War zone stress, personal and environmental resources, and PTSD symptoms in Gulf War veterans: a longitudinal perspective.

Cross-sectional research has demonstrated a link between personal and environmental resources and development of emotional distress after war zone service. Less is known about the longitudinal relationship between resources and distress. The authors addressed this issue in a study of 348 Gulf War returnees tested at 2 time points. Resources decreased and posttraumatic stress disorder (PTSD) symptoms increased over time. Time 1 avoidance and family cohesion predicted PTSD symptoms at Time 2. Regression analyses revealed a bidirectional relationship over time between resources and PTSD symptoms. Time 1 resources predicted Time 2 psychopathology after accounting for Time 1 emotional distress. PTSD symptoms at Time 1 also predicted changes in coping and family relationships, even after accounting for Time 1 resources. Findings are consistent with the concept of a loss spiral (Hobfoll, 1989), in which resource factors and emotional sequelae to war stress exert reciprocal effects.

Olfactory identification in combat-related posttraumatic stress disorder.

Recent neuropsychological conceptualizations of posttraumatic stress disorder (PTSD) implicate dysfunction of the fronto-limbic system, a brain system thought to be involved in the mediation of emotion. However, few studies have examined fronto-limbic subregions, such as the orbitofrontal cortex, in PTSD. As a measure of orbitofrontal integrity, olfactory identification was assessed in 26 Vietnam War veterans with PTSD, 25 Vietnam War veterans without mental disorders, and 17 Vietnam-era, non-war-zone veterans without mental disorders. Relative to veterans without PTSD, those diagnosed with PTSD were less proficient in odor identification and verbal learning but not on other cognitive tests sensitive to dorsolateral prefrontal and mesial temporal functioning. Results bolster prior research indicating fronto-limbic dysfunction in PTSD, and suggest involvement of the orbitofrontal region.

Relationship of psychiatric status to Gulf War veterans' health problems.

OBJECTIVE: A growing body of research has shown that there are important links between certain psychiatric disorders and health symptom reporting. Two disorders in particular (posttraumatic stress disorder (PTSD) and major depression) have been the most widely implicated to date, and this association has sometimes been used to explain the occurrence of ill-defined medical problems and increased somatic symptoms in certain groups, most recently Gulf War veterans. METHODS: Structured psychiatric diagnostic interviews were used to examine the presence of major psychiatric (axis I) disorders and their relation to health symptom reporting in a well-characterized, stratified subset of Gulf War veterans and a non-Gulf-deployed veteran comparison group. RESULTS: Rates of most psychiatric disorders were substantially lower than national comorbidity estimates, consistent with prior studies showing heightened physical and emotional well-being among active-duty military personnel. Rates of PTSD and major depression, however, were significantly elevated relative to the veteran comparison group. The diagnosis of PTSD showed a small but significant association with increased health symptom reports. However, nearly two-thirds of Gulf participants reporting moderate to high health symptoms had no axis I psychiatric diagnosis. CONCLUSIONS: Results suggest that rates of psychiatric illness were generally low with the exception of PTSD and major depression. Although PTSD was associated with higher rates of reported health problems, this disorder did not entirely account for symptoms reported by participants. Factors other than psychiatric status may play a role in Gulf War health problems.

Attention and memory dysfunction in posttraumatic stress disorder.

Attention and memory performances were studied in Persian Gulf War veterans with and without posttraumatic stress disorder (PTSD) diagnoses. Veterans diagnosed with PTSD showed relative performance deficiencies on tasks of sustained attention, mental manipulation, initial acquisition of information, and retroactive interference. Their performances were also characterized by errors of commission and intrusion. The tendency toward response disinhibition and intrusion on cognitive tasks was correlated positively with reexperiencing symptoms and negatively with avoidance-numbing symptoms. These cognitive deficit patterns are consistent with models of PTSD that emphasize the role of hyperarousal and implicate dysfunction of frontal-subcortical systems. Results suggest that intrusion of traumatic memories in PTSD may not be limited to trauma-related cognitions but instead reflects a more general pattern of disinhibition.

Health status of Persian Gulf War veterans: self-reported symptoms, environmental exposures and the effect of stress.

BACKGROUND: Most US troops returned home from the Persian Gulf War (PGW) by Spring 1991 and many began reporting increased health symptoms and medical problems soon after. This investigation examines the relationships between several Gulf-service environmental exposures and health symptom reporting, and the role of traumatic psychological stress on the exposure-health symptom relationships. METHODS: Stratified, random samples of two cohorts of PGW veterans, from the New England area (n = 220) and from the New Orleans area (n = 71), were selected from larger cohorts being followed longitudinally since arrival home from the Gulf. A group of PGW-era veterans deployed to Germany (n = 50) served as a comparison group. The study protocol included questionnaires, a neuropsychological test battery, an environmental interview, and psychological diagnostic interviews. This report focuses on self-reported health symptoms and exposures of participants who completed a 52-item health symptom checklist and a checklist of environmental exposures. RESULTS: The prevalence of reported symptoms was greater in both Persian Gulf-deployed cohorts compared to the Germany cohort. Analyses of the body-system symptom scores (BSS), weighted to account for sampling design, and adjusted by age, sex, and education, indicated that Persian Gulf-deployed veterans were more likely to report neurological, pulmonary, gastrointestinal, cardiac, dermatological, musculoskeletal, psychological and neuropsychological system symptoms than Germany veterans. Using a priori hypotheses about the toxicant effects of exposure to specific toxicants, the relationships between self-reported exposures and body-system symptom groupings were examined through multiple regression analyses, controlling for war-zone exposure and post-traumatic stress disorder (PTSD). Self-reported exposures to pesticides, debris from Scuds, chemical and biological warfare (CBW) agents, and smoke from tent heaters each were significantly related to increased reporting of specific predicted BSS groupings. CONCLUSIONS: Veterans deployed to the Persian Gulf have higher self-reported prevalence of health symptoms compared to PGW veterans who were deployed only as far as Germany. Several Gulf-service environmental exposures are associated with increased health symptom reporting involving predicted body-systems, after adjusting for war-zone stressor exposures and PTSD.

War zone stress, personal resources, and PTSD in Persian Gulf War returnees.

Posttraumatic stress disorder (PTSD) can occur subsequent to war stress, but not all troops are negatively affected. A discriminant function model was used to study associations between personal and environmental resources and psychological outcomes subsequent to war zone stress. Among 775 Persian Gulf War exposed troops, 2 subsets were identified: 97 with PTSD diagnoses and 484 who had no psychological distress. A discriminant function, double cross-validated in random subsamples, classified 87% of troops, and demographic and stress severity variables did not alter results significantly. Personality hardiness commitment, avoidance coping, and perceived family cohesion emerged as consistent predictors of PTSD diagnosis. Findings suggest personal characteristics and environmental factors may alter vulnerability to negative war stress outcomes. Work is needed to identify mechanisms and causal pathways by which resource factors enhance or lower stress resistance.

Assessment of psychological distress in Persian Gulf troops: ethnicity and gender comparisons.

This study reports results of psychological assessment among military participants in Operation Desert Storm, a more diverse ethnic and gender mix of American troops than has been mobilized for previous military operations. Symptoms of current psychological distress, including negative mood states, somatic complaints, and posttraumatic stress disorder, in addition to personal and trauma characteristics, were measured in 653 Persian Gulf war-zone-exposed and 259 stateside-duty troops to test the hypothesis that ethnic minority status and female gender are associated with greater levels of psychological distress following war-zone duty. Findings point to potentially negative sequelae to war-zone stress in a portion of troops and suggest that ethnic minorities, but not necessarily women, may be more vulnerable to psychological risk.

Psychopathology in war-zone deployed and nondeployed Operation Desert Storm troops assigned graves registration duties.

Early psychopathology outcomes were compared in troops mobilized for Persian Gulf graves registration duty but differentiated by war-zone deployment. Constructs of interest were Axis I psychiatric disorders, particularly posttraumatic stress disorder (PTSD), negative affect states, and somatic complaints. Psychometric instruments, including the Structured Clinical Interview for DSM-III-R, were administered to troops attending drill exercises. Although similar in personal characteristics and reporting low rates of premorbid psychopathology, groups differed in the prevalence of PTSD diagnoses, anxiety and anger symptoms, and somatic complaints. Current and lifetime PTSD rates of 48% and 65%, respectively, suggest that the psychological aftermath of war-zone participation involving the gruesome task of handling human remains was profound.

Psychological symptoms and psychiatric diagnoses in Operation Desert Storm troops serving Graves registration duty.

This clinical report describes symptoms of psychological and physical distress and psychiatric disorders in 24 Army Reservists who served war zone graves registration duty in support of Operation Desert Storm. Troops underwent comprehensive assessment for evidence of psychopathology that might be associated with war zone duty as one component of a debriefing protocol scheduled during regular drill exercises eight months after their return to the United States. Troops endorsed items suggestive of high war zone stress exposure, common symptoms of anxiety, anger, and depression, and multiple health and somatic concerns. Almost half of the sample met criteria for post-traumatic stress disorder, and diagnosis of this disorder was strongly associated with evidence of depressive and substance abuse disorders. The gruesome aspects of body recovery and identification in a war zone setting were cited as stressor elements of significant negative impact.

Psychopathy: traditional and clinical antisocial concepts.

Advances in our knowledge about the concept of psychopathy and the repeated occurrence of antisocial behaviors in the face of adversity and punishment have been limited by a complex interplay of conceptual and methodological issues that have not yet been addressed adequately by psychosocial scientists. Foremost among the problems facing clinicians and researchers interested in this topic is the lack of agreement on the meaning and labelling of the construct. Scholars have not reached consensus in describing a category within a diagnostic system that distinguishes a relatively homogeneous group of individuals sharing a set of characteristics, or a class of persons that can be identified reliably from those who exhibit other perhaps closely related behavioral abnormalities and so-called normal individuals. Disagreements about the construct in question have been sufficiently problematic that some researchers and clinicians have decided that the notion of psychopathy or APD, taken to represent a mental disorder, is simply a myth or a judgment label concocted to justify societal management of offensive and repugnant behaviors (cf., Blackburn, 1988; Lewis & Balla, 1975; Pilgrim, 1987). Scholars such as Holmes (1991) and Wulach (1983) have called for elimination of the category as a mental disorder diagnosis, because it offers an opportunity for making value assessments rather than clinically appropriate decisions. Few disorders described in our psychopathology nomenclature are associated with such markedly negative attributions as is psychopathy, whether defined in the American or British traditions. The logical underpinning of much work in the field equates psychopathy or APD with heinous forms of criminality, lifestyle criminality, and special cases of antisocial behavior. In keeping with tendencies for society to conceptualize psychopathy as extreme misbehavior and to decry its consequences is a paper by Wells (1988), which exemplifies the emotion-focused thought and rhetoric that have been mobilized in writings explaining the behaviors that are often subsumed under the psychopathy label. Given that this type of persuasion is more common than might be expected in an empirical literature, it is not surprising that some scholars have concluded that the term psychopathy is really relatively useless. On the other hand, the appeal of the realist approach to disease conceptualization, or the notion that such a disorder exists and therefore must have underlying causes, has defied elimination over the years.(ABSTRACT TRUNCATED AT 400 WORDS)

Psychopathology and psychiatric diagnoses of World War II Pacific theater prisoner of war survivors and combat veterans.

OBJECTIVE: This study assessed current and long-term psychological and psychiatric sequelae of war trauma in World War II Pacific theater combat veterans, some of whom had been Japanese prisoners of war (POWs). METHOD: A group of 36 POW survivors and a group of 29 combat veterans, all of whom had seen fierce fighting and heavy unit casualties, were compared approximately 40 years later on psychological instruments assessing psychopathology constructs, negative mood states, and symptoms of posttraumatic stress disorder (PTSD) and on the computer-administered National Institute of Mental Health Diagnostic Interview Schedule. RESULTS: Although similar in personal backgrounds and in having suffered catastrophic war trauma, the two groups differed in the severity and type of psychiatric symptoms and in the occurrence of psychiatric disorders. Anxiety and depressive disorders were common in both groups, but there were differences in the frequency of PTSD diagnoses. Among the POW survivors, 70% fulfilled the criteria for a current diagnosis and 78% for a lifetime diagnosis of PTSD, compared to 18% and 29%, respectively, of the combat veterans. CONCLUSIONS: The findings point to the persistent nature of symptoms thought to be residuals of extraordinary stress and the relation between severity of psychiatric sequelae and characteristics of the stressors.

Memory and learning performances in POW survivors with history of malnutrition and combat veteran controls.

Former prisoners of war (POWs) with histories of malnutrition and body wasting were compared on standardized measures of memory and learning with POW survivors who sustained less confinement body weight loss and combat veterans of similar ages and military assignments. Results showed that POWs who sustained the greatest degree of trauma-induced weight loss, or that exceeding 35% of their precaptivity body weights, performed significantly worse on four of the five Wechsler Memory Scale /3-Revised (WMS-R) indices, showed more rapid rates of forgetting on the Visual Reproduction test, and exhibited slower acquisition rates and less sophisticated mastery of the learning materials on a modified version of the Rey Auditory Verbal Learning Test (AVLT). Given their relatively intact performances on measures of general intelligence and attention-concentration, the POWs with a history of severe malnutrition appeared to evidence a pattern of cognitive limitations qualitatively similar to that associated with alcoholic Korsakoff's syndrome.

MMPI profiles of veterans of WWII and Korea: comparisons of former POWs and combat survivors.

MMPI profile patterns were compared between combat veteran groups of 168 POW survivors and 67 servicemen who were not war captives in WWII and the Korean Conflict. Results confirm previous reports that the scales, Hypochondriasis (Hs), Depression (D), and Hysteria (Hy), are characteristically elevated among former POWs. Findings also point to the contribution of scales, Psychasthenia (Pt), Paranoia (Pa), and Ego Strength (Es), in differentiating groups, suggesting that negative ruminations, heightened anxiety, interpersonal anger and suspiciousness, and low self-esteem contribute significantly to group differentiation.

Cognitive deficits and psychopathology among former prisoners of war and combat veterans of the Korean conflict.

OBJECTIVE: This study was conducted to describe the long-term psychological and psychiatric sequelae of prisoner of war (POW) confinement against the backdrop of psychiatric evaluations of Korean conflict repatriates more than 35 years ago. METHOD: A group of 22 POWs and a group of 22 combat veteran survivors of the Korean conflict were compared on measures of problem solving, personality characteristics, mood states, and psychiatric clinical diagnoses by means of a battery of psychometric instruments and structured clinical interviews. RESULTS: Although the two groups were similar in background and personal characteristics, they differed in reports of life adjustment problems, complaints of physical distress, proficiency on cognitive tests, objectively measured personality characteristics, and assigned psychiatric diagnoses. CONCLUSIONS: Illustrated by a case report which describes the prolonged brutality of the Korean conflict POW experience for one individual, the results suggest that the psychiatric symptoms documented more than three decades ago have persisted in severity and chronicity. In addition to problems with cognitive deficits and complaints of bodily discomfort, most common among POW survivors were symptoms of suspiciousness, apprehension, confusion, isolation, detachment, and hostility.

Trauma-induced weight loss and cognitive deficits among former prisoners of war.

Former prisoners of war (POWs) from the Korean Conflict and WWII reporting confinement weight losses of greater than 35% (n = 60) and less than or equal to 35% (n = 113) and non-POW combat veterans (n = 50) were compared on WAIS-R and Wechsler Memory Scale (WMS) Logical Memory indices. High weight-loss POWs performed more poorly than combat veterans on Performance IQ, Arithmetic, Similarities, and Picture Completion subtests, Witkin-Goodenough Attention-Concentration Factor, and WMS Immediate and Delayed Recall and more poorly than low weight-loss POWs on Arithmetic, Attention-Concentration Factor, and the WMS immediate memory measure. Low weight-loss POWs and combat veterans differed only on WMS immediate memory. Findings support the Thygesen, Hermann, and Willanger (1970) hypothesis that severity of POW confinement stress reflected by trauma-induced weight loss is predictive of long-term compromise in cognitive performance.

Assessment of long-term psychosocial sequelae among POW survivors of the Korean Conflict.

Psychological and psychiatric assessments were performed among 20 prisoner-of-war (POW) Korean-Conflict survivors. Results revealed extraordinary biological and psychological abuse with weight losses exceeding 35% of preservice weights and long-term cognitive, emotional, and behavioral sequelae. The full range of posttraumatic stress disorder symptoms was seen in 90% to 100% of the cases with high prevalence of co-morbidity, specifically mood (75%), other anxiety (45%), and alcohol abuse (20%) disorders. Documented by clinical investigators at POW release and now more than 30 years later, symptoms of apprehensiveness, confusion, detachment, and depression reflect the persistence of psychiatric morbidity over time.

Personality disorders classification and symptoms in cocaine and opioid addicts.

The extent to which personality disorders (PDs) and associated symptom criteria were found among 117 cocaine- and opioid-dependent men selected from 350 consecutive inpatient admissions to a Veterans Administration Drug Dependence Treatment Unit over a 30-month period was examined using structured interview methodology. Drug groups were distinguished by higher rates of antisocial and borderline symptomatology rather than by features associated with other PDs. Cocaine users showed lower rates of borderline and adult antisocial features and reported less subjective distress than opioid addicts, and different constellations of target problem features emerged for the two groups.