Empirical development of an MMPI subscale for the assessment of combat-related posttraumatic stress disorder

EMDR v. other psychological therapies for PTSD: a systematic review and individual participant data meta-analysis

BACKGROUND

This systematic review and individual participant data meta-analysis (IPDMA) examined the overall effectiveness of eye movement desensitization and reprocessing (EMDR) in reducing posttraumatic stress disorder (PTSD) symptoms, achieving response and remission, and reducing treatment dropout among adults with PTSD compared to other psychological treatments. Additionally, we examined available participant-level moderators of the efficacy of EMDR.

METHODS

This study included randomized controlled trials. Eligible studies were identified by a systematic search in PubMed, Embase, PsyclNFO, PTSDpubs, and CENTRAL. The target population was adults with above-threshold baseline PTSD symptoms. Trials were eligible if at least 70% of study participants had been diagnosed with PTSD using a structured clinical interview. Primary outcomes included PTSD symptom severity, treatment response, and PTSD remission. Treatment dropout was a secondary outcome. The systematic search retrieved 15 eligible randomized controlled trials (RCTs); 8 of these 15 were able to be included in this IPDMA (346 patients). Comparator treatments included relaxation therapy, emotional freedom technique, trauma-focused cognitive behavioral psychotherapies, and REM-desensitization.

RESULTS

One-stage IPDMA found no significant difference between EMDR and other psychological treatments in reducing PTSD symptom severity (β = -0.24), achieving response (β = 0.86), attaining remission (β = 1.05), or reducing treatment dropout rates (β = -0.25). Moderator analyses found unemployed participants receiving EMDR had higher PTSD symptom severity at the post-test, and males were more likely to drop out of EMDR treatment than females.

CONCLUSION

The current study found no significant difference between EMDR and other psychological treatments. We found some indication of the moderating effects of gender and employment status.

Self-Perceived Stress Is Associated With Chest Pain and Personality in Patients With Refractory Functional Gastrointestinal Disorders

ABSTRACT

Stressful events are frequently associated with functional gastrointestinal disorders (FGID). This study aims to determine if the severity of self-perceived stress is associated with specific FGID and personality characteristics in 822 patients with FGID who have filled a Rome III questionnaire, Minnesota Multiphasic Personality Inventory 2 (MMPI-2), and a 10-point Likert scale for self-perceived stress. According to stress severity, the patients were divided into three groups: low (<4; n = 183), moderate (4-6; n = 283), and severe stress (>6; n = 356). Female sex was more frequent in the severe stress group than in the low stress group (p = 0.001). Stress severity was strongly correlated with the two MMPI-2 posttraumatic stress scales. Clinically, chest pain was more frequently reported by severe stress patients than moderate stress patients. MMPI-2 clinical scales vary significantly according to the severity of stress, and "mild stress" patients have increased hysteria and depression scales and showed a higher frequency of irritable bowel syndrome-diarrhea. This study shows that severe stress severity is associated with a higher frequency of noncardiac chest pain and correlated with most personality items.

The Effect of Postmigration Factors on Quality of Life among North Korean Refugees Living in South Korea

North Korean refugees have not only endured traumatic experiences in North Korea and during defection but have also undergone an adaptation process after arrival in South Korea. Their quality of life (QoL) is likely to be affected by these traumatic life events, leading to subsequent posttraumatic stress disorder (PTSD), or postmigration adaptation-related stress, which involves a sense of dislocation with the culture, language, and people in South Korea. We investigated which aspects predicted the QoL of refugees from North Korea. Fifty-five participants currently living in South Korea completed a checklist about personal characteristics and traumatic experiences before, during and after migration. Diagnosis and symptom severity of PTSD, depressive mood, anxiety, and QoL were also assessed. A multiple regression analysis was performed to evaluate associations between QoL and other variables of interest. Overall, QoL was associated with previous economic status in North Korea, present occupation in South Korea, difficulty interacting with South Koreans, depressed mood, and state–trait anxiety. Finally, QoL was explained by having difficulty interacting with South Koreans, depressed mood, and state anxiety, with the model accounting for 51.3% of the variance. Our findings suggest that QoL among North Korean refugees in South Korea is influenced by the current level of their anxiety and depressed mood, and post-migration adaptation-related stress resulting from trying to integrate with South Koreans after settlement.

Negative Emotionality Interacts with Trauma Exposure to Prospectively Predict Posttraumatic Stress Disorder Symptoms During Firefighters' First 3 Years of Service

Firefighters (FFs) protect the public despite significant risks to their health and well-being stemming from frequent trauma exposure and other occupational stressors. A minority of FFs develop posttraumatic stress disorder (PTSD) or related mental health problems, whereas most remain remarkably resilient despite enormous stress. This points toward substantial variability in responses to traumatic stress among FFs. Personality, particularly negative emotionality (NEM), has been shown to predict the development of PTSD in other trauma-exposed populations, yet has not been prospectively studied in relation to PTSD in FFs. The aim of this secondary analysis from a broader study of mental health in FFs was to test whether preemployment NEM predicted PTSD symptom severity over time by influencing how FFs respond to traumatic experiences. In this first prospective study of the development of PTSD symptoms in professional FFs, 322 FFs were recruited from seven urban fire academies across the United States and followed over their first 3 years of fire service. We assessed NEM during the fire academy as well as trauma exposure and both self-reported and clinician-rated PTSD symptoms at 1-, 2-, and 3-year follow-ups. Level of trauma exposure and NEM predicted PTSD symptoms over time, and NEM moderated the effect of trauma exposure on clinician-rated PTSD symptoms across both trauma exposure measures at 1- and 3-year follow-ups, f² = .03-.10, but not at 2-year follow-up nor for self-reported PTSD symptoms. These findings indicate that NEM, assessed upon entry into a high-risk occupation, is useful in predicting PTSD symptom development.

Autonomic dysfunction in posttraumatic stress disorder indexed by heart rate variability: a meta-analysis

BACKGROUND

Changes in autonomic nervous system (ANS) function have been observed in a variety of psychological disorders, including posttraumatic stress disorder (PTSD). Analysis of heart rate variability (HRV) provides insight into the functioning of the ANS. Previous research on PTSD found lower HRV in PTSD patients compared to controls, indicating altered sympathetic and parasympathetic activity, but findings are inconsistent. The purpose of this meta-analysis was to examine differences in HRV indices between individuals with PTSD and healthy controls at baseline and during stress.

METHODS

The included primary studies present an aggregate of studies analyzing different HRV indices. Examined HRV indices were standard deviation of the normalized NN-intervals (SDNN), root mean square of successive differences (RMSSD), low-frequency (LF) and high-frequency (HF) spectral components, LF/HF ratio, and heart rate (HR). Moderating effects of study design, HRV and PTSD assessment, and sample characteristics were examined via subgroup-analyses and meta-regressions.

RESULTS

Random-effects meta-analyses for HRV parameters at rest revealed significant group differences for RMSSD and HF-HRV, suggesting lower parasympathetic activity in PTSD. The aggregated effect size for SDNN was medium, suggesting diminished total variability in PTSD. A small effect was found for LF-HRV. A higher LF/HF ratio was found in the PTSD sample as compared to controls. Individuals with PTSD showed significantly higher HR. During stress, individuals with PTSD showed higher HR and lower HF-HRV, both indicated by small effect sizes.

CONCLUSIONS

Findings suggest that PTSD is associated with ANS dysfunction.

Combat Experience and Posttraumatic Stress Symptoms among Military-Serving Parents: a Meta-Analytic Examination of Associated Offspring and Family Outcomes

In this meta-analysis, we review findings on the relationships between parental combat exposure and PTSD/PTSS in military-serving families and (1) parenting problems, (2) family maladjustment, and (3) offspring problems. We systematically searched for studies in PsycInfo, PsychArticles, Psychology and Behavior Sciences Collection, Published International Literature on Traumatic Stress (PILOTS), and PubMed/Medline as well as conducted manual searches. Search procedures identified 22 eligible studies, including 20 studies examining relationships between parental PTSD/PTSS and parenting, family, and/or offspring outcomes and 8 studies examining relationships between parental combat exposure and parenting, family, and/or offspring outcomes. Random effects meta-analytic models estimated omnibus associations between parental combat exposure/PTSD and pooled Family Difficulties, as well as individual relationships between parental combat exposure and PTSD/PTSS and parenting, family adjustment, and offspring outcomes. Small-to-moderate effect sizes were observed in the omnibus meta-analysis examining relationships between parental PTSD/PTSS and pooled Family Difficulties, and in the meta-analysis examining relationships between parental PTSD/PTSS and parenting problems, between parental PTSD/PTSS and poor family functioning, and between parental PTSD/PTSS and offspring problems. Associations between parental combat exposure and pooled Family Difficulties, as well as between parental combat exposure and parenting problems were smaller in magnitude. PTSD/PTSS among military-serving parents is associated with increased problems in the family environment, including parenting problems, family maladjustment, and offspring problems, whereas combat exposure alone is not as strongly associated with such family difficulties. Moderator analyses are presented and discussed as well. When military-serving parents show psychological symptoms, professionals should consider allocating resources to target broader family issues.

Assessing Voice Hearing in Trauma Spectrum Disorders: A Comparison of Two Measures and a Review of the Literature

Voice hearing (VH) can occur in trauma spectrum disorders (TSD) such as posttraumatic stress disorder (PTSD) and dissociative disorders. However, previous estimates of VH among individuals with TSD vary widely. In this study, we sought to better characterize the rate and phenomenology of VH in a sample of 70 women with TSD related to childhood abuse who were receiving care in a specialized trauma program. We compared the rate of VH within our sample using two different measures: 1) the auditory hallucination (AH) item in the Structured Clinical Interview for DSM-IV-TR (SCID), and 2) the thirteen questions involving VH in the Multidimensional Inventory of Dissociation (MID), a self-report questionnaire that comprehensively assesses pathological dissociation. We found that 45.7% of our sample met threshold for SCID AH, while 91.4% met criteria for MID VH. Receiver operating characteristics (ROC) analyses showed that while SCID AH and MID VH items have greater than chance agreement, the strength of agreement is only moderate, suggesting that SCID and MID VH items measure related but not identical constructs. Thirty-two patients met criteria for both SCID AH and at least one MID VH item ("unequivocal VH"), 32 for at least one MID VH item but not SCID AH ("ambiguous VH"), and 6 met criteria for neither ("unequivocal non-VH"). Relative to the ambiguous VH group, the unequivocal VH group had higher dissociation scores for child voices, and higher mean frequencies for child voices and Schneiderian voices. Our findings suggest that VH in women with TSD related to childhood abuse is common, but that the rate of VH depends on how the question is asked. We review prior studies examining AH and/or VH in TSD, focusing on the measures used to ascertain these experiences, and conclude that our two estimates are consistent with previous studies that used comparable instruments and patient samples. Our results add to growing evidence that VH-an experience typically considered psychotic or psychotic-like-is not equivalent to having a psychotic disorder. Instruments that assess VH apart from psychotic disorders and that capture their multidimensional nature may improve identification of VH, especially among patients with non-psychotic disorders.

Association between memory impairment and brain metabolite concentrations in North Korean refugees with posttraumatic stress disorder

Individuals with posttraumatic stress disorder (PTSD) had experiences of enormous psychological stress that can result in neurocognitive and neurochemical changes. To date, the causal relationship between them remains unclear. The present study is to investigate the association between neurocognitive characteristics and neural metabolite concentrations in North Korean refugees with PTSD. A total of 53 North Korean refugees with or without PTSD underwent neurocognitive function tests. For neural metabolite scanning, magnetic resonance spectroscopy of the hippocampus and anterior cingulate cortex (ACC) has been conducted. We assessed between-group differences in neurocognitive test scores and metabolite levels. Additionally, a multiple regression analysis was carried out to evaluate the association between neurocognitive function and metabolite levels in patients with PTSD. Memory function, but not other neurocognitive functions, was significantly lower in the PTSD group compared with the non-PTSD group. Hippocampal N-acetylaspartate (NAA) levels were not different between groups; however, NAA levels were significantly lower in the ACC of the PTSD group than the non-PTSD group (t = 2.424, p = 0.019). The multiple regression analysis showed a negative association between hippocampal NAA levels and delayed recall score on the auditory verbal learning test (β = -1.744, p = 0.011) in the non-PTSD group, but not in the PTSD group. We identified specific memory impairment and the role of NAA levels in PTSD. Our findings suggest that hippocampal NAA has a protective role in memory impairment and development of PTSD after exposure to traumatic events.

PTSD in Court III: Malingering, assessment, and the law

This journal's third article on PTSD in Court focuses especially on the topic's "court" component. It first considers the topic of malingering, including in terms of its definition, certainties, and uncertainties. As with other areas of the study of psychological injury and law, generally, and PTSD (posttraumatic stress disorder), specifically, malingering is a contentious area not only definitionally but also empirically, in terms of establishing its base rate in the index populations assessed in the field. Both current research and re-analysis of past research indicates that the malingering prevalence rate at issue is more like 15±15% as opposed to 40±10%. As for psychological tests used to assess PTSD, some of the better ones include the TSI-2 (Trauma Symptom Inventory, Second Edition; Briere, 2011), the MMPI-2-RF (Minnesota Multiphasic Personality Inventory, Second Edition, Restructured Form; Ben-Porath & Tellegen, 2008/2011), and the CAPS-5 (The Clinician-Administered PTSD Scale for DSM-5; Weathers, Blake, Schnurr, Kaloupek, Marx, & Keane, 2013b). Assessors need to know their own possible biases, the applicable laws (e.g., the Daubert trilogy), and how to write court-admissible reports. Overall conclusions reflect a moderate approach that navigates the territory between the extreme plaintiff or defense allegiances one frequently encounters in this area of forensic practice.

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 Los Angeles Symptom Checklist: A Self Report Measure of Posttraumatic Stress Disorder

A series of inquiries was conducted on the psychometric properties of the Los Angeles Symptom Checklist (LASC), a self-report measure of Posttraumatic Stress Disorder (PTSD) and associated features. Data were drawn from various samples of individuals who completed the LASC in prior studies: Vietnam veterans (n = 300), battered women (n = 123), adult survivors of child sexual abuse (n = 142), maritally distressed women (n = 36), psychiatric outpatients (n = 105), and high-risk adolescents (n = 168). The instrument was shown to possess high internal consistency (alphas ranging from .88-.95) and test-retest reliability (coefficients of .90 and .94 with a 2-week interval), to be dominated by a strong PTSD first factor, and to demonstrate acceptable levels of convergent validity. Normative information is provided for various samples, including help-seeking male combat veterans, help-seeking females, and high-risk adolescents. As a self-report PTSD assessment device, the LASC has potential for use with various trauma groups.

Psychometric Properties of the Embedded and Stand-Alone Versions of the MMPI-2 Keane PTSD Scale

This study investigated the comparability of the embedded and stand-alone versions of the Keane Posttraumatic Stress Disorder scale ( PK scale) of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Participants were 123 Vietnam theater veterans, 68 of whom (55%) were diagnosed with war zone-related posttraumatic stress disorder (PTSD). In separate testing sessions scheduled two to three days apart, all participants first completed the full MMPI-2 followed by the 46 PK scale items administered in a stand-alone format. Sixty participants completed the stand-alone version again in a third session. In addition, all participants were administered the Structured Clinical Interview for DSM-III-R (SCID), including the PTSD module, and completed a number of other questionnaire measures of combat exposure and PTSD. Results indicated that the embedded and stand-alone versions of the MMPI-2 PK scale are quite comparable in terms of mean scores, internal consistency, convergent validity, and diagnostic utility. Use of the standalone version is indicated for assessment applications in which the full MMPI-2 cannot be administered.

Personality Assessment Inventory (PAI) Profiles of Adult Female Abuse Survivors

Personality Assessment Inventory (PAI) profiles of 91 adult female, Caucasian subjects were examined to determine if there were significant differences between those subjects who reported a history of broadly-defined childhood/adolescent abuse and those subjects who did not report a history of abuse. PAI profiles of 44 self-reported survivors of abuse were compared with those of 47 subjects diagnosed with primary affective disorders, but without a reported history of abuse. Since there were significant age differences between the two groups, with the nonabused subjects being older, PAI scores were compared using age of subject as covariate in an Analysis of Covariance design. Significant differences between the groups were obtained on several PAI scales and subscales. In addition, the profiles of abuse survivors closely resembled Morey's PAI Cluster 2, which is associated with a diagnosis of post-traumatic stress disorder (PTSD). The PAI scale scores of the abuse survivors were believed to reflect the “acting-out” and “acting-in” tendencies reported in prior PTSD literature. The implications for evaluation of abuse survivors are discussed.

Latent Structure of the Mississippi Scale for Combat-Related Post-Traumatic Stress Disorder: Exploratory and Higher-Order Confirmatory Factor Analyses

A series of factor analyses evaluated the dimensionality of the Mississippi Scale for Combat-Related Post-Traumatic Stress Disorder. Over 2,200 Vietnam theater and era veterans were divided into three random subsamples, each of which was used in a separate stage of analysis. Initial exploratory factor analyses suggested an underlying single-factor solution. In the second subsample, a second-order solution comprised of a general factor subsuming several first-order factors was supported using chi-square difference testing. This model was successfully replicated with the third subsample. Cumulative evidence suggests that the latent structure of the Mississippi Scale is best represented as an umbrella Post-Traumatic Stress Disorder (PTSD) factor leading to four subsidiary facets or dimensions.

The Incremental Validity of MMPI-2 Supplementary Scales

Several hundred special or supplementary scales were created for the original Minnesota Multiphasic Personality Inventory (MMPI). At the time of the release of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) in 1989, 15 supplementary scales were included in, or developed for, this revised test. The degree to which the MMPI-2 supplementary scales provide either new information or data that are redundant with that already provided by the MMPI-2 basic scales has not been investigated in prior research. The current study examines the incremental validity of the MMPI-2 supplementary scales in a sample of 597 adult psychiatric inpatients using criterion measures composed of other self-report instruments and clinicians' ratings of psychopathology. MMPI-2 basic and supplementary scale data were entered in a series of hierarchical regression analyses to statistically evaluate the degree to which the supplementary scales provided incremental contributions in the prediction of variance on outcome measures. These results were compared with levels of prediction achieved by forced entry of all 13 of the basic scales and with incremental variance produced by the assignment of random 7-score values to the supplementary scales. Major findings indicate that the inclusion of supplementary scale data only marginally increased the proportion of variance accounted for in external criterion variables.

Assessment of Noncombat, War-Related Posttraumatic Stress Symptomatology

This study investigated effectiveness of MMPI-2 PK and PS scales and the Impact of Event (IES) scales in detecting posttraumatic stress symptomatology in 66 Marine reservists exposed to 3 months of war-related stress but no direct fighting in the Persian Gulf. The IES, MMPI-2, and War Stress Interview-Operation Desert Storm (WSI-ODS), administered 90 days later, revealed that 71% of participants experienced one or more symptoms of acute posttraumatic stress for at least 1 month after the Gulf War. PK, PS and IES scores were significantly related to number of symptoms reported and were moderately effective in detecting subclinical levels of war-related stress.

Three Studies on the Reliability and Validity of a Self-Report Measure of Posttraumatic Stress Disorder

This paper describes three studies of the reliability and validity of a newly revised version of the Purdue Posttraumatic Stress Disorder scale (PPTSD-R). The PPTSD-R is a 17-item questionnaire that yields four scores: Reexperiencing, Avoidance, Arousal, and Total. It is highly internally consistent (α = .91), and the scores are relatively stable across time. The PPTSD-R is highly correlated with other measures of PTSD symptomatology and moderately correlated with measures of related psychopathology, providing preliminary support for the measure's convergent and discriminant validity. It reliably distinguishes between groups of people who were and were not traumatized, it is sensitive to the impact of different types of traumatic events, and (within a clinical sample) it discriminates between those who did and did not seek treatment for difficulty coping with the traumatic event being assessed. The PPTSD-R shows promise as a measure of PTSD symptoms in the college population.

Adverse Health Effects in African American Residents Living Adjacent to Chemical Industries

The objective of the present study was to compare the physical and psychological health of three groups of African Americans (N = 310): acute sulfuric acid exposed, nonacute exposed, and unexposed controls. Instruments included a health questionnaire, a Toxic Symptom Checklist, the Profile of Mood States (POMS), the Post-Traumatic Stress and the Neurotoxic Anxiety scales of the MMPI-2, the Impact of Event Scale, the Symptom Check List 90-Revised (SCL 90-R), and several brief mood and personality scales. Blood pressure and pulse rates were also taken. Matching produced 51 three-way pairs. MANOVA results indicate significant effects for exposure. Significant univariate Fs (p < .05) were foundfor all the scales across the exposed groups exceptfor the Toxic Symptom category of memory/concentration, POMS depression, and 5 of the 9 SCL 90-R subscales. The t-test results using adjusted a = .0167 indicate both exposed groups had more mood and health symptoms than the controls. The acute were the most symptomatic, and both exposed groups had more respiratory problems, skin rashes, and allergies; results that are consistent with chemical exposure. Results also indicate all three groups had higher than average blood pressure, and the SCL 90-R scores for all three groups were higher than reported in the manual.

Assessing post-traumatic stress symptoms in a Latino prison population

PURPOSE

The purpose of this paper is to assess the reliability and validity of the Spanish version of the Davidson trauma scale (DTS-S) and to determine the prevalence and correlates of post-traumatic stress disorder (PTSD) symptoms in a non-clinical random sample of prison inmates.

DESIGN/METHODOLOGY/APPROACH

Probabilistic samples of 1,179 inmates from 26 penal institutions in Puerto Rico were selected using a multistage sampling design. Population estimates and correlations were obtained for PTSD, generalized anxiety and depression. The reliability, factor structure, and convergent validity of the DTS-S were assessed. Cross-validation was employed to confirm the results of the factor analyses.

FINDINGS

Using the cut-offs adopted by the scale's author, 136 (13.4 percent) of the inmates are likely to have current PTSD and 117 (11.6 percent) reach the cut-off for sub-threshold PTSD. Confirmatory factor analysis generated two factors explaining 53 percent of the variance. High reliabilities were obtained for the total scale (α=0.95) and for the frequency and severity scales (α=0.90 and 0.91). Significantly higher DTS-S scores were found for females (t=2.26, p<0.025), for inmates diagnosed with depression or anxiety (t=2.02, p<0.05), and those reporting suicide attempts (t=4.47, p<0.0001).

ORIGINALITY/VALUE

Findings support that the DTS-S is a reliable and valid measure to assess PTSD symptoms in Latino inmate populations and to identify individuals at risk for the disorder that require confirmatory diagnosis and clinical interventions.

Role of morality in the experience of guilt and shame within the armed forces

OBJECTIVE

Despite advances in our understanding of mental health issues among military forces, a large proportion of military personnel continue to exhibit deployment-related psychological issues. Recent work has identified symptoms of guilt and shame related to moral injury as contributing significantly to combat-related mental health issues. This systematic scoping review explores the association between morality and symptoms of guilt and shame within military forces.

METHOD

A search of the literature pertaining to guilt, shame and morality within military samples was conducted.

RESULTS

Nineteen articles were selected for review. There is strong evidence linking exposure to and the perceived perpetration of moral transgressions with experiences of guilt and shame. Critically, symptoms of guilt and shame were related to adverse mental health outcomes, particularly the onset of post-traumatic stress disorder (PTSD). No studies have explored moral judgment in conjunction with assessments of guilt or moral injury.

CONCLUSION

These findings have important implications for the prevention and treatment of PTSD-related symptoms in military samples. By measuring moral judgment prior to deployment, it may be possible to predict the likelihood of incurring moral injuries and the development of associated symptoms. Early intervention programmes aimed at ameliorating guilt and shame are required to prevent the long-term development of deployment-related psychological distress.

Assessment of the standard forensic procedure for the evaluation of psychological injury in intimate-partner violence

In judicial terms, a victim refers to any person who has suffered injury arising from an action or omission of an action that constitutes an offence, and the burden of proof lies with the prosecution. A review of Spanish judicial judgements underscored that the lack of evidence of psychological injury in cases of intimate-partner violence (IPV) accounted for approximately 40% of acquittals. Thus, the Spanish standard of proof for the forensic evaluation of psychological injury i.e., the MMPI-2 and the unstructured interview were assessed in order to determine if they met the statutory requirement for the assessment of psychological injury and the differential diagnosis of feigning. The results of the comparison of 51 women victims of IPV with firm convictions against their aggressors, and 54 women mock victims of IPV showed that the F, K, Fb, Fp and Ds scales, and the F-K index discriminated significantly and with medium and large effect sizes, between adjudicated and mock victims. However, the results did not provide a valid decision criterion for forensic settings i.e., false negatives (identifying feigner as honest protocols) were not classified correctly. In conclusion, the standard forensic procedure for the evaluation of psychological injury in cases of IPV did not constitute valid proof for judges who acquitted defendants on the grounds of not proven due to the lack of evidence of psychological injury.

Combat-related PTSD in military court: a diagnosis in search of a defense

As more veterans return from Iraq and Afghanistan, Posttraumatic Stress Disorder (PTSD) often returns with them. As a result, PTSD has quickly become the most prevalent mental disorder diagnosis among active duty United States (U.S.) military. Although numerous studies have not only validated PTSD but have chronicled its negative behavioral impact, it remains a controversial diagnosis. It is widely diagnosed by all types of mental health professionals for even minimal trauma, and DSM-IV PTSD criteria have wide overlap with other mood and anxiety disorders. This, however, has not stopped PTSD from being used in civilian courts in the U.S. as a mental disorder to establish grounds for mental status defenses, such as insanity, diminished capacity, and self-defense, or as a basis for sentencing mitigation. Not surprisingly, PTSD has recently found its way into military courts, where some defense attorneys are eager to draw upon its understandable and linear etiology to craft some type of mental incapacity defense for their clients. As in the civilian sphere, this has met with mixed success due to relevance considerations. A recent court-martial, U.S. v. Lawrence Hutchins III, has effectively combined all the elemental nuances of PTSD in military court.

Implementing an Assessment Clinic in a Residential PTSD Program

Creating useful treatment plans can help improve services to consumers of mental health services. As more evidence-based practices are implemented, deciding what treatment, at what time, for whom becomes an important factor in facilitating positive outcomes. Readiness for trauma-focused treatments for Posttraumatic Stress Disorder (PTSD) such as Cognitive Processing Therapy or Prolonged Exposure Therapy may influence whether an individual can successfully complete either protocol. In addition, components of adjunctive therapies such as Acceptance and Commitment Therapy or Dialectical Behavior Therapy may be useful in moving a particular patient toward readiness and successful completion of treatment. Psychological assessment adds valuable data to inform these types of treatment decisions. This paper describes the implementation of a psychological assessment clinic in a residential PTSD treatment setting. Barriers to implementation, use of the data, and Veterans’ reactions to the feedback provided to them are included.

Prefrontal responses to digit span memory phases in patients with post-traumatic stress disorder (PTSD): a functional near infrared spectroscopy study

Neuroimaging studies of post-traumatic stress disorder (PTSD)-related memory impairments have consistently implicated abnormal activities in the frontal and parietal lobes. However, most studies have used block designs and could not dissociate the multiple phases of working memory. In this study, the involvement of the prefrontal cortex in working memory phases was assessed among veterans with PTSD and age-/gender-matched healthy controls. Multichannel functional near infrared spectroscopy (fNIRS) was utilized to measure prefrontal cortex hemodynamic activations during memory of neutral (i.e., not trauma-related) forward and backward digit span tasks. An event-related experimental design was utilized to dissociate the different phases (i.e., encoding, maintenance and retrieval) of working memory. The healthy controls showed robust hemodynamic activations during the encoding and retrieval processes. In contrast, the veterans with PTSD were found to have activations during the encoding process, but followed by distinct deactivations during the retrieval process. The PTSD participants, but not the controls, appeared to suppress prefrontal activity during memory retrieval. This deactivation was more pronounced in the right dorsolateral prefrontal cortex during the retrieval phase. These deactivations in PTSD patients might implicate an active inhibition of dorsolateral prefrontal neural activity during retrieval of working memory.

Comparison of Memory Function and MMPI-2 Profile between Post-traumatic Stress Disorder and Adjustment Disorder after a Traffic Accident

OBJECTIVE

Differential diagnosis between post-traumatic stress disorder (PTSD) and adjustment disorder (AD) is rather difficult, but very important to the assignment of appropriate treatment and prognosis. This study investigated methods to differentiate PTSD and AD.

METHODS

Twenty-five people with PTSD and 24 people with AD were recruited. Memory tests, the Minnesota Multiphasic Personality Inventory 2 (MMPI-2), and Beck's Depression Inventory were administered.

RESULTS

There were significant decreases in immediate verbal recall and delayed verbal recognition in the participants with PTSD. The reduced memory functions of participants with PTSD were significantly influenced by depressive symptoms. Hypochondriasis, hysteria, psychopathic deviate, paranoia, schizophrenia, post-traumatic stress disorder scale of MMPI-2 classified significantly PTSD and AD group.

CONCLUSION

Our results suggest that verbal memory assessments and the MMPI-2 could be useful for discriminating between PTSD and AD.

MMPI-2 personality profiles and suicidal ideation and behavior in victims of bullying at work: a follow-up study

The main aim of this study was to investigate longitudinally the personality profile and suicidal ideation and behavior in victims of bullying at work in relation to the evolution of the victimization. Forty-eight victims were evaluated by means of medical and psychological assessment including the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). A follow up session was carried out after an average of 22 months. At first evaluation, the average MMPI-2 personality profile of victims showed abnormal elevations on scales Hs (Hypochondria), D (Depression), Hy (Hysteria), and Pa (Paranoia), which were strikingly similar to that found in previous studies. Furthermore, suicidal ideation and behavior were common among victims. At follow-up, 26 victims reported that the degree of bullying had remained the same or had even worsened, whereas 22 said that the situation had improved or had been resolved. Although there was a trend toward normalization in the MMPI-2 profile for all victims, the profile of the "static" group was still abnormal at follow up. On the contrary, the profile of the "improved" group was entirely within normal range. Suicidal ideation and behavior decreased in all victims, but only to a significant degree in the improved group. Results are discussed in the light of the bullying process.

Post-Traumatic Stress Disorder (PTSD) Symptoms in Adults with Psychiatric Disorders

OBJECTIVE

This study explores unrecognised symptoms related to post-traumatic stress disorder (PTSD) in individuals with a range of psychiatric disorders in the absence of traumatic events. We also examine the association between PTSD symptoms, social interaction with peers and therapeutic alliance with mental health professionals.

METHOD

A purposive sample of 120 adults consecutively referred to the psychology department from September 2008 to September 2010 was included in this study. We used the Minnesota Multiphasic Personality Inventory 2 (MMPI-2) to ascertain the presence of PTSD symptoms, social interaction levels and treatment alliance with health professionals.

RESULTS

Individuals previously undiagnosed with PTSD, referred without any noted traumatic event had high levels of symptoms related to PTSD, as measured by the PK scale of the MMPI-2. The PK scale was significantly correlated with several MMPI-2 clinical scales, the Social Introversion Scale (Si) and the Treatment Alliance Scale (TRT) (p < 0.001).

CONCLUSION

This study demonstrated the presence of symptoms related to PTSD in individuals with a range of psychiatric disorders despite the absence of reported trauma. The presence of symptoms related to PTSD may be associated with an indirect negative impact on social contacts and a poorer therapeutic alliance with mental health professionals. Investigating symptoms of PTSD during a psychological assessment even when trauma is not the presenting complaint is merited in most cases.

The trauma symptom inventory: Italian validation of an instrument for the assessment of post-traumatic symptoms

AIM

The trauma symptom inventory (TSI; Briere, 1995) is a useful instrument for the assessment of post-traumatic and common trauma-related mental health symptoms. The purpose of the study was to validate the Italian version of the original TSI.

METHODS

Participants from non-clinical (n = 285), clinical (n = 110) and post-traumatic (n = 30) samples completed the TSI as part of a battery that included self-report measures of trauma exposure [MMPI-2 PK scale and Impact of Event Scale-Revised (IES-R)] and of psychological symptoms [brief symptom inventory (BSI) and symptom questionnaire (SQ)]. TSI validity scales were compared with MMPI-2 validity scales in order to assess convergent validity.

RESULTS

The TSI Italian version showed adequate internal consistency reliability and a good convergent validity. Discriminant function analysis indicates a classification accuracy of TSI scales of 90% for true-positive and 91.4% for true-negative post-traumatic stress disorder (PTSD) cases. A revised three-factor structural model, which demonstrated an adequate and the best fit for the data, was proposed.

CONCLUSIONS

The study extended the generalization and validity of TSI and provided some suggestions for eventually revisiting factorial structure of the questionnaire.

Comprehension of self-report evidence-based measures of anxiety

BACKGROUND

Given their applicability in diverse settings and for a wide range of purposes, the generalizability of self-report symptom measures is particularly important. An understudied factor in the development and validation of self-report measures is the degree to which they are difficult to comprehend. This study evaluated the difficulty of self-report measures of anxiety with respect to several domains, including formatting, length, and linguistic problems.

METHODS

Ninety-two evidence based measures of anxiety were evaluated for comprehension level.

RESULTS

The majority of anxiety measures included challenging elements of formatting, linguistic ability, and readability. Measures of obsessive-compulsive disorder were associated with the highest level of comprehension (i.e., greatest difficulty).

CONCLUSIONS

The validity of self-report measures relies on the ability of respondents to understand the instructions and measure items. Factors related to the comprehension of self-report measures should be included among the basic psychometric properties in measure development and validation. Future research on the development of self-report measures that can be more broadly applicable across levels of education and literacy are of particular importance to research, clinical, and public health agendas.

The Adjustment of New Recruits to Military Life in the Chinese Army

In this article, the authors present the findings of two studies analyzing new recruits' adjustment to army life in the Chinese military. In the first exploratory study, we developed a scale to measure new recruits' adjustment to military life, and found that new soldiers' adaptation could be divided into two distinct types: interpersonal adjustment and training adjustment. Interpersonal adjustment was a soldier’s ability to build harmonious relationships with peer soldiers, supervisors, and military officers. Training adjustment was a soldier’s ability to achieve standards of professional competence and military training. Based on the findings of this first study, the authors conducted a second study to investigate the predictive power of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) on new recruits' adjustment. The results of this longitudinal study indicated that MMPI-2 could predict the initial stages of both interpersonal and training adjustment, as well as the subsequent change rate of these two types of adjustment. Our analyses have several important implications for recruiting, selecting, and training Chinese military leaders and human resource professionals.

The accuracy of the Clinician-Administered PTSD Scale (CAPS) to identify PTSD cases in victims of urban violence

As a consequence of the increasing urban violence in Brazil, many cases of posttraumatic stress disorder (PTSD) are now seen in the community and clinical settings. The main aim of this article is to assess the psychometric properties of the Clinician-Administered PTSD Scale (CAPS) to study factors related to the etiology, prognosis, and efficacy of interventions of PTSD in civilian populations. PTSD outpatients from a program of victims of violence and subjects identified in an epidemiological survey conducted in the city of Sao Paulo completed a battery of validated instruments and the CAPS. Instrument reliability and validity were measured. The comparison between the CAPS scores and the Structured Clinical Interview for DSM IV (SCID) interview resulted in the following validity coefficients: sensitivity=90%, specificity=95%, and misclassification rate=7.1%. The area under the receiver operating characteristic (ROC) curve was 0.97. There was a positive correlation between CAPS scores with Beck Depression Inventory (BDI; 0.70) and Beck Anxiety Inventory (BAI; 0.76) scores. The Kappa coefficients were all higher than 0.63 for all CAPS items. The internal consistency for all CAPS items resulted in a Cronbach's alpha coefficient of 0.97. The CAPS showed to be both an accurate and a reliable research instrument to identify PTSD cases in a civilian population.

Screening and assessment of crime victimization and its effects

The authors provide a review of tools used to screen and assess history and mental health consequences of adult crime victimization. These measures can be utilized across a broad range of settings that may serve crime victims, including venues for first response (e.g., law enforcement offices or emergency departments), primary medical care, or mental health treatment facilities, regardless of whether or not the crime was reported. The authors conclude with a discussion on limitations in the field and directions for future research.

Investigating the MMPI-2 trauma profile in treatment-seeking peacekeepers

Most available research on MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) scores in combat veterans suffering from posttraumatic stress disorder (PTSD) has focused on Vietnam veterans. No data are available from peacekeepers suffering from PTSD. The aim of this study was to investigate the relationship between PTSD and the MMPI-2 in a sample of 120 treatment seeking peacekeeping veterans. Results show that relative to a non-PTSD reference group, veterans who screened positive for PTSD scored higher on Scales F, 2 (D), 4 (Pd), 6 (Pa), 7 (Pt), 8 (Sc), and 0 (Si) of the MMPI-2. Scales 2 (D), 7 (Pt), and 8 (Sc) were highest in the mean PTSD profile but no 2- or 3-point code type could be defined. Moderate correlations were found between a self-report measure for PTSD symptoms and scores on MMPI-2 clinical scales 1 (Hs), 2 (D), 6 (Pa), 7 (Pt), and 8 (Sc). The MMPI-2 proved to be useful in assessing the broad range of symptoms typically present in trauma populations as well as the severity of posttraumatic morbidity.

In Harm's Way: Factors Related to Psychological Distress Following Sexual Harassment

The negative consequences for victims of sexual harassment are well documented. However, one area unexamined is the process that leads to harm. Researchers have proposed three influences (i.e., objective or stimulus factors, individual factors, and contextual factors) on the psychological, health-related, and organizational outcomes of sexual harassment. This article examines the relative contribution of these influences on psychological distress following sexual harassment. Two studies were conducted. First, we examined approximately 1,200 women in a financial industry class-action lawsuit. A series of hierarchical regressions and subsequent dominance analysis revealed that the severity of the experiences and attributions made about them were the most important influences on symptoms of psychological distress. Study 2 examined 85 female plaintiffs in sexual harassment litigation. Dominance analysis again showed that the magnitude of their experiences had the strongest relationship with distress. Implications of these findings are discussed.

The impact of killing in war on mental health symptoms and related functioning

This study examined the mental health and functional consequences associated with killing combatants and noncombatants. Using the National Vietnam Veterans Readjustment Study (NVVRS) survey data, the authors reported the percentage of male Vietnam theater veterans (N = 1200) who killed an enemy combatant, civilian, and/or prisoner of war. They next examined the relationship between killing in war and a number of mental health and functional outcomes using the clinical interview subsample of the NVVRS (n = 259). Controlling for demographic variables and exposure to general combat experiences, the authors found that killing was associated with posttraumatic stress disorder symptoms, dissociation, functional impairment, and violent behaviors. Experiences of killing in war are important to address in the evaluation and treatment of veterans.

MMPI-2 profiles in civilian PTSD: an examination of differential responses between victims of crime and industrial accidents

The authors studied MMPI-2 profiles of workers (N = 83) diagnosed with posttraumatic stress disorder (PTSD) and a control group comprising workers with chronic pain (N = 40). Significant differences were seen in profiles between the PTSD groups and the control group, and the authors compared the PTSD profiles according to exposure to two different kinds of traumatic incidents: industrial accidents or criminal events. They found differences in profile elevations based on the type of event: The level of distress and fear is greater in PTSD victims of crime, and the results also suggest that victims of crime are more suspicious and guarded compared with accident victims. Theoretically based reasons for the differences in profile elevations between the two PTSD groups are discussed.

The stressor Criterion-A1 and PTSD: a matter of opinion?

Considerable controversy exists with regard to the interpretation and definition of the stressor "A1" criterion for Post Traumatic Stress Disorder (PTSD). At present, classifying an event as either traumatic (satisfying DSM-IV Criterion-A1 for PTSD), or non-traumatic (life event) is determined by the rater's subjective interpretation of the diagnostic criteria. This has implications in research and clinical practice. Utilizing a sample of 860 Australian adults, this study is the first to provide a detailed examination of the impact of event categorization on the prevalence of trauma and PTSD. Overall, events classified as non-traumatic were associated with higher rates of PTSD. Unanimous agreement between raters occurred for 683 (79.4%) events. As predicted, the categorization method employed (single rater, multiple rater-majority, multiple rater-unanimous) substantially altered the prevalence of Criterion-A1 events and PTSD, raising doubts about the functionality of PTSD diagnostic criteria. Factors impacting on the categorization process and suggestions for minimizing discrepancies in future research are discussed.

Psychometric properties of seven self-report measures of posttraumatic stress disorder in college students with mixed civilian trauma exposure

In this study psychometric properties of seven self-report measures of posttraumatic stress disorder (PTSD) were compared. The seven scales evaluated were the Davidson Trauma Scale (DTS), the PTSD Checklist (PCL), the Posttraumatic Stress Diagnostic Scale (PDS), the Civilian Mississippi Scale (CMS), the Impact of Event Scale-Revised (IES-R), the Penn Inventory for Posttraumatic Stress Disorder (Penn), and the PK scale of the MMPI-2 (PK). Participants were 239 (79 male and 160 female) trauma-exposed undergraduates. All seven measures exhibited good test-retest reliability and internal consistency. The PDS, PCL and DTS demonstrated the best convergent validity; the IES-R, PDS, and PCL demonstrated the best discriminant validity; and the PDS, PCL, and IES-R demonstrated the best diagnostic utility. Overall, results most strongly support the use of the PDS and the PCL for the assessment of PTSD in this population.