Posttraumatic stress disorder following assault: The role of cognitive processing, trauma memory, and appraisals.

Two studies of assault victims examined the roles of (a) disorganized trauma memories in the development of posttraumatic stress disorder (PTSD), (b) peritraumatic cognitive processing in the development of problematic memories and PTSD, and (c) ongoing dissociation and negative appraisals of memories in maintaining symptomatology. In the cross-sectional study (n=81), comparisons of current, past, and no-PTSD groups suggested that peritraumatic cognitive processing is related to the development of disorganized memories and PTSD. Ongoing dissociation and negative appraisals served to maintain PTSD symptoms. The prospective study (n=73) replicated these findings longitudinally. Cognitive and memory assessments completed within 12-weeks postassault predicted 6-month symptoms. Assault severity measures explained 22% of symptom variance; measures of cognitive processing, memory disorganization, and appraisals increased prediction accuracy to 71%. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The structure of distress following trauma: Posttraumatic stress disorder, major depressive disorder, and generalized anxiety disorder.

The current report used confirmatory factor analysis to examine the latent structures of both key features and associated symptoms of three disorders that commonly develop following a traumatic event: posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD). Participants were 228 motor-vehicle accident survivors who sought treatment for emotional difficulties. PTSD, MDD, and GAD were assessed with a combination of self-report and interview-based measures. The results of construct level analyses suggested that PTSD, MDD, and GAD are distinguishable but highly correlated disorders following a traumatic event. Symptom level analyses supported a model where the Reexperiencing, Avoidance, and Hypervigilance factors were subsumed under the PTSD construct. However, in this model the Dysphoria factor was a higher order construct correlated with the PTSD, MDD, and GAD factors, suggesting that the Dysphoria cluster may not be unique to PTSD. Diagnostic and theoretical implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder patients' readiness to change alcohol and anger problems.

Notes that recovery from combat-related posttraumatic stress disorder (PTSD) is often complicated by unacknowledged problems with alcohol and anger. 102 males combat veterans (aged 42–63 yrs) entering a residential PTSD rehabilitation program completed University of Rhode Island Change Assessment and process-of-change questionnaires based on J. O. Prochaska and C. C. DiClemente's transtheoretical model (TTM; J. O. Prochaska et al, 1992). Separate assessments were made for alcohol abuse and anger control. Four motivational subtypes were identified for both problems. Motivation to change alcohol problems was independent of that for anger. Relative to less-motivated peers highly motivated patients were more like to spontaneously identify alcohol or anger as problems in their life and made greater use of change strategies specified by the TTM. These results support extension of the TTM to anger management and to PTSD management. Treatment implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and war-zone exposure as correlates of perceived health in female Vietnam war veterans.

Previous studies have identified traumatic exposure and posttraumatic stress disorder (PTSD) as predictors of physical health complaints without considering the relationship between exposure and PTSD. This study examined the unique associations of war-zone exposure and PTSD with perceived physical health outcomes in a nontreatment-seeking sample of 109 female veterans of the Vietnam War who responded to a series of psychological, exposure, and health questionnaires. Both PTSD and exposure were associated with reports of negative health outcomes when each variable was not adjusted for the other. The effects associated with exposure decreased when PTSD was controlled for, whereas the effects associated with PTSD remained when exposure was controlled for. Results suggest that effects of traumatic exposure on perceived health are partially mediated by increases in PTSD after exposure, supporting studies on the effects of stress on health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and standardized test-taking ability.

Given the widespread use and high-stakes nature of educational standardized assessments, understanding factors that affect test-taking ability in young adults is vital. Although scholarly attention has often focused on demographic factors (e.g., gender and race), sufficiently prevalent acquired characteristics may also help explain widespread individual differences on standardized tests. In particular, this article focuses on the role that posttraumatic stress symptoms (PSS) potentially play in standardized academic assessments. Using a military sample measured before and after exposure to war-zone stressors, the authors sought to explain test-taking ability differences with respect to symptoms of PTSD on two cognitive tasks that closely match standardized test constructs. The primary method for this analysis is based on an item response theory with covariates approach. Findings suggest that the effect for PSS is significant on both tasks, particularly for those who experience the highest levels of PSS following war-zone exposure. Findings provide potentially valuable information regarding the nature of the relationship between PSS and verbal and logical reasoning test performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and intimate relationship problems: A meta-analysis.

Objective: The authors conducted a meta-analysis of empirical studies investigating associations between indices of posttraumatic stress disorder (PTSD) and intimate relationship problems to empirically synthesize this literature. Method: A literature search using PsycINFO, Medline, Published International Literature on Traumatic Stress (PILOTS), and Dissertation Abstracts was performed. The authors identified 31 studies meeting inclusion criteria. Results: True score correlations (ρ) revealed medium-sized associations between PTSD and intimate relationship discord (ρ = .38, N = 7,973, K = 21), intimate relationship physical aggression perpetration (ρ = .42, N = 4,630, K = 19), and intimate relationship psychological aggression perpetration (ρ = .36, N = 1,501, K = 10). The strength of the association between PTSD and relationship discord was higher in military (vs. civilian) samples, and when the study was conducted in the United States (vs. other country), and the study represented a doctoral dissertation (vs. published article). The strength of the association between PTSD and physical aggression was higher in military (vs. civilian) samples, males (vs. females), community (vs. clinical) samples, studies examining PTSD symptom severity (vs. diagnosis), when the physical aggression measure focused exclusively on severe violence (vs. a more inclusive measure), and the study was published (vs. dissertation). For the PTSD–psychological aggression association, 98% of the variance was accounted for by methodological artifacts such as sampling and measurement error; consequently, no moderators were examined in this relationship. Conclusions: Findings highlight a need for the examination of models explaining the relationship difficulties associated with PTSD symptomatology and interventions designed to treat problems in both areas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and the genetic structure of comorbidity.

This study used structural equation modeling to examine the genetic and environmental architecture of latent dimensions of internalizing and externalizing psychiatric comorbidity and explored structural associations between posttraumatic stress disorder (PTSD) and these dimensions. Data were drawn from the Vietnam Era Twin Registry and included lifetime diagnoses for PTSD and a range of other psychiatric disorders for 3,372 male–male twin pairs. Examination of the phenotypic structure of these disorders revealed that PTSD cross-loaded on both Internalizing and Externalizing common factors. Biometric analyses suggested largely distinct genetic risk factors for the latent internalizing and externalizing comorbidity dimensions, with the total heritability of the Externalizing factor (69%) estimated to be significantly stronger than that for Internalizing (41%). Nonshared environment explained the majority of the remaining variance in the Internalizing (58%) and Externalizing (20%) factors. Shared genetic variance across the 2 dimensions explained 67% of their phenotypic correlation (r = .52). These findings have implications for conceptualizations of the etiology of PTSD and its location in an empirically based nosology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder: Silent problem among older combat veterans.

Examines posttraumatic stress disorder (PTSD) among older Vietnam combat veterans. It is suggested that PTSD among these veterans is generally chronic, silent, and exacerbated by the problems of aging. These Ss with PTSD can be divided into those with full PTSD and those with partial PTSD. Studies are cited showing prevalence rates for PTSD. The difficulties in measuring PTSD are described. Several moderating variables influence the expression of trauma problems at later life, including the presence of other stressors, health status, social support, and comorbidity. Several forms of therapy are considered, including cognitive behavioral therapy, reminiscence, and relaxational desensitization. Also, several treatment suggestions are given, advocating interventions of a stuck narrative in an aging population. (PsycINFO Database Record (c) 2010 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 validation of a self-report measure of posttraumatic stress disorder: The Posttraumatic Diagnostic Scale.

The present article reports on the development and validation of a self-report measure of posttraumatic stress disorder (PTSD), the Posttraumatic Diagnostic Scale (PTDS), that yields both a PTSD diagnosis according to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994 DSM-IV) criteria and a measure of PTSD symptom severity. Two-hundred forty-eight participants who had experienced a wide variety of traumas (e.g., accident, fire, natural disaster, assault, combat) were administered the PTSD module of the Structured Clinical Interview (SCID; Spitzer, Williams, Gibbons, & First, 1990), the PTDS, and scales measuring trauma-related psychopathology. The PTDS demonstrated high internal consistency and test-retest reliability, high diagnostic agreement with SCID, and good sensitivity and specificity. The satisfactory validity of the PTDS was further supported by its high correlations with other measures of trauma-related psychopathology. Therefore, the PTDS appears to be a useful tool for screening and assessing current PTSD in clinical and research settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder following the September 11, 2001, terrorist attacks: A review of the literature among highly exposed populations.

The September 11, 2001 (9/11), terrorist attacks were unprecedented in their magnitude and aftermath. In the wake of the attacks, researchers reported a wide range of mental and physical health outcomes, with posttraumatic stress disorder (PTSD) the one most commonly studied. In this review, we aim to assess the evidence about PTSD among highly exposed populations in the first 10 years after the 9/11 attacks. We performed a systematic review. Eligible studies included original reports based on the full Diagnostic and Statistical Manual of Mental Disorders (4th ed., rev.; American Psychiatric Association, 2000) criteria of PTSD among highly exposed populations such as those living or working within close proximity to the World Trade Center (WTC) and the Pentagon in New York City and Washington, DC, respectively, and first responders, including rescue, cleaning, and recovery workers. The large body of research conducted after the 9/11 attacks in the past decade suggests that the burden of PTSD among persons with high exposure to 9/11 was substantial. PTSD that was 9/11-related was associated with a wide range of correlates, including sociodemographic and background factors, event exposure characteristics, loss of life of significant others, and social support factors. Few studies used longitudinal study design or clinical assessments, and no studies reported findings beyond six years post-9/11, thus hindering documentation of the long-term course of confirmed PTSD. Future directions for research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Posttraumatic stress disorder and drug disorders: testing causal pathways

BACKGROUND: Although there is a high degree of comorbidity between posttraumatic stress disorder (PTSD) and drug use disorders, little is known about causal relationships between PTSD, exposure to traumatic events, and drug use disorders. METHODS: In a longitudinal study in southeast Michigan, 1007 adults aged 21 to 30 years were initially assessed in 1989 and were followed up 3 and 5 years later, in 1992 and 1994. Psychiatric disorders according to DSM-III-R criteria were measured by the National Institute of Mental Health Diagnostic Interview Schedule. To take into account temporal sequencing, the associations between PTSD, traumatic events, and drug use disorders were analyzed by using Cox proportional hazards models with time-dependent covariates. RESULTS: Posttraumatic stress disorder signaled an increased risk of drug abuse or dependence (hazards ratio, 4.5; 95% confidence interval, 2.6-7.6, adjusted for sex), whereas exposure to traumatic events in the absence of PTSD did not increase the risk of drug abuse or dependence. The risk for abuse or dependence was the highest for prescribed psychoactive drugs (hazards ratio, 13.0; 95% confidence interval, 5.3-32.0). There was no evidence that preexisting drug abuse or dependence increased the risk of subsequent exposure to traumatic events or the risk of PTSD after traumatic exposure. CONCLUSION: The results suggest that drug abuse or dependence in persons with PTSD might be the inadvertent result of efforts to medicate symptoms, although the possibility of shared vulnerability to PTSD and drug use disorders cannot be ruled out.     

Mental health of Somali adolescent refugees: The role of trauma, stress, and perceived discrimination.

The primary purpose of this study was to examine relations between trauma exposure, post-resettlement stressors, perceived discrimination, and mental health symptoms in Somali adolescent refugees resettled in the U.S. Participants were English-speaking Somali adolescent refugees between the ages of 11 and 20 (N = 135) who had resettled in the U.S. Participants were administered an interview battery comprising self-report instruments that included the UCLA Posttraumatic Stress Disorder (PTSD) Index, the War Trauma Screening Scale, the Every Day Discrimination scale, the Adolescent Post-War Adversities Scale, and the Acculturative Hassles Inventory. Results indicated that cumulative trauma was related to PTSD and depression symptoms. Further, post-resettlement stressors, acculturative stressors, and perceived discrimination were also associated with greater PTSD symptoms after accounting for trauma, demographic, and immigration variables. Number of years since resettlement in the US and perceived discrimination were significantly related to depressive symptoms, after accounting for trauma, demographic, and immigration variables. Further research elucidating the relations between post-resettlement stressors, discrimination, and mental health of refugee adolescents may inform intervention development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and substance abuse relapse among women: A pilot study.

The authors compared substance-dependent women with and without a comorbid diagnosis of posttraumatic stress disorder (PTSD) on their alcohol and drug use after inpatient substance abuse treatment. Participants were 31 women with a diagnosed substance dependence disorder. Forty-two percent of the entire sample (n?=?13) met DSM-III—R criteria for current PTSD. Follow-up interviews revealed that approximately 70% of the women relapsed during the 3 months posttreatment. Although rates of relapse did not significantly differ by PTSD status, PTSD women were found to relapse more quickly than non-PTSD women. Although preliminary, study findings suggest that the presence of PTSD among substance-dependent women may have prognostic significance as well as important treatment implications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and retrospectively reported stressor exposure: A longitudinal prediction model.

There has been recent concern about the degree to which posttraumatic stress disorder (PTSD) symptomatology influences reports of prior exposure to highly stressful life events. In this longitudinal study of 2,942 male and female Gulf War veterans, the authors documented change in stressor reporting across 2 occasions and the association between change and PTSD symptom severity. A regression-based cross-lagged analysis was used to examine the relationship between PTSD symptom severity and later reported stressor exposure. Shifts in reporting over time were modestly associated with PTSD symptom severity. The cross-lagged analysis revealed a marginal association between Time 1 PTSD symptom severity and Time 2 reported stressor exposure for men and suggested that later reports of stressor exposure are primarily accounted for by earlier reports and less so by earlier PTSD symptomatology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder among U.S. Army reservists: Comment on Stretch.

Stretch (1985) presented questionnaire data from an epidemiologic study concerning posttraumatic stress disorder (PTSD) among U.S. Army Reserve Vietnam and Vietnam-era veterans. Results indicated a lower prevalence rate of PTSD symptoms among reservists than that among civilian Vietnam veterans but a higher rate than that among active duty veterans. These results were interpreted as supportive of the hypothesis that reservists received more social support due to their continuing affiliation, thereby moderating the presence of PTSD within this population. Due to various methodological problems within that investigation, it is suggested that such an interpretation remains empirical. (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)     

Posttraumatic stress disorder and cannabis use in a nationally representative sample.

The present study examined the relations between posttraumatic stress disorder (PTSD) and cannabis use in a large representative survey of adults (N = 5,672) from the United States (Kessler et al., 2004). After adjusting for sociodemographic variables (i.e., age, marital status, ethnicity, education, income, and sex), alcohol use disorders, and nicotine dependence, lifetime and current (past year) PTSD diagnoses were associated with increased odds of lifetime history of cannabis use as well as past year daily cannabis use. Lifetime, but not current, PTSD diagnosis also was uniquely associated with increased risk for any past year cannabis use. Additional analyses revealed that the relations between PTSD (lifetime and current) and lifetime cannabis use remained statistically significant when adjusting for co-occurring anxiety and mood disorders and trauma type frequency. Overall, these findings add to the emerging literature demonstrating a possibly important relationship between PTSD and cannabis use. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The role of defeat and entrapment in depression, anxiety, and suicide.

Defeat and entrapment are psychological constructs that have played a central role in evolutionary accounts of depression. These concepts have since been implicated in theoretical accounts of anxiety disorders and suicidality. The current article reports on a systematic review of the existing research investigating the links among defeat, entrapment, and psychopathology in the domains of depression, suicidality, posttraumatic stress disorder (PTSD), and other anxiety syndromes. Fifty-one original research articles were identified and critically reviewed. There was strong convergent evidence for a link with depressive symptoms, across a variety of clinical and nonclinical samples. Preliminary support for an association with suicidality was also observed, with effects not readily explainable in terms of comorbid depression. There was strong evidence for an association between defeat and PTSD, although this may have been partly accounted for by comorbid depression. The findings for other anxiety disorders were less consistent. There was, however, evidence that social anxiety in individuals with psychosis may be related to perceptions of entrapment. Overall, there was evidence that perceptions of defeat and entrapment were closely associated with various forms of human psychopathology. These effects were often in the moderate to large range and superseded the impact of other environmental and psychological stressors on psychopathology. We provide a unified theoretical model of how defeat and entrapment may contribute to these different psychopathological conditions. Clinical implications and avenues for future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)