Key determinants of the MMPI-PTSD subscale: treatment considerations

The Utility of the PAI and the MMPI-2 for Discriminating PTSD, Depression, and Social Phobia in Trauma-Exposed College Students

This study investigated the Minnesota Multiphasic Personality Inventory—Revised (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and the Personality Assessment Inventory (PAI; Morey, 1991) with regard to each instrument's utility for discriminating post-traumatic stress disorder (PTSD) from depression and social phobia in a sample of college students with mixed civilian trauma exposure. Participants were 90 trauma-exposed undergraduates (16 male, 74 female) classified into one of four groups: PTSD, depressive disorders, social phobia, and well-adjusted. For both the PAI and the MMPI-2, profile analysis revealed that the groups differed in the elevation and shape of their profiles. The PAI Traumatic Stress subscale demonstrated good discriminant validity.

The overlooked relationship between motivational abilities and posttraumatic stress: a review

How does traumatic stress change the ability to motivate oneself to achieve certain goals? How do motivational abilities influence the development and course of trauma sequelae? Few studies have focused on motivational constructs within posttraumatic stress research. From a trauma research perspective, it can be hypothesized that traumatic stress may contribute to motivational dysfunction. The main goal of the present article is to fill this gap in research by reviewing and discussing the existing trauma literature in terms of motivation-related concepts, such as self-efficacy, locus of control, self-esteem, and self-control/impulsivity. Fifty-four studies were reviewed, 10 of which were longitudinal studies. Approximately 20% of the reviews assessed whether motivational concepts predict posttraumatic stress, whereas only 8% examined the reverse relationship. With the exception of a few studies, motivational constructs seem to predict posttraumatic stress over the life span. The strongest relationships were reported for self-efficacy, followed by locus of control and self-esteem and, lastly, impulsivity/self-control. Overall, the findings of this review indicate that there is a lack of research investigating motivational factors as outcome variables following traumatic experiences. Furthermore, the need for longitudinal studies and studies with older adults is noted.

Apparent symptom overreporting in combat veterans evaluated for PTSD

Psychometric studies have consistently shown that combat veterans evaluated for posttraumatic stress disorder (PTSD) appear to overreport psychopathology as exhibited by (a) extreme and diffuse levels of psychopathology across instruments measuring different domains of mental illness, and (b) extreme elevations on the validity scale of the MMPI-MMPI-2, in a "fake-bad" direction. The phenomenon of this ubiquitous presentational style is not well understood at present. In this review we describe and delineate the assessment problem posed by this apparent symptom overreporting, and we review the literature regarding several potential explanatory factors. Finally, we address conceptual and practical issues relevant to reaching a better understanding of the phenomenon, and ultimately the clinical syndrome of combat-related PTSD, in both research and clinical settings.

Sexual victimization, generalized perception of control, and posttraumatic stress disorder symptom severity

We examined the relations among various characteristics of sexual victimization, posttraumatic stress disorder (PTSD) symptom severity, and generalized perception of control. Our main focus lay in testing three predictions derived from the animal model of PTSD articulated by Foa, Zinbarg, and Olasov-Rothbaum (1992) based on the effects of uncontrollable and/or unpredictable aversive events. A sample of 117 female undergraduates participated and completed self-report measures of past experience with child sexual abuse, adult sexual victimization, PTSD symptom severity, and locus of control. The results showed that child sexual abuse experienced on multiple occasions was associated with diminished generalized perception of control and that diminished generalized perception of control is associated with greater PTSD symptom severity following adult sexual victimization when experienced on a single occasion or involving force. These results provide partial support for the uncontrollability/unpredictability model of PTSD. Further research is necessary, however, to firmly establish the direction of causality involved in these associations.

A Comparison of Vietnam Era Veterans and their Combat Exposure with the Symptomatology of Dying

This study examines the degree of differences exposure to combat had on Vietnam era veterans in relationship to the dimensions within Kübler-Ross' stages of dying. As a component of Post Traumatic Stress Disorder, the symptoms of dying are seen as contributing to an understanding of the effects of combat. The Veterans Diagnostic Scale was administered to 109 Vietnam era veterans. Correlational analysis and t-test were used to test significance. It was found that combat experience indicate that combat exposure relates to symptoms of dying as identified by the Veterans Diagnostic Scale. Combat and wounded Vietnam veterans scored significantly higher on those symptoms than non-combat and nonwounded Vietnam era veterans. Indicators do not support Kübler-Ross' sequential order of symptoms in the dying process.

Rorschach measures of posttraumatic stress in Persian Gulf War veterans

The effectiveness of the Rorschach in detecting acute posttraumatic stress (PTS) in Persian Gulf War veterans was investigated. Subjects were 30 U.S. Marine Reservists who reported experiencing symptoms of PTS after 3 months of active duty in Operation Desert Storm. Subjects were administered the Rorschach and MMPI-2 soon after their return from the Persian Gulf War. Results showed acute distress, a vulnerable capacity for coping and control, and a tendency to be overwhelmed by internal and external stimulation. Selected Rorschach variables were significantly related in a conceptually valid manner to MMPI-2 scales associated with defensiveness, coping ability, and PTS. These findings are discussed in relation to the assessment, understanding, and treatment of PTS symptomatology and posttraumatic stress disorder.

A comparison of MMPI and MMPI-2 in PTSD assessment

A sample of 47 Vietnam veterans with the diagnosis of combat-related Post-Traumatic Stress Disorder (PTSD) was administered the MMPI and MMPI-2. Pairwise comparisons were performed on the clinical scales, Harris Lingoes subscales, and scales relevant to the assessment of PTSD. Correlational analyses were performed as well. Hit rates of high-point pairs were compared across the tests. The results suggest a high degree of congruence between tests. Differences were seen on evaluations of some scales between tests that may influence interpretation and treatment.

Personality subgroups in an inpatient Vietnam veteran treatment program

Millon Clinical Multiaxial Inventory personality profiles of 250 male inpatient Vietnam veterans were examined to locate subgroups within that population. Using a hierarchical cluster analysis to form relatively homogeneous groups, four clusters were identified which accounted for 98% of the population. Three clusters had Millon profiles suggestive of a stress reaction and one cluster had a profile indicative of an antisocial adjustment. As measured by a PTSD subscale of the Minnesota Multiphasic Personality Inventory two clusters are high stress groups and two clusters are lower stress groups. The two Millon personality profiles in the high stress category were an 8-2-1/6 group and a 2-8-1-3 group. The lower stress groups had profiles of /8-2 and 6/8-5. The high stress groups are considered Posttraumatic Stress Disorder groups and the lower stress groups are considered nonPosttraumatic Stress Disorder groups.

A 6-year follow-up study of Cambodian refugee adolescents traumatized as children

Seventy-three percent of a sample of 46 Cambodian youth interviewed in 1984 and 1987 were reinterviewed in 1990 as part of a pretest for a multisite study of Cambodian refugee trauma now under way. An additional sample of convenience of 38 youth were also interviewed to determine reliability and validity of the diagnostic instruments chosen for the larger study. The DSM-III-R diagnosis of post-traumatic stress disorder (PTSD) was found to persist, but the symptoms appeared less intense over time. In contrast, the prevalence of depression dropped markedly since 1987. Subjects remained largely free of comorbid conditions. Diagnostic reliability and validity were satisfactory. The follow-up sample appeared to be functioning well despite their PTSD profiles. The findings are discussed in light of several current controversies surrounding the concept and measurement of PTSD.

Three forms of stress in Cambodian adolescent refugees

Sixty-nine Cambodian adolescents and young adults were interviewed to determine their experience as children surviving the Pol Pot regime (1975-1979); their first-year experience of resettlement in this country; and their experience of stressful events during the past year. Current DSM-III-R diagnostic status was also determined. A strong relationship between earlier war trauma, resettlement strain, and symptoms of posttraumatic stress disorder (PTSD) was found. In contrast, the strongest relationship with depressive symptoms was found for recent stressful events. These results are discussed in light of current findings from stress and PTSD research.