Potentially traumatizing events in panic disorder and other anxiety disorders.
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Adult↗
Biomedical subjects
B T Litz
Publications and source records attributed to B T Litz.
Predictors of emotional numbing, revisited: a replication and extension.
Litz et al. (1997), theorizing that emotional numbing (EN) is the result of emotional depletion caused by chronic hyperarousal, demonstrated that a cluster of hyperarousal symptoms was a robust predictor of EN symptoms. In the present study, these findings were replicated and extended in two multiple regression analyses of data from a large, multisite investigation (T. M. Keane et al., 1998) of psychophysiological responding by male combat veterans. The arousal (D) cluster of symptoms was again the most robust predictor of EN symptoms, whereas physiological indices of arousal and reactivity accounted for negligible amounts of variance in both regression equations. These findings underscore the possible link between disturbances related to arousal and the capacity of traumatized individuals to express and experience pleasant feelings.
Affect↗
Emotional processing in posttraumatic stress disorder.
The emotional deficits associated with posttraumatic stress disorder (PTSD) are the least understood and the most understudied aspect of the syndrome. In this study, the connection was evaluated between trauma-context reactivity and subsequent emotional deficits in PTSD. Combat veterans with PTSD and well-adjusted veteran control participants were exposed to reminders of combat, after which their emotional behavior was assessed in response to a series of emotionally evocative images. Under the neutral condition, both groups exhibited emotional behavior modulated by stimulus valence. Partially consistent with the conceptual model described by B. Litz (1992), the PTSD group exhibited suppressed expressive-motor responses to positively valenced images, in comparison with the control group, only after being exposed to a trauma-related prime. Contrary to expectations, the PTSD group showed no augmentation of emotional response to negatively valenced cues after being exposed to trauma reminders. However, the PTSD group responded to all images, in both prime conditions, with higher heart rate reactivity, suggesting an automatic preparation for demand or threat in any uncertain emotional context. Possible causes and consequences of these results are discussed.
Arousal↗
Hispanic ethnicity and risk for combat-related posttraumatic stress disorder.
Hispanic veterans are said to exhibit higher risk of developing posttraumatic stress disorder (PTSD) than veterans of other racial/ethnic backgrounds. This prediction is based largely on findings from the National Vietnam Veterans Readjustment Study (NVVRS; R. A. Kulka et al., 1990a, 1990b). This article first summarizes the findings of the NVVRS with regard to race/ethnicity and PTSD, and then it makes a careful assessment of both the external and the internal validity of these findings. Conceptual issues are addressed and, where possible, further analyses of the NVVRS data set are conducted to identify factors that account for ethnic differences in rates of the disorder. Possible mediators of the effects of Hispanic ethnicity on vulnerability to PTSD are identified, including psychosocial factors (racial/ethnic discrimination and alienation) and sociocultural influences (stoicism and normalization of stress, alexithymia, and fatalism). Areas in which future research is needed are indicated.
Confounding Factors, Epidemiologic↗
Emotional response at the time of a potentially traumatizing event and PTSD symptomatology: a preliminary retrospective analysis of the DSM-IV Criterion A-2.
DSM-IV added an emotional response component to the definition of Criterion A for PTSD. The present study investigated the relationship between retrospective reports of emotional responses (fear, helplessness, and horror) and disrupted emotional responses ("numbing") at the time of a potentially traumatizing event and reports of PTSD symptomatology among undergraduate participants. We found that, of the DSM-IV criteria, only helplessness was significantly correlated with post-traumatic symptomatology. Reports of peritraumatic emotional numbing uniquely predicted subsequent PTSD symptomatology beyond coincident emotional responses, suggesting that further research is needed to explore the various dimensions of peritraumatic emotional response relevant to the development of PTSD.
Adolescent↗
The quality of the intimate relationships of male Vietnam veterans: problems associated with posttraumatic stress disorder.
This study examined the quality of the intimate relationships of male Vietnam veterans. Heterosexual couples in which the veteran had posttraumatic stress disorder (PTSD; n = 26) were compared to couples in which the veteran did not have PTSD (n = 24). Over 70% of the PTSD veterans and their partners reported clinically significant levels of relationship distress compared to only about 30% of the non-PTSD couples. Relationship difficulties appeared to encompass a wide range of areas, with PTSD veterans and their partners reporting that they had more problems in their relationships, more difficulties with intimacy, and had taken more steps toward separation and divorce than the non-PTSD veterans and their partners. The degree of relationship distress was correlated with the severity of veterans' PTSD symptoms, particularly symptoms of emotional numbing. Research and clinical implications of the results are discussed.
Analysis of Variance↗
Increases in retrospective accounts of war-zone exposure over time: the role of PTSD symptom severity.
Retrospective reports of the frequency of war-zone exposure are commonly used as objective indices in studies investigating the mental health consequences of exposure to such stressors. To explore the temporal stability of these types of reports, we obtained frequency estimates of exposure to war-zone stressors at two time points from 460 U.S. soldiers who had served in the peace-keeping mission in Somalia. On average; soldiers demonstrated a significant increase in their frequency reports from initial (postdeployment) to subsequent (follow-up) assessment. Severity of posttraumatic symptomatology was uniquely associated with this change, indicating a possible systematic bias in which severity of symptoms leads to increased reports of stressor frequency. The implications of these findings for research in the field of traumatic stress are discussed.
Adult↗
Psychiatric symptomatology associated with contemporary peacekeeping: an examination of post-mission functioning among peacekeepers in Somalia.
Contemporary peacekeepers frequently confront complex stressors including the need to directly enforce peace between warring factions, to deliver humanitarian aid in the midst of political-social devastation, and to balance shifting rules of engagement. As such, it is proposed that participants may be at increased risk for the development of psychiatric distress. The present study examined the types of stressors encountered by 3,461 peacekeepers in Somalia, their current psychiatric functioning as measured by the Brief Symptom Inventory, and the relationship between exposure to various stressors and adjustment. Over one third of participants met criteria for psychiatric caseness. The most commonly reported symptoms included hostility, psychoticism, depression, and paranoid ideation. The best predictors of current functioning were found to be exposure to traditional war-zone-related stressors and general military pride and cohesion. These findings highlight the mental health consequences that service in a peacekeeping mission may have for United States solidiers. Further research is needed to investigate potential mechanisms that could serve as buffers to the stress associated with peacekeeping service.
Adult↗
Lower precombat intelligence is a risk factor for posttraumatic stress disorder.
The authors examined the relation between intelligence and posttraumatic stress disorder (PTSD) by studying the association among precombat intelligence, current intelligence, and self-reported PTSD symptoms. Military aptitude test results were obtained in 59 PTSD and 31 non-PTSD Vietnam combat veterans who had undergone a psychodiagnostic interview and current intelligence testing. People with lower precombat intelligence were more likely to develop PTSD symptoms as assessed by the Clinician-Administered PTSD Scale even after adjustment for extent of combat exposure. The association between current intelligence and PTSD was no longer significant after adjusting for precombat intelligence. These results suggest that lower pretrauma intelligence increases risk for developing PTSD symptoms, not that PTSD lowers performance on intelligence tests.
Adult↗
Predictors of emotional numbing in posttraumatic stress disorder.
Little is known about the mechanisms underlying emotional numbing (EN). The functional relationship between other classes of posttraumatic stress disorder (PTSD) symptoms and EN is also not well understood. In the present study, we examined the statistical predictors of EN. We hypothesized that the severity of EN would be most strongly associated with the hyperarousal symptoms rather than the avoidance symptoms of PTSD, or comorbid depression or substance abuse. This prediction was derived from psychological and biological models that posit EN to be a product of the depletion of emotional resources subsequent to chronic hyperarousal. Using hierarchical multiple regression in two separate samples of Vietnam combat veterans, we found hyperarousal symptoms to be the most robust predictor of EN. These data suggest that there is a substantive relationship between hyperarousal symptoms and EN in PTSD.
Adaptation, Psychological↗
Warriors as peacekeepers: features of the Somalia experience and PTSD.
There has been scant empirical study of the psychological consequences of contemporary peacekeeping missions. This study examined relationships among 4 variables characterizing this type of operation (traditional combat events, negative aspects of peacekeeping, pressure to uphold restraint, and positive aspects of peacekeeping) and symptoms of posttraumatic stress disorder (PTSD). Participants were 3,310 male and female soldiers who served in the 1992-1994 Somalia mission. Structural equation modeling procedures were applied to data from subsamples of non-African Americans and African Americans. For both groups, traditional combat and negative aspects of peacekeeping were associated with PTSD, frustration with restraint, and positive aspects of peacekeeping; however, restraint was not related to PTSD. Discrepancies between the groups involved relationships among the restraint, positive aspects, and PTSD variables. Recommendations are offered to foster inquiry into this new research.
Adult↗
Consistency of traumatic memories.
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Causality↗
Posttraumatic stress disorder associated with peacekeeping duty in Somalia for U.S. military personnel.
OBJECTIVE: The end of the Cold War has marked a period when the U.S. military is asked to secure peace under conditions in which peace is tenuous, yet the need for resolution of the conflict is great. Combat-trained soldiers are highly visible and are exposed to threats to their lives, yet are asked to exhibit restraint and neutrality. The psychiatric consequences of peace-keeping duty under these conflicting and volatile conditions have been underresearched. The authors examined the prevalence of posttraumatic stress disorder (PTSD) associated with exposure to peacekeeping duty in Somalia. METHOD: A large cohort of active duty personnel deployed to Somalia (N = 3,461) were surveyed approximately 5 months after their return to the United States. A variety of military service characteristics and exposure variables and PTSD symptoms were examined. RESULTS: Eight percent of peacekeepers were found to meet diagnostic criteria for PTSD. PTSD symptom severity was best predicted by the rewards of military service, war zone stress, and frustrations with peacekeeping (e.g., restrictive rules of engagement). CONCLUSIONS: It is likely that the mission in Somalia represents a new paradigm of dangerous military operations for the United States. These data suggest that peacekeeping may be difficult to reconcile for some combat-trained soldiers and can create a risk for PTSD.
Adult↗
Attention, arousal, and memory in posttraumatic stress disorder.
Vietnam combat veterans with current posttraumatic stress disorder (PTSD), with other Axis-I disorders, or with no Axis-I disorders completed a series of tasks designed to elucidate the psychophysiological parameters of information-processing in PTSD. These tasks included a modified Stroop procedure (MSP), a standard Stroop procedure, a recognition memory task, and a threat rating task. Physiological responses were recorded throughout the study. Our data supported several predictions derived from information-processing models of PTSD. PTSD subjects exhibited greater MSP interference to high threat words than both comparison groups, and a liberal response bias toward recognizing military-related words. PTSD symptoms and threat reactions contributed to MSP interference effects for high-threat words after controlling for medications, depression, and baseline physiological activity.
Adult↗
The utility of the SCL-90-R for the diagnosis of war-zone related posttraumatic stress disorder.
A scale for assessing war-zone-related posttraumatic stress disorder (WZ-PTSD scale) was derived from the Symptom Checklist-90-R by identifying items that best discriminated Vietnam theater veterans with and without PTSD (N = 202). The 25-item WZ-PTSD scale had excellent internal consistency, and signal detection analyses revealed that its diagnostic utility was comparable to or exceeded that of several established PTSD scales and measures of global distress. In a cross-validation sample (N = 99), the diagnostic utility of the WZ-PTSD scale was stable, whereas other PTSD scales performed more poorly. The WZ-PTSD scale appears to be a valuable new measure of PTSD that can be particularly useful in archival data sets or in any situation where other PTSD measures are not available.
Adult↗
Current and lifetime psychiatric disorders among veterans with war zone-related posttraumatic stress disorder.
Previous research has found high rates of psychiatric disorders among veterans with war zone-related posttraumatic stress disorder (PTSD). However, many studies in this area are methodologically limited in ways that preclude unambiguous interpretation of their results. The purpose of this study was to address some of these limitations to clarify the relationship between war zone-related PTSD and other disorders. Participants were 311 male Vietnam theater veterans assessed at the National Center for PTSD at the Boston Veterans Affairs Medical Center. The Clinician-Administered PTSD Scale and the Structured Clinical Interview for DSM-III-R were used to derive current and lifetime diagnoses of PTSD, other axis I disorders (mood, anxiety, substance use, psychotic, and somatoform disorders), and two axis II disorders (borderline and antisocial personality disorders only). Participants also completed several self-report measures of PTSD and general psychopathology. Relative to veterans without PTSD, veterans with PTSD had significantly higher rates of current major depression, bipolar disorder, panic disorder, and social phobia, as well as significantly higher rates of lifetime major depression, panic disorder, social phobia, and obsessive-compulsive disorder. In addition, veterans with PTSD scored significantly higher on all self-report measures of PTSD and general psychopathology. These results provide further evidence that PTSD is associated with high rates of additional psychiatric disorders, particularly mood disorders and other anxiety disorders. The implications of these findings and suggestions about the direction of future research in this area are discussed.
Adult↗
Clinical presentation of disorders of extreme stress in combat veterans.
Disorders of extreme stress (DES), previously referred to as disorders of extreme stress not otherwise specified and/or complex posttraumatic stress disorder, is a proposed diagnosis designed to describe the symptom presentation of those repeatedly exposed to traumatic stressors. Little is known, however, about the applicability of DES to combat veterans. We clinically assessed combat veterans for the presence or absence of DES in order to provide descriptive clinical information about the severity and patterns of endorsement of DES symptoms among combat veterans. Results indicate that DES is relevant to veterans and the implications of these results for both diagnoses and treatment are discussed.
Combat Disorders↗
Similarities and differences between MMPI and MMPI-2 applications to the assessment of posttraumatic stress disorder.
The purpose of this study was to address the question: Is the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) comparable to the original MMPI in its applicability to the assessment of posttraumatic stress disorder (PTSD) among Vietnam combat veterans? The question was addressed by administering both the original MMPI and MMPI-2 to 29 subjects classified as meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III-R) criteria for PTSD and comparing MMPI and MMPI-2 scores in terms of: degree of association, code-type congruence, diagnostic hit rates (when compared to two other clinical samples, and one normal sample), and congruence of the Keane PTSD Scale (PK). Results reveal highly significant correlations between MMPI and MMPI-2 basic scales for the PTSD sample as well as congruence in 2-point codes comparable to previous studies. The MMPI-2 was found to identify effectively PTSD subjects from the other groups. Results also showed a high degree of association between the MMPI and MMPI-2 in regard to PK scores, although minor differences were found in PK raw scores between the two tests. Overall, the findings suggest a high degree of comparability between the MMPI and MMPI-2 in the assessment of PTSD.
Adult↗