Search PubMed⌕ Search

Biomedical subjects

B C Frueh

Publications and source records attributed to B C Frueh.

At least 37 records · Page 2Linked to original sources

Relationship between symptom over-reporting and pre- and post-combat trauma history in veterans evaluated for PTSD.

We examined the prevalence of pre- and post-combat traumatic events in the histories of 129 combat veterans referred to be evaluated for PTSD and examined the impact of these non-combat traumatic events on self-reported psychiatric symptoms. Participants were consecutive referrals to a Veterans Affairs outpatient post-traumatic stress disorder (PTSD) clinic who completed structured interviews, self-report measures (e.g., Minnesota Multiphasic Personality Inventory-2; MMPI-2), and a trauma history questionnaire as part of their routine clinical evaluations. Findings show that non-combat trauma was prevalent in this sample, with 65% (21% pre-combat) reporting physical assaults and 12% (11% pre-combat) reporting sexual assaults. Overall, history of sexual or physical assaults did not appear to be systematically related to reported symptom level. However, chi square analyses revealed a consistent over-representation of veterans who reported sexual trauma in the category suggestive of response exaggeration (i.e., MMPI-2 F-K validity index > or = 13). Finally, a hierarchical regression equation predicting F-K scores was computed, but accounted for only 15.9% of the variance in F-K. Presence of sexual assault history was the only predictor associated with a more pronounced response set suggestive of exaggeration or deception. These findings tentatively indicate that if history of sexual or physical assault has an impact on symptom reporting in combat veterans evaluated for PTSD, it is of modest magnitude.

Adult↗

Compensation-seeking and extreme exaggeration of psychopathology among combat veterans evaluated for posttraumatic stress disorder.

We extended the work of Smith and Frueh (1996) by evaluating whether combat veterans classified as "extreme exaggerators" were more likely to be compensation-seeking, and to report greater levels of psychopathology across self-report instruments than "nonexaggerators." Of 119 veterans who completed the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) at an outpatient posttraumatic stress disorder (PTSD) clinic, 26 (22%) and 17 (14%) were identified as extreme exaggerators using two MMPI-2 validity indicators with stringent cutoffs (F-K > or = 22; F(p) > or = 8). These veterans were much more likely to be compensation seeking and scored much higher on self-report measures of various psychological symptoms than nonexaggerators, despite having lower rates of PTSD diagnoses and similar rates of other comorbid diagnoses. Findings suggest that the validity indices of the MMPI-2 can play a critical role, as a screening instrument, in identifying veterans who may be exaggerating their psychopathology to gain disability compensation.

Adult↗

Racial differences in combat-related PTSD: empirical findings and conceptual issues.

We critically review the empirical literature on racial differences in epidemiology, psychopathology, and treatment outcome in combat veterans with posttraumatic stress disorder (PTSD). Although there is a body of literature pertaining to various aspects of race and combat-related PTSD, much of the writing is conceptual in nature and based on single case or anecdotal reports, and there is a striking paucity of rigorous empirical findings. Furthermore, despite the prevailing zeitgeist and clinical lore, the limited extant empirical evidence suggests that veterans of different races are more similar to each other than they are different when it comes to the clinical manifestation and response to treatment of combat-related PTSD and associated features. The one area where clear differences exist is in epidemiological rates of PTSD, where minority combat veterans (i.e., Blacks and Hispanics) have been shown to have higher absolute rates of the disorder. However, secondary analyses within the existing epidemiological studies suggest that differential rates of PTSD between racial groups may be a function of differential rates of traumatic stressors and other pre-existing conditions. This finding, in combination with the general paucity of empirical data and certain methodological limitations, significantly moderates the conclusions that should be reached from this body of literature. Further research is needed before we can consider our knowledge in this area complete. A number of conceptual and methodological issues are discussed in order to highlight future research directions.

Black or African American↗

Response to venlafaxine in a previously antidepressant treatment-resistant combat veteran with post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is frequently treated with antidepressant medications, especially the newer selective serotonergic antidepressants which have documented efficacy in PTSD. Analogous to depression, however, some PTSD patients may not have a satisfactory response to these agents. This case report describes a PTSD patient who did not respond to several serotonergic antidepressants, but did improve with venlafaxine which has both noradrenergic and serotonergic properties.

Antidepressive Agents, Second-Generation↗

Combat guilt and its relationship to PTSD symptoms.

Guilt regarding combat experiences is often considered an associated symptom of PTSD in military veterans. Little is known, however, about the role combat guilt plays in the development and maintenance of PTSD. Inadequate measurement of combat-related guilt may be one reason for this deficiency in the literature. In the present study, 40 veterans with PTSD completed a novel measure of combat guilt. Items on the scale assessed various types of guilt and shame concerning combat experiences (i.e., survival guilt, guilt over acts of omission and acts of commission, guilt about thoughts/feelings). Guilt was quite prevalent within this sample, and severity of guilt regarding combat was positively correlated with the reexperiencing and avoidance symptoms of PTSD and a general measure of PTSD severity. Implications of these findings and recommendations for the development of measures for combat-related guilt are discussed.

Adult↗

Relationship between scores on anger measures and PTSD symptomatology, employment, and compensation-seeking status in combat veterans.

The interrelationship between the theoretically related constructs of anger and posttraumatic stress disorder (PTSD) symptoms was examined in a group of 42 combat veterans with PTSD using a multimeasure assessment strategy. Scores on several anger measures were found to be quite high in this sample and were significantly correlated with PTSD symptomatology. Furthermore, anger measures were found to be related to employment status independent of PTSD severity, but were not related to disability compensation-seeking status. Clinicians are advised to be aware of the potential implications for physical health and interpersonal functioning, and to incorporate anger management strategies into treatment plans for this population.

Adolescent↗

Personality and PTSD II: personality assessment of PTSD-diagnosed Vietnam veterans using the cloninger tridimensional personality questionnaire (TPQ).

Examined Tridimensional Personality Questionnaire (TPQ) responses of 53 Vietnam veterans with Combat-Related Posttraumatic stress disorder. When compared with normative data, veterans were found to be high on harm avoidance (HA), low on reward dependence (RD), and high on novelty seeking (NS). High HA and high NS scores were predictive of increased PTSD symptom severity as assessed by the MMPI-2 PK (PTSD)scale, Mississippi Combat Scale for PTSD (M-PTSD), and Beck Depression Inventory (BDI). Low RD was associated with higher scores on both the MMPI-2 PK and M-PTSD scales. The observed "high HA-low RD-high NS" TPQ configuration is consistent with previous research findings/clinical observations, and provides insights into a pattern of dysfunctional personality traits often observed in this population.

Adult↗

Preliminary evaluation of sexual problems in combat veterans with PTSD.

This study evaluated the potential relationship between posttraumatic stress disorder (PTSD) and sexual problems. The Golombok Rust Inventory of Sexual Satisfaction was mailed to combat veterans currently in treatment at an outpatient PTSD clinic. Completed questionnaires were received from 90 patients. Results indicated that over 80% of subjects were experiencing clinically relevant sexual difficulties. Impotence and premature ejaculation were the most frequently reported problems that have corresponding psychological diagnoses. The rates of sexual problems for this sample of veterans with PTSD was similar to those reported in other studies and exceeded rates of similar problems found in samples from community samples. These data suggest that PTSD may be a risk factor for sexual problems.

Adult↗

Symptom overreporting in combat veterans evaluated for PTSD: differentiation on the basis of compensation seeking status.

We examined the role of compensation-seeking status on response patterns to self-report inventories of acute psychopathology and psychological distress in a group of 165 combat veterans evaluated for posttraumatic stress disorder (PTSD) at a Department of Veteran Affairs (VA) Medical Center. Veterans completed the Minnesota Multiphasic Personality Inventory-Revised, Beck Depression Inventory, Mississippi Scale for Combat-Related PTSD, a fixed-response format version of the Dissociative Experiences Scale, and Impact of Events Scale as part of a standard assessment battery. Results showed that compensation-seeking veterans endorsed dramatically higher levels of psychopathology across measures and produced sharply elevated "fake-bad" validity indices as compared to non-compensation-seeking veterans. Differences between the two groups on most scales and indices exceeded effect sizes of 1.0, even when effects of income, global assessment of functioning, and clinician-rated severity of PTSD were controlled for. It is suggested that the availability of VA disability compensation for combat-related PTSD impedes accurate initial assessment of veterans presenting for treatment and may impair estimation of long-term therapeutic outcome in this population.

Bias↗

A racial comparison of combat veterans evaluated for PTSD.

This study attempted to replicate the work of Frueh, Smith, and Libet (1996), which showed racial differences on psychological measures of dissociation/thought disturbance and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) F-K index in combat veterans evaluated for posttraumatic stress disorder (PTSD). Veterans completed the Beck Depression Inventory, Mississippi Scale for Combat-Related PTSD, a fixed-response format version of the Dissociative Experiences Scale (DES-FRF), and MMPI-2 prior to treatment at a Veterans Affairs hospital outpatient PTSD clinic. Contrary to expectation, significant racial differences on the DES-FRF, MMPI-2 validity scales, and MMPI-2 Scales 6 and 8 were not found. Consistent with the previous study, no racial differences on measures of anxiety, depression, or PTSD symptomatology were found; nor were there racial differences on clinician ratings of global assessment of functioning or on most categories of psychiatric diagnoses. This suggests that Black and White combat veterans evaluated for PTSD do not differ with regard to reported manifestation or severity of psychopathology.

Adult↗

Compensation seeking status and psychometric assessment of combat veterans seeking treatment for PTSD.

Examined differences between compensation seeking (CS) veterans and noncompensation seeking (NCS) veterans on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and other psychological measures in 142 combat veterans evaluated for posttraumatic stress disorder (PTSD) at an outpatient Veterans Affairs (VA) hospital PTSD clinic. Patients were grouped on the basis of their compensation seeking status, with 69% classified as CS for PTSD. The CS veterans achieved significantly more pathological scores across a wide range of psychological inventories and MMPI-2 validity indices, although they did not differ in frequency of PTSD diagnoses from NCS veterans. Implications of these findings are discussed, and clinicians are advised to be aware of the compensation seeking status of combat-veterans being evaluated for PTSD.

Adult↗

Trauma management therapy: a preliminary evaluation of a multicomponent behavioral treatment for chronic combat-related PTSD.

The development and initial evaluation of a new, comprehensive and multicomponent behavioral treatment (Trauma Management Therapy, or TMT) for chronic combat-related Post-Traumatic Stress Disorder (PTSD) is described. The program utilizes elements of intensive exposure therapy, programmed practice, and structured social and emotional skills training to target the multiple aspects of chronic combat-related PTSD. The treatment was found to be effective in alleviating a broad spectrum of difficulties in combat veterans with chronic PTSD, most of whom had co-occurring Axis I and/or Axis II disorders. The results are discussed with respect to the implementation of the new treatment and the general need for a comprehensive approach to treating combat-related PTSD. Implications for the potential cost-effectiveness of the treatment program also are discussed.

Adult↗

Racial differences on psychological measures in combat veterans seeking treatment for PTSD.

In this article, we examined racial differences in psychometric data on 4 commonly used self-report inventories administered to a group of 206 combat veterans evaluated at a Veterans Affairs Medical Center outpatient posttraumatic stress disorder (PTSD) treatment program. Patients completed the Beck Depression Inventory, Mississippi Scale for Combat-Related PTSD, Dissociative Experiences Scale (DES), and Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Black veterans showed greater elevations than White veterans on the DES, and the F-K index and Scales 6 and 8 of the MMPI-2. In addition, normative data are presented for the entire sample on each measure. Results suggest that, consistent with studies using the original MMPI, these patients endorse severe levels of psychopathology across a broad range of symptoms, including depression and disturbed thinking. Implications for clinical practice and future research are addressed.

Adult↗

Personality disorder symptomatology among Vietnam veterans with combat-related PTSD.

This research examined self-report personality profiles of 42 Vietnam veterans with combat-related posttraumatic stress disorder (PTSD) evaluated at an outpatient Veteran's Administration hospital PTSD clinic. Assessment was via the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev; DSM-III-R) Personality Disorders-II (SCID-II) self-report. Self-reported personality disorder symptomatology of PTSD patients was contrasted with that of 51 outpatients with a primary diagnosis of an anxiety disorder other than PTSD and with 16 patients with a primary diagnosis of major depressive disorder (MDD). Symptomatology from each of the 11 DSM-III-R categories and from the three personality disorder "clusters" was calculated in terms of percentage of possible traits endorsed, thus creating personality "profiles" for the three groups. PTSD veterans endorsed more traits overall than did both the mixed anxiety and MDD groups, particularly on the Cluster A, avoidant, and borderline scales. Results suggest a PTSD-related personality profile characterized by emotional lability/poor anger control, paranoia/suspiciousness, identity disturbance/confusion, social withdrawal/avoidance, and feelings of emptiness and boredom.

Adult↗