Anxiety sensitivity and depression: mechanisms for understanding somatic complaints in veterans with posttraumatic stress disorder

Affective Depression Mediates PTSD to Suicide in a Sample of Treatment-Seeking First Responders

OBJECTIVE

The aim of this study was to examine the associations of comorbid posttraumatic stress disorder (PTSD), affective or somatic depression, and suicide among first responders (FRs).

METHOD

We used baseline data from FRs ( N = 232) who sought services at a nonprofit mental health agency specializing in treating trauma exposed FRs. We conducted two PROCESS simple mediation models with PTSD as the predictor, affective depression and somatic depression as the mediators, and suicidality as the dependent variable.

RESULTS

Affective depression significantly mediated the relationship between PTSD and suicidality, whereas somatic depression did not. The direct effect of PTSD on suicidality was not significant.

LIMITATIONS

These data are cross-sectional and should be followed up with longitudinal analyses across the course of treatment.

CONCLUSIONS

To reduce suicide risk, it is recommended that clinicians target affective depression instead of PTSD symptoms.

Depression and Anxiety as Mediators of PTSD Symptom Clusters and Pain in Treatment-Seeking Canadian Forces Members and Veterans

INTRODUCTION

Chronic pain (CP) commonly presents alongside psychiatric conditions such as depression, PTSD, and generalized anxiety. The current study sought to better understand this complex relationship by determining whether anxiety and depression symptom severity mediated the relationship between DSM-5 PTSD symptom clusters and pain symptoms in a sample of 663 Canadian Armed Forces (CAF) personnel and veterans seeking treatment for mental health conditions.

MATERIALS AND METHODS

Generalized anxiety disorder, depression, and PTSD symptom severity were measured using self-report scales provided as part of a standard intake protocol. Pain symptoms were measured using the Bodily Pain subscale of the SF-36 (SF-36 BPS). Linear regressions were used to explore the relationship between PTSD symptom clusters, depression, anxiety, and pain. Bootstrapped resampling analyses were employed to test mediation effects.

RESULTS

The average SF-36 BPS score in this sample was 36.6, nearly 1.5 SDs below the population health status, enforcing the salience of pain symptoms as a concern for veterans and CAF seeking treatment for military-related psychiatric conditions. The effects of PTSD symptom clusters avoidance, negative mood and cognitions, and arousal on pain were fully mediated by anxiety and depression severity. However, the effect of intrusion on pain was not mediated by depression and only partly mediated by anxiety.

CONCLUSION

Findings emphasize the importance of including anxiety and depression in models of PTSD and pain, particularly in samples where psychiatric comorbidity is high. Clinically, results highlight the need for improved treatment regimens that address pain symptoms alongside common psychiatric comorbidities.

Associations between Lower-Order Anxiety Sensitivity Facets and PTSD Symptomatology among Trauma-Exposed Firefighters

Firefighters are chronically exposed to potentially traumatic events, augmenting their risk of developing posttraumatic stress disorder (PTSD). The current study aimed to examine the incremental associations of lower-order dimensions of anxiety sensitivity (AS), examined concurrently, and PTSD symptom severity among a sample of trauma-exposed firefighters. We hypothesized that AS physical and cognitive concerns would be strongly associated with all PTSD symptom clusters and overall symptom severity, after controlling for theoretically relevant covariates (trauma load; years in fire service; alcohol use severity; depressive symptom severity). Participants were comprised of firefighters (N = 657) who completed an online questionnaire battery and endorsed PTSD Criterion A trauma exposure. Results revealed that the AS cognitive concerns, but not AS physical concerns, was significantly and robustly associated with overall PTSD symptom severity, intrusion symptoms, and negative alterations in cognitions and mood (∆R²'s = .028-.042; p's < .01); AS social concerns was incrementally associated with PTSD avoidance (∆R² = .03, p < .01). Implications for firefighter-informed, evidence-based interventions are discussed.

Investigating the latent dimensions of posttraumatic stress disorder and the role of anxiety sensitivity in combat-exposed Filipino soldiers

Identifying the optimal factor structure of posttraumatic stress disorder (PTSD) has recently been reinvigorated in literature due to the substantial changes to its diagnostic criteria in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Currently, six models of PTSD are supported in literature, but there is no consensus on the best-fitting factor structure. Additionally, the extant literature examining the relationship between PTSD symptom-grouping and AS in the latent level has been scarce. The present study's objectives are two-fold: first, we aimed to identify the best-fitted model of PTSD by comparing the six empirically-supported models, and; second, we examined the relationship between the best-fitting model with anxiety sensitivity (AS). Utilizing a sample of 476 combat-exposed soldiers, the results suggest that both the anhedonia and hybrid models provide the best fit to the data, with the anhedonia model achieving slightly better fit indices. Further, the examination on the influence of AS to PTSD reveal that while there is a pattern of decreasing factor loadings and factor correlations when accounting for AS, the changes are not significant to alter the PTSD symptom-structure. Based on these results, our findings suggest further investigation on the possible mediating or moderating mechanisms by which AS may influence PTSD.

Examining the cross-sectional and longitudinal effects of anxiety sensitivity on indicators of disease severity among patients with inflammatory arthritis

Few studies have investigated anxiety sensitivity (AS) in the context of inflammatory arthritis (IA), despite evidence of a relationship between AS and pain. This study examined cross-sectional and longitudinal relationships between AS and indicators of IA severity in 148 participants with IA. AS and its factors (social, physical, cognitive) were self-reported. Arthritis severity was physician-assessed (disease activity scales) and self-reported (physical function; pain and fatigue). Cross-sectional correlations assessed the association between AS and arthritis severity outcomes. Longitudinal multivariable mixed-effect regressions assessed the association of AS total and AS factors at each visit with disease severity outcomes. All AS factors were significantly and positively correlated (at the same visit) with function, pain, and fatigue. AS total significantly predicted pain, fatigue, and function. Cognitive AS significantly predicted fatigue, and physical AS significantly predicted pain and fatigue. Social AS significantly predicted pain, fatigue, function and weighted joint count (articular burden). AS is associated with several indicators of disease severity among those with IA; unique findings emerged across factors with the broadest disease impact by social AS. The AS factors, especially social AS, may contribute to the development and severity of IA symptoms, which may have implications for interventions.

Pain in the Acute Aftermath of Stalking: Associations With Posttraumatic Stress Symptoms, Depressive Symptoms, and Posttraumatic Cognitions

This longitudinal study examined whether posttraumatic stress and depressive symptoms, posttraumatic cognitions, and ongoing cyberstalking exposures were independently associated with changes in pain outcomes among 82 young adult women with recent exposure to stalking. Multilevel models indicated that higher sensory pain intensity and pain-related interference were associated with more negative cognitions about the self. Higher affective pain intensity was associated with higher posttraumatic stress and depressive symptoms. Cyberstalking exposures were not associated with pain intensity or pain-related interference. Results reveal persistent pain complaints in recent stalking victims and highlight distinct psychological risk factors for pain intensity and pain-related interference.

Posttraumatic Stress Disorder in Older Adults: A Conceptual Review

Objectives: We provide a review of the literature on posttraumatic stress disorder (PTSD) in older adults, focusing largely on older U.S. military veterans in two primary areas: 1) assessment and diagnosis and 2) non-pharmacological treatment of PTSD in late life. Methods: We performed a search using PubMed and Academic Search Premier (EBSCO) databases and reviewed reference sections of selected papers. We also drew on our own clinical perspectives and reflections of seven expert mental health practitioners. Results: Rates of PTSD are lower in older compared with younger adults. The presence of sub-syndromal/partial PTSD is important and may impact patient functioning. Assessment requires awareness and adaptation for potential differences in PTSD experience and expression in older adults. Psychotherapies for late-life PTSD appear safe, acceptable and efficacious with cognitively intact older adults, although there are relatively few controlled studies. Treatment adaptations are likely warranted for older adults with PTSD and co-morbidities (e.g., chronic illness, pain, sensory, or cognitive changes). Conclusions: PTSD is an important clinical consideration in older adults, although the empirical database, particularly regarding psychotherapy, is limited. Clinical Implications: Assessment for trauma history and PTSD symptoms in older adults is essential, and may lead to increased recognition and treatment.

Cannabis Use and Anxiety Sensitivity in Relation to Physical Health and Functioning in post-9/11 Veterans

Frequency of cannabis use and cognitive vulnerabilities such as anxiety sensitivity (i.e., the fear of bodily sensations), have been independently linked with poor physical health, however the interplay between these health-mental health processes may compound poor physical health and functioning in cannabis users. Thus, the current study evaluated the direct and interactive effects of cannabis use frequency and anxiety sensitivity on physical health and functioning among cannabis-using veterans. Participants (N = 138) were post-9/11 United States veterans recruited from a Veterans Affairs hospital who reported cannabis use in the past six months. Cannabis use frequency in the past month and anxiety sensitivity were significantly negatively correlated with perceived overall physical health. There was a significant interaction between cannabis use frequency and anxiety sensitivity, such that more frequent cannabis use was associated with poorer overall health and role functioning due to health problems among veterans with higher anxiety sensitivity (but not lower). Findings suggest that anxiety sensitivity is a cognitive vulnerability linked to poor perceived physical health and impairment among frequent cannabis users and could be targeted, along with cannabis use, for health-promotion in cannabis users.

Chronic Pain Types Differ in Their Reported Prevalence of Post -Traumatic Stress Disorder (PTSD) and There Is Consistent Evidence That Chronic Pain Is Associated with PTSD: An Evidence-Based Structured Systematic Review

Objectives

The hypotheses of this systematic review were the following: 1) Prevalence of post-traumatic stress disorder (PTSD) will differ between various types of chronic pain (CP), and 2) there will be consistent evidence that CP is associated with PTSD.

Methods

Of 477 studies, 40 fulfilled the inclusion/exclusion criteria of this review and were grouped according to the type of CP. The reported prevalence of PTSD for each grouping was determined by aggregating all the patients in all the studies in that group. Additionally all patients in all groupings were combined. Percentage of studies that had found an association between CP and PTSD was determined. The consistency of the evidence represented by the percentage of studies finding an association was rated according to the Agency for Health Care Policy and Research guidelines.

Results

Grouping PTSD prevalence differed ranging from a low of 0.69% for chronic low back pain to a high of 50.1% in veterans. Prevalence in the general population with CP was 9.8%. Of 19 studies, 16 had found an association between CP and PTSD (84.2%) generating an A consistency rating (consistent multiple studies). Three of the groupings had an A or B (generally consistent) rating. The veterans grouping received a C (finding inconsistent) rating.

Conclusion

The results of this systematic review confirmed the hypotheses of this review.

Posttraumatic Stress Disorder and Somatic Complaints in a Deployed Cohort of Georgian Military Personnel: Mediating Effect of Depression and Anxiety

Several studies have shown the relationship between symptoms of posttraumatic stress disorder (PTSD), somatic symptoms, and the mediating effect of depression and anxiety. The following study was conducted to investigate the relationship between PTSD symptoms and somatic complaints through underlying symptoms of depression and anxiety. The participants of the study were 2,799 veterans who were examined after a 6-month deployment. They were assessed using the PTSD Checklist (PCL-5) and Patient Health Questionnaire (PHQ) for depression, anxiety, and somatic complaints. To check the indirect effect of PTSD on somatic complaints through depression and anxiety, mediation model 4 (parallel mediation) of the SPSS PROCESS macro was used. There was a significant total indirect effect of PTSD through depression and anxiety on somatic complaints, b = 0.14, 95% confidence interval (CI) [0.12, 0.16], from which an indirect effect of PTSD on somatic complaints through depression was b = 0.08, 95% CI [0.06, 0.10], and through anxiety it equaled b = 0.06, 95% CI [0.04, 0.07]. The ratio of indirect to total effect was 0.66, 95% CI [0.59, 0.75]. The present study helps us to understand the role of depression and anxiety symptoms when the symptoms of PTSD and somatic complaints are present. These new findings may have implications for the management as well as treatment of PTSD because they recognize the importance of symptoms of anxiety and depression when somatic complaints are present.

Somatic symptom severity among primary care patients who are obese: examining the unique contributions of anxiety sensitivity, discomfort intolerance, and health anxiety

Prior research indicates the common presentation of somatic symptoms and obesity in primary care settings, as well as links between obesity and somatic symptoms. Anxiety sensitivity, discomfort intolerance, and health anxiety are three variables relevant to somatic symptoms. How those three variables relate to somatic symptom severity among individuals who are obese and the unique variance accounted for by each variable in somatic symptom severity remains unexamined. Among a large sample of primary care patients who are obese (N = 342), anxiety sensitivity, discomfort intolerance, and health anxiety collectively accounted for 35% of variance in somatic symptom severity beyond the effects of sociodemographic variables, body mass index, medical morbidity, and depression severity. Health anxiety accounted for the largest amount of unique variance in somatic symptom severity, potentially supporting the relevance of health anxiety to the presentation of increased somatic symptoms among patients who are obese.

The psychological morbidity in the long term after war related bilateral lower limb amputation

Background

To determine the psychological morbidity in the long term after war related bilateral lower limb amputation.

Methods

Mental health status was determined by the Symptom Checklist-90-R (SCL-90-R) and a structured psychiatrist interview using Structured Clinical Interview for DSM Disorders-IV (SCID-IV) in 327 male amputees. The survey was 22.3 (SD = 3.9) years after amputation. A one-sample t-test was conducted to compare our results with a survey carried out in a rural Iranian population.

Results

The mean age of the participants was 42 years (SD = 6.3). Only 22 persons had psychiatric diagnosis and were under treatment. The most common problems on SCL-90-R were somatization, obsessive-compulsive, interpersonal sensitivity, anxiety, and depression. Global severity index (GSI) of the bilateral lower limb amputees (BLLA) (0.88 ± 0.63) was significantly higher than Iranian population (0.35 ± 0.28) (p < 0.001). BLLA had significantly higher scores in all subscales of Scl-90-R compared with general population (p < 0.001). Of the total amputees about 39.1% (128 out 327) diagnosed with at least one psychiatric disorder in psychiatrist interview. About 83.9% (N = 115) of the psychiatrist diagnosed disorders were new cases. Mood disorders 37.3% (depression 28.7%) and anxiety disorders 12.2% (obsessive compulsive disorder 9.8%) were the most common disorders in the study group. There was not any relationship between demographic variables and mental disorder (p > 0.05).

Conclusion

The high prevalence and especially the large proportion of undiagnosed mental disorders high-light the need for targeted and appropriate psychological interventions in this vulnerable population.

Correlates of pain symptoms among Iraq and Afghanistan military personnel following combat-related blast exposure

Pain complaints are highly prevalent among military servicemembers and Veterans of the recent combat operations in Iraq and Afghanistan. The high comorbidity of pain with conditions such as posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) underscores the importance of a greater understanding of factors associated with complex polytraumatic injuries among military personnel. The present study aimed to identify correlates of current pain among 201 U.S. military personnel who reported at least one blast experience during combat deployment (age [mean +/– standard deviation]: 27.20 +/– 7.58 yr). Theoretically derived subsets of variables were analyzed in successive hierarchical regression models to determine correlates of self-reported pain symptoms. Preliminary models evaluated demographic features, medical and injury characteristics (e.g., TBI classification), psychosocial history (e.g., trauma exposure), and psychiatric variables. A final model was then derived, in which older age, possible or probable mild TBI, depression symptoms, and PTSD re-experiencing symptoms emerged as significant correlates of pain. The findings further the understanding of polytrauma symptoms among military personnel by identifying specific patient characteristics and comorbidity patterns related to pain complaints. Increased awareness of demographic, psychiatric, or medical factors implicated in pain will enhance comprehensive clinical assessment and intervention efforts.

Chronic Pain and PTSD: Evolving Views on Their Comorbidity

PURPOSE

This paper presents a literature review of post-traumatic stress disorder (PTSD) and its link to chronic pain.

DESIGN AND METHODS

Twenty-four papers are reviewed (included research and reviews), with the goal of improving and updating our understanding on this issue and its theoretical and clinical repercussions.

FINDINGS

The tight interdependence of symptoms that can be observed in both PTSD and chronic pain syndromes lends support to the idea that these disorders both constitute a reactive disorder.

PRACTICE IMPLICATIONS

Various forms of therapy and treatment focus on PTSD, but chronic pain symptoms must also be assessed.

Posttraumatic stress disorder and somatic symptoms among child and adolescent survivors following the Lushan earthquake in China: A six-month longitudinal study

OBJECTIVE

To explore somatic conditions in a sample of 2299 child and adolescent survivors of an earthquake and their relationship to posttraumatic stress disorder (PTSD) symptoms.

METHODS

The Children's Revised Impact of Event Scale, the Patient Health Questionnaire (PHQ)-13 scale, a short version of PHQ-15 scale that omits two items involving sexual pain/problems and menstrual problems, and a project-developed questionnaire were administered to participants three and six months after the earthquake.

RESULTS

Among child and adolescent survivors, the prevalence rates of probable PTSD were 37.4 and 24.2% three and six months, respectively, after the earthquake. The most common somatic symptoms were trouble sleeping (58.4 and 48.4%), feeling tired or having low energy (52.0 and 46.1%), and stomach pain (45.8 and 45.4%) after three and six months, respectively. Several specific somatic symptoms evaluated three months after the earthquake including trouble sleeping, headache, and shortness of breath were predictors of the overall PTSD symptoms evaluated six months after the earthquake. Additionally, the symptom of hyperarousal evaluated after three months could predict the overall somatic symptoms evaluated after six months.

CONCLUSIONS

PTSD and somatic symptoms were common after the earthquake, and a longitudinal association between PTSD and somatic symptoms was detected among child and adolescent survivors. These findings have implications in China and possibly elsewhere.

Chronic pain and comorbid mental health conditions: independent associations of posttraumatic stress disorder and depression with pain, disability, and quality of life

Both posttraumatic stress disorder (PTSD) and depression are highly comorbid with chronic pain and have deleterious effects on pain and treatment outcomes, but the nature of the relationships among chronic pain, PTSD, and depression has not been fully elucidated. This study examined 250 Veterans Affairs primary care patients with moderate to severe chronic musculoskeletal pain who participated in a randomized controlled pain treatment trial. Baseline data were analyzed to examine the independent associations of PTSD and major depression with multiple domains of pain, psychological status, quality of life, and disability. PTSD was strongly associated with these variables and in multivariate models, PTSD and major depression each had strong independent associations with these domains. PTSD demonstrated similar relationships as major depression with psychological, quality of life, and disability outcomes and significant but somewhat smaller associations with pain. Because PTSD and major depression have independent negative associations with pain, psychological status, quality of life, and disability, it is important for clinicians to recognize and treat both mental disorders in patients with chronic pain.

The association of interpersonal trauma with somatic symptom severity in a primary care population with chronic pain: exploring the role of gender and the mental health sequelae of trauma

OBJECTIVE

Female trauma survivors develop somatic symptoms more frequently than males. We propose a model for somatic symptom development among trauma survivors, focusing on gender.

METHODS

Among 597 urban primary care patients with chronic pain, we examined the association between somatic symptom severity and three interpersonal trauma types: 1) sexual trauma (ST), 2) intimate partner violence (IPV), and 3) childhood trauma history (≥3 adverse childhood experiences (3+ACE)). We developed a structural equation model in which PTSD, depression, and substance abuse were evaluated as potential mediators of the path between trauma exposure and somatic symptom severity, and explored the role of gender in this model.

RESULTS

350 (59%) respondents were female; the mean age was 47. Women reported significantly more somatic symptoms than men, although somatic symptoms were increased among all interpersonal trauma survivors. In models in which the potential intervening variables are considered in aggregate, we did not find a signficant interaction between gender and trauma on somatic symptom severity, with the exception of 3+ACEs. A structural equation model showed depression and substance abuse, for men, and depression, for women, were associated with somatic symptom severity. PTSD was not associated with somatic symptom severity. Paths from trauma exposures to mental health sequelae were stronger for men.

CONCLUSIONS

Women have more severe somatic symptoms. With the exception of 3+ACEs, the association between trauma and somatic symptoms is amplified in both genders. Structural equation models showed the pathways differed by gender in function and strength of association.

Somatic symptoms and health-related quality of life among treatment-seeking Canadian Forces personnel with PTSD

This study examined the association between somatic complaints and health-related quality of life (HR-QoL) in treatment-seeking Canadian military personnel with military-related Posttraumatic Stress Disorder (PTSD). Current and former Canadian Forces (CF) members attending the Parkwood Hospital Operational Stress Injury Clinic in London, Ontario (N=291) were administered self-report questionnaires assessing number and severity of somatic complaints, PTSD and depressive symptom severity, and mental and physical health-related quality of life (HR-QoL) prior to commencing treatment. Regression analyses were used to identify the role of somatic complaints on physical and mental HR-QoL, after controlling for PTSD symptom cluster and depressive symptom severity. Somatic symptom severity accounted for only a small amount of the variance in mental HR-QoL after accounting for PTSD symptom cluster and depressive symptom severity, but accounted for a larger proportion of the variance in physical HR-QoL after accounting for PTSD cluster and depressive symptom severity. Understanding the role of somatization in the symptom-presentation of military personnel with PTSD may provide additional avenues for treatment with this population.

Evidence for acute central sensitization to prolonged experimental pain in posttraumatic stress disorder

BACKGROUND

Post-traumatic stress disorder (PTSD) and pain have a well-documented high comorbidity; however, the underlying mechanisms of this comorbidity are currently poorly understood. The aim of this psychophysical study was to investigate the behavioral response to a prolonged suprathreshold pain stimulus in subjects with combat-related PTSD and combat controls (CC) for clinical evidence of central sensitization.

METHODS

Ten male subjects with current PTSD related to combat and 11 CC male subjects underwent baseline quantitative sensory testing (QST), temporal pain summation, and psychological profiling followed by an intramuscular injection of capsaicin into the quadriceps muscle.

RESULTS

There was no significant between-group difference for the initial maximal pain response or an initial pain reduction for the first 15 minutes postinjection on QST or pain ratings. However, we observed significantly higher scores in the PTSD group for the second 15 minutes postinjection on both pain intensity and pain unpleasantness ratings. Assessment of temporal summation to repetitive pressure stimuli showed significantly higher subjective pain in the PTSD group.

CONCLUSION

These findings are consistent with a significantly higher degree of acute central sensitization in individuals with PTSD. Increased acute central sensitization may underlie increased vulnerability for developing pain-related conditions following combat trauma.

PTSD symptoms and pain in Canadian military veterans: the mediating roles of anxiety, depression, and alcohol use

Symptoms of posttraumatic stress disorder (PTSD) and pain are often comorbid among veterans. The purpose of this study was to investigate to what extent symptoms of anxiety, depression, and alcohol use mediated the relationship between PTSD symptoms and pain among 113 treated male Canadian veterans. Measures of PTSD, pain, anxiety symptoms, depression symptoms, and alcohol use were collected as part of the initial assessment. The bootstrapped resampling analyses were consistent with the hypothesis of mediation for anxiety and depression, but not alcohol use. The confidence intervals did not include zero and the indirect effect of PTSD on pain through anxiety was .04, CI [.03, .07]. The indirect effect of PTSD on pain through depression was .04, CI [.02, .07]. These findings suggest that PTSD and pain symptoms among veterans may be related through the underlying symptoms of anxiety and depression, thus emphasizing the importance of targeting anxiety and depression symptoms when treating comorbid PTSD and pain patients.

Posttraumatic stress symptomatology as a mediator of the relationship between warzone exposure and physical health symptoms in men and women

The mediating role of posttraumatic stress symptomatology (PSS) on the association between warzone exposure and physical health symptoms in 7 bodily systems (cardiovascular, dermatological, gastrointestinal, genitourinary, musculoskeletal, neurological, and pulmonary) was examined. We also examined if mediation effects varied as a function of sex. A sample of 317 U.S. Gulf war veterans was assessed for warzone exposure, PSS, and physical health symptoms 10 years after deployment. PSS was significantly associated with postdeployment physical health in all symptom categories when accounting for predeployment health (with effect sizes ranging from a 1.27-1.64 increase in the likelihood of postdeployment physical health symptoms with a 1 standard deviation increase in the PSS symptoms). PSS severity mediated the relationship between warzone exposure and postdeployment symptoms in all physical health domains (with percent mediation ranging 44%-75%). A significant Warzone Exposure × PSS interaction emerged for 5 outcomes such that the effect of PSS on physical health was stronger for veterans reporting lower warzone exposure. No significant interactions with sex emerged. These findings suggest the important influence of PSS on physical health symptoms for both men and women.

The physical health consequences of PTSD and PTSD symptoms: a meta-analytic review

The present meta-analysis systematically examined associations between physical health and posttraumatic stress disorder (PTSD)/PTSD symptoms (PTSS), as well as moderators of this relationship. Literature searches yielded 62 studies examining the impact of PTSD/PTSS on physical health-related quality of life (HR-QOL), general health symptoms, general medical conditions, musculoskeletal pain, cardio-respiratory (CR) symptoms, and gastrointestinal (GI) health. Sample-specific and methodological moderators were also examined. Results revealed significantly greater general health symptoms, general medical conditions, and poorer HR-QOL for PTSD and high PTSS individuals. PTSD/PTSS was also associated with greater frequency and severity of pain, CR, and GI complaints. Results of moderation analyses were mixed. However, consistent relationships emerged regarding PTSD assessment method, such that effect sizes were largest for self-reported PTSD/PTSS and all but one health outcome. Results highlight the need for prospective longitudinal examination of physical health shortly following trauma, and suggest variables to consider in the design of such studies.

War-Related Somatoform Disorder in an Older Adult Veteran

This case study describes an older adult war veteran who served during World War II (WWII) and later developed disruptive behaviors related to psychosomatic symptoms, dementia, and his war-related fear of dying. While in the service, he developed lifelong gastrointestinal problems and was subsequently diagnosed with undifferentiated somatization disorder (USD). USD is a mental illness characterized by medically unexplained physical symptoms originating from psychological or emotional distress. The geropsychology team who worked with the veteran postulated the association of WWII experiences to his somatic symptoms; however, this veteran never received treatment for posttraumatic stress disorder (PTSD), and only a couple of notes in his computerized medical record referenced his wartime experiences. A stepwise approach to care was necessitated to identify a successful, individualized treatment. Phase I of treatment was aimed to reduce attachment anxiety and related behavioral disturbances when the veteran moved into the nursing home. In Phase II, cognitive behavioral therapy and acceptance and commitment therapy were used to help the veteran cope with somatic symptoms. In Phase III, Montessori-based interventions were used to minimize distress associated with dementia-related cognitive impairment and associated war-related somatization and fear of dying. We contemplate the possibility that the veteran’s presentation is a variant of PTSD that has not been described in the literature. We hope that you find this case study to be not the story of someone enduring a life of chronic mental and physical illnesses, but instead our discoveries about the man who persevered with courage and dignity.

A different kind of co-morbidity: Understanding posttraumatic stress disorder and chronic pain

Many traumatic events leave lingering physical injuries and chronic pain in their wake, in addition to trauma-related psychopathology. In this review, we provide an overview of developments in the recent literature on co-morbid posttraumatic stress disorder (PTSD) and chronic pain. Starting with the conceptual models presented by Sharp and Harvey (2001) and Asmundson, Coons, Taylor, and Klatz (2002), this review summarizes newer studies that examine prevalence of these co-morbid conditions. Additionally, we present an updated synthesis of research on factors that may maintain both chronic physical pain and PTSD in trauma survivors. Consideration of the impact of this co-morbidity on psychosocial assessment and treatment also is discussed, with particular attention to issues that warrant additional research.

Pain and post traumatic stress disorder - review of clinical and experimental evidence

Pain and Post Traumatic Stress Disorder (PTSD) are highly comorbid conditions. Patients with chronic pain have higher rates of PTSD. Likewise, patients with PTSD are often diagnosed with numerous chronic pain conditions. Despite the high pain-PTSD comorbidity, the neurobehavioral mechanisms underlying this phenomenon are incompletely understood and only recently researchers have started investigating it using experimental models. In this article, we systematically review the substantial clinical evidence on the co-occurrence of pain and PTSD, and the limited experimental evidence of pain processing in this disorder. We provide a detailed overview of the psychophysical and brain imaging experiments that compared somatosensory and pain processing in PTSD and non-PTSD populations. Based on the presented evidence, an extensive body of literature substantiates the clinical coexistence of pain and PTSD in patients but the limited experimental data show inconsistent results highlighting the need for well-controlled future studies. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.

The relationship between posttraumatic stress disorder, psychiatric comorbidity, and personality traits among patients with chronic idiopathic urticaria

BACKGROUND

Several studies have highlighted the link between posttraumatic stress disorder (PTSD) and physical illnesses. No empirical studies, however, have investigated the relationship between PTSD and chronic idiopathic urticaria (CIU). The role of personality traits in this relationship was also unknown.

OBJECTIVES

This study aimed to investigate (1) the extent to which patients with CIU fulfilled the PTSD diagnosis resulting from past traumas and (2) whether they developed psychiatric comorbidity, and (3) the relationship between CIU patients' personality traits, PTSD diagnosis, severity of CIU, and psychiatric comorbidity.

METHODS

One hundred patients with CIU and 60 patients with allergy (control) participated in the study. Patients' CIU severity was assessed. Both groups completed the Posttraumatic Stress Diagnostic Scale, the General Health Questionnaire-28, the Social Readjustment Rating Scale, the Perceived Stress Scale, and the NEO-Five Factor Inventory.

RESULTS

Thirty-four percent of patients with CIU and 18% of allergy patients met the diagnostic criteria for PTSD. Patients with CIU were 1.89 times more likely to have a current diagnosis of PTSD than the control group. Controlling for life event stress and perceived stress, significant differences were found between groups (CIU PTSD, CIU no PTSD, allergy PTSD, allergy no PTSD) in somatic problems, anxiety, and social dysfunction. Controlling for life event stress and perceived stress, regression analyses showed no significant associations between personality traits, PTSD diagnosis, and the severity of CIU. Posttraumatic stress disorder diagnosis and neuroticism were, however, associated with psychiatric comorbidity.

CONCLUSIONS

Patients with CIU have been shown to have concurrent PTSD resulting from past traumas and developed psychiatric comorbidity. Chronic idiopathic urticaria patients' comorbidity was related to the patients' PTSD diagnosis and their neurotic personality trait.

[PTSD and chronic pain: development, maintenance and comorbidity--a review]

In addition to posttraumatic stress disorder (PTSD) many traumatized individuals also suffer from chronic pain. Understanding the development and maintenance of these two disorders and how they interact is of crucial importance for treatment. This article provides an overview of the current literature on mechanisms of development, maintenance and comorbidity of PTSD and chronic pain. Moreover the perpetual avoidance model and its implications for practical application are presented.

Responses to interoceptive exposure in people with posttraumatic stress disorder (PTSD): a preliminary analysis of induced anxiety reactions and trauma memories and their relationship to anxiety sensitivity and PTSD symptom severity

A growing body of evidence suggests that anxiety sensitivity (AS; fear of arousal-related sensations) plays a role in posttraumatic stress disorder (PTSD). Consistent with this, evidence indicates that interoceptive exposure (IE), which is a method for reducing AS, reduces PTSD symptoms. Clinical observations from our treatment studies indicate that IE triggers both anxiety and trauma memories in people with PTSD. The primary aim of this study was to describe the anxiety responses to a series of IE exercises and to examine whether or not trauma memories were activated. A secondary aim was to explore the relationships among AS, PTSD symptom severity, and IE responses. Data were collected from 23 people with PTSD who completed measures of PTSD symptoms and AS and a standardized battery of 10 IE exercises. Elevated anxiety and strong arousal responses were frequently elicited by the exercises, and trauma memories were also frequently triggered. AS and IE-triggered trauma memories significantly predicted IE-induced peak anxiety. The implications of the findings are discussed in terms of how IE might exert its therapeutic effects in the treatment of PTSD.