Marital relations among former prisoners of war: Contribution of posttraumatic stress disorder, aggression, and sexual satisfaction.

In this study, the authors examined the marital adjustment, spousal aggression, and sexual satisfaction of prisoners of war (POWs) 3 decades after their release. More specifically, the authors examined the extent to which impaired marital relations among former POWs are an outcome of their captivity or of the posttraumatic stress disorder (PTSD) that some of them developed. The authors compared 25 former POWs with PTSD, 85 former POWs without PTSD, and 104 control veterans. The findings reveal that the marital problems of former POWs are more related to PTSD than to their captivity. PTSD is related to decreased marital satisfaction, increased verbal aggression, and heightened sexual dissatisfaction among former 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)     

PTSD among Israeli former prisoners of war and soldiers with combat stress reaction: a longitudinal study

OBJECTIVE: The aim of this study was to assess the long-term impact of war captivity and combat stress reaction on rates of posttraumatic stress disorder (PTSD) in Israeli veterans of the 1973 Yom Kippur war. METHOD: One hundred sixty-four former prisoners of war (POWs), 112 veterans who had had combat stress reaction, and 184 combat veteran comparison subjects filled out the PTSD Inventory, a self-report scale based on the DSM-III-R criteria for PTSD. The inventory diagnoses past and present PTSD, assesses its intensity, and provides a symptom profile. RESULTS: Thirty-seven percent of the veterans who had had combat stress reaction, 23% of the former POWs, and 14% of the comparison subjects had had diagnosable PTSD at some time in the past. The current rates were 13%, 13%, and 3%, respectively. The results showed different recovery rates over time: almost two-thirds of the veterans with combat stress reaction who had had PTSD in the past recovered, while less than one-half of the POW group showed this improvement. CONCLUSIONS: These findings indicate that small but significant proportions of the POWs and veterans with combat stress reaction were still suffering from PTSD almost two decades after the war. The different recovery rates in the two groups may reflect the differences in duration and severity of stressors, the impact of immediate intervention on long-term adjustment, or both.     

Psychological assessment of aviators captured in World War II.

Psychological assessments, including administration of the Minnesota Multiphasic Personality Inventory (MMPI) and structured interviews for Axis I mental disorders and posttraumatic stress disorder (PTSD) specifically, were used to describe 33 World War II (WWII) aviators who were held as prisoners of war (POWs) for an average of 14 months. Results showed more elevated MMPI profile patterns than expected given previous research with pilots (J. N. Butcher, 1994) and rates of current and lifetime PTSD at 33%, reasoned to derive from POW trauma. Despite this level of psychopathology, WWII aviator POW survivors were found to be more resilient to captivity effects than age-similar nonaviator WWII POW survivors characterized generally by less advantages in education, military rank, and other personal resources. Compared with aviator former POWs of the Vietnam War studied in their mid-life years (R. J. Ursano et al, 1981), the present sample appeared to be less psychologically robust. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder in a community group of former prisoners of war: a normative response to severe trauma

OBJECTIVE: The goal of this study was to assess and describe the long-term impact of traumatic prisoner of war (POW) experiences within the context of posttraumatic psychopathology. Specifically, the authors attempted to investigate the relative degree of normative response represented by posttraumatic stress disorder (PTSD) in comparison to other DSM axis I disorders often found to be present, either alone or concomitant with other disorders, in survivors of trauma. METHOD: A community group of 262 U.S. World War II and Korean War former POWs was recruited. These men had been exposed to the multiple traumas of combat, capture, and imprisonment, yet few had ever sought mental health treatment. They were assessed for psychopathology with diagnostic interviews and psychodiagnostic testing. Regression analyses were used to assess the contributions of age at capture, war trauma, and postwar social support to PTSD and the other diagnosed disorders. RESULTS: More than half of the men (53%) met criteria for lifetime PTSD, and 29% met criteria for current PTSD. The most severely traumatized group (POWs held by the Japanese) had PTSD lifetime rates of 84% and current rates of 59%. Fifty-five percent of those with current PTSD were free from the other current axis I disorders (uncomplicated PTSD). In addition, 34% of those with lifetime PTSD had PTSD as their only lifetime axis I diagnosis. Regression analyses indicated that age at capture, severity of exposure to trauma, and postmilitary social support were moderately predictive of PTSD and only weakly predictive of other disorders. CONCLUSIONS: These findings indicate that PTSD is a persistent, normative, and primary consequence of exposure to severe trauma.     

Clinical assessment of long-term cognitive and emotional sequelae to World War II prisoner-of-war confinement: Comparison of pilot twins.

Assessed late-life psychological outcomes of World War II flight combat exposure among identical-twin pilots raised, educated, and trained together but discordant for combat exposure and war imprisonment, using twin study methodology. It was hypothesized that the prisoner of war (POW) survivor would exhibit psychopathology attributable, in part, to nonshared environmental events, specifically war trauma. Differences were evident in reported psychological symptoms, MMPI profile patterns, psychiatric diagnoses, and intellectual performances. Assigned a lifetime diagnosis of posttraumatic stress disorder (PTSD), the former POW showed deficits in visuospatial analysis and organization, planning, impulse control, concept formation, and nonverbal memory. Results may be used to enhance understanding of measurement of stress-related symptoms among robust and well-trained servicemen. (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)     

Neurocognitive function in monozygotic twins discordant for combat exposure: Relationship to posttraumatic stress disorder.

Neuropsychological deficits have been reported among trauma survivors with posttraumatic stress disorder (PTSD). It is often assumed that these cognitive difficulties are toxic consequences of trauma exposure. Alternatively, they may reflect preexisting characteristics that contribute to the likelihood of developing PTSD. To address this possibility, the authors evaluated cognitive performance in monozygotic twin pairs who were discordant for combat exposure. Pairs were grouped according to whether the combat-exposed brother developed PTSD. The combat-unexposed cotwins of combat veterans with PTSD largely displayed the same performance as their brothers, which was significantly lower than that of non-PTSD combat veterans and their brothers. The results support the notion that specific domains of cognitive function may serve as premorbid risk or protective factors in PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of immediate-onset and delayed-onset posttraumatic stress disorder in military veterans.

Differences in symptoms, trauma exposure, dissociative and emotional reactions to trauma, and subsequent life stress in war veterans reporting immediate-onset or delayed-onset posttraumatic stress disorder (PTSD) or no PTSD were investigated. The role of life stress in delayed-onset PTSD was also studied. Retrospective interviews were conducted with 142 United Kingdom veterans receiving a war pension for PTSD or physical disability. Immediate-onset and delayed-onset PTSD were similar in the number and type of symptoms reported at onset, but the delayed-onset group differed in showing a gradual accumulation of symptoms that began earlier and continued throughout their military career. They were more likely to report major depressive disorder and alcohol abuse prior to PTSD onset. Both groups described similar amounts of trauma exposure, but those in the delayed-onset group reported significantly less peritraumatic dissociation, anger, and shame. Veterans with delayed onsets were more likely than veterans with no PTSD to report the presence of a severe life stressor in the year before onset. In conclusion, the results suggest that delayed onsets involve a more general stress sensitivity and a progressive failure to adapt to continued stress exposure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic Stress Disorder and Current Relationship Functioning Among World War II Ex-Prisoners of War.

This study examined the association of posttraumatic stress disorder (PTSD) with the quality of intimate relationships among present-day male World War II ex-prisoners of war (POWs). Ex-POWs had considerable marital stability; those with PTSD were no less likely to be in an intimate relationship. Ex-POWs in an intimate relationship who had PTSD (N=125 ) were compared with ex-POWs in a relationship who did not have PTSD (N=206). Marital functioning was within a range expected for persons without traumatic exposure. Yet, over 30% of those with PTSD reported relationship problems compared with only 11% of those without PTSD. Ex-POWs with PTSD reported poorer adjustment and communication with their partners and more difficulties with intimacy. Emotional numbing was significantly associated with relationship difficulties independent of other symptom complexes and severity of PTSD. Implications for clinical practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Complex Trauma, Complex Reactions: Assessment and Treatment.

Complex trauma occurs repeatedly and escalates over its duration. In families, it is exemplified by domestic violence and child abuse and in other situations by war, prisoner of war or refugee status, and human trafficking. Complex trauma also refers to situations such as acute/chronic illness that requires intensive medical intervention or a single traumatic event that is calamitous. Complex trauma generates complex reactions, in addition to those currently included in the DSM-IV (American Psychiatric Association, 1994) diagnosis of posttraumatic stress disorder (PTSD). This article examines the criteria contained in the diagnostic conceptualization of complex PTSD (CPTSD). It reviews newly available assessment tools and outlines a sequenced treatment based on accumulated clinical observation and emerging empirical substantiation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Peritraumatic dissociation and posttraumatic stress in male Vietnam theater veterans

OBJECTIVE: The aim of this study was to determine the reliability and validity of a proposed measure of peritraumatic dissociation and, as part of that effort, to determine the relationship between dissociative experiences during disturbing combat trauma and the subsequent development of posttraumatic stress disorder (PTSD). METHOD: A total of 251 male Vietnam theater veterans from the Clinical Examination Component of the National Vietnam Veterans Readjustment Study were examined to determine the relationship of war zone stress exposure, retrospective reports of dissociation during the most disturbing combat trauma events, and general dissociative tendencies with PTSD case determination. RESULTS: The total score on the Peritraumatic Dissociation Experiences Questionnaire--Rater Version was strongly associated with level of posttraumatic stress symptoms, level of stress exposure, and general dissociative tendencies and weakly associated with general psychopathology scales from the MMPI-2. Logistic regression analyses supported the incremental value of dissociation during trauma, over and above the contributions of level of war zone stress exposure and general dissociative tendencies, in accounting for PTSD case determination. CONCLUSIONS: These results provide support for the reliability and validity of the Peritraumatic Dissociation Experiences Questionnaire--Rater Version and for a trauma-dissociation linkage hypothesis: the greater the dissociation during traumatic stress exposure, the greater the likelihood of meeting criteria for current PTSD.     

Attachment deficits, personality structure, and PTSD.

Comments on an article by P. Verhaeghe and S. Vanheule (see record 2006-00627-003). The question surrounding etiological factors informing the emergence of posttraumatic stress disorder (PTSD) due to preexisting personality deficits is explored in relation to recent advances in understanding the indissolubility between attachment pathology and developmental trauma. Universal generalizations regarding the causal relation between structural self-deficits and the emergence of PTSD remain suspended. The nature of traumatic representation continues to be a contested area of empirical and theoretical debate, the consequences of which may inevitably inform clinical technique. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comorbidity and course of psychiatric disorders in a community sample of former prisoners of war

OBJECTIVE: The authors assessed DSM-III-R disorders among American former prisoners of war. Comorbidity, time of onset, and the relationship of trauma severity to complicated versus uncomplicated posttraumatic stress disorder (PTSD) were examined. METHOD: A community sample (N=262) of men exposed to combat and imprisonment was assessed by clinicians using the Structured Clinical Interview for DSM-III-R. RESULTS: The rates of comorbidity among the men with PTSD were lower than rates from community samples assessed by lay interviewers. Over one-third of the cases of lifetime PTSD were uncomplicated by another axis I disorder; over one-half of the cases of current PTSD were uncomplicated. PTSD almost always emerged soon after exposure to trauma. Lifetime PTSD was associated with increased risk of lifetime panic disorder, major depression, alcohol abuse/dependence, and social phobia. Current PTSD was associated with increased risk of current panic disorder, dysthymia, social phobia, major depression, and generalized anxiety disorder. Relative to PTSD, the onset of the comorbid disorders was as follows: major depression, predominantly secondary; alcohol abuse/dependence and agoraphobia, predominantly concurrent (same year); social phobia, equal proportions primary and concurrent; and panic disorder, equal proportions concurrent and secondary. Trauma exposure was comparable in the subjects with complicated and uncomplicated PTSD. CONCLUSIONS: The types of comorbid diagnoses and their patterns of onset were comparable to the diagnoses and patterns observed in other community samples. The findings support the validity of the PTSD construct; PTSD can be distinguished from comorbid disorders. Uncomplicated PTSD may be more common than previous studies suggest, particularly in clinician-assessed subjects exposed to severe trauma.     

Mathematical disabilities: Cognitive, neuropsychological, and genetic components.

Cognitive, neuropsychological, and genetic correlates of mathematical achievement and mathematical disability (MD) are reviewed in an attempt to identify the core deficits underlying MD in children. Three types of distinct cognitive, neuropsychological, or cognitive and neuropsychological deficits associated with MD are identified. The 1st deficit is manifested by difficulties in the representation or retrieval of arithmetic facts from semantic memory. The 2nd type of deficit is manifested by problems in the execution of arithmetical procedures. The 3rd type involves problems in the visuospatial representation of numerical information. Potential cognitive, neuropsychological, and genetic factors contributing to these deficits and the relationship between MD and reading disabilities are discussed. Finally, suggestions for the subtyping of math disorders are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early childhood trauma and disorders of extreme stress as predictors of treatment outcome with chronic posttraumatic stress disorder

History of early childhood trauma was prevalent and highly correlated with Disorders of Extreme Stress Not Otherwise Specified (DESNOS) in a sample of veterans in inpatient treatment for chronic posttraumatic stress disorder (PTSD). DESNOS predicted reliable change on a variety of measures of psychiatric symptomatology (including PTSD) and psychosocial functioning independently of the effects of PTSD diagnosis and early childhood trauma history. DESNOS also predicted treatment outcome on PTSD and quality of life measures after controlling for the effects of ethnicity, war zone trauma exposure severity, initial level of symptomatic severity or quality of life, Axis I (PTSD and major depression) and Axis II (personality disorder) diagnostic status, and early childhood trauma history. Early childhood trauma was not predictive of outcome. DESNOS appears to play an important role in assessment and treatment planning for psychotherapeutic rehabilitation of chronic PTSD.     

Coping, locus of control, social support, and combat-related posttraumatic stress disorder: A prospective study.

We examined the relations between coping, locus of control, and social support and combat-related posttraumatic stress disorder (PTSD). The sample consisted of 262 Israeli soldiers who suffered a combat stress reaction episode during the 1982 Lebanon war and were followed 2 and 3 years after their participation in combat. Cross-sectional analyses revealed significant relations between locus of control, coping, and social support and PTSD at the two points of assessment. Changes in PTSD from Time 1 to Time 2 were also associated with changes in coping. We discuss theoretical and methodological implications of the findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

War zone stress, personal resources, and PTSD in Persian Gulf War returnees.

Posttraumatic stress disorder (PTSD) can occur subsequent to war stress, but not all troops are negatively affected. A discriminant function model was used to study associations between personal and environmental resources and psychological outcomes subsequent to war zone stress. Among 775 Persian Gulf War exposed troops, 2 subsets were identified: 97 with PTSD diagnoses and 484 who had no psychological distress. A discriminant function, double cross-validated in random subsamples, classified 87% of troops, and demographic and stress severity variables did not alter results significantly. Personality hardiness commitment, avoidance coping, and perceived family cohesion emerged as consistent predictors of PTSD diagnosis. Findings suggest personal characteristics and environmental factors may alter vulnerability to negative war stress outcomes. Work is needed to identify mechanisms and causal pathways by which resource factors enhance or lower stress resistance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma-induced weight loss and cognitive deficits among former prisoners of war.

Former prisoners of war (POWs) from the Korean Conflict and WWII reporting confinement weight losses of >35% (n?=?60) and ≤35% (n?=?113) and non-POW combat veterans (n?=?50) were compared on Wechsler Adult Intelligence Scale—Revised (WAIS—R) and Wechsler Memory Scale (WMS) Logical Memory indices. High weight-loss POWs performed more poorly than combat veterans on Performance IQ, Arithmetic, Similarities, and Picture Completion subtests, Witkin-Goodenough Attention–Concentration Factor, and WMS Immediate and Delayed Recall and more poorly than low weight-loss POWs on Arithmetic, Attention–Concentration Factor, and the WMS immediate memory measure. Low weight-loss POWs and combat veterans differed only on WMS immediate memory. Findings support the hypothesis of P. Thygesen et al (1970) that severity of POW confinement stress reflected by trauma-induced weight-loss is predictive of long-term compromise in cognitive performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Together in pain: Attachment-related dyadic processes and posttraumatic stress disorder.

We used actor–partner interdependence modeling to explore associations among attachment-related dyadic processes, posttraumatic stress disorder (PTSD) in war veterans, and secondary traumatic stress (STS) in their wives. A sample of 157 Israeli couples (85 former prisoners of war and their wives and a comparison group of 72 veterans not held captive and their wives) completed self-report scales assessing attachment insecurities (anxiety, avoidance) and PTSD symptoms. For both groups of veterans and their wives, attachment anxiety was associated with the severity of their own and their spouses' PTSD and STS. Avoidant attachment was associated with PTSD and STS only in couples that included a former prisoner of war. A complex pattern of associations involving avoidant attachment was observed in the actor–partner analyses of these couples. The study demonstrates that attachment-related dyadic processes play a role in the development and maintenance of PTSD in traumatized veterans and STS in their wives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)