Correlational Structure of the MCMI-III Personality Disorder Scales and Comparisons With Other Data Sets

We examine the correlational structure of the personality disorder (PD) scales from the MCMI-III (Millon, 1994) among 614 college students. The correlation matrix from our nonclinical sample was highly similar to the clinical sample matrices reported by Millon (1994). Further analyses revealed that the correlation matrices from a variety of MCMI data sets are generally similar to one another, but are only moderately similar to PD correlation matrices based on other assessment techniques. PD correlation matrices based on different assessment techniques are generally not very similar to one another. Two-, 3-, and 4-factor solutions for the MCMI-III PD scales are reported and provide a framework for integrating apparently conflicting findings from previous work. The 4-factor solution was most meaningful and was consistent with the 5-factor model of PD.     

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.     

Qualitative block design analysis in posttraumatic stress disorder

Qualitative and quantitative Block Design performance was examined in Vietnam combat veterans with PTSD diagnoses (n = 23) and Vietnam combat veterans without PTSD or other mental disorders diagnoses (n = 19). Results indicated that PTSD-diagnosed veterans committed more single block rotations than the comparison sample, and that their errors occurred more frequently in right hemispace than errors made by the comparison sample. The two groups did not differ in the number of configural errors made, errors committed in left hemispace, or in quantitative performance measures. Findings are suggestive of relative left hemisphere hypoactivation and are congruent with prior research documenting cerebral asymmetries in emotional disorders.     

Proactive coping, gratitude, and posttraumatic stress disorder in college women

This study investigated relationships among proactive coping, positive emotions, and posttraumatic stress disorder (PTSD) symptom severity for 182 undergraduate women with trauma histories. Participants were administered the Life Events Checklist (LEC), PTSD Checklist, Proactive Coping Inventory, Proactive Attitude Scale, General Perceived Self-Efficacy Scale, and measures of posttrauma gratitude and emotional growth. An Exploratory Factor Analysis (EFA) with proactive coping, proactive attitude, and self-efficacy items indicated a one-factor solution. The proactive coping style factor and posttrauma gratitude were independently negatively associated with current PTSD symptom level, above and beyond the effects of trauma severity, trauma history, and time elapsed since the trauma. The implications of these results for future research and understanding of the development of PTSD and its treatment are discussed.     

Proactive coping,gratitude, and posttraumatic stress disorder in college women

Abstract

This study investigated relationships among proactive coping, positive emotions, and posttraumatic stress disorder (PTSD) symptom severity for 182 undergraduate women with trauma histories. Participants were administered the Life Events Checklist (LEC), PTSD Checklist, Proactive Coping Inventory, Proactive Attitude Scale, General Perceived Self-Efficacy Scale, and measures of posttrauma gratitude and emotional growth. An Exploratory Factor Analysis (EFA) with proactive coping, proactive attitude, and self-efficacy items indicated a one-factor solution. The proactive coping style factor and posttrauma gratitude were independently negatively associated with current PTSD symptom level, above and beyond the effects of trauma severity, trauma history, and time elapsed since the trauma. The implications of these results for future research and understanding of the development of PTSD and its treatment are discussed.     

Physiologic reactivity to startling tones in women with posttraumatic stress disorder.

Autonomic and eyeblink reactivity to startling tones were investigated in women with histories of childhood sexual abuse (CSA). Twenty-one women with current posttraumatic stress disorder (PTSD), 23 with lifetime but not current PTSD, and 13 women who never had PTSD listened to 15 95-dB, 500-ms, 1000-Hz tones with a 0-ms rise time while heart rate (HR), skin conductance (SC), and orbicularis oculi electromyogram (EMG) responses were measured. Participants in the current and lifetime PTSD groups produced larger HR responses across tones and showed slower absolute habituation of SC response magnitude compared with the never PTSD group. EMG response magnitudes did not differ among groups. Women with CSA-related PTSD showed increased autonomic reactivity and slower habituation to high-intensity tones similar to that observed in primarily male, combat PTSD samples. This suggests that heightened autonomic responsivity to startling stimuli in PTSD is not gender or event specific.     

The coherence of memories for trauma: Evidence from posttraumatic stress disorder

Participants with posttraumatic stress disorder (PTSD) and participants with a trauma but without PTSD wrote narratives of their trauma and, for comparison, of the most-important and the happiest events that occurred within a year of their trauma. They then rated these three events on coherence. Based on participants’ self-ratings and on naïve-observer scorings of the participants’ narratives, memories of traumas were not more incoherent than the comparison memories in participants in general or in participants with PTSD. This study comprehensively assesses narrative coherence using a full two (PTSD or not) by two (traumatic event or not) design. The results are counter to most prevalent theoretical views of memory for trauma.     

Personality dispositions in the prediction of posttraumatic stress reactions

The study examined the relationship of extraversion, neuroticism, and impulsiveness with posttraumatic stress reactions of avoidance and intrusion. 36 outpatients from a trauma unit at a major metropolitan hospital in Melbourne (Victoria), and 24 age-matched controls completed the Impact of Event Scale, the Eysenck Personality Questionnaire Revised, and the Impulsivity Questionnaire. Intrusion symptoms were predicted both by Extraversion and Neuroticism, after controlling for age and gender, with Neuroticism making a stronger contribution to the prediction. The only predictor of Avoidance symptoms was Neuroticism. Impulsivity correlated with Intrusion symptoms but predicted them only in the trauma group. This finding, along with the observed positive associations of Extroversion with both posttraumatic symptoms, lends support to Gray's model of dispositions influencing responses to trauma, suggesting that impulsive (extroverted) neurotics are more vulnerable to posttraumatic stress than introverted ones.     

The neuroendocrinology of posttraumatic stress disorder: new directions

Studies of the hypothalamic-pituitary-adrenal (HPA) axis in persons with posttraumatic stress disorder (PTSD) have produced variable findings. This review focuses on the factors likely to have affected the outcome of these studies, including population characteristics and experimental design. Also discussed is a possible role for the adrenal neurosteroid dehydroepiandrosterone (DHEA) as a mediator of HPA axis adaptation to extreme stress and the psychiatric symptoms associated with PTSD. The antiglucocorticoid properties of DHEA may contribute to an upregulation of HPA axis responses as well as mitigate possible deleterious effects of high cortisol levels on the brain in some PTSD subpopulations. The neuromodulatory effects of DHEA and its metabolite DHEAS at gamma-aminobutyric acid and N-methyl-D-aspartate receptors in the brain may contribute to psychiatric symptoms associated with PTSD. The possible importance of other neurohormone systems in modulating HPA axis and symptom responses to traumatic stress is also discussed. Understanding the complex interactions of these stress-responsive neurosteroid and peptide systems may help explain the variability in patterns of HPA axis adaptation, brain changes, and psychiatric symptoms observed in PTSD and lead to better targeting of preventive and therapeutic interventions.     

The psychophysiology of posttraumatic stress disorder: a meta-analysis

This meta-analysis of 58 resting baseline studies, 25 startle studies, 17 standardized trauma cue studies, and 22 idiographic trauma cue studies compared adults with and without posttraumatic stress disorder (PTSD) on psychophysiological variables: facial electromyography (EMG), heart rate (HR), skin conductance (SC), and blood pressure. Significant weighted mean effects of PTSD were observed for HR (r = .18) and SC (r = .08) in resting baseline studies; eyeblink EMG (r = .13), HR (r = .23), and SC habituation slope (r = .21) in startle studies; HR (r = .27) in standardized trauma cue studies; and frontalis EMG (r = .21), corrugator EMG (r = .34), HR (r = .22), and SC (r = .19) in idiographic trauma cue studies. The most robust correlates of PTSD were SC habituation slope, facial EMG during idiographic trauma cues, and HR during all study types. Overall, the results support the view that PTSD is associated with elevated psychophysiology. However, the generalizability of these findings is limited by characteristics of the published literature, including its disproportionate focus on male veterans and neglect of potential PTSD subtypes.     

Anxiety sensitivity and distress tolerance typologies and relations to posttraumatic stress disorder: A cluster analytic approach

A growing literature suggests a relationship between a high anxiety sensitivity (AS; the fear of anxiety and its related consequences)/low distress tolerance (DT; the capacity tolerate internal negative states) profile and posttraumatic stress disorder (PTSD) symptoms. However, specific profiles have not been identified or examined specifically in Veteran samples. Thus, the aims of the present study were to establish empirically derived profiles created from response patterns on the Anxiety Sensitivity Index and Distress Tolerance Scale and to examine associations with PTSD symptom clusters among a sample of combat-exposed Veterans (N = 250). A cluster analytic approach was used to identify AS/DT profiles, and a series of multivariate analyses of variance with post hoc analyses was conducted to examine the relationship between each AS/DT profile and each PTSD symptom cluster. Results indicated a 3-cluster solution including a high AS/low DT “at risk” profile, a low AS/high DT “resilient” profile, and an average AS/DT “intermediate” profile. The at-risk profile was associated with significantly greater symptoms in each PTSD cluster (i.e., hyperarousal, avoidance, re-experiencing) when compared to the other two profiles. The at-risk profile was also associated with greater depressive symptoms and lower self-reported resilience. These findings extend the previous literature by identifying a high AS/low DT “at risk” profile and its associations with PTSD symptoms, underscoring the potential utility in targeting these affect-regulation constructs for clinical intervention.     

Posttraumatic stress disorder among battered women: analysis of legal implications

The diagnosis of posttraumatic stress disorder (PTSD) has recently been applied to the psychological experiences of victims of intimate violence, including physical and sexual assault. The use of trauma theory to explain battered women's responses to violence has laid a foundation for expert testimony on PTSD, where relevant, within more general testimony concerning partner violence. This article discusses the relevance of the PTSD diagnosis within the legal context for explaining battered women's responses to violence.     

Selective processing of threat cues in posttraumatic stress disorder

Vietnam combat veterans with (n = 15) and without (n = 15) posttraumatic stress disorder (PTSD) performed a modified Stroop task in which they named the colors of neutral words (e.g., INPUT), positive words (e.g., LOVE), obsessive-compulsive disorder (OCD) words (e.g., GERMS), and PTSD words (e.g., BODYBAGS). In contrast to normal controls, PTSD patients took significantly longer to color-name PTSD words than to color-name neutral, OCD, and positive words. Because Stroop interference reflects involuntary semantic activation, it may provide a quantitative measure of intrusive cognitive activity--the hallmark symptom of PTSD.     

Diagnostic issues in posttraumatic stress disorder: considerations for the DSM-IV

Four issues of key interest with regard to posttraumatic stress disorder in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) are discussed. These include: (a) how to define the stressor criterion, especially, whether or not the victim's response ought to be included and whether low-magnitude traumas qualify etiologically; (b) the cohesiveness of the syndrome and the validity of items across stressor groups; (c) the position of posttraumatic stress disorder within DSM-IV; and (d) comorbidity with other illnesses.     

Measures of prefrontal system dysfunction in posttraumatic stress disorder

Clinical observations have suggested that individuals who have suffered traumatic stressful events exhibit disruption in abilities mediated by frontal brain systems. Therefore, this study employed tasks sensitive to frontal lobe dysfunction, including delayed response (DR), delayed alternation (DA), object alternation (OA), delayed matching-to-sample (DMTS), and delayed nonmatching-to-sample (DNMTS), with participants having posttraumatic stress disorder (PTSD). Compared to controls, the PTSD participants were unimpaired on DA and DMTS, but they showed deficits on DR, OA, and DNMTS tasks. This pattern of results suggests disruption of functioning in selective prefrontal brain systems. Results are discussed in the context of the neuropsychological features of PTSD, as well as possible neuropathological and etiological underpinnings of this disorder.     

Epidemiology of trauma and posttraumatic stress disorder in Mexico

Prevalence rates of trauma and posttraumatic stress disorder (PTSD) were estimated from a probability sample of 2,509 adults from 4 cities in Mexico. PTSD was assessed according to Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) criteria using the Composite International Diagnostic Interview (CIDI; WHO, 1997). Lifetime prevalence of exposure and PTSD were 76% and 11.2%, respectively. Risk for PTSD was highest in Oaxaca (the poorest city), persons of lower socioeconomic status, and women. Conditional risk for PTSD was highest following sexual violence, but nonsexual violence and traumatic bereavement had greater overall impact because of their frequency. Of lifetime cases, 62% became chronic; only 42% received medical or professional care. The research demonstrates the importance of expanding the epidemiologic research base on trauma to include developing countries around the world.     

Fear conditioning in posttraumatic stress disorder: evidence for delayed extinction of autonomic, experiential, and behavioural responses

Aversive conditioning has been proposed as an important factor involved in the etiology of posttraumatic stress disorder (PTSD). However, it is not yet fully understood exactly which learning mechanisms are characteristic for PTSD. PTSD patients (n=36), and healthy individuals with and without trauma exposure (TE group, n=21; nTE group, n=34), underwent a differential fear conditioning experiment consisting of habituation, acquisition, and extinction phases. An electrical stimulus served as the unconditioned stimulus (US), and two neutral pictures as conditioned stimuli (CS+, paired; CS-, unpaired). Conditioned responses were quantified by skin conductance responses (SCRs), subjective ratings of CS valence and US-expectancy, and a behavioural test. In contrast to the nTE group, PTSD patients showed delayed extinction of SCRs to the CS+. Online ratings of valence and US-expectancy as well as the behavioural test confirmed this pattern. These findings point to a deficit in extinction learning and highlight the role of affective valence appraisals and cognitive biases in PTSD. In addition, there was some evidence that a subgroup of PTSD patients had difficulties in learning the CS-US contingency, thereby providing preliminary evidence of reduced discrimination learning.