A Relational Model for the Intergenerational Transmission of Captivity Trauma: A 23-Year Longitudinal Study

Objectives: The aversive, long-term toll of war captivity and fathers’ combat-induced posttraumatic stress disorder (PTSD) on adult offspring’s secondary traumatization (ST) has been recently exemplified. However, the study of potential mechanisms of the intergenerational transmission of trauma to offspring is still lacking. This prospective study aimed to assess the role of fathers’ PTSD symptoms (PTSS), paternal parenting, and adult offspring’s attachment insecurities in adult offspring’s PTSS. Method: A sample of 124 Israeli father–child dyads (80 ex-POW dyads and a comparison group of 44 veteran dyads) completed self-report measures. The fathers participated in three waves of measurements following the Yom Kippur War (T1: 1991, T2: 2003, T3: 2008), while the offspring took part in T4 (2013). Results: Offspring of ex-POWs with PTSD at T3 reported more PTSS and higher levels of attachment insecurities than offspring of ex-POWs without PTSD and controls at T4. Fathers’ proximity to the children and sensitivity to the children’s needs were negatively related. Offspring’s attachment insecurities were positively related to offspring’s PTSS. Importantly, serial multiple mediation model results show that war captivity increased the level of the fathers’ PTSD at T2 and T3, which in turn decreased the level of the fathers’ parenting at T3, and thereby increased the level of offspring’s attachment avoidance at T4, which by its own merit was related to higher levels of adult offspring’s PTSS. Conclusions: The mechanisms of the intergenerational transmission of captivity-related trauma of veterans’ PTSD and paternal parenting, through offspring’s attachment insecurities and offspring’s PTSS, was exemplified.     

Posttraumatic Growth and Shattered World Assumptions Among Ex-POWs: The Role of Dissociation

Objective: The controversy regarding the nature of posttraumatic growth (PTG) includes two main competing claims: one which argues that PTG reflects authentic positive changes and the other which argues that PTG reflects illusionary defenses. The former also suggests that PTG evolves from shattered world assumptions (WAs) and that the co-occurrence of high PTG and negative WAs among trauma survivors reflects reconstruction of an integrative belief system. The present study aimed to test these claims by investigating, for the first time, the mediating role of dissociation in the relation between PTG and WAs. Method: Former prisoners of war (ex-POWs; n = 158) and comparable controls (n = 106) were assessed 38 years after the Yom Kippur War. Results: Ex-POWs endorsed more negative WAs and higher PTG and dissociation compared to controls. Ex-POWs with posttraumatic stress disorder (PTSD) endorsed negative WAs and a higher magnitude of PTG and dissociation, compared to both ex-POWs without PTSD and controls. WAs were negatively correlated with dissociation and positively correlated with PTG. PTG was positively correlated with dissociation. Moreover, dissociation fully mediated the association between WAs and PTG. Conclusion: These findings imply that PTG might reflect illusory defenses and raise questions regarding the integration between the co-occurrence of high PTG and negative WAs among trauma survivors.     

Changes in diagnostic criteria of PTSD: implications from two prospective longitudinal studies

This study assesses differences in PTSD rates according to different sets of diagnostic criteria. Two samples have been studied: one comprised of 286 combat stress reaction (CSR) casualties and 218 non-CSR veterans from the Lebanon war (Study 1); the other of 95 ex-POWs and 101 non-POWs from the Yom Kipur war (Study 2). Participants were administered two versions of the PTSD inventory based on different Diagnostic and Statistical Manual of Mental Disorders (DSM) editions: DSM-III and DSM-IV in Study 1 and DSM-III-R and DSM-IV in Study 2. PTSD rates declined when criteria of more recent DSM editions were applied. In addition, findings clearly demonstrate the importance of the dysfunction criterion (F) in PTSD. The highly complex nature of the PTSD diagnosis is discussed, as well as the important role of dysfunction and distress.     

The contribution of stressful life events throughout the life cycle to combat-induced psychopathology

This study examines the contribution of prewar life events, war exposure, and postwar life events to combat-induced psychopathology among 425 Israeli War veterans from the Lebanon War. Data was collected at two time points (1983 and 2002). The sample included veterans with and without combat stress reaction (CSR). Battle intensity and subjective experience of risk in war were associated with CSR. Negative childhood life events, CSR, PTSD in 1983 and postwar negative life events were associated with PTSD in 2002. Furthermore, a path analysis revealed that CSR mediated the relation between battle intensity and PTSD in 2002. Our findings suggest that stressful life events throughout the life cycle contribute significantly to veterans' posttraumatic symptomatology, above and beyond combat exposure.     

The effects of antimuscarinic treatments in overactive bladder: an update of a systematic review and meta-analysis

CONTEXT: Antimuscarinic agents are currently the first-line pharmacotherapy for overactive bladder. OBJECTIVES: A systematic review published in 2005 was updated, including data on a newly licensed antimuscarinic (fesoterodine). The primary aim of this study was to systematically review evidence on the efficacy of licensed administration of antimuscarinic treatments in overactive bladder from randomised controlled trials. Secondary aims were to review evidence on tolerability and safety and health-related quality of life (HRQL). EVIDENCE ACQUISITION: All relevant data sources from randomised controlled trials were searched, and two independent reviewers considered publications for inclusion and extracted relevant data. Meta-analysis was used to pool efficacy, tolerability, safety, and HRQL outcomes by treatment. Efficacy was measured by continent days, mean voided volume, urgency episodes, and micturition frequency. Tolerability and safety were measured by means of adverse event and withdrawal rates. HRQL was measured by various instruments. EVIDENCE SYNTHESIS: An additional 1118 references were retrieved with data on 83 studies extracted. Antimuscarinics were found to be more effective than placebo. Tolerability was good; few of the antimuscarinics were found to have significantly higher withdrawal rates in comparison to placebo. No serious adverse event for any product was statistically significant compared to placebo. Dry mouth (mild, moderate, severe) was the most commonly reported adverse event (29.6% on treatment vs 7.9% on placebo), followed by pruritus (15.4% on treatment vs 5.2% on placebo). Improvements were seen in HRQL with treatment by darifenacin, fesoterodine, oxybutynin transdermal delivery system, propiverine extended release (ER), solifenacin, tolterodine ER and immediate release, and trospium. Limitations of the study include restrictions on the types of patients typically included in overactive bladder trials and topics that have not been adequately addressed in the current antimuscarinic literature. CONCLUSIONS: Antimuscarinics are efficacious, safe, and well-tolerated treatments that improve HRQL. Profiles of each drug and dosage differ and should be considered in making treatment choices.     

Posttraumatic growth in adolescence: examining its components and relationship with PTSD

To address gaps in the literature, this study examined the components of posttraumatic growth, and the relationship between growth and posttraumatic stress disorder (PTSD). Participants were from a pooled sample of 4,054 Israeli adolescents exposed to terror of whom 210 (5.5%) met criteria for PTSD. Measures included the Child Post-Traumatic Stress Reaction Index and Posttraumatic Growth Inventory. Principal components analysis showed two correlated components of outward and intrapersonal growth. Regression modeling showed that the relationship between the growth and PTSD measures was linear and curvilinear (inverted-U). These results replicated accounting for heterogeneity in PTSD, exposure and subsamples. Collectively, the results imply that posttraumatic growth in adolescence is characterized by two robust components, and is greatest at moderate posttraumatic stress levels.     

Acute Gout of the Right Sacroiliac Joint

An eighty-year-old woman suffered from acute idiopathic gout of the right sacroiliac joint and tophaceous deposits in two fingers of her right hand. Hyperuricemia and findings consistent with gout detected by histological examination of a biopsy specimen taken from the digital nodules supported the diagnosis. The radiological workup revealed osteolytic changes at the bases of the phalanges in Roentgenograms of the feet. Various aspects of the very rare incidence of sacroiliac gout are discussed.