Arousal, numbing, and intrusion: symptom structure of PTSD following assault

OBJECTIVE: This study investigated hypotheses concerning the importance of symptoms of numbing in posttraumatic stress disorder (PTSD). METHODS: Symptoms of PTSD were assessed in 72 female rape victims and 86 female victims of nonsexual assault approximately 3 months after the crimes occurred. A principal-components factor analysis of subjects' symptoms was then undertaken. RESULTS: The analysis yielded three factors: arousal/avoidance, numbing, and intrusion. These were somewhat different from the symptom clusters in DSM-III-R, since effortful avoidance and numbing symptoms did not load on the same factor. Numbing symptoms appeared to be particularly important in identifying individuals with PTSD. CONCLUSIONS: The results imply that there are two patterns of posttrauma symptoms, one characterizing PTSD and the second characterizing a phobic reaction.     

Family functioning predicts outcomes for veterans in treatment for chronic posttraumatic stress disorder.

A longitudinal framework was used to examine the competing hypotheses of (a) whether family functioning predicts changes in posttraumatic stress disorder (PTSD) symptoms or (b) whether PTSD symptoms predict changes in family functioning. Veterans (N = 311) admitted to a treatment program completed a series of questionnaires at 3 time points: at intake, from intake to completion of a treatment program, and at the 6-month follow-up. Alcohol use and general mental health symptoms were also measured at intake. A cross-lagged panel model using structural equation modeling analyses indicated that family functioning was a moderate predictor of PTSD symptoms at posttreatment and at the 6-month follow-up. PTSD was not a significant predictor of family functioning across time and alcohol use, and general mental health symptoms did not affect the overall findings. Further analyses of PTSD symptom clusters indicated that the avoidance symptom cluster was most strongly related to family functioning. Targeting family relationships for treatment may be important in the future for veterans with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder symptoms, physiological reactivity, alcohol problems, and aggression among military veterans.

This study examined the association between posttraumatic stress disorder (PTSD) symptomatology and aggressive behavior among a sample of male Vietnam veterans (N = 1,328). Results indicated that the hyperarousal PTSD symptom cluster evidenced the strongest positive association with aggression at the bivariate level when compared with the other PTSD symptom clusters. When the PTSD symptom clusters were examined together as predictors, hyperarousal symptoms evidenced a significant positive relationship with aggression, and avoidance/numbing symptoms were negatively associated with aggression. Examination of potential mediators indicated that hyperarousal symptoms were directly associated with aggression and indirectly related to aggression via alcohol problems. Reexperiencing symptoms were associated with aggression only indirectly and through their positive association with physiological reactivity and negative association with alcohol problems. Study results highlight the complexity of the relationship between PTSD symptoms and aggression, and suggest possible mechanisms explaining this association. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between acute stress disorder and posttraumatic stress disorder: A prospective evaluation of motor vehicle accident survivors.

Motor vehicle accident survivors (n?=?92) were assessed for acute stress disorder (ASD) within 1 month of the trauma and reassessed (n?=?71) for posttraumatic stress disorder (PTSD) 6 months posttrauma. ASD was diagnosed in 13% of participants, and a further 21% had subclinical levels of ASD. At follow-up, 78% of ASD participants and 60% of subclinical ASD participants met criteria for PTSD. The strong predictive power of acute numbing, depersonalization, a sense of reliving the trauma, and motor restlessness, in contrast to the low to moderate predictive power of other symptoms, indicates that only a subset of ASD symptoms is strongly related to the development of chronic PTSD. Although these findings support the use of the ASD diagnosis, they suggest that the dissociative and arousal clusters may require revision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive symptoms of psychosis in posttraumatic stress disorder

The possible presence of hallucinations and delusional thoughts in posttraumatic stress disorder (PTSD) was investigated. Other symptom clusters were also assessed in order to further clarify the nature of PTSD. Twenty combat veterans with PTSD were compared to 18 combat veterans without PTSD on symptom rating scales. The subjects with PTSD exhibited a greater degree of depression, anxiety, agitation, anhedonia, and positive symptoms of psychosis than the comparison group. Specifically, the PTSD group manifested increased hallucinations, delusions, and bizarre behavior. Some of these positive symptoms did not appear to be due to reexperiencing of the trauma. The groups were not significantly different on indices of mania, thought disorder, or inertia. The clinical and diagnostic implications of the results are discussed. A diagnosis of PTSD should be considered with patients who have positive symptoms in the absence of thought disorder.     

Dimensionality of posttraumatic stress disorder symptoms in children exposed to disaster: Results from confirmatory factor analyses.

Factor analytic studies of trauma victims' posttraumatic stress disorder (PTSD) have offered conflicting hypotheses about how to conceptualize PTSD into symptom categories. The present study used confirmatory factor analyses of self-reported PTSD symptomatology from 5,664 child and adolescent victims of Hurricane Hugo to compare 10 models of PTSD dimensionality. PTSD was best represented by a 2nd-order PTSD factor that manifests in 3 symptom clusters (Intrusion/Active Avoidance, Numbing/Passive Avoidance, and Arousal). This model was cross-validated on 3 age groups (late childhood, early adolescence, and late adolescence), and results indicated factorial invariance across groups. PTSD symptoms varied in relative centrality to the underlying dimensions of PTSD, which differed in their relations with anxiety and degree of traumatic exposure. Implications for classification criteria and an empirically supported theory of PTSD are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Key Elements in Couples Therapy With Veterans With Combat-Related Posttraumatic Stress Disorder.

If a client dealing with combat-related posttraumatic stress disorder (PTSD) presents for psychotherapy, should you consider including his or her partner in treatment? How could couples therapy be beneficial? What framework do you have to conceptualize the relational issues and potential treatment? Although clinicians have long been encouraged to include families in the treatment of combat-related PTSD, few specific couple-family therapies exist, and outcome research is scarce. Because of the adverse effects of PTSD on relationships, couples therapy can be a powerful adjunct treatment; however, few receive this service. A new framework for conceptualizing couples therapy organizes treatment around the 3 PTSD symptom clusters (reexperiencing, avoidance, and arousal). Relationship consequences of each symptom cluster are summarized, followed by useful treatment interventions and a case study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Functional associations among trauma, PTSD, and substance-related disorders

This review article presents several potential functional pathways which may explain the frequent co-occurrence of PTSD and substance abuse disorders in traumatized individuals. Emerging empirical studies which have examined these potential pathways are reviewed, including studies on relative order of onset, PTSD patients' perceptions of various drug effects, comparisons of PTSD patients with and without comorbid substance use disorders, and correlational studies examining the relations between severity of specific PTSD symptom clusters and substance disorder symptoms. Research on the acute and chronic effects of alcohol and other drugs on cognitive and physiological variables relevant to PTSD intrusion and arousal symptoms is reviewed to highlight ways in which these two sets of PTSD symptoms might be functionally interrelated with substance abuse. Finally, based on these findings, recommendations are made for the treatment of individuals with comorbid PTSD-substance use disorders.     

Meal patterns in the SENECA study of nutrition and the elderly in Europe: assessment method and preliminary results on the role of the midday meal

This study compared the acute stress disorder and post-traumatic stress disorder (PTSD) symptom profiles in motor vehicle accident survivors who sustained a mild traumatic brain injury (MTBI) or no TBI. Consecutive adult patients who sustained a MTBI (n = 79) and no TBI (n = 92) were assessed for acute stress disorder within 1 month of their trauma and reassessed for PTSD (MTBI: n = 63; non-TBI; n = 72) 6-months post-trauma. Comparable rates of acute stress disorder and PTSD were reported in MTBI and non-TBI patients. Intrusive memories and fear and helplessness in response to the trauma were reported less frequently by MTBI than non-TBI patients at the acute phase. Six-months post-trauma fewer MTBI patients than non-TBI reported fear and helplessness in response to the trauma. These findings suggest that, whereas impaired consciousness at the time of a trauma may reduce the frequency of traumatic memories in the initial month post-trauma, MTBI does not result in a different profile of longer-term PTSD.     

Acute stress disorder: a critical review of diagnostic issues

Acute stress disorder (ASD) is a recently developed diagnosis that describes posttraumatic stress reactions that occur in the first month following a trauma. Diagnostic criteria include dissociative, intrusive, avoidance, and arousal symptoms. ASD was driven by the proposal that trauma leads to dissociative reactions, and these are predictive of longer-term psychopathology. This paper reviews a series of anomalies in the diagnostic criteria, highlights discrepancies between criteria for ASD and posttraumatic stress disorder (PTSD), and illustrates the lack of empirical evidence for some assumptions inherent in the conceptualization of ASD. It is argued that future revisions of ASD criteria need to be based on empirical evidence of acutely traumatized individuals.     

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)     

Electroconvulsive shocks exacerbate the heightened acoustic startle response in stressed rats.

Electroconvulsive therapy (ECT) has been successfully used in the treatment of depression, particularly when the illness is refractory to pharmacological therapy. A recent study has shown that ECT is also effective in reducing both depressive and posttraumatic stress disorder (PTSD) symptoms in patients with major depression (MDD) and co-occurring PTSD. This raises the possibility that ECT might be effective in the treatment of PTSD, a disease whose prevalence has increased substantially in recent years. A characteristic symptom of PTSD is an exaggerated reactivity to startling sounds (acoustic startle response; ASR). In the present study, we investigated the effects of electroconvulsive shocks (ECS) on the ASR, in a rat model of traumatic stress. The animals were subjected to a restraint/tailshock paradigm and then administered ECS. ASR measurements were obtained at several time points following ECS administration. Although ECS had no effect in control rats, it significantly exacerbated the already potentiated ASR in the stressed group. While ECT may prove to be an effective treatment for certain symptoms of co-occurring MDD/PTSD or PTSD alone, it may exacerbate heightened arousal associated with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress symptoms mediate the relation between childhood sexual abuse and nonsuicidal self-injury.

Prior research consistently has shown a strong relation between childhood abuse and nonsuicidal self-injury (NSSI), yet it is unclear why this relation exists. The authors examined 2 specific posttraumatic stress disorder (PTSD) symptom clusters as potential mechanisms through which childhood abuse may be related to NSSI. Participants were 86 adolescents (78% female, 22% male; 73% Caucasian, 27% other races/ethnicities; mean age = 17.03 years, range = 12-19 years) who completed measures of childhood abuse, Diagnostic and Statistical Manual of Mental Disorders (4th ed.) PTSD symptoms, and NSSI. Analyses revealed a significant relation between childhood sexual abuse in particular and the presence and frequency of NSSI. Moreover, data supported a theoretical model in which PTSD reexperiencing and avoidance/numbing symptoms independently mediate this relation. Future research must test the temporal relation between childhood sexual abuse, PTSD symptoms, and NSSI and identify additional pathways to engagement in NSSI. (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)     

Unresolved attachment, PTSD, and dissociation in women with childhood abuse histories.

The primary objective of this study was to examine unresolved trauma as assessed by the Adult Attachment Interview and current psychiatric symptoms, focusing on posttraumatic stress disorder (PTSD) and dissociation, in a group of adult female childhood abuse survivors. The authors examined psychiatric symptoms and attachment representations in a group with (n = 30) and without (n = 30) abuse-related PTSD. The findings revealed that unresolved trauma carried a 7.5-fold increase in the likelihood of being diagnosed with PTSD and was most strongly associated with PTSD avoidant symptoms rather than dissociative symptoms. The utility of a PTSD framework for understanding unresolved trauma and the role of intentional avoidance of trauma cues in the maintenance of traumatized states of mind are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and anxious and fearful reactivity to bodily arousal: A test of the mediating role of nicotine withdrawal severity among daily smokers in 12-hr nicotine deprivation.

Posttraumatic stress disorder (PTSD) is associated with high rates of smoking and fear of bodily perturbation. The current study examined the role of nicotine withdrawal in the association between PTSD and responding to bodily arousal among 52 participants (27 women; Mage = 30.50 years). Compared to participants without current axis I psychopathology, persons with current PTSD responded to a 3-min voluntary hyperventilation procedure with greater increases in anxiety and more intense cognitive and physical panic symptoms, despite no group differences in physiological arousal. Nicotine withdrawal demonstrated significant mediational effects in the relations between diagnostic group and panic symptoms elicited by the hyperventilation procedure. Findings suggest nicotine withdrawal is an important factor to consider in terms of better understanding the nature of fear responding to bodily sensations among persons with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of psychophysiological arousal, acute stress disorder, and posttraumatic stress disorder.

This study investigated the role of acute arousal in the development of posttraumatic stress disorder (PTSD). Hospitalized motor-vehicle-accident survivors (n?=?146) were assessed for acute stress disorder (ASD) within 1 month of the trauma and were reassessed (n?=?113) for PTSD 6 months posttrauma. Heart rate (HR) and blood pressure (BP) were assessed on the day of hospital discharge. Participants with subclinical ASD had higher HR than those with ASD and no ASD. Participants who developed PTSD had higher HR in the acute posttrauma phase than those without PTSD. Diagnosis of ASD and resting HR accounted for 36% of the variance of the number of PTSD symptoms. A formula composed of a diagnosis of ASD or a resting HR of >90 beats per minute possessed strong sensitivity (88%) and specificity (85%) in predicting PTSD. These findings are discussed in terms of acute arousal and longer term adaptation to trauma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Event-related potentials to stimuli with emotional impact in posttraumatic stress patients

BACKGROUND: Psychophysiological research has given conflicting results with respect to whether the abnormal physiologic responses observed in posttraumatic stress disorder (PTSD) reflect a general abnormality or are linked to trauma-related stimuli. We studied differences in the central nervous processing of words with emotional impact in survivors after a ship fire disaster. METHODS: Event-related potentials were studied in 11 survivors with posttraumatic stress pathology, and compared with 9 survivors without such pathology. Nonwords and words with negative or positive emotional valence were used as distractors in a P3 oddball paradigm. RESULTS: PTSD subjects had increased N1 latency to standard tones and increased positive amplitude to both words and nonwords compared with controls, occurring between 200 and 350 msec after stimulus onset. The amplitudes to emotionally meaningful words were significantly related to Clinician-Administered PTSD Scale-assessed PTSD dimensions, in particular avoidance and arousal. CONCLUSIONS: The abnormality in information processing observed in PTSD patients seems in part to be linked with increased attention, in part with emotional responses to the trauma. Intrusion was mainly related to the processing of nonwords, while arousal and avoidance were related to event-related potential amplitudes to emotionally meaningful words, suggesting that intrusion has a different neurobiological basis than arousal and avoidance.     

Trauma reactivity, avoidant coping, and PTSD symptoms: A moderating relationship?

In the immediate aftermath of a traumatic event, many individuals experience physiological reactivity in response to reminders of the traumatic event that typically lessens over time. However, an overreliance on avoidant coping strategies may interfere with the natural recovery process, particularly for those who are highly reactive to trauma reminders. In the current investigation, we examined avoidant coping as a moderator of the association between heart rate reactivity to a trauma monologue measured shortly after a traumatic event and severity of posttraumatic stress disorder (PTSD) symptoms measured several months later. Fifty-five female survivors of assault completed PTSD diagnostic interviews and a self-report coping measure and participated in a trauma monologue procedure that included continuous heart rate measurement. These procedures were completed within 1 month of the assault and again 3 months postassault. After we controlled for the effect of initial symptom levels, the interaction of heart rate reactivity to the trauma monologue and avoidant coping measured at Time 1 was associated with PTSD symptom severity at Time 2. Individuals who are relatively highly reliant on avoidant coping strategies and relatively highly reactive to trauma reminders may be at greatest risk of maintaining or potentially increasing their PTSD symptoms within the first few months following the trauma. These findings may help inform early intervention efforts for survivors of traumatic events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Directed forgetting following mood induction in chronic posttraumatic stress disorder patients.

Current research of posttrauma sequelae suggests that intrusive rather than avoidant-dissociative models more accurately represent the encoding processes of trauma cues. However, posttraumatic stress disorder (PTSD) is often conceptualized as a phasic phenomenon, altering between arousal and avoidance states. The failure to support a relationship between avoidant encoding style and PTSD may reflect this alteration. To explore this hypothesis, participants with PTSD and controls (no PTSD) completed an item-cued directed-forgetting task, following either a dissociative or a serenity (control) mood induction. Results suggested that, following the serenity induction, a standard directed-forgetting effect was observed. However, following the dissociation induction, this effect was not observed. The role of dissociation in impairing encoding via lack of selective rehearsal or source discrimination is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)