Personality patterns among Black, White, and Hispanic combat veterans.

Little is known about racial and ethnic differences in personality pathology in combat veterans. This investigation explored the relationship between race, ethnicity, and personality disorders (PDs) in a sample of 96 combat veterans. Ethnoracial group status was based on self-identification, and the groups were mutually exclusive. PDs were assessed with the MCMI-III, posttraumatic stress disorder (PTSD) was assessed with the Clinician Administered PTSD scale, and combat exposure was assessed with the Combat Exposure Scale. The findings suggest that Hispanic veterans were more likely to have cluster A PDs compared to non-Hispanic veterans, even after controlling for demographics, level of combat exposure, and current PTSD. Implications of the results for the research and treatment of culturally diverse individuals with PDs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of a motivation enhancement intervention on veterans’ engagement in PTSD treatment.

This study is the first randomized controlled trial of the posttraumatic stress disorder (PTSD) motivation enhancement (PME) Group, a brief intervention based on Motivational Interviewing and designed to enhance combat veterans’ engagement in PTSD treatment by increasing awareness of the need to change PTSD-related problems. Outpatients in a year-long, group- and cognitive–behavioral therapy (CBT)–oriented Veterans Affairs PTSD treatment program were randomly assigned to 4 sessions of the PME Group (n = 60) or a Psychoeducation Group (n = 54) in the 2nd month of treatment. Hypotheses about the proposed impact of the PME Group on PTSD treatment engagement (i.e., readiness to change, perceived treatment relevance, and PTSD program attendance) were all supported, although predicted differences were not found on all measures. These results support the need to address readiness to change in combat-related PTSD treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intimate partner abuse and PTSD symptomatology: Examining mediators and moderators of the abuse-trauma link.

Posttraumatic stress disorder (PTSD) has been linked to intimate partner abuse, physiological reactivity, and social support. The authors used structural equation modeling to test social support as a moderator and psychophysiological reactivity and anger as mediators of the relation between abuse and traumatic symptoms among a sample of women reporting psychological abuse, including women reporting both physical violence and no physical violence. Both physical and psychological abuse were related to PTSD symptoms. Whereas physical and psychological abuse were highly correlated, psychological abuse did not predict PTSD symptomatology over and above the effect due to physical assault. Psychophysiological reactivity and anger and fear displayed during an argument with the partner did not mediate the abuse?trauma link. Social support moderated the relation between psychological abuse and PTSD symptomatology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Confirmatory factor analysis of the PTSD Checklist and the Clinician-Administered PTSD Scale in disaster workers exposed to the World Trade Center Ground Zero.

Although posttraumatic stress disorder (PTSD) factor analytic research has yielded little support for the DSM-IV 3-factor model of reexperiencing, avoidance, and hyperarousal symptoms, no clear consensus regarding alternative models has emerged. One possible explanation is differential instrumentation across studies. In the present study, the authors used confirmatory factor analysis to compare a self-report measure, the PTSD Checklist (PCL), and a structured clinical interview, the Clinician-Administered PTSD Scale (CAPS), in 2,960 utility workers exposed to the World Trade Center Ground Zero site. Although two 4-factor models fit adequately for each measure, the latent structure of the PCL was slightly better represented by correlated reexperiencing, avoidance, dysphoria, and hyperarousal factors, whereas that of the CAPS was slightly better represented by correlated reexperiencing, avoidance, emotional numbing, and hyperarousal factors. After accounting for method variance, the model specifying dysphoria as a distinct factor achieved slightly better fit. Patterns of correlations with external variables provided additional support for the dysphoria model. Implications regarding the underlying structure of PTSD are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Heterogeneity in the latent structure of PTSD symptoms among Canadian veterans.

The current study used factor mixture modeling to identify heterogeneity (i.e., latent classes) in 2 well-supported models of posttraumatic stress disorder's (PTSD) factor structure. Data were analyzed from a clinical sample of 405 Canadian veterans evaluated for PTSD. Results were consistent with our hypotheses. Each PTSD factor model was best represented by 2 latent classes of participants, differing with respect to PTSD symptom severity. Furthermore, classes were most strongly distinguished by factor scores related to emotional numbing or dysphoria. For both factor models, class membership was significantly predicted by age and depression diagnosis. Implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attention, learning, and memory performances and intellectual resources in Vietnam veterans: PTSD and no disorder comparisons.

Attention, learning, memory, and estimated intellectual potential were examined in 26 Vietnam veterans diagnosed with posttraumatic stress disorder (PTSD) and in 21 Vietnam veterans without mental disorders. Results revealed PTSD-associated cognitive deficits on tasks of sustained attention, working memory, initial learning, and estimated premorbid intelligence but not on measures of focus of attention, shift of attention, or memory savings. Cognitive task performances adjusted for estimated native intelligence remained negatively correlated with PTSD severity. An intellectual measure adjusted for cognitive task performances was negatively correlated with PTSD severity, even after the authors statistically controlled the level of combat exposure. Results suggested that although intellectual resources may constitute a vulnerability-protective factor for PTSD development, PTSD was associated with cognitive impairment independent of intellectual functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding factors associated with early therapeutic alliance in PTSD treatment: Adherence, childhood sexual abuse history, and social support.

Objective: Therapeutic alliance has been associated with better treatment engagement, better adherence, and less dropout across various treatments and disorders. In treatment of posttraumatic stress disorder (PTSD), it may be particularly important to establish a strong early alliance to facilitate treatment adherence. However, factors such as childhood sexual abuse (CSA) history and poor social support may impede the development of early alliance in those receiving PTSD treatment. We sought to examine treatment adherence, CSA history, and social support as factors associated with early alliance in individuals with chronic PTSD who were receiving either prolonged exposure therapy (PE) or sertraline. Method: At pretreatment, participants (76.6% female; 64.9% Caucasian; mean age = 37.1 years, SD = 11.3) completed measures of trauma history, general support (Inventory of Socially Supportive Behaviors), and trauma-related social support (Social Reactions Questionnaire). Over the course of 10 weeks of PE or sertraline, they completed early therapeutic alliance (Working Alliance Inventory) and treatment adherence measures. Results: Early alliance was associated with PE adherence (r = .32, p     

Combat and human existence: Toward an intersubjective approach to combat-related PTSD.

The author proposes a short-term, intersubjective model for treating combat-related post-traumatic stress disorder (PTSD). Psychodynamic approaches to adult-onset PTSD lack the evidence and popularity of other approaches because adult-onset traumas are fundamentally distinct from the developmental, or childhood-based, traumas that psychoanalysis evolved to treat. An approach based in intersubjective systems theory can address this problem. The writings of Robert Stolorow (2007) in Trauma and Human Existence, which the author first read while deployed to Iraq as a psychiatrist, fundamentally changed his understanding of trauma and its treatment. The author gives an overview of Stolorow's ideas about trauma, and then describes his six-phase short-term intersubjective treatment approach. Extensive case material from a treatment that occurred in Iraq illustrates each of these phases. The author then compares his and Stolorow's views to those of other contemporary relational psychoanalytic writers. Future directions include the manualization and empirical testing of this approach in order to determine its replicability, its utility for therapists who lack extensive psychoanalytic training, and its generalizability to populations with adult-onset trauma outside the military. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Posttraumatic stress disorder, anger, and partner abuse among Vietnam combat veterans.

The authors examined interrelationships among posttraumatic stress disorder (PTSD) symptomatology, anger, and partner abuse perpetration among a sample of 60 combat veterans. Compared with PTSD-negative participants, PTSD-positive participants reported higher state anger across time and neutral and trauma prime conditions and higher anger reactivity during the trauma prime condition. PTSD-positive participants also exhibited more anger reactivity during the trauma prime than during the neutral condition. The same pattern of results was not found for anxiety reactivity during trauma memory activation. PTSD symptoms were associated with physical assault and psychological aggression perpetration, and trait anger mediated these relationships. Findings indicate a heightened anger response among PTSD-positive veterans and suggest the salience of dispositional components of anger in abuse perpetration in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The implication of combat-induced stress reaction, PTSD, and attachment in parenting among war veterans.

This study examined parental functioning, parental satisfaction, and concern for offspring during their child's military service, among war veterans, some of whom suffered from acute combat-induced stress reaction (CSR) and posttraumatic stress disorder (PTSD). In addition, we examined the additive and interactive contributions of CSR, PTSD and attachment dimensions to parenting measures. The sample consisted of 477 participants divided into two groups: a clinical group of veterans who had been diagnosed with CSR on the battlefield (N = 267), and a matched control group of veterans who did not suffer from CSR (NCSR; N = 210). CSR, PTSD, avoidant-attachment, and anxious-attachment, were all related to lower levels of parental functioning and satisfaction. Veterans who suffered from both CSR and PTSD reported more concern for their offspring during their child's military service compared to veterans with PTSD but without antecedent CSR. Attachment dimensions and specifically attachment-avoidance, made the greatest contribution to parenting measures, followed by posttraumatic symptoms. In addition, attachment-avoidance moderated the relationship between posttraumatic symptoms and parental functioning. Theoretical and clinical implications of these results are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Multidimensional Personality Questionnaire profiles of veterans with traumatic combat exposure: Externalizing and internalizing subtypes.

This study used the Multidimensional Personality Questionnaire (MPQ; A. Tellegen, in press) to identify personality-based subtypes of posttraumatic response. Cluster analyses of MPQs completed by combat veterans revealed subgroups that differed on measures relating to the externalization versus internalization of distress. The MPQ profile of the externalizing cluster was defined by low Constraint and Harmavoidance coupled with high Alienation and Aggression. Individuals in this cluster also had histories of delinquency and high rates of substance-related disorder. In comparison, the MPQ profile of the internalizing cluster was characterized by lower Positive Emotionality, Alienation, and Aggression and higher Constraint, and individuals in this cluster showed high rates of depressive disorder. These findings suggest that dispositions toward externalizing versus internalizing psychopathology may account for heterogeneity in the expression of posttraumatic responses, including patterns of comorbidity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationships between posttraumatic stress symptom clusters and marital intimacy among war veterans.

This study examined (a) the relationships between posttraumatic stress disorder (PTSD) symptom clusters and marital intimacy among Israeli war veterans and (b) the role of self-disclosure and verbal violence in mediating the effects of PTSD avoidance and hyperarousal symptoms on marital intimacy. The sample consisted of 219 participants divided into 2 groups: ex-prisoners of war (ex-POWs; N = 125) and a comparison group of veterans who fought in the same war but were not held in captivity (N = 94). Ex-POWs displayed higher levels of PTSD symptoms and verbal violence and lower levels of self-disclosure than did controls. Although ex-POWs and controls did not differ in level of marital intimacy, they did, however, present a different pattern of relationships between PTSD clusters and intimacy. In ex-POWs, self-disclosure mediated the relations between PTSD avoidance and marital intimacy. Verbal aggression was also found via indirect effect of hyperarousal on marital intimacy. The results point to the importance of self-disclosure and verbal violence as interpersonal mechanisms for the relations between posttraumatic symptoms on marital intimacy of ex-POWs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of PTSD and other mental disorders in World War II and Korean Conflict POW survivors and combat veterans.

Mental disorders were assessed in 326 prisoners of war (POWs) of the World War II (WWII) European theater, WWII Pacific theater, and Korean Conflict (KC) and in combat veterans of both wars. Diagnoses were identified using a structured diagnostic interview including a posttraumatic stress disorder (PTSD) module. POW trauma severity was measured by a trauma events index, captivity weight loss, and captivity duration. KC and WWII Pacific former POWs reported the most extreme trauma and, as hypothesized, showed highest prevalences of lifetime and current mental disorders and PTSD. POW subgroups exhibited greater psychopathology than combat veterans. PTSD was frequently associated with other mental disorders and found in high prevalences in all subgroups, pointing to the persistent, far-reaching impact of combat and POW experiences on mental health. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Holographic reprocessing: Empirical evidence to reduce posttraumatic cognitions in women veterans with PTSD from sexual trauma and abuse.

Holographic reprocessing (HR) facilitates holistic reappraisal of attributions regarding interpersonal violence and maltreatment. The authors tested the feasibility to train therapists to run a protocol using HR to reduce negative thoughts associated with posttraumatic stress disorder (PTSD) in women veterans who have had sexual trauma or abuse. The study assessed pre- and postscores on the Posttraumatic Cognitions Inventory (PTCI) in a naturalistic clinical setting with 5 therapists. The protocol consisted of screening for PTSD, followed by an average of 9 HR treatment sessions. Twenty-two women were referred to the study; 17 enrolled and completed treatment (0% dropout rate). Significant decreases were found on all scales of the PTCI, with large effect sizes: total negative thoughts, t(16) = 4.42, p     

Depression, PTSD, and suicidal ideation among active duty veterans in an integrated primary care clinic.

Active duty veterans increasingly access primary care for needed mental health services, but the relationship among depression, PTSD, and suicidal ideation in this subpopulation remains unclear. The relationship is explored in 120 active duty members treated in a military integrated primary care behavioral health service. Logistic regression analyses resulted in a significant relationship between PTSD and suicidal ideation, but this relationship was fully explained by depression symptoms. The interaction between depression and PTSD symptoms was likewise unrelated to suicidal ideation, and it did not improve overall model fit, suggesting that depression independently explained increased risk for suicidal ideation in the current sample. The authors discuss the differences between suicidal ideation and suicidal behaviors, and how depression and PTSD symptoms might differentially relate to each. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Sources and Types of Social Support in Youth Physical Activity.

This study examines the influence of sources and types of social support on youth physical activity. The sample comprised 372 youth (mean age = 12.05 years, SD = 1.63). Youth were 76% White and 50.3% female. The annual household income for the sample was 20% under $30,000; 30% $30,000-$49,999; 25% $50,000-$69,999; 13% $70,000-$89,999; and 12% $90,000 and above. Results revealed that friends who support and watch youth engage in activities are significantly and positively related to youth physical activity. Significant correlations existed among the type factors. Future research should examine the sources and nature of support and the mechanisms through which social support influences youth physical activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social Relationships and Health.

The author discusses 3 variables that assess different aspects of social relationships-social support, social integration, and negative interaction. The author argues that all 3 are associated with health outcomes, that these variables each influence health through different mechanisms, and that associations between these variables and health are not spurious findings attributable to our personalities. This argument suggests a broader view of how to intervene in social networks to improve health. This includes facilitating both social integration and social support by creating and nurturing both close (strong) and peripheral (weak) ties within natural social networks and reducing opportunities for negative social interaction. Finally, the author emphasizes the necessity to understand more about who benefits most and least from social-connectedness interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social Support and Social Strain Among Husbands and Wives: A Multilevel Analysis.

In response to recent calls in the literature for within-person examinations of social support processes over time, this study explores the relationships of spousal support, spousal strain, and well-being among husbands and wives, both within the same day and across days. Eighty-three couples were interviewed and completed a structured diary twice daily for 1 week. The results of multilevel hierarchical modeling suggest that both spousal support and spousal strain made significant, independent contributions to concurrent negative affect, although only spousal support was a significant predictor of next-day negative affect. Spousal strain interacted with spousal support to predict next-day negative affect. Direct and moderating effects of perceived marital adjustment on negative affect were discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couple adjustment and posttraumatic stress disorder symptoms in National Guard veterans of the Iraq war.

Relationship adjustment and posttraumatic stress disorder (PTSD) symptoms were assessed across two time points in a sample of 313 married or partnered National Guard soldiers recently returned from combat duty in Iraq. Structural equation modeling using a four-factor model for PTSD found the latent variable dysphoria (reflecting generalized distress including aspects of emotional numbing and arousal) had the strongest independent contribution to predicting relationship adjustment at Time 1 and indirectly predicted poorer relationship adjustment at Time 2. Exploratory analysis of gender differences (n = 33 women; n = 280 men) suggested a different pattern of relations between PTSD factors and relationship adjustment among female soldiers at Time 1, with a trend toward trauma specific avoidance being more highly related to relationship adjustment. Clinical and research implications are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Pretreatment predictors of dropout from cognitive behavioral therapy for PTSD in Iraq and Afghanistan war veterans.

Cognitive–behavioral therapies (CBTs) can be effective treatments for posttraumatic stress disorder (PTSD) but their effectiveness is limited by high rates of premature dropout. Few studies have compared pretreatment characteristics of treatment completers and dropouts, and only one has examined these factors in Operations Iraqi Freedom and Enduring Freedom (OIF/OEF) Veterans. This study analyzed archival clinical data from 117 OEF/OIF Veterans evaluated and treated through a Veterans Affairs PTSD clinic. High numbers dropped out of treatment (68%). Treatment dropouts (n = 79) and completers (n = 38) differed significantly on Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scales, PTSD symptom severity, and age. Regression analyses identified one MMPI-2 scale, TRT (negative treatment indicators), and age as unique but modest predictors of dropout. (PsycINFO Database Record (c) 2011 APA, all rights reserved)