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2 History, Diagnostic Criteria, and Epidemiology
Pages 25-58

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From page 25...
... The remainder of the chapter presents factors associated with trauma and PTSD, first in the general population and then in military and veteran populations, with an emphasis on combat as the traumatic event that triggered the development of PTSD. Although other traumatic events -- such as the terrorist attacks of September 11, 2001, and Hurricane Katrina -- have increased knowledge about PTSD, this chapter does not focus on civilian populations or nonmilitary related trauma.
From page 26...
... The current diagnostic criteria, taken from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) , can be found in Box 2-1 (APA, 2000)
From page 27...
... Duration of the disturbance is at least 1 month Acute -- when the duration of symptoms is less than 3 months Chronic -- when symptoms last 3 months or longer With Delayed Onset -- at least 6 months have elapsed between the traumatic event and onset of symptoms F Requires significant distress or functional impairment SOURCE: American Psychiatric Association (2000)
From page 28...
... . The condition is considered partial or subthreshold PTSD if a person does not meet the full diagnostic criteria -- exposure to a traumatic event and at least six symptoms: at least one B criterion of re-experiencing, at least three C criteria of numbing or avoidance, and at least two D criteria of hyperarousal -- or if symptoms are not in the correct distribution.
From page 29...
... . Other factors found to be associated with increased risk of experiencing traumatic events include lower education attainment (less than a 4-year college degree)
From page 30...
... Men were more likely to report having experienced a traumatic event over their lifetimes, but women were more likely to meet criteria for PTSD (Tolin and Foa, 2006) , have PTSD symptoms four times as long as men (48 months vs.
From page 31...
... The findings on the strength of association between family psychiatric history and PTSD are mixed. In one analysis of NCS data, after controlling for previous traumatic events, parental mental health disorders were associated with increased risk of PTSD in both men and women (Bromet et al., 1998)
From page 32...
... Second, both family and twin studies suggest that there is strong overlap for genetic influences on PTSD and those of other mental disorders including major depression, generalized anxiety disorder, and alcohol and drug dependence. For example, in a sample of Vietnam veterans, common genetic influences explained 63% of the major depression–PTSD comorbidity and 58% genetic variance in PTSD (Koenen et al., 2008a)
From page 33...
... Persons who experienced a traumatic event before the target stressor reported higher levels of PTSD symptoms on the average than persons who did not. Prior trauma was more strongly associated with PTSD in connection with traumatic experiences of noncombat interpersonal violence than with combat exposures (Ozer et al., 2003)
From page 34...
... . Other studies have shown remission of PTSD after particular traumatic events, such as disasters, in the first 6 months after exposure to the event (Galea and Resnick, 2005)
From page 35...
... . Men who reported combat as their worst trauma in the NCS were more likely to have lifetime PTSD, delayed onset of PTSD symptoms, and unresolved PTSD symptoms than men who named other types of trauma as their worst (Prigerson et al., 2001)
From page 36...
... . The strength of the relationship between prior adjustment problems and PTSD symptoms or diagnosis changed as a function of type of traumatic experience (stronger for noncombat interpersonal violence and accidents than for combat exposure)
From page 37...
... The epidemiology of PTSD in active-duty, National Guard, and reserve military populations and in veteran populations is then presented. Finally, some special considerations of PTSD in the military and veteran populations and their implications for screening, diagnosis, and treatment are highlighted.
From page 38...
... . Stressors and traumatic events have likewise shifted over time.
From page 39...
... ; therefore, estimates of mental health burden based on service records probably underestimate the burden in these populations. Combat Stress Severity Known risk factors for PTSD specific to military populations include experiencing combat, high combat severity, being wounded or injured, witnessing death (especially grotesque death)
From page 40...
... . Many studies assessing PTSD onset and duration in service members have used the 1990–1991 Gulf War veteran population because that war was the first large U.S.
From page 41...
... , no sex differences were found in combat-associated stressors for predicting posttraumatic stress symptoms. In a sample of National Guard service members 1 month before deployment, no differences between males and females were found in posttraumatic stress symptoms (mean scores on the PTSD Checklist -- Civilian version were 26.0 and 27.4, respectively)
From page 42...
... Although sexual trauma is significantly associated with PTSD, MST was more likely to result in PTSD than sexual assault occurring outside of military service (Himmelfarb et al., 2006)
From page 43...
... . In a study of veterans exposed to potentially traumatic events recruited from the Vietnam Era Twin Registry after controlling for confounders, persons who had the highest AFQT scores (76–99 and 56–75)
From page 44...
... Although a family history of mood disorders was associated with increased risk of exposure to traumatic events, people who had a pre-existing mood disorder were less likely to be exposed to traumatic events. Family history of paternal depression and pre-existing psychologic disorders (conduct disorder, panic or generalized anxiety disorder, and major depression)
From page 45...
... A study that examined PTSD as a risk factor for suicidal ideation among 407 OEF and OIF veterans who were referred to the VA health care system for mental health services found that veterans who screened positive for PTSD were about 4.5 times more likely to report suicidal ideation than veterans who did not have PTSD (Jakupcak et al., 2009)
From page 46...
... . However, those may be underestimates of the prevalence of PTSD in the military and veteran populations.
From page 47...
... . General Chiarelli has proposed a change to "posttraumatic stress injury" to encourage afflicted soldiers and their commanders to support the importance of diagnosis and treatment.
From page 48...
... This issue has become particularly important in military populations inasmuch as its presence is formally recognized as making someone eligible for DoD and VA benefits. Thus, a diagnosis of PTSD is problematic in both active-duty and veteran populations, and can lead to underreporting (for example, to remain in one's position)
From page 49...
... SUMMARY PTSD is prevalent in the general population in which it has a lifetime prevalence of about 8% in adults, but military and veteran populations are exposed to many more traumatic events than the general population, and service members who have served in OEF and OIF have a lifetime PTSD prevalence of 13% to 20%. Many factors increase a service member's risk of PTSD, some demographic -- such as age; sex; prior exposure to trauma, particularly sexual assault and childhood maltreatment; lower education attainment; and lower IQ -- and some combat-specific -- such as killing someone, seeing someone killed, and being in an explosion or being badly injured.
From page 50...
... 1998. Risk factors for DSM-III-R posttraumatic stress disorder: Findings from the national comorbidity survey.
From page 51...
... 2007. Differential etiology of posttraumatic stress disorder with conduct disorder and major depression in male veterans.
From page 52...
... 2001. Perceived threat to life predicts posttraumatic stress disorder after major trauma: Risk factors and functional outcome.
From page 53...
... 2002. A twin registry study of familial and individual risk factors for trauma exposure and posttraumatic stress disorder.
From page 54...
... 2009. A prospective study of posttraumatic stress disorder symptoms and coronary heart disease in women.
From page 55...
... sexual orientation minority adults and risk of posttraumatic stress disorder. American Journal of Public Health 100(12)
From page 56...
... 2007. Childhood antecedents of exposure to traumatic events and posttraumatic stress disorder.
From page 57...
... 1997. Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans.


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