Gulf War and Health Volume 6: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress (2008) / Chapter Skim
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5 POSTTRAUMATIC STRESS DISORDER
5 POSTTRAUMATIC STRESS DISORDER
Pages 75-114
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War-related traumatic events have been detailed in numerous studies (see Chapter 3)
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Because the DSM-III provided a formal operational definition of PTSD, it presented a platform for large-scale studies of PTSD in Vietnam veterans and veterans of later wars. In the sections below, the committee discusses the diagnosis and clinical features of PTSD; its prevalence in military populations; the course of the disorder; the comorbidity of PTSD with other psychiatric disorders and associated disability of people who have PTSD; risk and protective factors for PTSD; and finally the neurobiology of PTSD.
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. BOX 5-1 DSM-IV Diagnostic Criteria for Posttraumatic Stress Disorder A
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. In a comparison group of 500 civilians in the National Vietnam Veterans Readjustment Study (NVVRS)
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. A 1998-2001 mail survey of 23,358 UK Gulf War veterans also found increased self-reports of PTSD and associated symptoms compared with nondeployed military personnel (1.0% vs 0.4%, OR 2.4, 95% CI 1.83.1)
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and 12% for current PTSD, 20-25 years after the war. World War II and Korean War Veterans of World War II and the Korean War who are participating in the Normative Aging Study, a long-term study established by the VA in Boston that has screened and tracked
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and 401 Korean War veterans (19% of whom experienced combat) ; the Combat Exposure Scale and two additional questions on length of time in combat and exposure to combat outcomes were used to assess combat-exposure severity.
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Gulf War Current: 3.4% CIDI February 2000-October Fiedler et al. 2006 veterans (n = 967)
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(1999) in a larger cohort of 2119 male and 194 female Gulf War veterans screened for PTSD.
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. Trauma can also lead to the simultaneous development of PTSD and other psychiatric disorders, such as major depression (Shalev et al.
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Zatzick et al. evaluated 1190 male and 432 female Vietnam veterans by using data from the NVVRS (1997a,b)
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. Female Gulf War veterans were more likely than men to have PTSD symptoms when assessed 5 days after their return from the gulf (8% vs 3%, respectively, OR 3.2, 95% CI 1.9-5.5)
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(2005) found that among 2131 female and 9310 male Gulf War veterans, PTSD was associated with in-theater sexual harassment and assault in women (OR 5.41, 95% CI 3.19-9.17)
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for those 30-39 years old. Developmental History and Early-Life Stress Numerous epidemiologic studies of Vietnam and Gulf War veterans and of civilians have found that childhood trauma from physical or sexual abuse is a risk factor for PTSD, regardless of later combat exposure.
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by a previous history of any psychiatric disorder. A study of Australian Gulf War veterans by Ikin et al.
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. In a prospective study of 348 Gulf War veterans (all military reservists)
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Low income and lack of education are associated with chronic stress-related disorders -- for example, anxiety disorders, major depression, and substance-use disorders -- in Gulf War and Vietnam veterans (Black et al. 2004; Boscarino 1995; Brewin et al.
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Most findings regarding social support come from studies of homecoming support, whether given by family, friends, or community. A perceived lack of family cohesion has also been associated with PTSD in Gulf War veterans (Sutker et al.
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. Combat-related lifetime PTSD is associated with increased current PTSD symptoms and a lower rate of remission among a group of 255 Hispanic and American Indian Vietnam veterans with PTSD.
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Numerous psychophysiologic studies have documented heightened sympathetic nervous system arousal in combat veterans who suffer from PTSD (Orr et al. 1990; Prins et al.
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To assess adrenergic responsivity of the peripheral and central nervous system more directly, yohimbine was administered to 20 Vietnam combat veterans with PTSD and 18 healthy controls (Southwick et al.
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Several recent studies have found that trauma victims who develop PTSD have lower initial cortisol responses to a traumatic event than do trauma victims who do not develop PTSD (McFarlane 1997; Resnick et al.
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Prospective studies indicate that those who recover from PTSD show a decrease in PTSD symptoms beginning soon after the trauma, but those who do not recover show a different pattern: their PTSD symptoms decrease in the first month after trauma but then remain fairly steady (Rothbaum et al.
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Eight of 11 of the studies found medium to large-sized effects for eye-blink electromyogram startle-response magnitude to acoustic stimuli. Studies included Vietnam and Gulf War combat veterans and victims of sexual assault and mixed trauma.
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. Possible explanations for discrepant findings on hippocampal volume in PTSD include variability in intensity and duration of trauma exposure, the presence of comorbid psychiatric disorders, differences in imaging methods (Vythilingam et al.
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PTSD (or symptoms associated with it) has been reported in veterans from World War II, the Korean War, the Vietnam War, the Gulf War, and OEF and OIF.
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1988. Combat level and social support in the development of posttraumatic stress disorder in Vietnam veterans.
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1990. Duration and intensity of combat exposure and posttraumatic stress disorder in Vietnam veterans.
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2001. A pilot longitudinal study of hippocampal volumes in pediatric maltreatment-related posttraumatic stress disorder.
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2004. The Hawaii Vietnam Veterans Project: Is minority status a risk factor for posttraumatic stress disorder?
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2007. Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq War veterans.
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1999. Posttraumatic stress disorder in a national sample of female and male Vietnam veterans: Risk factors, war-zone stressors, and resilience-recovery variables.
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1990. Autonomic responses to stress in Vietnam combat veterans with posttraumatic stress disorder.
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1989. Prevalence of posttraumatic stress disorder in wounded Vietnam veterans.
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2002. Prazosin reduces nightmares in combat veterans with posttraumatic stress disorder.
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2005. Delayed onset of posttraumatic stress disorder among male combat veterans: A case series.
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2005. Correlates for posttraumatic stress disorder in Gulf War veterans: A retrospective study of main and moderating effects.
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1999. Course and predictors of posttraumatic stress disorder among Gulf War veterans: A prospective analysis.
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1997a. Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans.
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