Motor vehicle accident trauma exposure: Personality profiles associated with posttraumatic diagnoses

Abstract

Personality profiles associated with diagnostically distinct posttraumatic responses were examined. Profiles were compared between three groups defined on the basis of posttraumatic diagnosis following motor vehicle accident (MVA) trauma exposure. The diagnostic groups were: Posttraumatic Stress Disorder (PTSD), Acute Stress Disorder (ASD) without progression to PTSD, and subclinical responses. Participants were male and female community volunteers aged 18 to 77 (N = 83) who had all been exposed to an MVA meeting the DSM-IV diagnostic criteria for a traumatic event. The Personality Assessment Inventory (Morey, 1991) was used to assess psychological variables in the framework of posttraumatic diagnostic groups. The PTSD group scored significantly higher than the ASD and subclinical groups on scales assessing somatic complaints, anxiety, anxiety related disorders, depression, non-psychotic symptoms of schizophrenia, and negative relationships. The profile of the ASD group was characterized by self report of greater interpersonal warmth and a trend for greater egocentricity than the PTSD group. There were no significant differences in the personality profiles of the ASD and subclinical groups. The role of personality factors in posttraumatic adjustment is discussed in the context of previous literature.     

Relationship of posttraumatic growth to symptoms of posttraumatic stress disorder and depression: A pilot study of Iraqi students

Posttraumatic growth (PTG) and psychopathology are common outcomes following exposure to adversity and trauma. We examined the relationship of PTG to posttraumatic stress disorder (PTSD) and depression in a group of young Iraqi students with war trauma exposure. These young Iraqis had experienced an average of 13 different war‐related adversities. The prevalence of probable PTSD was 17.2% and probable depression 23.1%. PTSD was associated with higher and depression with lower PTG. In addition, the relationship between PTG and PTSD was stronger among males than females. Although PTSD and depression were relatively common, they were related to PTG in opposite directions.     

Comorbidity of DSM-IV Personality Disorders in unipolar and bipolar affective disorders: a comparative study

The aim of this study was to compare the prevalence of Personality Disorders assessed by Structured Clinical Interview for Axis-II in 155 inpatients diagnosed with Unipolar Disorder vs inpatients with Bipolar Disorder (39). The most frequent Axis II diagnoses among Unipolar inpatients were Borderline (31.6%), Dependent (25.2%), and Obsessive-Compulsive (14.2%) Personality Disorders. Among Bipolar inpatients, the most prevalent personality disorders were Borderline (41%), Narcissistic (20.5%), Dependent (12.8%), and Histrionic disorders (10.3%). Using chi squared analysis, few differences in distribution emerged between the two groups: Unipolar patients had more recurrent Obsessive-Compulsive Personality Disorder than Bipolar patients (chi(1)2=6.24, p<.005). Comorbid Narcissistic Personality Disorder was significantly more frequent in the Bipolar than in the Unipolar group (chi(1)2=6.34, P<.01). Considering the three clusters (DSM-IV classification), there was a significant difference between the groups, Cluster C (fearful, avoidant) diagnoses being more frequent in the Unipolar than in the Bipolar group (48.4% vs 20.5%, respectively). Cluster B (dramatic, emotionally erratic) diagnoses were found more frequently in patients with Bipolar Disorders (71.8% vs 45.2% in Unipolar patients, chi(2)2=10.1, p<.006). The differences in the distribution and prevalence of Personality Disorders between the two patient groups are discussed.     

Choosing Assessment Instruments for Posttraumatic Stress Disorder Screening and Outcome Research

Effect‐size results from Erford et al.'s ( 2016 ) meta‐analysis for the treatment of posttraumatic stress disorder (PTSD) were used to compare 6 instruments' usefulness in measuring counseling treatment outcomes. Effect‐size comparisons indicated equivalent overall effect sizes using the Clinician‐Administered PTSD Scale, the Impact of Event Scale–Revised, the Posttraumatic Stress Diagnostic Scale, the PTSD Checklist, and the Structured Interview for PTSD. The Mississippi Scale for Combat‐Related PTSD yielded significantly more conservative (i.e., lower) effect‐size comparisons.     

Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample.

The comorbidity of current and lifetime DSM-IV anxiety and mood disorders was examined in 1,127 outpatients who were assessed with the Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L). The current and lifetime prevalence of additional Axis I disorders in principal anxiety and mood disorders was found to be 57% and 81%, respectively. The principal diagnostic categories associated with the highest comorbidity rates were mood disorders, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). A high rate of lifetime comorbidity was found between the anxiety and mood disorders; the lifetime association with mood disorders was particularly strong for PTSD, GAD, obsessive-compulsive disorder, and social phobia. The findings are discussed in regard to their implications for the classification of emotional disorders.     

Subtypes of clinical presentations in malingerers of posttraumatic stress disorder: an MMPI-2 cluster analysis

This paper investigated subtypes of individuals trained and instructed to malinger Posttraumatic Stress Disorder (PTSD) through a cluster analysis of their Minnesota Multiphasic Personality Inventory-2 (MMPI-2) clinical and validity scales. Participants were 84 men and women college students at a community college in the southeastern United States. Two well fitting MMPI-2 cluster solutions were evaluated with discriminant analyses and multivariate analyses of variance (MANOVAs); a 2-cluster solution was deemed optimal. Significant between-cluster differences emerged in follow-up analyses on most of the content scales of the MMPI-2. Most demographic variables did not account for differences in cluster membership. Clusters differed in their reported clarity of the materials used to educate them about PTSD. Discriminant analyses yielded better correct classification rates than those from previous studies, when the more severely symptomatic cluster was compared with a sample of clinical combat-related PTSD veterans. Implications are considered in conducting future malingered PTSD investigations.     

Comparison of characteristics of Vietnam veterans with and without posttraumatic stress disorder

Characteristics of 107 Vietnam veterans with and without Posttraumatic Stress Disorder (PTSD), who had been exposed to varying levels of combat, were compared. Severity of psychopathology as assessed on the Eysenck Personality Questionnaire, locus of control orientation as measured by the Nowicki-Strickland Internal-External Control Scale, and ability to have provided structure and meaning to the Vietnam experience were examined. Compared to veterans with Posttraumatic Stress Disorder, those without the disorder had lower Neuroticism and Psychoticism scores, were more internal in their locus of control orientation, and were more likely to have shown ability to provide structure to the Vietnam experience. The additional finding that veterans with high combat experience but without PTSD evidenced less neuroticism than low combat veterans without PTSD provides evidence that those who did not develop the disorder despite high exposure to combat stress are individuals with exceptional emotional strength and resilience.     

PTSD symptoms of mothers following occurrence of a disaster affecting their children

This study investigated the PTSD symptoms of 37 mothers whose adolescent children had been directly involved in a disaster, the Jupiter sinking in 1988. This group included mothers whose children were (a) not diagnosed with Posttraumatic Stress Disorder and (b) were diagnosed with Posttraumatic Stress Disorder. The measure used was the Posttraumatic Stress Disorder Symptom Scale. Women whose children were involved in the disaster presented PTSD symptoms. 35% (n = 13) were diagnosed with PTSD 3 mo. after the disaster, and 89% (n = 3) of them were diagnosed with PTSD 6 yr. afterward. This effect was greater in the subgroup whose children had developed traumatic stress disorder following the disaster.     

Abusive relationships: Is a new category for traumatization needed?

The concept of a spectrum of posttraumatic disorders has been postulated by a variety of major contributors to the field of psychotraumatology. Although Posttraumatic Stress Disorder (PTSD) is one trauma-based mental health disorder, there are other posttraumatic illnesses that do not qualify for PTSD, nor are they accurately described by other diagnostic categories in the DSM-IV. The present paper proposes and delineates a new syndrome, entitled Posttraumatic Relationship Syndrome (PTRS), which is a function of the experience of trauma in the context of an emotionally intimate relationship. It differs from PTSD in four fundamental ways: (1) the nature of the Stressor criterion; (2) the response to the Stressor; (3) the inclusion of a category of relational symptoms; and (4) the way of coping with the trauma (i.e., it lacks the emotional numbing and avoidance of stimuli associated with the trauma). The latter is the most salient difference as it involves a qualitatively different experience of the “world of trauma”-a primarily conscious experience in PTRS and an often unconscious experience in PTSD.     

Abusive relationships: Is a new category for traumatization needed?

The concept of a spectrum of posttraumatic disorders has been postulated by a variety of major contributors to the field of psychotraumatology. Although Posttraumatic Stress Disorder (PTSD) is one trauma-based mental health disorder, there are other posttraumatic illnesses that do not qualify for PTSD, nor are they accurately described by other diagnostic categories in the DSM-IV. The present paper proposes and delineates a new syndrome, entitled Posttraumatic Relationship Syndrome (PTRS), which is a function of the experience of trauma in the context of an emotionally intimate relationship. It differs from PTSD in four fundamental ways: (1) the nature of the Stressor criterion; (2) the response to the Stressor; (3) the inclusion of a category of relational symptoms; and (4) the way of coping with the trauma (i.e., it lacks the emotional numbing and avoidance of stimuli associated with the trauma). The latter is the most salient difference as it involves a qualitatively different experience of the “world of trauma”-a primarily conscious experience in PTRS and an often unconscious experience in PTSD.     

Posttraumatic Stress Disorder and Marital Adjustment: The Mediating Role of Forgiveness

The study assessed the effects of war captivity on posttraumatic stress symptoms and marital adjustment among Prisoners of War (POWs) from the Yom Kippur War. It was hypothesized that men's perception of level of forgiveness mediates the relation between posttraumatic symptoms and marital adjustment. The sample consisted of 157 Israeli veterans divided into 3 groups: 21 POWs with Posttraumatic Stress Disorder (PTSD), 58 former POWs without PTSD, and 70 control veterans. The findings indicated that former POWs with PTSD reported lower levels of marital satisfaction and forgiveness than veterans in the other 2 groups. In addition, men's perception of level of forgiveness mediated the relationship between their posttraumatic symptoms and their marital adjustment. The theoretical and clinical implications of these results are discussed.     

Personality-based latent classes of posttraumatic psychopathology: personality disorders and the internalizing/externalizing model

Prior research using the Brief Form of the Multidimensional Personality Questionnaire (MPQ-BF; Patrick, Curtin, & Tellegen, 2002) has shown evidence of 3 temperament-based subtypes--termed internalizing, externalizing, and simple PTSD--among individuals with symptoms of posttraumatic stress disorder (PTSD; Miller, Greif, & Smith, 2003). This study sought to replicate and extend research in this area by conducting a latent profile analysis of higher order temperament scales from the MPQ-BF using a new sample of 208 veterans with symptoms of PTSD. Results suggest that a 3-class solution reflecting internalizing, externalizing, and simple subtypes of posttraumatic psychopathology provided the best fit to the data. The externalizing subtype was characterized by features of antisocial, borderline, histrionic, and narcissistic personality disorders on the International Personality Disorder Examination (Loranger, 1999) as well as low levels of constraint and high levels of negative emotionality on the MPQ-BF. In contrast, individuals in the internalizing class exhibited features of schizoid and avoidant personality disorders, low levels of positive emotionality, and high levels of negative emotionality. The simple subtype was defined by low levels of comorbid personality disorder features and relatively normal personality profiles. Findings support the reliability of this typology and support the relevance of the internalizing and externalizing model to the structure of personality disorders.     

Change in posttraumatic stress disorder symptoms: do clinicians and patients agree?

This study assessed the longitudinal association between clinician and patient ratings of posttraumatic stress disorder (PTSD) symptoms over the course of 2 different randomized clinical trials of veterans with chronic PTSD. One trial, the Department of Veterans Affairs Cooperative Study 420 (CSP 420; N = 360) compared trauma-focused and present-centered group therapies, and the 2nd trial compared cognitive processing theory and a waitlist control condition (N = 60). Linear mixed effects modeling revealed significant associations between clinician ratings (Clinician-Administered PTSD Scale; CAPS; D. D. Blake et al., 1990) and patient ratings (Posttraumatic Stress Disorder Checklist; PCL; F. W. Weathers, B. T. Litz, J. A. Herman, J. A. Huska, & T. M. Keane, 1993) in total and symptom clusters of PTSD. Contrary to hypothesis, the amount of change on the CAPS ranged from .75 to .82 standard deviations for every 1 standard deviation change on the PCL. The CAPS and PCL were more closely associated in the trauma-focused vs. present-centered treatment condition in CSP 420, and especially regarding hyperarousal symptoms. When comparing categorization of clinically significant change on the CAPS and PCL, the authors found no differences in the percentages of agreement between clinicians and patients in improvement and exacerbation. The value of multimodal assessment of PTSD treatment outcomes is discussed.     

The development of posttraumatic stress disorder following four different types of traumatization

The Children's Posttraumatic Stress Disorder Inventory (CPTSDI) was used to identify 230 childhood posttraumatic stress disorder (PTSD) cases. Of these cases, 58 had been traumatized through direct experience, 128 through observation, 13 through verbal mediation, and 31 by combinations thereof. The 230 children and 35 controls completed the Revised Children's Manifest Anxiety Scale (RCMAS) and the Children's Depression Inventory (CDI). In addition, their conduct was rated on the Connor's Teacher Rating Scale (CTRS) criteria. Each of the PTSD groups had significantly greater RCMAS, CDI, and CTRS scores than the non-clinical controls, but there were no differences between the four types of PTSD cases.     

Post-traumatic stress reactions following the March 11, 2004 terrorist attacks in a Madrid community sample: a cautionary note about the measurement of psychological trauma

Posttraumatic stress reactions related to the Madrid March 11, 2004, terrorist attacks were examined in a sample of Madrid residents (N = 503) 18-25 days after the attacks, using multiple diagnostic criteria and different cut-off scores. Based on the symptoms covered by the Posttraumatic Stress Disorder Checklist-Civilian (PCL-C; Weathers, Litz, Herman, Huska, and Keane, 1993), rates of probable posttraumatic stress disorder (PTSD) ranged from 3.4% to 13.3%. Taking into account additional criteria from the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 200; i.e., the impact of initial reaction and problems in daily functioning as a consequence of the traumatic event), only 1.9% of respondents reported probable PTSD. These results suggest that inferences about the impact of traumatic events on the general population are strongly influenced by the definition of traumatic response. Our findings also revealed that the magnitude of posttraumatic reactions is associated with several risk factors, including living close to the attacked locations, physical proximity to the attacks when they occurred, perception of one's life being at risk, intensity of initial emotional reactions, and being a daily user of the attacked train lines. The use of different cut-off scores did not affect the pattern of risk to develop traumatic stress. The implications of these results for public health policies related to terrorist attacks are discussed.     

Assessing posttraumatic stress disorder with the MMPI-2 in a sample of workplace accident victims

In this study, the predictive capacity of the Minnesota Multiphasic Personality Inventory-2 Posttraumatic Stress Disorder-Keane (MMPI-2 PK) scale was examined in a sample of trauma victims who experienced a serious workplace-related accident and subsequent injury. In keeping with a number of previous investigations, the PK scale was largely ineffective in identifying posttraumatic stress disorder (PTSD) beyond overall symptom and functional severity. In contrast, sets of clinical and content scales proved to be significant predictors of PTSD. These findings suggest that the PK scale is not particularly useful in detecting PTSD in civilian trauma samples. Clinicians might be best advised to use the MMPI-2 clinical and content scales in their assessment of PTSD in civilian patients presenting with a history of trauma.     

Diagnostic efficiency of the Iowa personality disorder screen items in a nonclinical sample

The diagnostic efficiency of the 11-item Iowa Personality Disorder Screen (IPDS; Langbehn et al., 1999) was evaluated in a nonclinical sample of young adults, 35% of whom met DSM-III-R criteria for a personality disorder, in a retrospective analysis of SIDP-R data. Results indicated that two IPDS item sets (i.e., combinations of items) produced hit rates of more than 80% along with good sensitivity, specificity, positive predictive power, and negative predictive power. Combined with the findings of Langbehn et al. (1999), these results suggest that the IPDS may be useful as a screening measure for personality disorder in both clinical and nonclinical populations.     

负性生活事件、社会支持和创伤后应激障碍症状：对汶川地震后青少年的追踪研究

创伤后应激障碍是灾难后常见的心理病理问题, 灾后继发负性生活事件和社会支持是影响创伤后应激障碍症状的重要因素。该研究采用追踪设计, 历时2年对汶川地震后都江堰地区1573名青少年进行3次测查, 考察震后继发负性生活事件、不同类型社会支持与创伤后应激障碍症状之间的相互作用关系。研究发现：不同类型的社会支持与震后继发负性生活事件、创伤后应激障碍症状存在不同的作用关系; 震后继发负性生活事件不仅直接影响个体的心理健康还对个体的社会支持系统有损害; 震后负性生活事件、主观支持与创伤后应激障碍症状存在联动效应, 即三者中任一方面的变化都可能引起其他方面的变化。