Brian N. Smith

Comorbidity of partial and subthreshold ptsd among men and women with eating disorders in the national comorbidity survey‐replication study

OBJECTIVE The comorbidity of posttraumatic stress disorder (PTSD) and eating disorders (EDs) is high among women but has been understudied in men. Little is known about the association between partial or subthreshold PTSD and EDs among women or men. METHOD This study included PTSD and ED data from male (n = 2,382) and female (n = 3,310) National Comorbidity Survey-Replication study participants. RESULTS The vast majority of women and men with anorexia nervosa, bulimia nervosa (BN), and binge eating disorder (BED) reported a history of interpersonal trauma. Rates of PTSD were significantly higher among women and men with BN and BED. Subthreshold PTSD was more prevalent than threshold PTSD among women with BN and women and men with BED. DISCUSSION Interpersonal forms of trauma, PTSD, and subthreshold/partial PTSD, were prevalent among men and women with EDs. Findings highlight the importance of assessing for trauma and PTSD in ED patients.

A Pilot Study of a Randomized Controlled Trial of Yoga as an Intervention for PTSD Symptoms in Women

Posttraumatic stress disorder (PTSD) is a debilitating condition that affects approximately 10% of women in the United States. Although effective psychotherapeutic treatments for PTSD exist, clients with PTSD report additional benefits of complementary and alternative approaches such as yoga. In particular, yoga may downregulate the stress response and positively impact PTSD and comorbid depression and anxiety symptoms. We conducted a pilot study of a randomized controlled trial comparing a 12-session Kripalu-based yoga intervention with an assessment control group. Participants included 38 women with current full or subthreshold PTSD symptoms. During the intervention, yoga participants showed decreases in reexperiencing and hyperarousal symptoms. The assessment control group, however, showed decreases in reexperiencing and anxiety symptoms as well, which may be a result of the positive effect of self-monitoring on PTSD and associated symptoms. Between-groups effect sizes were small to moderate (0.08-0.31). Although more research is needed, yoga may be an effective adjunctive treatment for PTSD. Participants responded positively to the intervention, suggesting that it was tolerable for this sample. Findings underscore the need for future research investigating mechanisms by which yoga may impact mental health symptoms, gender comparisons, and the long-term effects of yoga practice.

Main and interactive effects of social support in predicting mental health symptoms in men and women following military stressor exposure

Abstract Evidence across a multitude of contexts indicates that social support is associated with reduced risk for mental health symptoms. More information is needed on the effectiveness of different sources of support, as well as sex differences in support. Associations between social support from two sources – the military unit and friends and family – and mental health symptoms were examined in a study of 1571 Marine recruits assessed at the beginning and end of a highly stressful 13-week training program. Military social support buffered the stressor exposure–posttraumatic stress symptomatology (PTSS) relationship, whereas the relationship between stressor exposure and PTSS was highest when civilian social support was high. Further inspection of the interactions revealed that military support was most important at high levels of stressor exposure. Sex differences in the relationship between social support and symptoms were found, such that support from military peers was associated with lower levels of PTSS for men, whereas civilian support was associated with lower PTSS for women. While civilian social support was associated with lower levels of depression symptom severity in both women and men, the relationship was stronger for women. Reviewed implications focus on the importance of considering the recipient, source, and context of social support.

Gulf war illness: symptomatology among veterans 10 years after deployment.

Objective: To further elucidate the nature of illness in veterans of the 1990 to 1991 Gulf War (GW) by examining the GW Illness (GWI) definition advanced by the Centers for Disease Control and Prevention, which specified caseness as having at least one symptom from two of the three factors: fatigue, mood-cognition, and musculoskeletal. Methods: A total of 311 male and female GW veterans drawn from across the nation were assessed in a survey-based study approximately 10 years after deployment. Results: A total of 33.8% of the probability-weighted sample met GWI criteria. Multiple symptom profiles were found, with more than half of GWI cases endorsing a symptom on all the three factors, and almost all cases endorsing at least one mood-cognition symptom. Conclusion: Although the Centers for Disease Control and Prevention definition has some limitations that should be considered, it remains a useful tool for assessing the presence of illness in GW veterans.

PTSD and obesity in younger and older veterans: Results from the mind your heart study

Posttraumatic stress disorder (PTSD) is increasingly recognized as a relatively common condition that is associated with poor health, including obesity. With a sizable proportion of the population approaching older adulthood, it is important to understand PTSD-health associations in the context of age. Participants were recruited from two Veterans Administration medical centers and included 380 patients age 60 and over and 365 under age 60. PTSD diagnosis was determined by the Clinician Administered PTSD Scale. BMI was trichotomized into normal/under (≤24.9), overweight (25.0-29.9), and obese (≥30.0). Models were run in the total sample, as well as stratified by age group, and adjusted for demographics, depression, antipsychotic medication use, and physical activity. Current PTSD was associated with greater likelihood of overweight and obesity in the total sample, and lifetime PTSD was associated with significantly increased odds of obesity. In the stratified models, current and lifetime PTSD were associated with increased likelihood of overweight and obesity in the older group only. Results suggest that PTSD is associated with risk for overweight and obesity, an effect that may be particularly strong in older adults. These findings support the importance of examining PTSD and potential health correlates across the life course.

Does Guilt Mediate the Association Between Tonic Immobility and Posttraumatic Stress Disorder Symptoms in Female Trauma Survivors

Tonic immobility (TI) is an involuntary freezing response that can occur during a traumatic event. TI has been identified as a risk factor for posttraumatic stress disorder (PTSD), although the mechanism for this relationship remains unclear. This study evaluated a particular possible mechanism for the relationship between TI and PTSD symptoms: posttraumatic guilt. To examine this possibility, we assessed 63 female trauma survivors for TI, posttraumatic guilt, and PTSD symptom severity. As expected, the role of guilt in the association between TI and PTSD symptom severity was consistent with mediation (B = 0.35; p < .05). Thus, guilt may be an important mechanism by which trauma survivors who experience TI later develop PTSD symptoms. We discuss the clinical implications, including the importance of educating those who experienced TI during their trauma about the involuntary nature of this experience.

Consequences of PTSD for the work and family quality of life of female and male U.S. Afghanistan and Iraq War veterans.

PurposeAlthough it is well established that combat-related PTSD can lead to reduced quality of life, less is known about the relative effect of PTSD on different aspects of former service members’ post-military readjustment. Moreover, research on female veterans’ reintegration experiences is limited. This study aimed to document the work and family quality of life of post-9/11 male and female veterans and evaluate the gender-specific impact of PTSD on veterans’ work and family outcomes.MethodsA national sample of 524 post-9/11 veterans completed mailed surveys as part of a longitudinal study. Descriptive and regression-based analyses were gender-stratified and weighted to enhance representativeness to the larger population.ResultsWith a few notable exceptions, the majority of post-9/11 U.S. veterans reported high work and family quality of life. PTSD was not associated with either employment or relationship status; however, it did predict poorer work and family functioning and satisfaction for both men and women, with the most consistent negative effects on intimate relationships. Several gender differences were found, primarily with respect to work experiences.ConclusionsAlthough most post-9/11 veterans appear to be doing well in both their work and family lives, results support the need for interventions that can mitigate the negative effect of PTSD and other associated mental health conditions on several aspects of work and family quality of life. Findings contribute to research suggesting both similarities and differences in the post-military readjustment of male and female post-9/11 veterans and underscore the need for additional consideration of the unique work-related challenges women experience following military service.

High rates of PTSD treatment dropout: A possible red herring?

Few studies have examined symptom change among dropouts from posttraumatic stress disorder (PTSD) treatment. However, dropout is widely considered a negative event needing to be addressed. The present study investigated PTSD and depression symptom change in patients with PTSD who discontinued psychotherapy. Female civilians (n=321) diagnosed with PTSD participated in two randomized clinical trials examining PTSD treatment outcomes. Of those, 53 were identified as dropouts and included in this study. Symptom change was assessed by clinically significant change (CSC) criteria and symptom end-state criteria. Results demonstrated that considerable proportions of participants (35.85-55.56%) displayed significant improvement and/or met good end-state criteria for PTSD and depression. Results also revealed that participants who displayed symptom improvement were younger, attended more treatment sessions, were married or partnered, and had higher annual household income. Although preliminary, these findings contradict belief that treatment dropouts do not display symptom improvement.

Family Stressors and Postdeployment Mental Health in Single Versus Partnered Parents Deployed in Support of the Wars in Afghanistan and Iraq

Little is known about the family-related stress and postdeployment adjustment of single versus partnered parents deployed in support of the wars in Iraq and Afghanistan. This study examined exposure to family-related stressors during and after deployment, as well as postdeployment psychological symptoms in a national sample of 318 single (n = 74) and partnered (n = 244) parent veterans of Operation Enduring Freedom and Operation Iraqi Freedom. Results demonstrated that single parents experienced higher levels of concern about life and family disruptions during deployment, lower levels of social support during and after deployment, and poorer postdeployment family functioning than partnered parents. Single parents also reported higher posttraumatic stress symptom severity, but not depression or anxiety symptom severity, compared with partnered parents. Family-related stressors demonstrated different associations with mental health for single and partnered parents, suggesting that some stressor-symptom relations may be more salient for single parents, and others may be more salient for partnered parents. Findings suggest that the deployment and postdeployment experiences of parents differ based on their partnered status, which has implications for the design and provision of services to single and partnered parents.

Depression and dissociation as predictors of physical health symptoms among female rape survivors with posttraumatic stress disorder

OBJECTIVE To investigate the relative contributions of depression and dissociation, as well as posttraumatic stress disorder (PTSD), to physical health symptoms and to examine the relationships among somatic symptoms, PTSD, depression, and dissociation in relation to childhood and adult trauma exposure. METHOD Cross-sectional data are from 132 female rape survivors with PTSD assessed before engaging in a study of trauma-focused cognitive therapy for PTSD. Measures included the Pennebaker Inventory of Limbic Languidness, Clinician Administered PTSD Scale, Beck Depression Inventory, Trauma Symptom Inventory-Dissociation Subscale, Childhood Sexual Abuse Exposure Questionnaire, and Assessing Environments-III-Physical Punishment Scale. RESULTS Hierarchical regression analyses revealed that only dissociative and depression symptoms contributed significantly to physical health symptoms. Similarly, among the subsample of women with either childhood sexual or physical abuse, depression and dissociation were significant predictors of somatic symptoms. However, among women without childhood abuse, only dissociation significantly predicted somatic symptoms. CONCLUSION Understanding the psychological and biological mechanisms that link childhood versus adult trauma exposure, PTSD, and comorbid depression or dissociation to physical health symptoms may aid development of individualized treatments for the physical and psychological consequences of trauma. (PsycINFO Database Record