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Aggressive behavior in combat veterans with post-traumatic stress disorder.

The incidence of aggression and violent behavior in combat veterans varies and can be observed with regard to the presence or absence of post-traumatic stress disorder (PTSD). Significantly greater occurrence of aggression was observed in combat veterans with PTSD compared with those without PTSD. There are various types of aggressive behavior that frequently are combined. Autoaggressive (suicidal) and heteroaggressive (interpersonal violence) behaviors predominate, with dominating verbal aggression and impulsive somatic reactions. Impulsive reactions are more frequently directed toward unknown persons, whereas verbal aggression is mostly aimed at known people. In the occurrence of aggressive behavior in combat veterans with PTSD, important roles are played by education level, low socioeconomic status, maltreatment in childhood, and previous types of violent behavior (before participation in war events).

Adult↗

Performance on visuospatial copying tasks in individuals with chronic posttraumatic stress disorder.

The ability to copy figures was evaluated in 41 subjects with chronic posttraumatic stress disorder (PTSD) and 27 trauma-exposed, non-PTSD comparison subjects. Individuals with PTSD demonstrated significantly impaired performance. However, after adjusting for pre-trauma variables, there was only a marginally significant association between figure-copying performance and PTSD. These findings are consistent with pre-trauma visual-spatial impairment as being among the risk factors for chronic PTSD.

Adult↗

Double trauma: a group therapy approach for Vietnam Veterans suffering from war and childhood trauma.

A model of a 9-month exploratory psychotherapy group for male Vietnam War veterans diagnosed with posttraumatic stress disorder (PTSD) who also experienced childhood physical and sexual abuse is presented. Recent literature delineating an association between combat PTSD and earlier childhood abuse is briefly reviewed and forms the basis for a new treatment strategy. A trauma group psychotherapy approach that investigates the connections between war and childhood traumas and their effects on later adult coping and interpersonal relationships is fundamentally different than existing trauma group treatment paradigms that focus primarily on war-related events. A description of the group formation, philosophy, course, and outcome is provided and enriched by clinical material.

Adaptation, Psychological↗

Multidimensional assessment of anger in Vietnam veterans with posttraumatic stress disorder.

This study examined the effects of combat exposure and posttraumatic stress disorder (PTSD) on dimensions of anger in Vietnam veterans. Vietnam combat veterans were compared with Vietnam era veterans without war zone duty on the Multidimensional Anger Inventory (MAI). Combat veterans were not significantly more angry than their veteran peers who did not serve in Southeast Asia. Additionally, various parameters of war zone duty were not highly associated with anger scores. However, combat veterans with PTSD scored significantly higher than veterans without PTSD on measures of anger arousal, range of anger-eliciting situations, hostile attitudinal outlook, and tendency to hold anger in. These results suggest that PTSD, rather than war zone duty, is associated with various dimensions of angry affect.

Adult↗

Plasma beta-endorphin levels in post-traumatic stress disorder: a preliminary report on response to exercise-induced stress.

Post-traumatic stress disorder (PTSD) may be associated with changes in endogenous opioid peptide function. To test this hypothesis, 10 male Vietnam combat veterans with PTSD and 8 age-matched male controls underwent a standard grade-incremented exercise treadmill stress test. Plasma beta-endorphin measurements were obtained at rest and following maximal exercise. Resting plasma beta-endorphin levels were comparable between groups. Post-exercise plasma beta-endorphin levels were significantly higher than resting levels in the PTSD patients only (P less than 0.05). These pilot data suggest a differential alteration in plasma beta-endorphin response to exercise in PTSD.

Adult↗

Measuring exposure to racism: development and validation of a Race-Related Stressor Scale (RRSS) for Asian American Vietnam veterans.

This article describes the development and validation of the Race-Related Stressor Scale (RRSS), a questionnaire that assesses exposure to race-related stressors in the military and war zone. Validated on a sample of 300 Asian American Vietnam veterans, the RRSS has high internal consistency and adequate temporal stability. Hierarchical regression analyses revealed that exposure to race-related stressors accounted for a significant proportion of the variance in posttraumatic stress disorder (PTSD) symptoms and general psychiatric symptoms, over and above (by 20% and 19%, respectively) that accounted for by combat exposure and military rank. The RRSS appears to be a psychometrically sound measure of exposure to race-related stressors for this population. Race-related stressors as measured by the RRSS appear to contribute uniquely and substantially to PTSD symptoms and generalized psychiatric distress.

Asian↗

Dual factitious disorder.

The DSM-III classification of factitious disorders encourages artificial separation into disorders with physical and those with psychologic symptoms. Despite documented examples of similar patients who present with psychiatric complaints, Munchausen's syndrome is usually considered a form of chronic factitious physical disorder. Three patients with both factitious physical and psychologic symptoms are presented. These patients illustrate the importance of focusing on the fundamental behavior of assuming the patient role, rather than on the specific category of symptoms. We recommend that the category of symptoms be used as a modifying statement, rather than defining separate disorders.

Adult↗

Symptom patterns associated with posttraumatic stress disorder among Vietnam veterans exposed to war trauma.

The authors tested whether the relationship between traumatic stress and posttraumatic stress disorder is captured more accurately by aggregating symptoms, as in DSM-III, or differentiating them into the subtypes of denial and reexperiencing. Their findings indicate that distinguishing between the responses of denial and reexperiencing is an alternative and potentially more useful approach for understanding posttraumatic stress disorder and its origins in war trauma than the comprehensive model proposed in DSM-III. The analysis suggests that biases in the current model of posttraumatic stress disorder may lead to underestimation of its prevalence. The authors conclude that reconsideration of what constitutes the disorder is warranted.

Adolescent↗

Post-traumatic stress disorder: an overview.

An overview of post-traumatic stress disorder, including a brief historical survey, and its epidemiology, nosology, etiology, clinical presentation, treatment, prognosis as well as a short vignette, highlights the fact that this disorder prevails in times of war and peace. Early intervention is emphasized as the key to successful treatment. The timeliness for Canadian mental health professionals to review this disorder is also mentioned.

Adult↗

The epidemiology of posttraumatic stress disorder: what is the extent of the problem?

Until recently, our understanding of posttraumatic stress disorder (PTSD) relied almost entirely on studies of war veterans and disaster victims. A handful of epidemiologic studies have now been conducted that investigate the natural course of PTSD as it occurs in the general population. Estimates of PTSD prevalence have tended to vary according to the diagnostic criteria used to define the disorder, assessment procedures, sample characteristics, and the definition of qualifying traumatic events. This article reviews key findings from these studies to provide insight into the burden of PTSD in the general population. Possible reasons for the observed difference in lifetime prevalence of PTSD between the sexes (a female-to-male lifetime prevalence ratio of 2:1 is typically reported) and factors thought to be associated with an increased risk for the disorder after exposure to trauma are reviewed.

Adolescent↗

MMPI-2 profiles of Gulf and Vietnam combat veterans with chronic posttraumatic stress disorder.

The current study examined service era differences in a sample of 172 Gulf and Vietnam outpatient veterans with combat-related posttraumatic stress disorder (PTSD). Participants completed the MMPI-2 and several additional self-report measures of symptom severity (PTSD, depression, anxiety, hostility, and health complaints). Results indicated that MMPI-2 profiles differed significantly according to service era with Vietnam veterans scoring higher on scales 2, 8, and 0 and lower on scale 9 than did Gulf veterans. Examination of group means derived from parametric analysis of MMPI-2 data suggested a mean two-point code type of 2-8/8-2 for Vietnam veterans and 1-8/8-1 for Gulf veterans. In contrast, when the data were examined using descriptive techniques based on frequency counts of individual MMPI-2 profiles, the most frequently occurring two-point codetype was 7-8/8-7 for Vietnam veterans, and 6-8/8-6 for Gulf veterans. In addition, Gulf veterans reported a greater number of total health complaints than Vietnam veterans, whereas Vietnam veterans reported a greater number of physician-diagnosed physical conditions. Potential advantages of incorporating descriptive approaches versus parametric methods when examining profile data are also presented.

Adult↗