Posttraumatic stress disorder and physical health symptoms among women seeking help for relationship aggression.

This study examined associations between intimate partner aggression and physical health symptoms among a sample of help-seeking women experiencing relationship aggression (N = 388). Using a structural equation modeling framework, the authors found posttraumatic stress disorder (PTSD) symptoms to fully mediate the associations of both physical and psychological aggression with physical health symptoms. The influence of PTSD symptoms on physical health symptoms was partially mediated by anger/irritability. Results were consistent with studies from other trauma groups suggesting that PTSD is pivotal with respect to explaining the effects of trauma on health.     

Posttraumatic stress disorder among survivors of a kamikaze attack

26 sailors who survived a Kamikaze attack during the battle for Okinawa in World War II were given two adapted forms of the Posttraumatic Stress Disorder Checklist-Civilian to assess the psychological reactions they had to the sinking of their ship. Depending on the assessment criteria used, their responses indicated significant stress reactions ranging from 8.3% to 44% of the sample. The findings provide evidence that a single combat experience can have lifelong, averse psychological effects.     

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.     

Posttraumatic stress disorder: A sensitization reaction

This article discusses past research bearing on the question of the etiology of Posttraumatic Stress Disorder (PTSD). It argues that PTSD can be adequately accounted for by a process of emotional sensitization and that this is a more parsimonious explanation than the two-factor learning theory of Mowrer, now postulated by several writers. In brief, the etiology and subsequent development of PTSD is viewed as the result of the sensitization of fear/anxiety which is linked to a variety of to be conditional stimuli by both backward and forward association: these become conditional stimuli (CSi) once paired with the instigating circumstances. It is furthermore assumed that PTSD will not occur in the absence of a genetic susceptibility that may vary from zero to absolute certainty. Thus far, our evidence is limited to a sensitivity to loud sounds, but it is highly probable that touch and other sensory systems are involved (not necessarily in parallel). The fact that abuse often leads to behavioral disorders, including sexually seductive behaviors in children sexually abused, requires a recognition that emotional reactions other than fear may be sensitized. Fear in combination with pleasure or pleasure alone coupled with a loss of self-esteem may explain these acting-out behaviors.     

Posttraumatic symptomatology in children exposed to war

This study examines affective and behavioral symptomatology in two groups of school-age children who were traumatized to different degrees during the war in Croatia (N = 1034). Six self-reported questionnaires were used to assess the following: number and type of war experiences, PTSD symptoms, anxiety, depression, psychosomatic symptoms, and psychosocial adaptation. Canonical discriminant analysis yielded a significant discriminant function that indicates moderate differentiation between the two groups of children according to the assessed symptoms. The results of a 2 x 2 x 2 ANOVAs (gender x age x level of traumatization) indicate that the children's reactions to war traumata varied in respect to all factors, as well as their interaction. The results indicate that gender differences are more prominent in older children. Older girls report more posttraumatic stress reactions, anxiety and depression, but at the same time seem better adapted than boys. Younger children, particularly those who survived more war even report more PTSD symptoms than older children.     

Posttraumatic stress disorder in a patient with no left amygdala

Existing biological models of posttraumatic stress disorder (PTSD) posit that the amygdala plays a critical role in the development and expression of this disorder. However, increasing data indicate that the amygdalae are not functionally identical, raising the possibility that the 2 amygdalae may make differential contributions to the expression of PTSD. The authors present a unique patient who developed PTSD following a traffic accident that occurred 2 years after she had undergone removal of her left amygdala to treat pharmacologically intractable epilepsy. The authors propose that the right amygdala is preferentially involved in several processes related to the expression of PTSD symptoms, such that the disorder can occur even in the absence of the left amygdala.     

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 relationship between borderline personality disorder and number of sexual partners

In this study, we examined the number of self-reported lifetime sexual partners between those with and without borderline personality disorder (BPD). Our hypothesis was that, due to the nature of the disorder, those with BPD would exhibit a greater number of lifetime sexual partners. Using a survey methodology in a consecutive sample of internal medicine outpatients (N = 354), we administered two self-report measures for BPD (the borderline personality scale of the Personality Diagnostic Questionnaire-4 and the Self-Harm Inventory), and queried participants, "How many sexual partners have you had in your lifetime?" Correlation coefficients and one-way ANOVAs were conducted to determine the relationship between BPD and the number of sexual partners. According to BPD status with the borderline personality scale of the Personality Diagnostic Questionnaire-4, we found that the mean number of sexual partners among BPD-positive participants was nearly double (p < .001) that of BPD-negative participants; according to BPD status with the Self-Harm Inventory, the mean number of sexual partners among BPD-positive participants was more than double (p < .001) that of BPD-negative participants. Compared to internal medicine outpatients without BPD, those with BPD exhibit a statistically significantly greater number of sexual partners.     

Posttraumatic stress disorder, traumatic brain injury, and suicide attempt history among veterans receiving mental health services

History of posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI) has been found to increase risk of suicidal behavior. The association between suicide attempt history among veterans with PTSD and/or TBI was explored. Cases (N = 81) and 2:1 matched controls (N = 160) were randomly selected from a Veterans Affairs Medical Center clinical database. PTSD history was associated with an increased risk for a suicide attempt (OR = 2.8; 95% CI: 1.5, 5.1). This increased risk was present for those with and without a history of TBI. Results support incorporating PTSD history when assessing suicide risk among veterans with and without TBI.     

Responsivity to stress in chronic posttraumatic stress disorder due to childhood sexual abuse

The purpose of this study was to investigate psychological, cardiovascular, and neuroendocrine reactivity to standardized stress tests (orthostatic challenge, Stroop Color Word Test) in drug-free adult women with chronic PTSD due to repetitive childhood sexual abuse. At baseline, the 11 patients showed significantly higher mean scores on the Symptom Check List-90 and the Profile of Mood States than 13 healthy female controls, whereas baseline cardiovascular or hormonal parameters showed no differences between the groups. Also, no significant differences were found between the two groups in cardiovascular and hormonal responsivity to the stress tests. Thus, in the presence of robust psychological differences, the patients with chronic PTSD due to childhood sexual abuse did not show alterations in baseline values of neurobiological parameters, nor did they react differently to a physical and mental stress test when compared to healthy controls.     

The relationship between posttraumatic stress symptomatology and suicidal behavior in school-based adolescents

This study investigated the relationship between posttraumatic stress disorder (PTSD) symptomatology and suicidal behavior, specifically suicidal ideation and suicide attempt history, while controlling for depression and gender in 106 adolescents in an urban high school. Participants completed self-report measures of the Adolescent Psychopathology Scales-Posttraumatic Stress Disorder Subscale (APS-PTS), the APS-Suicide Attempt History (APS-SAH), the Suicidal Ideation Questionnaire-Junior (SIQ-JR), and the Reynolds Adolescent Depression Scale (RADS). Analyses were conducted using a hierarchical multiple regression design to account for the relationship between PTSD symptomatology and depression. Regression results showed that after controlling for depression and gender, PTSD symptomatology was significantly related to suicidal ideation and showed a trend toward suicide attempt history. In addition, adolescents with high levels of PTSD symptomatology were more likely than peers with "average" levels of PTSD symptomatology to be currently thinking about suicide and to have made a past suicide attempt. These findings show that PTSD symptomatology has a unique relationship to adolescent suicidal behavior that cannot be explained by depression or gender. The importance of these results and their implications for future research are discussed.     

Posttraumatic stress disorder in the emergency room: exploration of a cognitive model

Ehlers and Clark (Behav. Res. Ther., 38 (2000) 319) recently proposed a cognitive model of posttraumatic stress disorder (PTSD). In this study, we examined two facets of this model, appraisal and peritraumatic dissociation, in the context of a hospital emergency room. Fifty-one emergency room personnel completed questionnaires measuring posttraumatic stress symptoms, interpretations of traumatic events experienced while working in the emergency room and subsequent intrusive recollections, and peritraumatic dissociation. Twelve percent of participants met formal diagnostic criteria for PTSD, and 20% met PTSD symptom criteria. As predicted, both negative appraisals of the trauma and of intrusive recollections were associated with increased PTSD severity. Although peritraumatic dissociation did not correlate with overall PTSD symptom severity, it was associated with the reexperiencing symptom cluster. Discussion focuses on the factors associated with PTSD in emergency room professionals and implications for intervention.     

The role of postdeployment social factors in linking deployment experiences and current posttraumatic stress disorder symptomatology among male and female veterans

Background and Objectives: The postdeployment social context is likely highly salient in explaining mental health symptoms following deployment. The aim of this study was to examine the role of postdeployment social factors (social support and social reintegration difficulty) in linking deployment-related experiences (warfare exposure, sexual harassment, concerns about relationship disruptions, and deployment social support) and posttraumatic stress disorder (PTSD) symptomatology in male and female veterans.

Design: A survey was administered to 998 potential participants (after accounting for undeliverable mail) who had returned from deployment to Afghanistan or Iraq. Completed surveys were received from 469 veterans, yielding a response rate of 47%.

Methods: Hypotheses were examined using structural equation modeling.

Results: For male and female veterans, deployment factors predicted later PTSD symptoms through postdeployment social support and social reintegration, with lower support and higher social reintegration difficulty both associated with higher PTSD symptomatology. While the final models for women and men indicated similar risk mechanisms, some differences in pathways were observed. Sexual harassment presented more of a risk for women, whereas lower social support was a greater risk factor for men.

Conclusions: Postdeployment social factors appear to represent potentially important targets for interventions aiming to reduce the potential impact of stressful deployment experiences.     

The impact of borderline personality disorder on process group outcome among women with posttraumatic stress disorder related to childhood abuse.

The outcome of a 12-week interpersonal process group therapy for women with postraumatic Stress Disorder (PTSD) related to childhood sexual abuse with and without borderline personality disorder (BPD) was assessed by comparing three naturally occurring treatment conditions: groups that did not have any members with borderline personality disorder (BPD-) (n = 18), groups in which at least one member carried the diagnosis (BPD+)(n = 16), and a 12-week waitlist (WL) (n = 15). PTSD, anger, depression, and other symptoms were significantly reduced in the BPD- groups. However, the BPD+ and WL conditions did not show any pre- to posttreatment improvements. Furthermore, the BPD+ condition showed a significant worsening on measures of anger. Analyses within the BPD+ condition indicated that women with and without the diagnosis experienced equal posttreatment increases in anger problems. These latter results suggest the presence of an anger "contagion" effect. That is, women without BPD did well in the BPD- groups but showed increased anger similar to the BPD+ women when treated in groups with them. Implications for client-treatment matching considerations in PTSD group therapy are discussed.     

Family-of-origin maltreatment, posttraumatic stress disorder symptoms, social information processing deficits, and relationship abuse perpetration

In this study, the authors examined the interrelations among family-of-origin maltreatment variables, posttraumatic stress disorder (PTSD) symptoms, social information processing deficits, and male-to-female psychological and physical intimate relationship abuse perpetration in adulthood among a community sample of 164 men and their partners. In bivariate analyses, higher family-of-origin childhood parental rejection was associated with the perpetration of psychological and physical abuse in adulthood, and childhood exposure to interparental violence was also associated with adult psychological abuse perpetration. Structural equation modeling analyses indicated that when childhood variables and other study variables were considered together, only childhood parental rejection was associated with the abuse perpetration outcomes, and these effects were indirect through PTSD symptoms and social information processing deficits. Results indicate a need for further investigation into the mechanisms accounting for the impact of early maltreatment on the development of abusive intimate relationship behavior.     

Posttraumatic stress disorder and psychosocial functioning within two samples of MVA survivors

To examine criterion F variables of PTSD, the psychosocial functioning of two samples of motor vehicle accident (MVA) survivors was investigated. Within each sample, comparisons between MVA survivors with and without PTSD were conducted on four psychosocial functioning indices at three time points. In addition, the relationships between specific PTSD symptom clusters and psychosocial functioning indices were examined. The study revealed that, in general, MVA survivors with PTSD evidenced poorer psychosocial functioning than did survivors without PTSD. The emotional numbing symptoms of PTSD emerged as the most consistent predictors of the psychosocial functioning indices. The implications of these findings to the comprehensive treatment of PTSD are discussed.     

The relationship between acute stress disorder and posttraumatic stress disorder in severely injured trauma survivors

This prospective longitudinal study was designed to investigate the relationship between acute stress disorder (ASD) and the subsequent development of posttraumatic stress disorder (PTSD) in a population of severely injured hospitalised trauma survivors. Symptoms of ASD were assessed just prior to discharge in 307 consecutive admissions to a Level 1 Trauma Centre, with PTSD assessments completed at 3 and 12 months post-injury. A well-established structured clinical interview was adopted for both assessments. Only 1% of the sample met criteria for an ASD diagnosis (at a mean of 8 days post-injury), while the incidence of PTSD was 9% at 3 months and 10% at 12 months. Although all ASD symptom clusters contributed to the prediction of subsequent PTSD severity, logistic regression indicated that only re-experiencing and arousal predicted a categorical PTSD diagnosis. The dissociative symptoms that form the core of ASD were rarely endorsed and showed high specificity but low sensitivity, resulting in a high proportion of false negative diagnoses. Reducing the number of dissociative symptoms required for a diagnosis ameliorated, but did not resolve, the problem. In this particular population, the low sensitivity of the ASD diagnosis renders it a poor screening test for use in identifying high risk individuals for early intervention and prevention strategies.