The role of hyperarousal in the manifestation of posttraumatic psychological distress following injury

The authors examined the temporal relation among posttraumatic stress disorder symptom clusters, using data derived from a longitudinal study of survivors of orofacial injury (N = 264). They conducted cross-lagged panel analyses, with self-reported symptom data collected at 1, 6, and 12 months postinjury. Results demonstrate that hyperarousal was a potent predictor of subsequent symptoms of reexperiencing and avoidance as well as hyperarousal. By contrast, neither reexperiencing nor avoidance was significantly related to other symptom clusters other than themselves over time. These findings underscore the distinctive nature of hyperarousal in the manifestation of posttraumatic psychological distress over time. Implications for theory, clinical intervention, and future research are discussed.     

Convergent validity of the Chinese Personality Assessment Inventory and the Minnesota Multiphasic Personality Inventory-2: preliminary findings with a normative sample

We examined the convergent validity of the Chinese Personality Assessment Inventory (CPAI; Cheung, Leung, et al., 1996), an indigenously constructed measure, by comparing its patterns of correlations with the MMPI-2 (Butcher et al., 2001). A valid sample of 147 Chinese students took both the CPAI and the MMPI-2. Results provide preliminary support for the convergence between most of the CPAI clinical scales and the relevant MMPI-2 scales. The CPAI personality scales further illustrated the patterns of personality features associated with the MMPI-2 scales in a Chinese cultural context. We discuss discrepancies in the correspondence between a number of CPAI and MMPI-2 clinical scales.     

Associations between dimensions of anxiety sensitivity and PTSD symptom clusters in active-duty police officers

Prior studies have shown that anxiety sensitivity (AS) plays an important role in posttraumatic stress disorder (PTSD) symptom severity. The purpose of this study was to evaluate associations between empirically supported PTSD symptom clusters (i.e. reexperiencing, avoidance, numbing, hyperarousal) and AS dimensions (i.e. psychological concerns, social concerns, somatic concerns). Participants were 138 active-duty police officers (70.7% female; mean age = 38.9 years; mean time policing = 173.8 months) who, as a part of a larger study, completed measures of trauma exposure, PTSD symptoms, AS, and depressive symptoms. All participants reported experiencing at least one event that they perceived as traumatic, and 44 (31.9%) screened positive for PTSD. Officers with probable PTSD scored significantly higher on AS total as well as the somatic and psychological concerns dimensional scores than did those without PTSD. As well, a higher percentage of officers with probable PTSD scored positively on the AS-derived Brief Screen for Panic Disorder (Apfeldorf et al., 1994) compared with those without PTSD. A series of regression analyses revealed that depressive symptoms, number of reported traumas, and AS somatic concerns were significant predictors of PTSD total symptom severity as well as severity of reexperiencing. Avoidance was predicted by depressive symptoms and AS somatic concerns. Only depressive symptoms were significantly predictive of numbing and hyperarousal cluster scores. These findings contribute to understanding the nature of association between AS and PTSD symptom clusters. Implications for the treatment of individuals having PTSD with and without panic-related symptomatology are discussed.     

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.     

The MMPI-2 as a predictor of symptom change following treatment for posttraumatic stress disorder

This study sought to examine the impact of personality factors on symptom change following treatment for 141 Vietnam veterans with chronic combat-related posttraumatic stress disorder (PTSD) using the Minnesota Multiphasic Personality Inventory-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). A series of partial correlation and linear multivariate regression analyses identified social alienation, associated with anger and substance use, as the most potent negative predictor of symptom change. Of the scales assessing personality disorder, Borderline Personality was identified as the strongest negative predictor of outcome. Regression analyses examining the most salient scales identified 5 items that contributed 14% of the variance in the prediction of change scores independently of the 21% accounted for by pretreatment PTSD severity.     

Convergent validity of alternative MMPI-2 personality disorder scales

The Morey, Waugh, and Blashfield (1985) MMPI (Hathaway et al., 1989) personality disorder scales provided a significant contribution to personality disorder research and assessment. However, the subsequent revisions to the MMPI and the multiple revisions to the diagnostic criteria sets that have since occurred may have justified comparable revisions to these scales. Somwaru and Ben-Porath (1995) selected a substantially different set of items from the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) to assess Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) personality disorder diagnostic criteria. In our study, we compared the convergent validity of these alternative MMPI-2 personality disorder scales with respect to 3 self-report measures of personality disorder symptomatology in a sample of 82 psychiatric outpatients. The results suggested that Somwaru and Ben-Porath's scales are as valid as the original Morey et al. scales and might be even more valid for the assessment of borderline, antisocial, and schizoid personality disorder symptomatology.     

Assessing psychopathic personality traits with the MMPI-2

In this study, we examined the utility of the MMPI-2 (Butcher et al., 2001) in assessing psychopathic personality traits. We explored whether MMPI-2 scales that measure affective and interpersonal traits add to the instrument's social deviance measures in assessing global psychopathy and its two facets. Our study of 281 male and female college students indicates that the MMPI-2 Social Deviance scales (e.g., Clinical Scales 4 and 9, ASP) predict substantial variance in the social deviance factor and affiliated subscales of the Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996), whereas MMPI-2 measures of affective and interpersonal functioning predict substantial variance in the affective-interpersonal PPI factor. In addition, the results of two regression models indicate that the Restructured Clinical scales provide the most parsimonious assessment of psychopathic personality traits.     

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.     

The Relationship Between Posttraumatic Stress Symptoms and Suicide Ideation Among Child Survivors Following the Wenchuan Earthquake

The association between posttraumatic stress disorder (PTSD) symptoms and suicide ideation was examined in a sample of 2,298 child survivors of the Wenchuan earthquake. Results indicated that intrusion, avoidance, hyperarousal symptom clusters, and PTSD total score were significantly associated with suicide ideation. Except for intrusion, other measures of PTSD remained as statistically significant correlates of suicide ideation even after controlling for age, gender, direct exposure, indirect exposure, and depression. Furthermore, results showed that PTSD symptoms had an indirect influence on suicide ideation that was mediated by depression. The findings suggest that avoidance and hyperarousal symptom clusters of PTSD may be two important indicators of suicide ideation among child survivors of the Wenchuan earthquake. Implications of the results for intervention and prevention of suicide behavior are discussed.     

Comparing posttraumatic stress disorder's symptom structure between deployed and nondeployed veterans

We tested two empirically validated 4-factor models of posttraumatic stress disorder (PTSD) symptoms using the PTSD Checklist: King, Leskin, King, and Weathers' (1998) model including reexperiencing, avoidance, emotional numbing, and hyperarousal factors, and Simms, Watson, and Doebbeling's (2002) model including reexperiencing, avoidance, dysphoria, and hyperarousal. Our aim was to determine which fit better in two groups of military veterans: peacekeepers previously deployed to a war zone (deployed group) and those trained for peacekeeping operations who were not deployed (nondeployed group). We compared the groups using multigroup confirmatory factor analysis. Adequate model fit was demonstrated among the nondeployed group, with no significant difference between King et al.'s (1998) model (separating avoidance and numbing) and Simms et al.'s (2002) similar model involving a dysphoria factor. A better fitting factor structure consistent with Simms et al.'s (2002) model was found in the deployed group. Comprehensive measurement invariance testing demonstrated significant differences between the deployed and nondeployed groups on all structural parameters, except observed variable intercepts (thus indicating similarities only in PTSD item severity). These findings add to researchers' understanding of PTSD's factor structure, given the revision of PTSD that will appear in the forthcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2010)--namely, that the factor structure may be quite different between groups with and without exposure to major traumatic events.     

An examination of three sets of MMPI-2 personality disorder scales

Three sets of personality disorder scales (PD scales) can be scored for the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). Two sets (Levitt & Gotts, 1995; Morey, Waugh, & Blashfield, 1985) are derived from the MMPI (Hathaway & McKinley, 1983), and a third set (Somwaru & Ben-Porath, 1995) is based on the MMPI-2. There is no validity research for the Levitt and Gotts scale, and limited validity research is available for the Somwaru and Ben-Porath scales. There is a large body of research suggesting that the Morey et al. scales have good to excellent convergent validity when compared to a variety of other measures of personality disorders. Since the Morey et al. scales have established validity, there is a question if additional sets of PD scales are needed. The primary purpose of this research was to determine if the PD scales developed by Levitt and Gotts and those developed by Somwaru and Ben-Porath contribute incrementally to the scales developed by Morey et al. in predicting corresponding scales on the MCMI-II (Millon, 1987). In a sample of 494 individuals evaluated at an Army medical center, a hierarchical regression analysis demonstrated that the Somwaru and Ben-Porath Borderline, Antisocial, and Schizoid PD scales and the Levitt and Gotts Narcissistic and Histrionic scales contributed significantly and meaningfully to the Morey et al. scales in predicting the corresponding MCMI-II (Millon, 1987) scale. However, only the Somwaru and Ben-Porath scales demonstrated acceptable internal consistency and convergent validity.     

The joint structure of maladaptive personality traits and psychopathology

We examined the joint structure of symptoms/syndromes of psychopathology (MMPI-2 Restructured-Clinical Scales; MMPI-2-RC; Tellegen et al., 2003) and maladaptive personality traits (Schedule for Nonadaptive and Adaptive Personality; SNAP-2; Clark, Simms, Wu, & Casillas, 2014) via a series of top-down factor analyses—Goldberg (2006) “bass-ackwards approach”—in a sample of 419 mental-health outpatients and 567 military veterans. A three-factor solution consisting of Negative Affectivity (including Oddity), Low Positive Affectivity, and Disinhibition-versus-Constraint best represented the joint symptom-trait structure, consistent with the third level of Markon et al. (2005) joint hierarchical structure of normal and maladaptive personality traits. Our results point to robustness of the structure of adaptive and maladaptive personality traits and symptoms of psychopathology at the three-factor level.     

Personality and psychopathology: mapping the MMPI-2 Restructured Clinical (RC) Scales onto the Five Factor Model of personality

The MMPI-2 Restructured Clinical (RC) Scales (Tellegen et al., 2003) reflect a recent shift for this instrument toward the measurement of contemporary conceptualizations of psychopathology. The current investigation aimed to replicate and extend the theoretical and empirical linkage between the RC scales and dimensional models of personality and to investigate how well the RC scales conform to a higher-order structure of psychopathology. Participants were 271 psychiatric patients who had been administered the MMPI-2 and revised NEO Personality Inventory (Costa & McCrae, 1992) as part of a routine psychological evaluation. The results indicated that the RC scales map onto the Five Factor Model of personality as hypothesized and in congruence with previous findings in personality and psychopathology. The RC scales conformed to a higher-order structure of internalizing, externalizing, and thought disturbance, replicating and extending previous work concerning hierarchical structures of psychopathology.     

Incremental validity of the MMPI-2 Restructured Clinical (RC) scales in a private practice sample

Building on results reported in Sellbom, Graham, and Schenk (2005), in this study, we examined the incremental validity of the newly introduced MMPI-2 (Butcher et al., 2001) Restructured Clinical (RC) scales (Tellegen et al., 2003) over both the Clinical and Content scales. Participants were 647 clients in private practice who were administered the MMPI-2 and the Multiaxial Diagnostic Inventory (Doverspike, 1990) early in therapy. The results indicate that the RC scales had acceptable internal consistency, reduced intercorrelations (compared to the Clinical scales), and promising convergent and discriminant validity. Hierarchical regression analyses revealed that the RC scales added incrementally to both the Clinical and Content scales in predicting self reported clinical symptoms. These findings suggest that the RC scales are relatively homogenous measures of core clinical constructs that can add unique information to the understanding of private practice clients above and beyond the Clinical and Content scales.     

Clarifying the relationship between AS dimensions and PTSD symptom clusters: are negative and positive affectivity theoretically relevant constructs?

The association between anxiety sensitivity (AS) and posttraumatic stress disorder (PTSD) has been established in contemporary literature; however, research is divided over the nature of specific relationships between AS dimensions and PTSD symptoms clusters. Further, a paucity of research has examined the AS and PTSD relationship while accounting for theoretically relevant variables, such as negative (NA) and positive affect (PA). The purpose of the current study was twofold: first, to clarify divergent findings regarding the contribution of AS dimensions to PTSD symptom clusters, and, second, to further assess the relevance of NA and PA within the AS/PTSD relationship. Hierarchal regression analyses showed that, beyond shared variance attributable to NA and PA, AS somatic concerns were significantly associated with three of four PTSD symptom (i.e., reexperiencing, numbing, hyperarousal), AS cognitive concerns were only associated with hyperarousal, and AS socially observable symptoms were not significantly associated with any PTSD symptom clusters. These findings suggest that AS somatic concerns are the most robust predictor of variance within the AS/PTSD relationship and further clarify the theoretical importance of NA and PA within this relationship. Comprehensive results, implication, and directions for future research are discussed.     

The detection of feigned uncoached and coached posttraumatic stress disorder with the MMPI-2 in a sample of workplace accident victims

In this study research participants completed the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) under standard instructions and then were asked to fake posttraumatic stress disorder (PTSD) when completing the MMPI-2 for a 2nd time in 1 of 4 conditions with different instructions on how to fake PTSD: (a) uncoached, (b) coached about PTSD symptom information, (c) coached about MMPI-2 validity scales, or (d) coached about both symptoms and validity scales. These MMPI-2 protocols were then compared with protocols of claimants with workplace accident-related PTSD. Participants given information about the validity scales were the most successful in avoiding detection as faking. The family of F scales (i.e., F, FB, FP), particularly FP, produced consistently high rates of positive and negative predictive power.     

Clinical utility of the MMPI-2 Restructured Clinical (RC) Scales in therapeutic assessment: a case study

In the following article, we provide a case study on a 25-year-old man who was released from a crisis stabilization unit following a suicide attempt. After completing a diagnostic intake, the client participated in a Therapeutic Assessment (Finn, 1996, 2003), which included the MMPI-2 (Butcher et al., 2001) and the Incomplete Sentences Blank (Rotter & Rafferty, 1950). In particular, in the article, we focus on how the Restructured Clinical (RC; Tellegen et al., 2003) scales can be used to form a personological conceptualization of the client. The RC scales measure important personality and affective trait dimensions including demoralization and both positive and negative affect, which allows for a clear explanation of the underlying etiological factors that influence a client's negative emotional experience. In this article, we highlight how explaining these underlying personality characteristics to the client within the framework of therapeutic assessment allowed for an increase in his insight.     

All symptoms are not created equal: the prominent role of hyperarousal in the natural course of posttraumatic psychological distress

This 3-wave longitudinal study examined the natural course of posttraumatic stress disorder symptoms using data collected from young adult survivors of community violence. Three key findings emerged. 1. Mean levels of distress for each symptom cluster decreased over time, with reexperiencing decreasing most rapidly. 2. Cross-lagged panel analysis revealed that hyperarousal strongly influences, but is not generally influenced by, other symptoms clusters. 3. Trajectory analysis demonstrated that respondents for whom hyperarousal was the most pronounced baseline symptom showed lower overall symptom improvement relative to trauma exposed counterparts for whom hyperarousal was a less prominent early symptom. Implications for theory, research, and clinical practice are discussed.     

What do the MMPI-2 restructured clinical scales reliably measure? Answers from multiple research settings

The Restructured Clinical (RC; Tellegen et al., 2003) scales were developed to improve measurement of the core constructs of the MMPI-2 (Butcher et al., 2001) Clinical scales by removing "demoralization," hypothesized to affect these scales adversely. Using 25 samples with MMPI-2 responses from 78,159 subjects across diverse clinical settings, we found that each RC scale was highly correlated with a Supplementary, Content, or Personality Psychopathology 5 (PSY-5; Harkness, McNulty, & Ben-Porath, 1995) scale: higher, in fact, than the correlation between the RC scale and its parent scale. Furthermore, for over half the RC scales (i.e., RC1, RC3, RC7, RC8, and RCd), the correlations were strong enough to conclude that the RC scales replicate MMPI-2 scales with rich empirical foundations; the remaining RC scales were not redundant. Next, we examined reliability estimates using alpha coefficients and interitem correlations and did not reveal superior reliability for most of the RC scales over existing MMPI-2 scales.