Violence without a Face: the Analysis of Testimonies of Women Who Were Sexually Assaulted During the War in Croatia and Bosnia and Herzegovina.

BACKGROUND: This study examined testimonies of women who were sexually assaulted multiple times by multiple unknown offenders. In these testimonial narratives, it is possible to detect specific modalities of traumatic event expression. This expression lacks any spatial, temporal, auditory or emotional determinants of the event. SUBJECTS AND METHODS: These fourteen women (out of 17) were imprisoned and forcefully isolated in detention camps or private houses in the occupied territories of Croatia and Bosnia and Herzegovina, during the war. At the same time, some of these women were raped by the offenders that were previously known to them. The average length of detention was 141 days among the seventeen victims (range of 7 to 395 days), while the average time from the first day of imprisonment to the first day of testimony was 311 days (range of 30 to 889 days). RESULTS: Based on the narrative descriptions of the events acquired from these testimonies, our analysis showed that these expressions differed when the offender was known to the victim, contrasted to the situation when the offender was completely unknown. This finding has a significant implication in victim's testimony at judicial hearings. Specifically, women that were raped by unknown perpetrator(s) were often unable to provide persuasive testimony and their recollection of the events was deemed insufficient for the further prosecution. Testimonies in these cases substantially lacked in vividness and were devoid of visuospatial determinants of the rape event. Consequently, this often resulted in the case's dismissal. CONCLUSION: The unusual and problematic expression of these traumatic memories might indicate that these events were not properly stored in the conceptual form of memory. Ultimately, victims could not make any coherent recollection or reconstruct the cascade of events by using perceptual information. We argue that this could be due to an aberrant mechanism of memory storage and difficulties that emerge on the level of sensory input. This problem needs to be further examined and correspondingly accounted for since it can exert significant influence on judicial outcomes in the domain of sexual assault cases worldwide.

Cardiovascular Disease Risk Factors in Patients with Posttraumatic Stress Disorder (PTSD): A Narrative Review.

Posttraumatic stress disorder (PTSD) is a chronic condition related to severe stress and trauma. There is a mounting evidence about increased prevalence and mortality from cardiovascular diseases (CVD) in patients with PTSD. This review summarizes the current data on possible relations between PTSD and increased risks of CVD, including biological, psychological and behavioral factors. Biological factors refer to increased prevalence of metabolic syndrome (MetS), hypertension, elevation of pro-inflammatory cytokines and homocysteine levels. Peripheral Brain-derived neurotropic factor (BDNF), serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and quantitative electroencephalogram (qEEG) are promising surrogate markers of increased cardiovascular risk. Among psychological factors, some personality traits, such as neuroticism and trait impulsivity/hostility, contribute to the development of PTSD, and are associated with general cardiovascular distress. Recently, type-D (distressed) personality is usually investigated in relation to cardiovascular morbidity, but in populations other than PTSD patients. Behavioral factors refer to unhealthy life-styles, encompassing high smoking rate, drug substances abuse and addiction, physical inactivity and unhealthy diet. The relationships among all these factors are complex and yet incompletely taken into consideration. Because of a high prevalence of CVD in patients with PTSD, there is a strong need for a more intensive focus on this vulnerable population in both primary and secondary cardiovascular prevention as well as in effective treatment possibilities.

Anger in Adulthood in Participants Who Lost Their Father During the War in Croatia When They Were in Their Formative Age.

BACKGROUND: Loss of parents in early childhood can have serious long-term psychological consequences. Abandoned by a close figure of attachment, many persons have developed the emotion of anger, even though the separation was caused by death. The traumatic experience of the loss of a parent is particularly hard in war, because most often it does not occur as an individual trauma. Our aim is to research anger as a personality trait in persons whose father had died in war at a time when they were children, and to compare it with an appropriate civilian control group of subjects. SUBJECTS AND METHODS: The study comprised 155 persons of both sexes. The target group consisted of persons (N=98) whose father had died in the Homeland War and who had just been born at the time of their father's death, or were children or adolescents, and had since their father's death grown up in a single-parent family with their mother, while the control group of subjects (N=57) had not suffered any war losses in the family in the war time from 1991 to 1995. The examined variables were: sex, age, loss of father due to civilian or war causes, marital status, age when the subject lost their father, anger as a state and as a personality trait. STAXI is used in this study; it is frequently used in studies of experiencing, expressing and controlling anger in persons suffering from PTSD. RESULTS: Statistically significant differences were demonstrated in some of the scales and subscales of anger as a state and anger as a personality trait between the abovementioned subject groups, with higher scores in persons who had suffered a civilian loss of father. CONCLUSIONS: The study supports the opinion that the social context in which the grieving person is before, during and after the loss of a close person has an important role in the process of grieving, and eventually defines the social and personal meaning of death.

Temperament, character, and suicidality among Croatian war veterans with posttraumatic stress disorder.

BACKGROUND: The occurrence of suicidal thoughts and behaviors is rather frequent among war veterans, particularly those suffering from posttraumatic stress disorder (PTSD). Understanding factors present within these individuals that increase suicide risk may inform prevention efforts. The present study aimed to determine whether the dimensions of temperament and character are associated with various aspects of suicidality among Croatian war veterans with PTSD. SUBJECTS AND METHODS: A sample of 72 Croatian male war veterans (mean age 52.33 years) diagnosed with PTSD was gathered at the National Center for Psychotrauma between May and October 2014. The participants completed the Temperament and Character Inventory - Revised (TCI-R) and the Suicidal Behaviors Questionnaire - Revised (SBQ-R). RESULTS: Zero-order analyses revealed that temperament dimension Harm avoidance and character dimension Self-directedness were moderately associated with the total risk for suicide (i.e., the SBQ-R total score), while Persistence and Cooperativeness showed significant but weaker relations. Different dimensions of suicidality were associated with different personality traits. Harm Avoidance was shown to be significantly increased among the subgroup of war veterans with high suicidal risk. CONCLUSIONS: Notwithstanding some limitations of this study, these findings could help extend our understanding of the elevated suicide risk in war veterans with PTSD. Detection of individuals displaying high Harm Avoidance and low Self-Directedness might facilitate prevention of suicidal behaviors in this population.

Pathological narcissism and depressive symptoms in psychiatric outpatients: mediating role of dysfunctional attitudes.

OBJECTIVE: The aim of this study was to examine the relationships between pathological narcissism (narcissistic grandiosity and narcissistic vulnerability), dysfunctional attitudes (perfectionism and dependency on other people), and depressive symptoms in psychiatric outpatients. METHOD: A sample of 234 adult psychiatric outpatients (57.3% male; mean age 44.39 years) completed the Pathological Narcissism Inventory, the Dysfunctional Attitudes Scale-Form A, and the Depression, Anxiety, Stress Scales-21. RESULTS: Narcissistic vulnerability exhibited unique positive correlations with depressive symptoms, whereas narcissistic grandiosity showed substantially weaker correlations with depressive symptoms. Perfectionism partially mediated the relationship between narcissistic vulnerability and depressive symptoms. The mediating role of dependency was not confirmed. CONCLUSIONS: Among adult psychiatric outpatients, narcissistic vulnerability is more strongly related to depressive symptoms than narcissistic grandiosity, and dysfunctional perfectionism represents one of the underlying mechanisms of this relationship. The implications of these findings are discussed in relation to the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria and the treatment of pathological narcissism.

Predicting symptom clusters of posttraumatic stress disorder (PTSD) in Croatian war veterans: the role of socio-demographics, war experiences and subjective quality of life.

BACKGROUND: Previous research has documented multiple chains of risk in the development of PTSD among war veterans. However, existing studies were mostly carried out in the West, while they also did not analyze specific symptom clusters of PTSD. The aim of this study was to examine the role of socio-demographic characteristics, war experiences and subjective quality of life in the prediction of three clusters of PTSD symptoms (i.e., avoidance, intrusion, hyperarousal). SUBJECTS AND METHODS: This study comprised 184 male participants who have survived war imprisonment during the Croatian Homeland War in the period from 1991 to 1995. The data was collected through several self-report measuring instruments: questionnaire on socio-demographic data, war experiences (Questionnaire on Traumatic Combat and War Experiences), subjective quality of life (WHO-Five Well-being Index), and PTSD symptoms (Impact of Events Scale - Revised). RESULTS: The level of three symptom clusters of PTSD was found to be moderate to high, as indicated by the scores on the IES-R. Results of the three hierarchical regression analyses showed the following: traumatic war experiences were significant predictors of avoidance symptoms; traumatic war experiences and subjective quality of life were significant predictors of hyperarousal symptoms; and traumatic war experiences, material status and subjective quality of life were significant predictors of intrusion symptoms. CONCLUSIONS: These findings support the widespread belief that the development of war-related PTSD is accounted for by multiple chains of risk, while traumatic war experiences seem to be the only predictor of all three symptom clusters. Future research should put more emphasis on specific PTSD symptom clusters when investigating the etiopathogenesis of this disorder among war-affected populations.

Somatic comorbidity, metabolic syndrome, cardiovascular risk, and CRP in patients with recurrent depressive disorders.

AIM: To investigate the association between depression, metabolic syndrome (MBS), somatic, particularly cardiovascular comorbidity, and low-grade chronic inflammation assessed using C-reactive protein (CRP). METHODS: This cross-sectional study included 76 patients with recurrent depressive disorder (RDD) and 72 non-depressed medical staff controls from the Department of Psychiatry, University Hospital Center Zagreb between January 2011 and June 2012. RESULTS: Seventy-five percent of patients had somatic comorbidity. The most common comorbid conditions were cardiovascular disorders (46.1%), locomotor system diseases (35.5%), carcinoma (15.8%), thyroid diseases (9.2%), and diabetes (9.2%). MTB was more common in RDD patients (31.6%) than in controls (23.6%), but the difference was not significant. Elevated CRP was found to be significantly more frequent in patients with recurrent depressive disorders (RDD) (35.5%; χ(2) test, P=0.001, Cramer V=0.29) than in controls (12.5%) and was associated with lowered high-density lipoprotein and overweight/obesity. CONCLUSION: We found some intriguing links between stress, depression, metabolic syndrome, and low grade inflammation, which may be relevant for the prevalence of somatic comorbidity in patients with RDD, but further studies are needed to confirm our results.

Posttraumatic stress disorders (PTSD) between fallacy and facts: what we know and what we don't know?

BACKGROUND: PTSD been recognized as a major problem in public health and has attracted an ever-growing scientific, epistemological and clinical interest. On the other side, PTSD is one of the most controversial diagnosis in psychiatry as well as in medicine in general. METHOD: We have made an overview of available literature on PTSD to identify what is our real knowledge about PTSD with all dilemmas, controversies and challenges. RESULTS: We have various options as to how to evaluate, explain and describe PTSD and other trauma-related mental and somatic disorders. In this paper we compiled an extensive set of facts and meta-facts in order to to understand the real nature of traumatic stress, negative life events and PTSD. CONCLUSION: Conflict between various concepts of PTSD and our current knowledge will probably bring with itself a new scientific paradigm with new diagnostic phenotypes and refining the old ones.

Posttraumatic stress disorders (PTSD) from different perspectives: a transdisciplinary integrative approach.

BACKGROUND: Psychotraumatization continues to be a pervasive aspect of life in the 21st century all over the world so we should better understand psychological trauma and PTSD for the sake of prevention and healing. METHOD: We have made an overview of available literature on PTSD to identify explanatory models, hypotheses and theories. RESULTS: In this paper we describe our transdisciplinary multiperspective integrative model of PTSD based on the seven perspective explanatory approach, on the fifth discipline, the art and practice of the learning organization as well as on the method of multiple working hypotheses.Trauma vulnerability, strengths, resilience and posttraumatic growth are key concepts that enable an integration of the distinct perspectives into a coherent transdisciplinary multiperspective explanatory and treatment model of PTSD. CONCLUSION: PTSD is a complex highly disabling and suffering disorder where the past is always present in people haunted by the dread frozen in memory of the traumatic events. However, PTSD also represents an oportunity for psychological and spiritual growth due to the human ability to adapt and thrive despite experiencing adversity and tough times.

Age-developmental stage and severity of trauma related symptoms, anxiety and depressive symptoms in participants who lost their fathers during the war in Croatia.

Children of different ages will experience a traumatic event in a different ways. The most important in the generalization of research findings is recognizing that children of different ages think differently, act differently and have different emotional functioning. Experiences that are extremely traumatic to an adult may be perceived by a young child as something that is not so frightening. The fear that the child feels will more frequently be a reflection of that of the adult rather than generated by the child's own perception of the event. So, the individual experience of the trauma is age dependent. Our study focused on children who lost their fathers in conditions of war The aim was to explore the association between age-developmental stages and the severity of trauma related symptoms, anxiety and depressive symptoms in participants who lost their fathers during the war. The study included 103 people who lost their fathers during the war in Croatia, who came to the physical and psychiatric examination organized by the Ministry of Family, War Veterans and Intergenerational Solidarity. The sample was consisted of the participants who were children, or not born yet, at the time when they lost their fathers during the war in Croatia. At the time of interview, the participants were aged between 15 and 35 years old. Data was collected using a structured clinical interview which also included socio-demographic data. Data about former and current psychiatric symptoms were collected using the following instruments: Clinician- Administrated PTSD Scale (CAPS), Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD). Results showed that there was significant correlation between age and results on used scales. The participants who lost their fathers at a very young age or even before they were born showed less trauma symptoms (r=0.249; p < 0.05) less anxiety (r=0.374; p < 0.01) and depressive (r=0.384; p<0.01) symptoms than participants who lost their fathers at an older age. The study confirmed that the individual experience of the trauma of losing a father in war circumstances is associated with age.

Correlation of sleep disturbances, anxiety and depression in Croatian war veterans with posttraumatic stress disorder.

The aim of the study was to examine the relationships between global sleep quality and its specific components and Posttraumatic Stress Disorder (PTSD) symptom severity questionnaire. We also researched whether sleep quality and sleep disturbances differed among groups of PTSD based on symptom severity categories. This study was conducted on the sample of 120 Croatian war veterans with PTSD. The following self-report instruments were used: Pittsburgh Sleep Quality Index, the Pittsburgh Sleep Quality Index Addendum for PTSD, the Mississippi Scale for Combat-Related PTSD, the Spielberger State and Trait Anxiety Inventory and the Beck Depression Inventory. There were statistically significant differences between the three PTSD severity groups on general nervousness (PSQI-A variable), where patients with extremely severe PTSD have more symptoms of general nervousness than groups with severe or moderate PTSD. Differences were found between PTSD severity groups in episodes of terror and acting-out dreams, where patients with extremely severe PTSD have more symptoms of episodes of terror and acting-out dreams than groups with severe or moderate PTSD. Sleep quality was significantly correlated with state anxiety, trait anxiety, and depression, indicating that with decrease of anxiety and depression, sleep quality improves. Sleep latency was positively correlated with both state and trait anxiety. There wasn't any significant correlation between sleep latency and depression. Study suggests that sleep disturbances are equally severe across groups of veterans based on PTSD severity and that the severity of sleep disturbances is significantly related to severity of anxiety and depression symptoms.

Subjective assessment of quality of life of persons whose fathers had died in the homeland war.

The aim of this paper is to show the current subjective assessment of the quality of life of persons whose fathers had died in war, and compare it with regard to some of their socio-demographic characteristics. The study included 494 participants who had come for a physical and psychiatric examination to one of the health institutions in Zagreb, Rijeka, Osijek or Split in which examinations were arranged. The inclusion criterion was growing up in a single-parent family as a consequence of the father dying in war. Data were collected using a structured clinical interview which also included socio-demographic data: the age and gender of the participant, educational status, marital status, employment status, household income. Also, participants were asked to fill out the World Health Organization Quality of Life Questionnaire - short form (WHOQOL-BREF). Data obtained from this study are descriptive, and are in line with the data obtained on the general population when it comes to comparisons of the assessment of quality of life and certain demographic characteristics. Special emphasis should be given to the link between age and overall satisfaction with the quality of life, with younger persons being more satisfied with the total quality of life than the older study participants. In conclusion, all participants of this study had a specific traumatic experience during the war - their father's death, therefore more data regarding the quality of life of this population can be expected upon a more detailed analysis and establishment of the contribution of traumatization, socio-demographic variables and current mental health to the explanation of the subjective satisfaction with life. A more detailed analysis of the collected data will be available in subsequent papers.

Quality of life in families of Croatian veterans 15 years after the war.

Exposure to war trauma with its consequences such as post traumatic stress disorder (PTSD) and disability due to combat injuries poses a significant problem for modern Croatian society. However, this is also a public health problem requiring continuous study of effective treatment strategies to achieve an increase in quality of life of most war-affected groups. Aim of this study was to examine the quality of life of population most affected by war - families of Croatian veterans. Present study included 126 female participants, who agreed to complete physical and psychiatric examination organized by the Ministry of Family, War Veterans and Intergenerational Solidarity. Included were participants with status of either wife of war veteran suffering from PTSD, wife who lost her husband in war circumstances or wife of war veteran with physical disabilities resulting from war activities. All three groups were asked to fill out the World Health Organization Quality of Life Questionnaire - short form (WHOQOL-BREF). Results indicate that assumed intensity of secondary trauma is not associated with quality of life. Namely, the highest level of satisfaction was found in wives of the most seriously affected invalids of war (M=3.77; sd=0.741), folowed by the wives of deceased soldiers (M=3.5; sd= 0.697), while the lowest quality of life results were found in wives of veterans suffering from PTSD (M=3.12; sd=0.608). Our results confirm that, nearly 15 years after the war, wives of disabled or killed Croatian soldiers have a (comparatively) satisfactory quality of their everyday lives, compared to the wives of veterans suffering from PTSD.

1-H MRS changes in dorsolateral prefrontal cortex after donepezil treatment in patients with mild to moderate Alzheimer's disease.

Magnetic resonance spectroscopy (MRS) noninvasively provides information on the concentration of some cerebral metabolites in vivo. Among those measurable by proton magnetic resonance spectroscopy (1H-MRS), N-acetyl-aspartate (NAA) is decreased, and myo-inositol (ml) and choline (Cho) levels are increased in patients with Alzheimer's disease (AD). Donepezil, an acetylcholinesteraze inhibitor, has proven effect on cognitive symptoms in patients with AD. In previous studies, treatment response was associated with an increase of NAA and NAA/Cr in the parietal lobe and hippocampi. Correlation of longitudinal changes of 1H-MRS detectable metabolites in dorsolateral prefrontal cortex (DLPFC) with clinically observable changes is a poorly researched topic. The objective of this non-interventional study is to assess whether changes in 1H-MRS measurable metabolites correlate with clinical outcome after donepezil treatment. Twelve patients with mild to moderate AD were evaluated during 26 weeks of donepezil treatment. 1H-MRS parameters in DLPFC were assessed before and after 26 weeks of donepezil treatment. Cognition was assessed with Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-Cog). A significant increase in NAA/Cr ratio and significantly lower decrease in mI/Cr ratio were found in AD patients with positive treatment response. The results of this study indicate possible modest donepezil effect on prevention of neuronal functional deterioration in DLPFC which correlates with clinical outcome and point the use of 1HMRS as technique of help in assessment of drug effect.

Self-assessment of well-being as an indicator of quality of life of former war prisoners - A Croatian study.

The impact of war on the population is vast, especially when it comes to those who were directly affected by war, among other things as concentration camp detainees. Because of the specific war experience of this population it is important to better understand the possible contribution of key socio-demographic variables, war traumatization and acute disturbances in mental health to their subjective assessment of their own well-being, which represents a psychological category and is based on a subjective assessment. The starting point is a theoretical precept according to which individual characteristics, together with war experience, can have repercussions on mental health, and eventually on the general well-being of an individual and their quality of life. The study comprised 184participants who had given their informed consent for participation and filled out complete questionnaires. The participants were a convenience sample of male persons who had survived war captivity in the Homeland War in the period from 1991 to 1995. The study was conducted as part of the physical examinations at the University Hospital "Fran Mihaljevic" in Zagreb. The data was collected using several self-evaluation measuring instruments one of which served to collect socio-demographic data, two to collect data on the participants' mental health, one for the data on the participants' combat and war experiences and one to assess the participants' well-being. The data obtained suggest that only avoidance and arousal symptoms and psychosomatic difficulties are predictors of the well-being of persons who have experienced war captivity.

Serum cholesterol concentration and structured individual psychoanalytic psychotherapy in suicidal and non-suicidal male patients suffering from borderline personality disorder.

Findings from numerous studies suggest an association between low cholesterol levels and suicidal behavior in patients with different psychiatric diagnoses. The aims of this case-control study were to test whether cholesterol levels in male suicidal patients (N=20) with borderline personality disorder (BPD) are lower than in male non-suicidal patients (N=20) with BPD and male healthy control group (N=20), and to evaluate the influence of structured individual psychoanalytic psychotherapy on suicidal behavior. The groups were matched for age and body mass index (BMI). Results showed that serum cholesterol levels did not differ significantly between suicidal and non-suicidal BPD patients and healthy controls. The level of psychopathology (measured by Brief Psychiatric Rating Scale and Hamilton Depression Rating Scale) was significantly higher in the group of suicidal patients, which indicates the importance of evaluating particular clinical symptoms in BPD, in order to prevent suicidal behavior. Non-suicidal male patients suffering from BPD received more frequently structured individual psychoanalytic psychotherapy prior to the hospitalization than suicidal group. These results emphasized the role of this type of psychotherapy in preventing suicidal behavior in BPD patients.

Serum cholesterol concentrations in suicidal and non-suicidal male patients suffering from persistent delusional disorder.

Suicidal behavior is a major health risk in psychiatric disorders, especially in affective and psychotic disorders. The neurobiology of suicidal behavior is still unclear. Suicidality has been related to a reduced cholesterol levels. The aim of this study was to evaluate serum cholesterol concentrations in suicidal and non-suicidal men suffering from persistent delusional disorder and in healthy volunteers. Results showed that serum cholesterol concentrations were significantly lower in suicidal than in non-suicidal patients and healthy controls. Also, level of psychopathology (measured by Brief Psychiatric Rating Scale) is significantly marked in the group of suicidal patients, which indicates the importance of detecting some clinical symptoms in patients with persistent delusional disorder in order to prevent suicidal behavior.

Psychological consequences of rape on women in 1991-1995 war in Croatia and Bosnia and Herzegovina.

AIM: To explore the short- and long-term psychological consequences of rape on women victims of rape during the 1992-1995 war against Croatia and Bosnia and Herzegovina. METHODS: The study included 68 women victims of rape and was conducted at the Medical Center for Human Rights, Zagreb, Croatia, from 1992 to 1995. Testimony method and a questionnaire were used to retrospectively obtain the description of rapes and symptoms women suffered immediately after rape and at the time of the study, ie, 11.9-/+2.4 after the trauma. Structured clinical interviews were conducted to diagnose psychiatric disorders that were present at the time of study, according to the third edition of Diagnostic and Statistical Manual of Mental Disorders. RESULTS: The raped women were Croatian and Muslim (Bosniak) women, residents of Croatia and Bosnia and Herzegovina. Forty-four of them were raped more than once, 21 were raped every day during their captivity, and 18 were forced to witness rapes. Most of the rapes (n=65) were accompanied by physical torture. The most frequent psychological symptoms felt immediately after the rape were depressiveness (n=58), avoidance of thoughts or conversations associated with the trauma (n=40), and suicidal ideas (n=25). Although none of the women had a psychiatric history before the rape, at the time of study 52 suffered from depression, 51 from social phobia, 21 from posttraumatic stress disorder (PTSD), and 17 had sexual dysfunctions. These disorders were often comorbid. Out of 29 women who got pregnant after rape, 17 had artificial abortion. The decision to have an abortion was strongly predicted by suicidal thoughts and impulses (odds ratio, 25.8; 95% confidence interval, 2.53-263.2). CONCLUSION: War-time rapes had deep immediate and long-term consequences on the mental health of women victims of rapes and their social and interpersonal functioning.

[Psychiatric comorbidity in veterans with chronic PTSD treated at Center for Crisis Intervention, Zagreb University Hospital Center]. / Psihjatrijski komorbiditet branitelja lijecenih zbog kronicnog PTSP-a u Centru za krizna stanja KBC-a Zagreb.

UNLABELLED: Epidemiological and clinical studies provide evidence that veterans with chronic PTSD can be at risk of relapse with respect to a number of high-risk behaviors, including attempted suicide, violence, and misuse of alcohol and drugs. AIM, PATIENTS AND METHODS: The aim of our study was to assess the prevalence of psychiatric comorbidity in veterans with chronic PTSD treated at Center for Crisis Intervention, Zagreb University Hospital Center, for 4 years. The diagnosis of PTSD and comorbid psychiatric diagnosis were confirmed according to DSM-IV criteria. RESULTS AND DISCUSSION: Study results showed PTSD without comorbid psychiatric diagnosis to persist in 25.3%, and PTSD with comorbid psychiatric diagnosis in 74.7% of study subjects. The most common psychiatric disorders were depression, personality disorders, and alcoholism. CONCLUSION: It is important to recognize other comorbid disorders because of the increased risk of suicidal behavior. Accordingly, therapeutic intervention should be adjusted to each individual case.

The Connection between Alexithymia and Somatic Morbidity in a Population of Combat Veterans with Chronic PTSD.

PURPOSE: To investigate the connection between alexithymia and somatic illness, or, somatization, in veterans suffering from chronic combat-related post-traumatic stress disorder, PTSD. METHODS: Croatian combat veterans (N=127) were studied at the Department of Psychology, Zagreb Clinical Hospital Center. The diagnosis of PTSD was confirmed and verified according to the International Classification of Diseases (ICD-10). A version of the Mississippi Scale for Combat Related PTSD (M-PTSD) standardized for the Croatian population was used to assess the severity of PTSD. In addition to the clinical interview, the existence of alexithymia was confirmed by the score on the Toronto Alexithymia Scale (TA S-20). RESULTS: A statistically significant association was found between the total number of diagnosed physical illnesses and the scores on three subscales of an alexithymia questionnaire, the TA S-20, with a 1% risk (p<0.01, 0.487; 0.450; 0.335). Regression analysis confirmed the most statistically significant predictive value of the first item of the TA S-20, which refers to difficulty in identifying feelings (=0.408, p=0.019). The total score on the M-PTSD scale correlated significantly to the subscales for alexithymia. There was a statistically significant negative correlation of the total score on the M-PTSD scale with social support. CONCLUSION: The total scores obtained in this study, particularly those related to alexithymia, indicate the importance of this construct in the etiopathogenesis of somatic morbidity in the study population and confirm that as in other countries the TA S-20 is a useful instrument in Croatia for the assessment of this phenomenon.