Attachment representation and suicidal ideation in Vietnam combat veterans with posttraumatic stress disorder.

Attachment representation has been linked to psychopathology and suicidality. Possible links between attachment representations and suicidal ideation in a PTSD sample were examined. Vietnam combat veterans in treatment for PTSD (N = 48) were assessed for PTSD severity, attachment representation and current and lifetime suicidality. Contrary to expectation individuals with secure attachment representations had higher levels of current suicidal ideation than those with insecure attachment representations, and unresolved/disorganized attachment was associated with lower levels of current suicidal ideation. Secure attachment may not provide protection against high levels of distress and suicidal ideation among combat veterans with PTSD.

Attachment organization in Vietnam combat veterans with posttraumatic stress disorder.

Attachment organization in a combat-related PTSD sample was investigated and compared with previously published clinical and non-clinical samples. The association between insecure attachment and unresolved mourning classification (U-loss) and between U-loss and PTSD symptoms was investigated. Vietnam combat veterans diagnosed with PTSD and in treatment (N = 48) were administered the Adult Attachment Interview, the SCID-IV, and CAPS. The PTSD sample was like non-clinical samples in the incidence of secure attachment (50%), but were more commonly unresolved. Veterans with insecure attachment organizations were more likely than those with secure attachment to be classified U-loss. U-loss classification was associated with greater likelihood of comorbid anxiety disorders and PTSD avoidance/numbing symptoms. The results suggest that while insecure attachment organization is associated with unresolved mourning in response to loss, it is not differentially associated with combat-related PTSD. The relationship between U-loss and PTSD is discussed in light of current literature.

Specific symptoms predict suicidal ideation in Vietnam combat veterans with chronic post-traumatic stress disorder.

Previous research documented the elevated risk of suicide and suicidal ideation among Vietnam veterans with post-traumatic stress disorder (PTSD). The aim of the current study was to examine which Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, PTSD symptom clusters are most associated with suicidal ideation in this population. Fifty Vietnam combat veterans enrolled in treatment for PTSD responded to the Beck Scale for Suicide Ideation and were interviewed with the Clinician-Administered PTSD Scale. In linear regression analysis, it was found that the reexperiencing symptom cluster was significantly associated with suicidal ideation but the other two symptom clusters (avoidance/numbing and increased arousal) were not. Furthermore, scores on a measure of severity of combat exposure were not found to be significantly related to PTSD symptoms or suicidal ideation. The results of this study suggest the importance of reexperiencing symptoms for predicting which individuals with combat-related PTSD are most at risk for suicidal ideation and behavior.

The Trauma Symptom Inventory: factors associated with invalid profiles in a sample of combat veterans with post-traumatic stress disorder.

The assessment of combat-related post-traumatic stress disorder (PTSD) relies upon self-reported symptoms and the need for indicators of valid reporting is critical. The Trauma Symptom Inventory (TSI) is a testing instrument specific to PTSD which includes validity scales. In a pilot study examining the use of the TSI with combat veterans, 50 male veterans diagnosed with PTSD were administered the TSI. Nineteen percent of the profiles were invalid, all but one based on the Atypical Response Scale. Differences between veterans with valid and invalid TSI profiles are examined in terms of demographic and historical factors, TSI profiles, and individual scale items. The model best able to predict invalid profiles included high scores on subscales measuring dissociative experiences and tension reduction behaviors. Implications for the interpretation of TSI validity scales in assessing combat-related PTSD are discussed.