Dissociative disorders in Vietnam combat veterans

A group of Vietnam combat veterans were surveyed to determine the quantity and quality of their dissociative symptoms. The results suggest that the symptoms of post-traumatic stress disorder (PTSD) and dissociative disorders in this group of patients may be much more closely intertwined than we have heretofore considered. Those who suffer from PTSD have a continuum of severity of dissociative symptoms ranging from the frequent experience of a partially forgotten traumatic experience to the rare occurrence of a full blown case of multiple personality disorder (MPD). Most cases of MPD are related to trauma during childhood in environments fraught with extreme ambivalence and victimization, in association with abandonment and betrayal. However, the high frequency of dissociative symptoms and even occasional occurrences of MPD in Vietnam veterans suggests a similarity in the environmental factors associated with the Vietnam war.     

Interpersonal styles of Vietnam Era veterans.

The study aims were to identify the interpersonal style characteristics of Vietnam Era veterans by comparison with World War II veterans. The sample included 3,075 veterans in treatment in 47 VA health care facilities. Patients were categorized as medical-surgical, psychiatric, and drug addicted, and divided by age into the 24 or less, and the 45 to 55 age groups. The measuring device was the Interpersonal Style Inventory. Group differences on the 17 scores were tested by discriminant function analyses. The Vietnam Era veterans were found to be more rebellious, mistrustful, adventure-seeking and expedient than the older veterans.     

Gratitude and hedonic and eudaimonic well-being in Vietnam war veterans

Little information exists on the contribution of psychological strengths to well-being in persons with post-traumatic stress disorder (PTSD). Data from other populations suggest that gratitude, defined as the positive experience of thankfulness for being the recipient of personal benefits, may have salutary effects on everyday functioning. We investigated whether dispositional gratitude predicted daily hedonic and eudaimonic well-being in combat veterans with and without PTSD. We also examined associations between daily gratitude and daily well-being across time. Veterans with PTSD, compared to those without PTSD, exhibited significantly lower dispositional gratitude; no differences were found on daily gratitude. Dispositional gratitude predicted greater daily positive affect, percentage of pleasant days over the assessment period, daily intrinsically motivating activity, and daily self-esteem over and above effects attributable to PTSD severity and dispositional negative and positive affect in the PTSD group but not the non-PTSD group. Daily gratitude was uniquely associated with each dimension of daily well-being in both groups. Although preliminary, these results provide support for the further investigation of gratitude in trauma survivors.     

MCMI characteristics of DSM-III posttraumatic stress disorder in Vietnam veterans

Compared the MCMI profiles of 25 veterans with a diagnosis of Posttraumatic Stress Disorder (PTSD) with those of 25 veterans carrying psychiatric disorders which typically cause problems in the differential diagnosis of PTSD. The PTSD group had higher elevations on nine of the 20 MCMI scales (all ps less than .05). Profiles were also significantly different in shape and scatter. A discriminant analysis accounted for 100% of the variance and correctly classified 88% of the patients. Resulting MCMI profiles appear to be consistent with DSM-III criteria for PTSD.     

The psychophysiology of combat-induced post-traumatic stress disorder in Vietnam veterans

The psychophysiological responses of heart rate (HR), systolic and diastolic blood pressure, skin conductance level and forehead electromyogram were compared during: rest, mental arithmetic and combat sounds of gradually increasing intensity for five groups of Ss: Vietnam veterans with post-traumatic stress disorder (PTSD); Vietnam veterans without PTSD but with comparable levels of combat experience; Vietnam veterans with other psychiatric disorders; Vietnam-era veterans; and nonveteran phobics. HR response to low-intensity combat sounds provided good discrimination between veterans with PTSD and the other groups and seems to resemble a conditioned emotional response.     

Comprehensive system Rorschach data on Vietnam combat veterans

To better understand and, therefore, treat Vietnam combat veterans with a diagnosis of posttraumatic stress disorder (PTSD), the Rorschach was administered to 50 patients so diagnosed. The most important findings were that, on average: (a) These patients have a low level of stress tolerance and are, therefore, likely to respond impulsively to stressful situations; (b) this low stress tolerance appears to be a long-term adjustment problem; and (c) their perception of reality is unconventional and often distorted. A primary therapeutic indication from these data is that the use of structure would be important for successful therapy. Other findings and therapeutic recommendations are also discussed.     

Gestalt therapy in the treatment of Vietnam veterans experiencing PTSD symptomatology

In the author's clinical work with Vietnam veterans experiencing symptoms of PTSD, Gestalt theory and concepts have proven to be very helpful in (a) conceptualizing what sustains Vietnam as a deleterious problem in the lives of these veterans and (b) providing techniques which are effective in helping them overcome their Vietnam-related troubles. Although of great potential, the author feels that the effective application of Gestalt therapy techniques necessitates the kind of prudent clinical discretion which ordinarily requires a solid background in general psychotherapy and specialized training in Gestalt theory, concepts, and techniques.     

Psychodynamic group treatment of posttraumatic stress disorder in Vietnam veterans.

Exposure to combat frequently imparts a sense of aloneness, guilt, and helplessness. These and other intrapsychic and interpersonal issues need to be addressed in treating Vietnam veterans suffering from posttraumatic stress disorder (PTSD). Group therapy is proposed as a core treatment modality for dealing with these problems. A model is proposed in which patients are treated for 1 year or more in weekly groups that meet for 16-week sequential segments. Clinical guidelines are made explicit to new members by the co-therapists. Discussion topics deal not only with traumatic experiences related to combat, but also with important pre- and postwar issues that are relevant to the symptoms of PTSD. Timely integration and working through of these issues in the group is critical.     

Group therapy with Vietnam veterans: A brief review

This paper reviews the benefits and general considerations regarding group therapy with Vietnam veterans. A review of veteran rap groups and traditional therapy groups highlights the similarities and differences between types of groups used to treat this population. The importance of countertransference reactions and the need to consider a variety of treatment approaches is emphasized.     

Process and content in a long-term PTSD therapy group for Vietnam veterans

Process and content were studied in four 16-session segments of a psychodynamically oriented therapy group for Vietnam veterans suffering from posttraumatic stress disorder (PTSD). On the Group Climate Questionnaire (GCQ-S), the group scored significantly higher in the Engaged dimension and significantly lower in the Avoiding and Conflict dimensions than contrasting samples of neurotic and psychotic groups. There was no evidence of group stages. Topics related to symptoms of PTSD were discussed most frequently (43.1%), followed by issues concerning relations with others (32.4%),general group therapy issues (13.7%), and other topics (10.8%). Clinical implications of these findings are discussed.The authors thank Tom Metzler, M.A., and Heidi Ronfeldt, B.S., for their assistance with the data analysis.Parts of this paper were presented at the American Group Psychotherapy Association Annual Meeting, February 15–20, 1993, San Diego, CA.     

Treatment outcomes of Vietnam veterans with Posttraumatic Stress Disorder.

This study examined changes on the Millon Clinical Multiaxial Inventory for 45 Vietnam veterans who completed a specialized inpatient treatment program. The average length of stay for these veterans was 140 days. Patients' scores on the Millon decreased on 12 of the 20 scales and increased on 8, and their Posttraumatic Stress Disorder-related symptoms of anxiety and dysthymia decreased significantly. Posttraumatic Stress Disorder-related character styles, schizoid, avoidant, and passive-aggressive, also showed significant decreases.     

Adapted character styles of Vietnam veterans with Posttraumatic Stress Disorder

A total of 189 male Vietnam veterans who were admitted to a specialized inpatient treatment program were evaluated using the Millon Clinical Multiphasic Personality Inventory to assess character styles. The veterans were assessed for Posttraumatic Stress Disorder by using a subscale of the Minnesota Multiphasic Personality Inventory (MMPI) and 72% of the patients were classified as having Posttraumatic Stress Disorder. The character styles of passive-aggressive, schizoid, avoidant, and borderline were significantly associated with these patients. The most common 2-point profile was passive-aggressive and avoidant (8-2 or 2-8) and was significantly related to the diagnosis. While drug and alcohol abuse were common problem areas for the entire sample, the profile of patients with Posttraumatic Stress was different from those of substance abusers. These results indicate that treating Vietnam veterans with this disorder requires adopting strategies which include a character style focus as well as a symptom focus.     

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.     

Post-traumatic stress disorder in Vietnam veterans: Assessment in a forensic setting

The recognition and proper evaluation of Vietnam veterans' demonstrating Post-Traumatic Stress Disorder syndromes is reviewed. The special problems of accurate diagnosis and assessment of former Vietnam combatants is emphasized. The forensic evaluation of Vietnam veterans' raising the Post Traumatic Stress Disorder syndrome in either civil or criminal proceedings is comprehensively discussed. The question “What are the clinical techniques necessary to accomplish a competent forensic evaluation of the Vietnam veterans?” is specifically addressed with special emphasis on legal dispositions and treatment implications. The relationship between the criminal acts of combat veterans and their exposure to the psychological trauma of war is explored.     

The relationship between spiritual distress, PTSD and depression in Vietnam combat veterans

Presents empirical data showing the relationship between combat-related posttraumatic stress disorder (PTSD), depression and spiritual distress. Uses spiritual injury scale to measure distress; scale measures guilt, anger or resentment, sadness/grief, lack of meaning, feeling God/life has treated one unfairly, religious doubt, and fear of death. Shows high association between spiritual injuries and both PTSD and depression. Also finds inverse relationship between intrinsic religious faith and these two diagnostic categories. An inverse relationship also exists between religious faith as measured by regular worship with a faith community and both depression and PTSD.     

Post-traumatic accelerated cohesion: Its recognition and management in group treatment of Vietnam veterans

Post-traumatic accelerated cohesion (p-TAC) is the name given to a frequently observed group phenomenon in the treatment of Vietnam veterans who suffer traumatic war neuroses. It is critical that this group dynamic be discussed, especially since group is widely regarded as the modality of choice in treating these veterans. Post-traumatic accelerated cohesion is the rapid, premature development of cohesion in a group of virtual strangers, and is here presented in terms of its harmful impact on the group and the impasses it creates. Suggestions are given to resolve p-TAC and move the group toward fulfilling its goals. Placed within the self psychology and object relations theoretical frameworks, the discussion addresses issues pertaining to developmental arrests and post-traumatic self disorders and their relationship to p-TAC dynamics.The views in this paper are the author's sole responsibility and do not necessarily reflect those of the Veterans Administration.