Minnesota Multiphasic Personality Inventory profiles of Vietnam combat veterans with posttraumatic stress disorder and their children

Current Treatments of Post-traumatic Stress Disorder and Amygdala Ablation as a Potential Cutting-Edge Therapy in Its Refractory Cases

Post-traumatic stress disorder (PTSD)is a very common psychiatric disorder occurring in an individual of any age, gender, or race who underwent trauma, with women being twice more at risk than men. It is generally seen more in American Indians, United States Latinos, and African American ethnic groups. A patient is diagnosed with PTSD if the symptoms of intrusion, avoidance, changes in cognition and emotions, arousal, and mood reactivity changes persist for more than a month and cause the individual severe difficulty in their everyday cognitive and psychological functioning. The psychological treatment includes numerous therapies including trauma-focused therapies such as cognitive behavioral therapy, cognitive processing therapy, prolonged exposure therapy, eye movement desensitization and reprocessing, and non-trauma-focused therapies such as relaxation techniques, interpersonal therapy, and mindfulness. Various pharmacological measures have also been tried with mixed results such as selective serotonin reuptake inhibitors, benzodiazepines, adrenergic drugs, atypical antipsychotics, and mood stabilizers like lithium and valproate. As numerous studies have proven, PTSD is linked with right-side stimulation of the amygdala. The purpose of this article is to highlight the use of extremely selective laser ablation of the amygdala-hippocampal unit as a successful surgical intervention for medically unresponsive PTSD and as a revolutionary solution and prospective cutting-edge therapy in the near future.

Impact of paternal deployment to the conflicts in Iraq and Afghanistan and paternal post-traumatic stress disorder on the children of military fathers

BACKGROUND

Little is known about the social and emotional well-being of children whose fathers have been deployed to the conflicts in Iraq/Afghanistan or who have post-traumatic stress disorder (PTSD).AimsTo examine the emotional and behavioural well-being of children whose fathers are or have been in the UK armed forces, in particular the effects of paternal deployment to the conflicts in Iraq or Afghanistan and paternal PTSD.

METHOD

Fathers who had taken part in a large tri-service cohort and had children aged 3-16 years were asked about the emotional and behavioural well-being of their child(ren) and assessed for symptoms of PTSD via online questionnaires and telephone interview.

RESULTS

In total, 621 (67%) fathers participated, providing data on 1044 children. Paternal deployment to Iraq or Afghanistan was not associated with childhood emotional and behavioural difficulties. Paternal probable PTSD were associated with child hyperactivity. This finding was limited to boys and those under 11 years of age.

CONCLUSIONS

This study showed that adverse childhood emotional and behavioural well-being was not associated with paternal deployment but was associated with paternal probable PTSD.Declaration of interestN.T.F. is a trustee of the Warrior Programme, a charity supporting ex-service personnel and their families. She is also a member of the Independent Group Advising on the Release of Data (IGARD). S.W. is a trustee of Combat Stress, a charity supporting ex-service personnel and their families, and President of the Royal Society of Medicine. S.W. is partially funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with Public Health England (PHE), in collaboration with the University of East Anglia and Newcastle University.

Posttraumatic Stress Disorder, Parenting, and Marital Adjustment among a Civilian Population

While psychopathology in general is linked to poorer marital and parental satisfaction, there is a paucity of data regarding these interactions in parents with Posttraumatic stress disorder (PTSD). The current study addresses this issue among a civilian population. Two hundred trauma-exposed parents, mean age of 37.2, 62% mothers, were assessed using self-report questionnaires, for background variables, PTSD symptoms using the Posttraumatic Stress Diagnostic Scale (PDS), depression symptoms (Beck Depression Inventory, BDI), marital satisfaction (Dyadic Adjustment Scale, DAS-7), parenting behavior (Alabama Parenting Questionnaire, APQ-9), and parenting satisfaction (Parenting Satisfaction Questionnaire). We hypothesized that positive parenting behavior and parenting satisfaction would be negatively correlated with PTSD symptom levels, and that this relationship would be mediated by marital satisfaction; the independent effects of depression on marital and parenting functioning were also examined. Data was analyzed using structural equation modeling (SEM). Results indicated that PTSD was related to poorer parenting behavior (B = 0.089, p = 0.033), depression had a negative impact on parenting satisfaction (B = 0.983, p = 0.003), and marital satisfaction (B = -0.672, p = 0.004), and marital satisfaction fully mediated the relationship between depression and parenting. The findings demonstrated that the effects of PTSD can cast a pall not only over the individual but over the entire family. Interventions are needed to address these issues.

Paternal history of mental illness associated with posttraumatic stress disorder among veterans

This study examined the association between parent and family reported history of non-PTSD mental illness (MI), PTSD specifically, and substance use problems, and participant clinical diagnosis of PTSD. Participants were drawn from the US Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC) Post-Deployment Mental Health (PDMH) study (n = 3191), an ongoing multi-site cohort study of US Afghanistan and Iraq conflict era veterans. Participants who recalled a father history of PTSD had a 26-percentage point higher likelihood of meeting criteria for PTSD; while participants reporting any family history of PTSD had a 15-percentage point higher probability of endorsing symptoms consistent with PTSD. Mother history of substance use problems was associated with Veteran current PTSD, but results were sensitive to model specification. Current PTSD was not associated with family/parent history of non-PTSD mental illness, mother history of PTSD, or family/father history of substance use problems. Family history of PTSD may increase PTSD risk among veterans exposed to trauma, particularly when a father history is reported. Knowledge of family history could improve clinical decision-making for trauma-exposed individuals and allow for more effective targeting of programs and clinical services.

Veterans are not the only ones suffering from posttraumatic stress symptoms: what do we know about dependents' secondary traumatic stress?

PURPOSE

Previous research has mainly focused on veterans' mental health problems, especially on posttraumatic stress disorder (PTSD). Less is known about the impact that the veteran's experienced potentially traumatic events (PTEs) might have on their significant others. Therefore, we reviewed the scientific literature to find out what is known about the prevalence of secondary traumatic stress (STS) in significant others of veterans.

METHODS

We systematically searched Pubmed, PsycINFO, Embase, Cochrane Library and PILOTS for relevant articles. This search resulted in 3100 records from which we included 48 articles.

RESULTS

Two studies that reported on parental PTSD did not find evidence that parents were affected by their offspring's experience. Nine studies that reported on PTSD in mainly adult children of veterans found only scant evidence that children were affected by their parent's experienced PTE. Twenty-seven studies investigated PTSD symptoms in partners of veterans. Here results varied largely between studies with PTSD rates between 0 and 51 %.

CONCLUSIONS

Overall, we found the strongest evidence of STS in partners of help-seeking veterans with PTSD. The lack of clarity provided by the currently available evidence suggests a pressing need for further work to examine this subject in more detail.

Weapon carrying, physical fighting and gang membership among youth in Washington state military families

To examine associations between parental military service and school-based weapon carrying, school-based physical fighting and gang membership among youth. We used cross-sectional data from the 2008 Washington State Healthy Youth Survey collected in 8th, 10th, and 12th grades of public schools (n = 9,987). Parental military service was categorized as none (reference group), without combat zone deployment, or deployed to a combat zone. Multivariable logistic regression was used to test associations between parental military service and three outcomes: school-based weapon carrying, school-based physical fighting and gang membership. Standard errors were adjusted for the complex survey design. In 8th grade, parental deployment was associated with higher odds of reporting gang membership (OR = 1.8) among girls, and higher odds of physical fighting (OR = 1.6), and gang membership (OR = 1.9) among boys. In 10th/12th grade, parental deployment was associated with higher odds of reporting physical fighting (OR = 2.0) and gang membership (OR = 2.2) among girls, and physical fighting (OR = 2.0), carrying a weapon (OR = 2.3) among boys. Parental military deployment is associated with increased odds of reporting engagement in school-based physical fighting, school-based weapon carrying, and gang membership, particularly among older youth. Military, school, and public health professionals have a unique, collaborative opportunity to develop school- and community-based interventions to prevent violence-related behaviors among youth and, ultimately, improve the health and safety of youth in military families. Ideally, such programs would target families and youth before they enter eighth grade.

Long-term trajectories and service needs for military families

The deployment of US military personnel to recent conflicts has been a significant stressor for their families; yet, we know relatively little about the long-term family effects of these deployments. Using data from prior military service eras, we review our current understanding of the long-term functioning and needs of military families. These data suggest that overseas deployment, exposure to combat, experiencing or participating in violence during war deployment, service member injury or disability, and combat-related post-traumatic stress disorder (PTSD) all have profound impacts on the functioning of military families. We offer several recommendations to address these impacts such as the provision of family-centered, trauma-informed resources to families of veterans with PTSD and veterans who experienced high levels of combat and war violence. Recent efforts to address the needs of caregivers of veterans should be evaluated and expanded, as necessary. We should also help military families plan for predictable life events likely to challenge their resilience and coping capacities. Future research should focus on the following: factors that mediate the relationship between PTSD, war atrocities, caregiver burden, and family dysfunction; effective family-centered interventions that can be scaled-up to meet the needs of a dispersed population; and system-level innovations necessary to ensure adequate access to these interventions.

Self-reported emotional and behavioral symptoms, parent-adolescent bonding and family functioning in clinically referred adolescent offspring of Croatian PTSD war veterans

The presence of posttraumatic stress disorder (PTSD) in male war veterans has been linked with family dysfunction and psychopathology in their children [1, 2]. This study aimed to evaluate self-reported emotional and behavioral symptoms, parent-adolescent bonding and family functioning in clinically referred adolescent offspring of Croatian PTSD war veterans and determine the degree that parent-child bonding and family functioning contributed to adolescent behavior problems. Internalizing and externalizing behavior problems, parent-child bonding and family functioning were assessed in a sample of clinically referred Croatian PTSD veterans adolescent offspring (N = 122) and non-PTSD veteran adolescent offspring (N = 122) matched for age, sex, educational level, family income, parental employment status, ethnicity, and residential area. Youth Self-Report, Parental Bonding Instrument, Family Assessment Device were used. Adolescent offspring of PTSD veterans reported having significantly more internalizing and externalizing problems than non-PTSD veteran offspring, and also more difficulties in their family functioning, lower levels of maternal and paternal care, and more impaired mother-child and father-child bonding than control subjects. Internalizing symptoms were associated with family dysfunction, while externalizing symptoms were associated with paternal overcontrol/overprotection, and low maternal and paternal care. In conclusion, the increase in internalizing and externalizing symptoms as well as family and parental dysfunction among clinically referred adolescent offspring of PTSD veterans compared to their non-PTSD veteran counterparts indicates a need for early detection and interventions targeting both adolescent psychopathology and family relationships.

Offspring psychological and biological correlates of parental posttraumatic stress: review of the literature and research agenda

Millions of individuals with posttraumatic stress disorder (PTSD) are parents. A burgeoning literature suggests that offspring of parents with this condition may be at increased risk for psychological problems. The current paper provides an integrative and comprehensive review of the diverse research literature examining the sequelae of parental posttraumatic stress among offspring. Over 100 studies that evaluated psychological and/or biological variables among children of parents with PTSD are reviewed. Findings suggest parental symptoms of posttraumatic stress are uniquely related to an array of offspring outcomes, including internalizing-type problems, general behavioral problems, and altered hypothalamic-pituitary-adrenal axis functioning. Although very little work has directly evaluated mechanisms of transmission, there is increasing support for genetic and epigenetic effects as well as parenting behaviors. These and other mechanisms are discussed; drawing upon findings from other literatures to consider how parental PTSD may impart psychobiological vulnerability upon offspring. We conclude with a detailed discussion of the methodological strengths and challenges of the extant research, along with a recommended agenda for future research in this important area of study.

Associations between parental posttraumatic stress disorder and both offspring internalizing problems and parental aggression within the National Comorbidity Survey-Replication

Data from the National Comorbidity Survey-Replication were used to evaluate links between parental posttraumatic stress disorder (PTSD) and elevated (1) offspring internalizing problems and (2) parental physical aggression toward children. We extended prior tests via the use of an independent nationally representative sample and by examining specific associations between these outcomes and PTSD above and beyond variance accounted for by several theoretically relevant demographic factors and PTSD-related comorbidity. As hypothesized, offspring anxiety and depression was elevated among parents with PTSD compared to those without the condition. Parents with PTSD also were more likely to endorse the use of both moderate (e.g., pushing) and severe (e.g., hitting with a fist) physical aggression with their children. These findings advance work in the area by suggesting that there is a unique relation between PTSD and these outcomes, which sets the stage for research to elucidate factors uniquely introduced by PTSD.

Physical activity within a CBT intervention improves coping with pain in traumatized refugees: results of a randomized controlled design

OBJECTIVE

Many traumatized refugees experience both posttraumatic stress disorder and chronic pain. Based on Mutual Maintenance Theory and the Perpetual Avoidance Model, this study examined the additional effect of physical activity within a biofeedback-based cognitive behavioral therapy (CBT-BF) for traumatized refugees.

DESIGN

In a controlled design, 36 patients were randomized into one of three conditions (CBT-BF, CBT-BF with physical activity [CBT-BF+active], and a waiting list control group [WL]). Thirty patients (n=10 in each group) completed the treatment and a follow-up assessment 3 months later. Participants' coping strategies, pain and mental health status, and physiological reactivity were assessed before and after the intervention and at 3-month follow-up. Treatment effects were analyzed using analyses of variance with baseline scores as covariates (ANCOVAs) and the Reliable Change Index.

RESULTS

The CBT-BF and CBT-BF+active groups showed improvements in all outcome measures relative to the WL group. The effect sizes for the main outcome measures were higher in the CBT-BF+active group than in the CBT-BF group. Repeated measures analyses of covariance showed significant group effects for coping strategies--in particular, for the "cognitive restructuring" and "counter-activities" subscales as well as a marginally significant group effect for "perceived self-competence"--with the CBT-BF+active group showing more favorable outcomes than the CBT-BF group. Moreover, 60% of participants in the CBT-BF+active group showed clinically reliable intraindividual change in at least one subscale of the pain coping strategies questionnaire, compared with just 30% of participants in the CBT-BF group.

CONCLUSION

Findings of improved coping strategies, larger effect sizes, and higher rates of clinical improvement in the CBT-BF+active group suggest that physical activity adds value to pain management interventions for traumatized refugees. Given the small sample size, however, these preliminary results need replication in a larger trial.

Improving risk assessment of violence among military veterans: an evidence-based approach for clinical decision-making

Increased media attention to post-deployment violence highlights the need to develop effective models to guide risk assessment among military Veterans. Ideally, a method would help identify which Veterans are most at risk for violence so that it can be determined what could be done to prevent violent behavior. This article suggests how empirical approaches to risk assessment used successfully in civilian populations can be applied to Veterans. A review was conducted of the scientific literature on Veteran populations regarding factors related to interpersonal violence generally and to domestic violence specifically. A checklist was then generated of empirically-supported risk factors for clinicians to consider in practice. To conceptualize how these known risk factors relate to a Veteran's violence potential, risk assessment scholarship was utilized to develop an evidence-based method to guide mental health professionals. The goals of this approach are to integrate science into practice, overcome logistical barriers, and permit more effective assessment, monitoring, and management of violence risk for clinicians working with Veterans, both in Department of Veteran Affairs settings and in the broader community. Research is needed to test the predictive validity of risk assessment models. Ultimately, the use of a systematic, empirical framework could lead to improved clinical decision-making in the area of risk assessment and potentially help prevent violence among Veterans.

Parental combat injury and early child development: a conceptual model for differentiating effects of visible and invisible injuries

The injuries (physical and emotional) sustained by service members during combat influence all members of a family system. This review used a systemic framework to conceptualize the direct and indirect effects of a service member's injury on family functioning, with a specific focus on young children. Using a meta-ethnographic approach to synthesize the health research literature from a variety of disciplines, this review makes relevant linkages to health care professionals working with injured veterans. Studies were included that examined how family functioning (psychological and physical) is impacted by parental illness; parental injury; and posttraumatic stress disorder. The synthesis of literature led to the development of a heuristic model that illustrates both direct and indirect effects of parental injury on family functioning and the development of young children. It further illustrates the contextual factors or moderating variables that buffer detrimental effects and promote family resilience. This model can be a foundation for future research, intervention, and policy.

Military-related PTSD and intimate relationships: from description to theory-driven research and intervention development

Military operations in Iraq and Afghanistan have brought heightened awareness of military related PTSD, as well as the intimate relationship problems that accompany the disorder and can influence the course of veterans' trauma recovery. In this paper, we review recent research that documents the association between PTSD and intimate relationship problems in the most recent cohort of returning veterans and also synthesize research on prior eras of veterans and their intimate relationships in order to inform future research and treatment efforts with recently returned veterans and their families. We highlight the need for more theoretically-driven research that can account for the likely reciprocally causal association between PTSD and intimate relationship problems to advance understanding and inform prevention and treatment efforts for veterans and their families. Future research directions are offered to advance this field of study.

Influence of posttraumatic stress disorder of the fathers on other family members

The purpose of this work is to analyze the frequency of depression and anxiety and children behaviour in families whose heads of the family (father) suffer from post-traumatic stress disorder (PTSD). The study was conducted from September 2005 until July 2006, with patients living in Mostar. The frequency of depression and anxiety in family members older than 18 years, and changes of the behaviour in children younger than 18 years of age were measured. The data were collected from 60 men and their families who had been diagnosed with PTSD by their psychiatrist. The control group was formed using matching criteria (age of the head of the family, his education, religion, family income and number of children). In this study, three questionnaires were used: one specially designed for this study, covering general information about family members, and a personal opinion of each family member about the family situation and relations within the family; Hopkins symptoms checklist - 25 (HSCL-25) for evaluation of depression and anxiety for subjects older than 18; and General Health Questionnaire (GHQ) for children 5 to 18 years of age, which was completed by their mothers. More wives from the PTSD families had depression than wives from the controlled group (chi2=21,099; df=1; P<0,050). There was no difference between groups in frequency of depression and anxiety (chi2=0,003; df=1; P=0,959) for children older than 18 years. No difference in answers between groups of children younger than 18 years were found in the General Health Questionnaire. However, we found significant differences in separate questions. Mothers, who filled the questionnaire form, reported that children from fathers who had PTSD experienced stomach pain more often (chi2=10,474;df=2; P=0,005), eating problems (chi2=14,204;df=2; P=0,001) and breathing problems (chi2=9,748;df=2; P=0,008), than children from fathers who did not have PTSD. Children from fathers with PTSD were more easily upset (chi2=7,586; df=2; P=0,023) and worried more often (chi2=12,093; df=2; P=0,002), they were also more aggressive towards other children (chi2=6,156; df=1; P=0,013). The controlled group of children who wanted to help with the house work was larger than the tested group (chi2=10,383; df=2; P=0,006). More children from the controlled group missed school than from the other group of surveyed children (chi2=6,056; df=2; P=0,048). A significantly larger number of women, whose husbands had PTSD, were depressed, unlike women whose husbands were not ill. There was no significant difference in depression manifestation in a group of children older than 18, as well as in behaviour of a group of children younger than 18, but significant differences in some provided answers were found, that indicate the differences between controlled and tested groups.

Post-traumatic stress disorder: evidence-based research for the third millennium

The stress that results from traumatic events precipitates a spectrum of psycho-emotional and physiopathological outcomes. Post-traumatic stress disorder (PTSD) is a psychiatric disorder that results from the experience or witnessing of traumatic or life-threatening events. PTSD has profound psychobiological correlates, which can impair the person's daily life and be life threatening. In light of current events (e.g. extended combat, terrorism, exposure to certain environmental toxins), a sharp rise in patients with PTSD diagnosis is expected in the next decade. PTSD is a serious public health concern, which compels the search for novel paradigms and theoretical models to deepen the understanding of the condition and to develop new and improved modes of treatment intervention. We review the current knowledge of PTSD and introduce the role of allostasis as a new perspective in fundamental PTSD research. We discuss the domain of evidence-based research in medicine, particularly in the context of complementary medical intervention for patients with PTSD. We present arguments in support of the notion that the future of clinical and translational research in PTSD lies in the systematic evaluation of the research evidence in treatment intervention in order to insure the most effective and efficacious treatment for the benefit of the patient.

Response style and posttraumatic stress disorder (PTSD): a review

Response style is an important issue that is often not addressed when assessing or treating patients with posttraumatic stress disorder (PTSD). In this paper, various response styles are discussed along with their relevance to clinical work and research with PTSD patients. Two of the most prevalent measures of response style, the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Structured Interview of Reported Symptoms (SIRS) scales are evaluated for use in assessing for PTSD. In addition, the Trauma Symptom Inventory's potential for use in evaluating response style is briefly discussed. Implications for future work and directions for future investigation are outlined.

A cluster analysis of symptom patterns and adjustment in Vietnam combat veterans with chronic posttraumatic stress disorder

This study investigated whether a subgroup of veterans with malignant posttraumatic stress syndrome, as described by Rosenheck (1985) and Lambert et al. (1996), could be identified via cluster analysis within two samples of Vietnam veterans with combat-related posttraumatic stress disorder (PTSD). In the initial subsample (n = 157), four clusters were identified, including a subgroup that scored consistently higher on measures of interpersonal violence and current physical problems. Similar results were found in the cross-validation subsample (n = 156). These results provide support for the theoretical concept of malignant PTSD and suggest that veterans with chronic PTSD are not homogenous. Whereas some manifest extreme levels of both functional impairment and PTSD symptomatology, others exhibit markedly less functional impairment despite manifesting clinically significant levels of PTSD. Clinicians can consider this heterogeneity in their treatment decisions.

The sound of barking dogs: violence and terror among Salvadoran families in the postwar

This article examines the transgenerational transmission of trauma among campensino living in a rural, repopulated community in El Salvador. Research with Holocaust survivors and their children has shown that traumatic symptoms can be transmitted to children who did not directly experience the Holocaust. The mechanisms by which this transgenerational transmission occurs have not been fully explored and require an expansion of medical and anthropological conceptualizations of posttraumatic illness. Through their reactions to and interpretations of everyday events, campesino parents who lived in the guerrilla camps explicitly transmit trauma to children who did not experience the recent civil war. Illness narratives by sufferers of nervios transmit trauma and point to the basic immorality of the war, an immorality that continues today. In addition, the symptoms of nervios constitute a mechanism by which trauma is implicitly transmitted. Symptoms of nervios point to what generally is not and, indeed, cannot be voiced: the destruction of primary relationships in the family and unresolved grief and helplessness, which, through the responses of family members to the sufferer, are reproduced and reenacted in the present family context.

Male war-zone veterans' perceived relationships with their children: the importance of emotional numbing

Despite growing recognition of substantial interpersonal impairment among many war-zone veterans with posttraumatic stress disorder (PTSD), little is known about the association between PTSD symptomatology and veterans' relationships with their children. This study examined the differential pattern of associations between the symptom clusters of PTSD and the perceived father-child relationships of 66 male Vietnam veterans. Analyses revealed that only the emotional numbing cluster was significantly related to perceived quality of all relationship domains. The association between emotional numbing and perceived relationship quality remained significant in regression analyses even after controlling for fathers' family-of-origin stressors, combat exposure, depression, and substance abuse. Findings suggest that emotional numbing may be the component of PTSD most closely linked to interpersonal impairment in war-zone veterans.

Violence and hostility among families of Vietnam veterans with combat-related posttraumatic stress disorder

The current study provides a portrait of emotional-behavioral functioning within a small sample of Vietnam veterans with combat-related posttraumatic stress disorder (PTSD), their partners, and older adolescent and adult children. Veterans, their partners and children reported moderate-low to moderate-high levels of violent behavior. In addition, partner and veteran hostility scores were elevated relative to gender and age matched norms. Partners also reported heightened levels of psychological maltreatment by veterans. Veterans' combat exposure was positively correlated with hostility and violent behavior among children but unrelated to partner variables. Veterans' reports of PTSD symptoms were positively associated with reports of hostility and violence among children, and hostility and general psychological distress among partners. Veterans' violent behavior was also positively correlated with children's violent behavior, but did not yield significant correlations with other child or partner variables. Findings are discussed in relation to prior work and directions for future research are addressed.

Clinical presentations of posttraumatic stress disorder across trauma populations: a comparison of MMPI-2 profiles of combat veterans and adult survivors of child sexual abuse

This investigation examined differences in symptom patterns of two different trauma samples using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). MMPI-2s of 122 male combat veterans seeking outpatient treatment for combat-related PTSD were compared with those of 64 PTSD-diagnosed adults seeking outpatient treatment for the effects of child sexual abuse (CSA). We examined variables related to degree of health concerns, depression, somatization, anger and hostility, masculine-feminine traits, paranoid ideation, anxiety, difficulties thinking and concentrating, elevated mood, and social introversion, as well as test-taking attitude. MANOVAs revealed between-group differences on several variables. However, when analyses controlled for the effect of age, nearly all differences disappeared; the only remaining difference was in a scale measuring anger. Thus, it appears CSA survivors and combat veterans are much more similar than different in their clinical presentation on the MMPI-2. Conceptual issues in the assessment of PTSD are discussed.

Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans

A study was conducted to investigate chronic pain patterns in Vietnam veterans with posttraumatic stress disorder (PTSD). Combat veterans with PTSD completed standardized PTSD severity, pain, somatization, and depression measures. Of 129 consecutive out-patient combat veterans with PTSD, 80% reported chronic pain. In descending order were limb pain (83%), back pain (77%), torso pain (50%), and headache pain (32%). Compared to PTSD combat veterans without chronic pain, PTSD veterans who reported chronic pain reported significantly higher somatization as measured by the Minnesota Multiphasic Inventory 2 hypochondriasis and hysteria subscales. In the sample of 103 combat veterans with PTSD and chronic pain, MMPI 2 hypochondriasis scores and B PTSD symptoms (reexperiencing symptoms) were significantly related to pain disability, overall pain index, and current pain level MMPI 2 hypochondriasis and depression scores were also significantly related to percent body pain. These results are discussed in the context of current conceptualizations of PTSD.