSD. The idea of reprocessing trauma memories to bring about recovery, central to the psychological account of PTSD, is translated into terms more familiar in the biological literature using the concept of reconsolidation of active memories. It is suggested that physiological arousal enhances the reprocessing of trauma memories. Drugs that influence arousal may have effects after trauma which depend on the psychosocial context, helping to prevent the development of PTSD in some trauma victims, but impeding recovery in others who would do well without treatment.     

PTSD Scale of the Child Behavior Checklist: Concurrent and Discriminant Validity with Non-Clinic-Referred Sexually Abused Children

Several assessment instruments include measures that are purported to assess characteristics of posttraumatic stress disorder (PTSD). Although these measures are used often by researchers and clinicians, few are supported by extensive validity data. The PTSD scale of the Child Behavior Checklist (CBCL) is one that has not yet encountered significant challenges to its validity. We examine the concurrent and discriminant validity of the CBCL-PTSD scale. Participants included 63 non-clinic-referred sexually abused (SA) children, 60 non-SA psychiatric outpatient children, and 61 non-SA, non-clinic-referred schoolchildren. Results revealed questionable concurrent validity for this scale, and suggest poor discriminant validity between SA children and non-SA psychiatric outpatients.     

A Descriptive Analysis of PTSD Chronicity in Vietnam Veterans

This study examined the chronicity of PTSD in 530 male and female Vietnam veterans who were drawn from 2 large, ethnically diverse samples. Delayed onset was common, as was a failure to fully remit: 78% of the 239 veterans with full or partial lifetime PTSD were symptomatic in the 3 months prior to assessment. Cluster analysis identified 4 subtypes of posttraumatic response, with women most likely to be in a delayed onset cluster, and minority men most likely to be in a severe chronic cluster. The extent of chronicity observed in this sample underscores the need for treatments that address the persistence of posttraumatic symptoms.     

Characteristics and Content of Intrusive Memories in PTSD and Their Changes With Treatment

Although intrusive reexperiencing is a core symptom of postraumatic stress disorder (PTSD), relatively little is known about its phenomenology. The present study assessed the characteristics and content of intrusive trauma memories in 22 patients with PTSD, and followed their changes in the course of cognitive behavioral treatment. Patients had a small number of different intrusive memories (1-4, M = 2.2) that occurred in an invariable, repetitive way. The intrusions were distressing and had a vivid perceptual content. They appeared to the patient to be happening in the "here and now." With therapy, the frequency, vividness, distress, and nowness of the intrusions faded gradually. There was no exacerbation with imaginal reliving. The content of intrusions was classified by raters to test A. Ehlers et al.'s (2002) hypothesis that intrusive memories are usually of warning stimuli that signalled the moments with the greatest emotional impact. The results were consistent with this hypothesis.     

Race, Combat, and PTSD in a Community Sample of New Zealand Vietnam War Veterans

The association between posttraumatic stress disorder (PTSD), combat exposure, and race was examined in a New Zealand community sample of 756 Vietnam War veterans. Maori veterans reported higher levels of PTSD than their non-Maori counterparts. However, the race effect was shown to be mediated by combat exposure level, rank, and combat role. These findings support differential experience explanations for the relationship between postwar adjustment and race, suggesting that higher levels of psychological symptoms reported by minority group veterans can be accounted for by their experience of higher levels of combat stressors.     

Perceived Coping Ability Mediates the Relationship Between PTSD Severity and Heart Rate Recovery in Veterans

Most psychophysiological studies of PTSD have not assessed physiological recovery, correlational relationships between PTSD severity and physiological measures within clinical populations, or mediation by cognitive appraisal. Relationships of PTSD severity to psychophysiological reactivity (to acoustic startle), habituation, and recovery were assessed in 29 combat veterans, and mediation by cognitive appraisal (perceived threat and coping ability) was assessed in a subset (n = 16) of participants. Heart rate (HR) recovery was linearly related to PTSD severity. Perceived ability to cope with the lab task, but not perceived threat inherent in the task, mediated the HR recovery-PTSD association. Potential implications of delayed HR recovery for functioning, treatment outcome, and health-risk in PTSD are presented. Cognitive appraisal may represent an important target for treatments.     

A new development in PTSD and the law: the case of Fairfax County v. Mottram

The decision of the Virginia Supreme Court in Fairfax County Fire & Rescue Department v. Mottram (2002) has important implications for Workers' Compensation claims for posttraumatic stress disorder, particularly those involving emergency services personnel. A firefighter/paramedic who developed chronic, disabling PTSD after responding to a fatal fire was denied benefits because he had previously reported symptoms of the disorder, whereas the statute recognized a single traumatic incident only. The court held that PTSD resulting from multiple traumatic stressors may be considered a compensable occupational disease analogous to dermatitis developed by a flower shop employee with chronic exposure to irritating stimuli. The decision, which constitutes legal recognition of work-related cumulative PTSD in rescue workers, provides benefits for treatment and encourages earlier treatment of traumatic stress in this group.