A cybernetic model of obsessive-compulsive psychopathology.
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Adult↗
Biomedical subjects
R K Pitman
Publications and source records attributed to R K Pitman.
Pre-Vietnam contents of posttraumatic stress disorder veterans' service medical and personnel records.
We reviewed the pre-Vietnam contents of the service medical and personnel records of 250 Vietnam combat veterans, in an attempt to identify factors predisposing to the development of posttraumatic stress disorder (PTSD). PTSD and non-PTSD veterans did not differ significantly on self-reported medical history items, sick call visits, or military efficiency and conduct ratings. There were trends for PTSD veterans to have lower arithmetic aptitude, more self-reported school difficulties, and (paradoxically) lower pulse rate at military induction.
Achievement↗
Posttraumatic obsessive-compulsive disorder: a case study.
Recent epidemiologic evidence has pointed to a disproportionate rate of obsessive-compulsive disorder (OCD) among high-combat-exposed Vietnam veterans. This case report describes an individual without previous overt psychopathology who under the stress of combat developed concurrent OCD and posttraumatic stress disorder (PTSD) persisting for more than 20 years. Phenomenologic, behavioral, psychodynamic, and biologic considerations all help to elucidate the potential role of emotional trauma in the pathogenesis of obsessions and compulsions.
Combat Disorders↗
Aggression and its correlates in Vietnam veterans with and without chronic posttraumatic stress disorder.
This study measured self-reported aggression, hostility, and anger in Vietnam combat veterans with (n = 27) and without (n = 15) posttraumatic stress disorder (PTSD). On the Buss-Durkee Hostility Inventory, Past Feelings and Acts of Violence Scale, Episodic Dyscontrol Scale, and State-Trait Anger Expression Inventory (STAXI), PTSD subjects scored significantly higher than non-PTSD subjects, whose scores fell in the range reported for normative, noncombat populations. The PTSD versus non-PTSD group differences were not explained by combat exposure, which did not correlate significantly with the psychometric aggression measures. These findings suggest that increased aggression in war veterans is more appropriately regarded as a property of PTSD, rather than a direct consequence of military combat. The association between compromised neurologic and neuropsychologic status and the psychometric measures was modest and explained little of the group differences.
Adult↗
Five-year follow-up study of eye movement desensitization and reprocessing therapy for combat-related posttraumatic stress disorder.
This study reports the results of a 5-year follow-up evaluation of 13 Vietnam combat veterans with chronic posttraumatic stress disorder (PTSD) who participated in a study of eye movement desensitization and reprocessing (EMDR) therapy previously reported in this journal. Pretreatment and follow-up psychometric outcome measures were compared with those of a demographically matched control group of 14 combat veterans with chronic PTSD who did not receive EMDR. Analysis of variance showed that the modest to moderate therapeutic benefits that were manifest immediately following EMDR were lost at the 5-year follow-up evaluation, and there was an overall worsening of PTSD symptomatology over the 5-year period in both EMDR-treated and nontreated control subjects.
Case-Control Studies↗
Emotional processing and outcome of imaginal flooding therapy in Vietnam veterans with chronic posttraumatic stress disorder.
This study examined emotional processing and outcome in 20 Vietnam veterans with chronic posttraumatic stress disorder (PTSD) who underwent imaginal flooding therapy. Results supported the occurrence of emotional processing, as manifest in significant activation, within-session habituation, and partial across-session habituation of physiologic and self-reported process variables. The flooding therapy produced only modest overall improvement, which was statistically significant for avoidance symptomatology measured by the impact of Events Scale (IOES) and number of intrusions per day recorded by the subject in a log. Symptomatic improvement appeared to generalize from a treated to an untreated experience. Heart rate activation during the first flooding session predicted a decrease in daily number of intrusive combat memories across the therapy. Otherwise, there was little association between extent of emotional processing and therapeutic outcome. The results provide limited support for the notion that mobilization of psychophysiologic arousal during exposure therapy predicts improvement.
Adult↗
Emotional processing during eye movement desensitization and reprocessing therapy of Vietnam veterans with chronic posttraumatic stress disorder.
This study examined emotional processing and outcome in 17 Vietnam veterans with chronic posttraumatic stress disorder (PTSD) who underwent eye movement desensitization and reprocessing (EMDR) therapy, with and without the eye movement component, in a crossover design. Results supported the occurrence of partial emotional processing, but there were no differences in its extent in the eye-movement versus eyes-fixed conditions. Therapy produced a modest to moderate overall improvement, mostly on the impact of Event Scale. There was slightly more improvement in the eyes-fixed than eye-movement condition. There was little association between the extent of emotional processing and therapeutic outcome. In our hands, EMDR was at least as efficacious for combat-related PTSD as imaginal flooding proved to be in a previous study, and was better tolerated by subjects. However, results suggest that eye movements do not play a significant role in processing of traumatic information in EMDR and that factors other than eye movements are responsible for EMDR's therapeutic effect.
Adult↗
Psychophysiologic assessment of mental imagery of stressful events in Israeli civilian posttraumatic stress disorder patients.
This study explored the physiological responses of posttraumatic stress disorder (PTSD) patients to reminders of a stressful event that had preceded the onset of their illness and was not related to its cause: the SCUD missile alarms of the Gulf War. A mental-imagery technique used in previous studies of PTSD was used. Three 30-second audiotapes were presented to each subject, including (1) the Gulf War's missile alarm, (2) a radio announcement of a terrorist attack, and (3) a standardized relaxing scene. Subjects were instructed to imagine each event as vividly as possible while heart rate (HR), skin conductance (SC), and left lateral frontalis electromyogram (EMG) responses were measured. The responses of 12 outpatients with PTSD were compared with those of panic disorder patients (n = 11), survivors of traumatic events who had not developed PTSD (n = 9), and mentally healthy subjects with no lifetime history of major trauma (n = 19). Multivariate analysis of variance (MANOVA) for the three physiological measures showed a significant group difference during imagery of the Gulf War alarm, with PTSD subjects showing higher SC and EMG responses than the others. The differences remained significant when age, level of distress during the war, and concurrent anxiety were controlled for. There were no group differences in responses to the other stimuli. We conclude that, PTSD patients may either acquire and maintain prolonged conditioned responses to various stressors during their life span or become sensitized to reminders of past traumata following the onset of their illness. Heightened conditionability may be expressed before the trauma in subjects who are liable to develop PTSD.
Adult↗
Psychophysiologic assessment of posttraumatic stress disorder in breast cancer patients.
The authors performed psychodiagnostic, psychometric, and psychophysiologic evaluations on 37 patients referred by local surgeons approximately 2 years after tissue diagnosis of Stage I to III breast cancer. The Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale (CAPS) was used to classify patients into the following groups: "Current PTSD" (n = 5) "Past PTSD" (n = 7), and "Never had PTSD" (n = 25). Individualized "scripts" portraying personal life events were tape recorded and played back to the patients in the laboratory. Current PTSD patients showed significantly higher heart rate, skin conductance, and corrugator electromyogram responses during imagery of their personal breast cancer experiences than Past and Never patients. Physiologic responses were significantly and positively correlated with CAPS scores. These results provide psychophysiologic support for the proposition that a diagnosis of with a life-threatening illness can cause PTSD.
Breast Neoplasms↗