Comorbid Anxiety Disorders in Civilians Seeking Treatment for Posttraumatic Stress Disorder

Research indicates that posttraumatic stress disorder (PTSD) is associated with high rates of comorbid psychiatric diagnoses. Yet, it remains unknown whether PTSD is associated with greater comorbidity relative to patients with other anxiety disorders. This study examined prevalence of comorbid anxiety disorders with PTSD relative to other disorders among a treatment-seeking population. Patients with PTSD (n = 83) evidenced greater overall comorbidity as compared to patients with other anxiety (n = 151) or Axis I (n = 73) disorders. Compared to patients with panic disorder, patients with PTSD were more likely to be diagnosed with depression and social phobia, but not other anxiety disorders. Extent of anxiety disorder comorbidity was not related to PTSD severity. These findings are discussed in terms of their relevance for treatment of PTSD.     

Posttraumatic stress disorder among deliberate self-poisoning patients

This study explored posttraumatic stress disorder (PTSD) among suicide attempters. Participants were 330 hospital-treated deliberate self-poisoning (DSP) patients. Twelve-month prevalence of PTSD and comorbid psychiatric disorders was determined using the Composite International Diagnostic Interview (CIDI-A). Standard disability measures and demographic information were also obtained. PTSD prevalence was 32% among women and 15% among men. The PTSD group had significantly higher levels of affective disorder, anxiety disorders other than PTSD, psychiatric disability, and service utilization than DSP patients without PTSD. Logistic regression modeling showed that PTSD was associated with the type of traumatic event, number of events, affective disorder, and anxiety disorder other than PTSD.     

The Mediating Role of Alexithymia in the Association Between Adverse Childhood Experiences and Postdeployment Mental Health in Canadian Armed Forces Personnel

Recent studies showing an association between adverse childhood experiences and the development of alexithymia in military personnel have generated interest regarding the role of alexithymia in the pathway linking childhood trauma exposure to mental health disorders. Accordingly, the current study was conducted to (a) examine the associations among adverse childhood experiences, alexithymia, and symptoms of depression and posttraumatic stress disorder (PTSD) among recently deployed Canadian military personnel and (b) assess the mediating role of alexithymia in these associations. Data collected from 2,927 members of the Canadian Armed Forces at baseline and after their return from an overseas deployment were subjected to a prospective path analysis. The results of the path analysis, R² = .35, pointed to a significant direct effect of childhood adversity on postdeployment mental health symptoms. Contrary to our expectations, the results also pointed to a negative indirect effect of childhood neglect, suggesting that childhood neglect contributed to lower levels of postdeployment depression and PTSD symptoms through the dimension of alexithymia related to difficulty in describing feelings. These patterns of associations, for the most part, persisted even when accounting for combat exposure during recent deployments, R² = .42. The present results are discussed in light of study limitations and methodological considerations, and policy and clinical implications are noted.     

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.     

Meta-analysis of alexithymia in posttraumatic stress disorder

The authors present a meta-analysis investigating the prevalence of alexithymia in 12 studies encompassing 1,095 individuals with posttraumatic stress disorder (PTSD). A large effect size was found associating PTSD with alexithymia. Effect sizes were higher in studies of male combat PTSD samples in comparison with studies of other PTSD samples. Clinical and research directions are discussed.     

Posttraumatic Stress Disorder in a General Psychiatric Inpatient Population

This study examined the incidence of traumatic experiences and prevalence of lifetime posttraumatic stress disorder (PTSD) in a sample of 141 general hospital psychiatric inpatients. Sixty-one percent of the patients reported at least one traumatic event during their lifetime and 28% met the formal DSM-III-R criteria for a lifetime diagnosis of PTSD. A high degree of comorbidity between PTSD and other psychiatric disorders was found, but PTSD was the incident disorder in at least 50% of cases. The experience of trauma and its associated complex patterns of symptomatology suggest that PTSD complicates the process of recovery from another disorder.     

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.     

Borderline Personality Disorder and Posttraumatic Stress Disorder at Psychiatric Discharge Predict General Hospital Admission for Self‐Harm

We investigated whether posttraumatic stress disorder (PTSD) was predictor of suicidal behavior even when adjusting for comorbid borderline personality disorder (BPD) and other salient risk factors. To study this, we randomly selected 308 patients admitted to a psychiatric hospital because of suicide risk. Baseline interviews were performed within the first days of the stay. Information concerning the number of self‐harm admissions to general hospitals over the subsequent 6 months was retrieved through linkage with the regional hospital registers. A censored regression analysis of hospital admissions for self‐harm indicated significant associations with both PTSD (β = .21, p < .001) and BPD (β = .27, p < .001). A structural model comprising two latent BPD factors, dysregulation and relationship problems, as well as PTSD and several other variables, demonstrated that PTSD was an important correlate of the number of self‐harm admissions to general hospitals (B = 1.52, p < .01). Dysregulation was associated directly with self‐harm (B = 0.28, p < .05), and also through PTSD. These results suggested that PTSD and related dysregulation problems could be important treatment targets for a reduction in the risk of severe self‐harm in high‐risk psychiatric patients.     

Correlates of posttraumatic stress disorder in forensic psychiatric outpatients in the Netherlands

Using a sample of 154 Dutch forensic psychiatric outpatients aged 18-62 years, this study investigated whether risk factors of posttraumatic stress disorder (PTSD), mainly identified in nonforensic research, forensic psychiatric factors, and potential comorbid mental disorders were associated with PTSD. Data on demographics, victimization during childhood or adolescence, and forensic psychiatric factors were derived from electronic medical records. Mental disorders were assessed using structured psychiatric interviews and consensus diagnoses were established during weekly case consultations. The PTSD rate was 75% in the sample. Whereas the PTSD group was significantly more likely to be older, female, not Dutch, and to have a history of victimization, previously perpetrated family violence, and lower psychosocial and occupational functioning than the non-PTSD group, the latter group had significantly higher rates of psychiatric history, attention-deficit/hyperactivity disorder (ADHD), antisocial personality disorder, drug abuse, and previous repeated nonfamily violence perpetration. Effect sizes ranged from Nagelkerke R(2) = .04 for psychosocial and occupational functioning to Nagelkerke R(2) = .70 for ADHD. This study demonstrated differences between those with and without PTSD in demographic, victim, forensic, and psychological characteristics. Future studies should examine the complexity between early victimization, delinquency patterns, and psychopathology regarding the prediction of PTSD among forensic psychiatric outpatients.     

Posttraumatic stress and related symptoms among neglected and physically and sexually maltreated adolescents

Posttraumatic stress disorder (PTSD) is common among maltreated youth, but few investigations compare neglect with other maltreatment types. This study examined 84 adolescents who experienced neglect only, physical and/or sexual maltreatment only, or neglect with physical and/or sexual maltreatment. Symptoms of PTSD, dissociation, and depression were measured. Adolescents who experienced physical and/or sexual maltreatment, whether neglected or not, reported significantly greater symptomatology than adolescents who experienced neglect only (η2 = .094). This difference applied to PTSD symptoms, dissociative amnesia, depersonalization and derealization, negative mood, and anhedonia. Adolescents exposed to neglect only displayed substantial psychopathology but less than that of other groups. The findings may reflect emerging cascade models of the etiology of symptoms of PTSD following extensive maltreatment history.     

Criminal Victimization, Posttraumatic Stress Disorder, and Comorbid Psychopathology Among a Community Sample of Women

This paper provides information on the relation between victimization status, crime factors, posttraumatic stress disorder (PTSD), and several other psychological disorders among a community sample of women. Results indicated that victims of crime were more likely than nonvictims to suffer from PTSD, major depressive episode, agoraphobia, obsessive-compulsive disorder, social phobia, and simple phobia. Furthermore, life threat was associated with increased risk of major depression, agoraphobia, obsessive-compulsive disorder, and social phobia. Completed rape was strongly related to almost every disorder assessed, while robbery and burglary were not related to any disorder. When demographics, victimization status, and crime factors were entered hierarchically into multivariate logistic regressions with PTSD in the final step, associations between victimization status, other crime characteristics (e.g., life threat, injury), and non-PTSD Axis I disorders were greatly reduced. This suggests that PTSD may be an important mediating factor in the victimization-psychopathology relation for many disorders.     

Dialectical behavior therapy as a precursor to PTSD treatment for suicidal and/or self‐injuring women with borderline personality disorder

This study examined the efficacy of dialectical behavior therapy (DBT) in reducing behaviors commonly used as exclusion criteria for posttraumatic stress disorder (PTSD) treatment. The sample included 51 suicidal and/or self‐injuring women with borderline personality disorder (BPD), 26 (51%) of whom met criteria for PTSD. BPD clients with and without PTSD were equally likely to eliminate the exclusionary behaviors during 1 year of DBT. By posttreatment, 50–68% of the BPD clients with PTSD would have been suitable candidates for PTSD treatment. Borderline personality disorder clients with PTSD who began treatment with a greater number of recent suicide attempts and more severe PTSD were significantly less likely to become eligible for PTSD treatment.     

A prospective study of sex differences in the lifetime risk of posttraumatic stress disorder among abused and neglected children grown up

In the general population, women's lifetime risk of developing posttraumatic stress disorder (PTSD) is twice that of men's. However, evidence is contradictory as to whether this sex difference is present among child abuse/neglect victims. The authors examined sex differences in PTSD among a sample of 674 individuals with documented child abuse/neglect histories assessed for PTSD in adulthood. Across all types of abuse/neglect, women were more than twice as likely to develop PTSD as men. The sex difference was greatest among sexual abuse victims. Female victims' greater revictimization explained a substantial proportion (39%) of the sex differences in PTSD risk. Future research should identify mechanisms that make female victims particularly vulnerable to revictimization and the development of PTSD.     

The Effects of Prolonged Exposure on Substance Use in Patients With Posttraumatic Stress Disorder and Substance Use Disorders

Despite research demonstrating the benefit of exposure-based therapy for posttraumatic stress disorder (PTSD) in patients with co-occurring substance use disorders, there remains a strong clinical expectation that this treatment will exacerbate substance use or other psychiatric symptoms. The present study evaluated within-session and session-to-session changes in (a) craving and use of substances for a range of drug classes and (b) symptoms of PTSD and other psychiatric distress in a sample of 44 SUD patients who received prolonged exposure (PE) therapy for PTSD. Visual analog scales showed no within-session increases in craving, except for cocaine, within Session 8. Across sessions, craving scores dropped for heroin, methadone, benzodiazepines, and cocaine; no increases in craving were found. Past-week substance use reported at each session did not differ. The severity of PTSD symptoms and self-reported serious emotional problems decreased from Session 1 to subsequent sessions, with no increases or decreases in other psychiatric, social, or medical problems. Finally, PTSD severity was unrelated to substance use reported 1 or 2 weeks later. Substance use during the past week was associated with higher PTSD severity scores at the next session, B = 6.86 (SE = 2.87), p = .018, but was not associated 2 weeks later. These findings indicate that the concern that exposure therapy for PTSD will increase SUD patients’ substance use or other psychiatric symptoms may be unwarranted, and, thus, SUD patients, including those who are actively using, should have access to effective treatments for PTSD, like PE.     

Psychological consequences of the 1999 earthquake in Turkey

We explored the prevalence of posttraumatic stress disorder (PTSD) and its relation to demographic characteristics and other risk factors for developing PTSD in a large sample (N = 910) of earthquake survivors living in tent city. Twenty-five percent of the sample met DSM-IV criteria for PTSD assessed with the Posttraumatic Stress Disorder Self Test (PTSD-S). Peritraumatic factors explained the most variance when the risk factors were grouped as demographics, pretraumatic, peritraumatic, and posttraumatic. The study emphasized that PTSD among the earthquake victims was as prevalent in Turkey as after disasters in other developing countries but higher than usually found after disasters in developed countries, and there was a relation between some factors-mostly peritraumatic-and PTSD.     

The internalizing and externalizing structure of psychiatric comorbidity in combat veterans

This study examined the latent structure of psychiatric disorders in a sample with a high prevalence of PTSD. A series of confirmatory factor analyses tested competing models for the covariation between Structured Clinical Interview for DSM-III-R diagnoses among 1,325 Vietnam veterans. The best-fitting solution was a 3-factor model that included two correlated internalizing factors: anxious-misery, defined by PTSD and major depression, and fear, defined by panic disorder/agoraphobia and obsessive-compulsive disorder. The third factor, externalizing, was defined by antisocial personality disorder, alcohol abuse/dependence, and drug abuse/dependence. Both substance-related disorders also showed significant, albeit smaller, cross-loadings on the anxious-misery factor. These findings shed new light on the structure of psychiatric comorbidity in a treatment-seeking sample characterized by high rates of PTSD.     

Posttraumatic stress disorder symptoms in treatment-seeking pathological gamblers

Little is known about posttraumatic stress disorder (PTSD) among pathological gamblers (PGs), even though the two disorders share several clinical characteristics. We examined the relationship between pathological gambling and PTSD on measures of gambling disorder severity, experience of specific traumas, psychiatric symptoms, impulsivity, and dissociation. A total of 149 treatment-seeking PGs were surveyed. Participants were divided into two groups on the basis of their score on the PTSD Checklist (Weathers, Litz, Herman, Huska, & Keane, 1993). Thirty-four percent (n = 51) reported a high frequency of PTSD symptoms. Participants who had high scores reported greater lifetime gambling severity, psychiatric symptom severity, impulsivity, and dissociation than participants who had low PTSD symptom scores. These findings point to a need for more assessment and research about PTSD in PGs.     

Alexithymia as a predictor of treatment response in post-traumatic stress disorder

Fifty-seven veterans with post-traumatic stress disorder (PTSD) completed the Alexithymia Provoked Response Questionnaire (APRQ) upon entering an 8-week randomized trial comparing phenelzine, imipramine, and placebo. Low alexithymia on the APRQ significantly predicted improvement on the avoidance items of the Impact of Events Scale (IES) particularly among patients treated with placebo, but was not associated with changes in the intrusion items of the scale.     

Post-traumatic stress disorder among Croat soldiers in the defence war in Croatia 1991–1993

During the Defence War in Croatia from 1991 to 1993 prospective case-control study was designed with a randomly selected sample of 60 wounded (30 with disabling and 30 with non-disabling injuries) and 30 active soldiers. They were not professionally trained soldiers, but had joined the war by spontaneously defending their homes. None of them had requested help or had any previous psychiatric diagnosis. The aim of this study is to establish the influence of the general characteristics and traumas of soldiers on the development of post-traumatic stress disorder. General characteristics and traumas between the group of soldiers who developed PTSD and those who did not were compared. A significant difference was found in the type of injuries of the soldiers between the two groups. In the group of soldiers who developed PTSD, 53 per cent had non-disabling injuries, 29 per cent permanent disabling injuries and 18 per cent were active soldiers. There was no significant difference found in the general characteristics of the study groups. We found that soldiers with non-disabling injuries (less seriously wounded) developed PTSD more often than the more seriously wounded soldiers. Less seriously wounded soldiers suffered tremendous stress caused by consciously experiencing and living through being wounded. © 1998 John Wiley & Sons, Ltd.     

Posttraumatic stress disorder after motor vehicle accidents

Summary Posttraumatic stress disorder (PTSD) can occur after motor vehicle accidents (MVAs). It is an anxiety disorder characterized by intrusive reliving of the accident, avoidance of reminders of the trauma and increased arousal. Diagnostic criteria as specified in DSM-IV and in ICD-10 are discussed. A case example illustrates the features of PTSD incurred by MVA. An overview concerning the history of empirical studies on the consequences of MVAs is given. PTSD is one of the more common psychiatric disorders, with prevalence rates after MVAs ranging from 1 % to nearly 9 %. Other psychiatric and comorbid disorders that can occur as a consequence of MVAs are described. The present paper reviews the most influential etiological theories for PTSD. It describes and discusses current knowledge on risk factors for the development of PTSD after surviving an MVA. In the treatment of PTSD cognitive-behavioural approaches have proven to be the most effective interventions.