Posttraumatic stress disorder symptoms in Korean conflict and World War II combat veterans seeking outpatient treatment.

Given important differences in the Korean conflict and World War II, samples of treatment-seeking combat veterans from these wars (30 Korea, 83 World War II) were compared on the prevalence and severity of posttraumatic stress disorder (PTSD). With age, ethnicity, and combat exposure taken into account, the Korean veterans reported significantly more severe symptoms on both interview and self-report PTSD measures. Group differences in the prevalence of current PTSD were in a similar direction but not significant. These results are generally consistent with other studies that have found Korean combat veterans to exhibit higher rates of psychosocial maladjustment than World War II combat veterans. Based on related research with Vietnam veterans, one direction for future investigation is to examine what role stressful postmilitary homecoming experiences may have played in influencing the development and course of combat-related PTSD in the aging cohort of "forgotten" Korean conflict veterans.

The interaction of posttraumatic stress disorder and depression among older combat veterans.

The question whether depression is related to trauma as part of posttraumatic stress disorder (PTSD) itself or whether it represents autonomous symptoms occurring separately (from PTSD) has not been answered. We addressed two issues: (a) What is the relationship between PTSD and depression as measured by continuous measures on outcomes? and (b) By removing depression components from the PTSD diagnosis, what is the impact on standard outcomes? Older veterans from World War II or Korea were interviewed and given self-report measures on PTSD and depression. The CAPS-1 and the MMPI-D were used as the continuous measures for PTSD and depression. The outcome measures were health status, overall adjustment, social support, and physiological status. Results showed that depression influenced health status and social support: PTSD did not contribute to the equation. The CAPS-1 also was further divided into CAPS-PTSD and CAPS-D (depression) based on item content. For adjustment and health status, PTSD asserted a greater influence; for social support and heart rate, depression was the greater influence. Discussion addressed the fact that depression is an important consideration in the expression of PTSD.

EMDR minus eye movements equals good psychotherapy.

Eye Movement Desensitization and Reprocessing (EMDR) is a therapy roughly equal in efficacy to others currently available. It is argued that this treatment method is efficacious independent of the value of its component parts (e.g., eye movements) and is successful because it applies common and generally accepted principles of psychotherapy. Ten curative principles of this procedure are discussed as reflective of sound psychotherapy practice. It is hoped that an understanding of this therapy from the perspective of the practice and theory of psychotherapy will assist in its study.

Validation of the MCMI-III PTSD scale among combat veterans.

The new MCMI-III Posttraumatic Stress Disorder (PTSD) scale was validated on 104 combat veterans who were divided into two groups, PTSD Treatment Group and Non-PTSD Treatment Group. PTSD status was carefully determined by clinical interview and therapists' reports. The Combat Exposure Scale, the Mississippi Scale for Combat-related PTSD, and the Impact of Events Scale were also given. Analysis showed that the MCMI-III PTSD scale had a low internal consistency, but that it significantly differentiated the two groups and significantly correlated to those on other PTSD self-report scales. This scale appeared to be influenced by an acquiescent response style. Further validation studies are needed.

Interaction of posttraumatic stress disorder and major depressive disorder among older combat veterans.

This study investigated the interaction of PTSD and major depressive disorder with common aging-related variables for a community sample of older World War II and Korean War veterans. Older veterans (N = 139) were divided into PTSD and depressed groups on the basis of interviewers' measures and compared on overall adjustment, social support, and health status. Only PTSD affected adjustment and health status.

Personality scales as predictors of older combat veterans with posttraumatic stress disorder.

The sparse literature on Posttraumatic Stress Disorder among older combat veterans has not explored individual personality styles. 120 older combat veterans who were treatment-seeking in medical and psychiatric outpatient clinics, were assessed whether two personality styles (identified in other research as potentially reflective of PTSD) added to the problems of PTSD beyond the information associated with the stressors of combat and aging. Analyses indicated that the personality style, Sensitivity, was significantly related to PTSD beyond these other factors.

Assessment of older combat veterans with the clinician-administered PTSD scale.

A study of the posttraumatic stress disorder (PTSD) among older combat veterans of World War II and the Korean Conflict was conducted. The Clinician-Administered PTSD Scale (CAPS) was given to 125 older combat veterans, along with a computerized variant of the Structured Clinical Interview for DSM-III-R for PTSD, the SCID-DTREE. (The SCID-DTREE was itself validated against the full SCID). Results showed the CAPS to be a good discriminator of PTSD: Out of the 125 cases, only 9 were misclassified using the SCID-DTREE as the base measure, a 93% efficiency. An alpha on the full CAPS was .95. This suggests that the CAPS is an appropriate scale for use with older combat veterans.

Effects of Outward Bound Experience as an adjunct to inpatient PTSD treatment of war veterans.

There is a paucity of studies on Outward Bound Experiences (OBE) with adult psychiatric populations and, more notably, with trauma victims. This study evaluates the efficacy of OBE as an adjunct to specialized inpatient PTSD treatment with survivors of chronic combat-related PTSD (N = 219) at two Veterans Administration Medical Centers. On several measures of PTSD and general adaptation, results showed that the five-day OBE did not differ from standard treatment of PTSD survivors. Two other issues were addressed: identification of successful and non-successful subjects as a result of OBE, and exploration of objective versus subjective measures among this chronic group. Finally, as a post-study analysis, inferred curative components of the OBE were discussed as each appeared to impact on the participants.

Modes of long-term coping with trauma memories: relative use and associations with personality among Vietnam veterans with chronic PTSD.

Little is known about how individuals who develop chronic posttraumatic stress disorder (PTSD) cope with recurring trauma memories, or how enduring personality characteristics influence such coping. Focusing on 110 hospitalized Vietnam combat veterans with chronic PTSD, this exploratory study assessed the relative frequency of using eight ways of coping with war memories, and associations between relative use of these strategies and eight dysfunctional personality styles. As a secondary issue, associations between coping strategies, combat exposure, and PTSD severity were also examined. Consistent with prior findings, these veterans predominantly used emotion-focused and avoidant strategies to cope with war memories. Differing personality styles and relative use or nonuse of particular coping strategies were also associated in psychologically coherent ways. These preliminary findings are discussed in relation to methodologic and future research issues.

Examining comorbidity and posttraumatic stress disorder in a Vietnam veteran population using the MMPI-2.

Examined the discriminant validity of the MMPI-2 in assessing comorbidity in a posttraumatic stress disorder (PTSD) Vietnam veteran population. The Structured Clinical Interview for the DSM-III-R (SCID) was used to diagnose veterans and to classify them into four groups: PTSD Only, PTSD with mood disorders, PTSD with other anxiety disorders, and PTSD with mood and anxiety disorders. All groups had clinical elevations on scales F, 1, 2, 3, 4, 6, 7, 8, 0, PK, and PS, with peak elevations on scales 8, 7, and 2. The PTSD Only group's MMPI-2 scores were not significantly lower than other groups' scores. The PTSD+Mood/Anxiety group was significantly more elevated on scales 2 and 7 than the PTSD Only and PTSD+Anxiety group but did not otherwise show significantly higher scale elevations than others groups. No significant differences existed between groups on scales F, L, K, PK, and PS. Implications of these results for PTSD and the current diagnostic system are explored.

Self-critical depressive experience in posttraumatic stress disorder.

Consistent with prior research, 73 hospitalized male Vietnam veterans with combat-related Posttraumatic Stress Disorder (PTSD) reported high scores on Self-criticism as measured by the Depressive Experiences Questionnaire. Self-criticism scores predicted greater severity of PTSD (Mississippi scale) after controlling for symptomatic depression (MMPI-D scale), suggesting that the nature of depression in Posttraumatic Stress Disorder differs from that in major depressive disorder.

Relationship of NEO-PI to personality styles and severity of trauma in chronic PTSD victims.

The relationship of the NEO-PI to personality disorders was evaluated in a clinical population. Eighty subjects with post-traumatic stress disorder (PTSD) were given this measure, along with the MCMI-II and PTSD and combat scales. Two questions were addressed: (1) What is the relationship of NEO-PI domains and facets to personality disorders?; and (2) What is this scale's relationship to PTSD problems? Results support previous studies that employed a clinical population, but with lower correlation coefficients. For the most part, then, the NEO-PI domains and facets correlated in expected ways with the MCMI-II. On PTSD measures, N accounted for the majority of the variance, but other domains were entered when independent regression equations were calculated to account for different personality disorders.

Cluster analysis of MCMI and MCMI-II on chronic PTSD victims.

A cluster analysis was used to identify groups of inpatients with confirmed post-traumatic stress disorder (PTSD) due to combat. In Study 1 the MCMI was administered to 256 subjects, in addition to the MMPI, PTSD measures, and background variables. Three clusters resulted: a Traumatic Personality (8-2), Schizoid Influence (8-2-1), and Antisocial Influence (8-6). Comparison on the MCMI symptom scales, MMPI, and PTSD scales showed that the Antisocial Influence cluster was "healthier" on all measures. The Schizoid Influence was most psychopathological. In Study 2 the MCMI-II was administered to 136 new subjects who met the same criteria as in Study 1. Four clusters resulted: Global (1-2-6A-6B-8A-8B), Subclinical (1), Aggressive (6A-6B-8A), and Detached/Self-defeating (1-2-8A-8B).

MMPI profiles in PTSD as a function of comorbidity.

A sample of 135 Vietnam veteran inpatients with combat-related PTSD was sorted into three groups, depending upon the presence of concurrent psychiatric disorders: Depression (n = 68), Psychosis (n = 31), and Other (n = 36). Pairwise comparisons were made on the MMPI with respect to the validity indicators, clinical scales, four relevant Harris-Lingoes subscales, the Psychoticism content scale, and the MMPI-PTSD subscale. Results indicate variations in scale elevations as a function of comorbid diagnosis. Various items and scales appear to differentiate the Psychosis group due to greater psychopathology. In general, the results spotlight the heterogeneous aspects that comorbidity brings to PTSD assessment.

A comparison of MMPI and MMPI-2 in PTSD assessment.

A sample of 47 Vietnam veterans with the diagnosis of combat-related Post-Traumatic Stress Disorder (PTSD) was administered the MMPI and MMPI-2. Pairwise comparisons were performed on the clinical scales, Harris Lingoes subscales, and scales relevant to the assessment of PTSD. Correlational analyses were performed as well. Hit rates of high-point pairs were compared across the tests. The results suggest a high degree of congruence between tests. Differences were seen on evaluations of some scales between tests that may influence interpretation and treatment.

MCMI-II high-point codes: severe personality disorder and clinical syndrome extensions.

The MCMI-II is becoming more widely used in both clinical practice and research settings. From a research perspective, one area that has not received a great deal of attention is high-point codes. While the MMPI has a very lengthy history of high-point code analysis and ancillary interpretative manuals, the MCMI-II has no such traditional data base. The present study determined the prevalence of single and two-point high codes in a large sample of VA patients. Additionally, associated severe personality scales and clinical syndrome scales are delineated as a function of the 20 most common profiles. These 20 common profiles accounted for 82% of the patients.

Dissociative experiences of Vietnam veterans with chronic posttraumatic stress disorder.

Interest in dissociation has been renewed, and its relationship to Post-traumatic Stress Disorder is especially intriguing. In this study 57 consecutively admitted chronic, combat-related Posttraumatic Stress Disorder sufferers were grouped by scores on a dissociative scale (Dissociative Experiences Scale). The three groups (high, medium, and low) were compared on personality measures (MMPI basic scales and subscales, and Millon's MCMI), Posttraumatic Stress Disorder measures, and a psychophysiological index of heart rate under baseline trauma conditions. The results showed that the survivors with more dissociative experiences show distinctive and higher symptom levels--excessive fearfulness, symptoms of strange experiences, and high tonic psychophysiological states--as well as greater severity of ratings of Posttraumatic Stress Disorder (on the Mississippi Scale). The discussion addressed the possible role of dissociation in Posttraumatic Stress Disorder.

NEO-PI profiles in PTSD as a function of trauma level.

One hundred Vietnam veterans with combat-related PTSD were administered the NEO Personality Inventory (NEO-PI) and the Combat Exposure Scale and were sorted into three groups based on trauma exposure level. Results indicate no significant differences among the personality profiles of the three trauma-exposed groups. A normative NEO-PI profile for persons diagnosed with combat-related PTSD is presented, characterized by an extremely high Neuroticism score (T > 75) and an extremely low Agreeableness score (T < 25).

Relationship between the Millon Clinical Multiaxial Inventory and the Millon-II: value of scales for Aggressive and Self-defeating personalities in Posttraumatic Stress Disorder.

This study addressed two issues, the interrelationship between the Millon Clinical Multiaxial Inventory (MCMI) and the Millon II (MCMI-II) and the value of the new personality scales, Aggressive and Self-defeating, in a sample with diagnoses of combat-related Posttraumatic Stress Disorder. 100 confirmed cases of combat-related Posttraumatic Stress Disorder were given a battery of measures including both Millon inventories and the Minnesota Multiphasic Personality Inventory (basic scales and selected subscales). They were rated on discharge status during a structured treatment program. Basic treatment and background information were also obtained. Analysis showed scores on the MCMI-II scales were higher but generally reflective of MCMI scales and that the Self-defeating personality style tends to be reflective of greater psychopathology, suicidal problems, treatment/disposition difficulties, overreporting of symptoms, and intensity of problems. Discussion encouraged the use of the MCMI-II with special emphasis given to the Self-defeating style in this group with Posttraumatic Stress Disorder.

Validation of PTSD measures for older combat veterans.

This study evaluated three nosologically similar older groups (Older PTSD, POW, and Older Psychiatric) and a group of Younger PTSD veterans from Vietnam. Group membership was derived from index admission diagnoses and clinical validation of status. Groups were compared on the MMPI, PTSD measures, background variables, health measures and an outcome measure. Results showed that the Older PTSD group is closer to the Younger PTSD group than to the other groups on the MMPI and PTSD measures and also that members of this group remain in the hospital longer than do members of the other older groups. Parameters of effective test classification showed the PTSD measures to be helpful in correct identification of this disorder for the older groups.