David W. Foy

The Assessment of Posttraumatic Stress Disorder in Battered Women

This study examined battered womens psychological symptoms using instruments developed to assess posttraumatic stress disorder (PTSD) in other trauma victims. Women who had been in a physically violent relationship (n = 26) were assessed for PTSD using self-report measures and the Structured Clinical Interview for DSM-III-R (SCID). Results indicated that 45% of those subjects interviewed met full DSM-III-R criteria for PTSD on the SCID, and that exposure to violence was significantly associated with PTSD symptomatology. When divided into high and low exposure groups based on degree of life threat, 60% of those in the high exposure group met criteria for diagnosable PTSD in contrast to a 14% rate in the low exposure group. These data suggest that battered women do experience symptoms of psychological trauma, and future cross-trauma research that includes this population, along with other previously identified trauma groups, would be beneficial.

Childhood abuse experiences and combat-related PTSD†

Current literature on the etiology of combat-related PTSD strongly implicates combat trauma exposure as a primary etiological factor. However, studies of premilitary variables have produced conflicting results, perhaps in part due to methodological inconsistencies and failure to employ standardized measures. The present study examines one premilitary variable, childhood physical abuse history. Using a standardized measure developed by child abuse researchers, forty-five percent of veterans with PTSD were identified as recipients of abusive physical punishment during childhood. A positive correlation between physical abuse history and severity of combat-related PTSD was found. These preliminary findings set the stage for further investigation of the child abuse variable and underscore the need for treatment of veterans with combat-related PTSD which addresses developmental traumagenic events.

Etiologic factors in the development of posttraumatic stress disorder in children and adolescents

Abstract This article presents an overview of the literature on potential etiological factors in the development of PTSD in children. An etiological model for PTSD is offered which generates hypotheses for identifying links between exposure to traumatic events and consequent symptoms, as well as testing relationships between exposure variables and other possible mediating factors. Three possible kinds of interaction between etiologic and mediating variables, leading to different levels of symptoms, are presented. Findings from 25 recent studies examining etiologic factors are considered to form an empirical basis for current knowledge about PTSD in children. Severity of trauma exposure and parental trauma-related distress have consistently produced positive correlations with PTSD symptoms. Length of time since trauma exposure is consistently negatively correlated with PTSD severity. Findings regarding relationships between PTSD risk, age and gender are inconsistent at this time. Other gaps in our current knowledge and understanding are identified, and implications for future clinical and research efforts are discussed.

Etiological factors in the development of PTSD in clinical samples of Vietnam combat veterans

This paper presents a review of empirical literature that deals with etiological factors in combat-related post-traumatic stress disorder (PTSD). Variables implicated in PTSD from three time frames, premilitary, military, and postmilitary, are identified, and findings from relevant research are discussed. There is consistency across studies in showing significant correlations between PTSD and combat exposure and post-military psychosocial adjustment. Less consistent are the findings with regard to relationships between premilitary psychosocial factors and PTSD. Recent findings from studies that have explored possible physiological correlates of PTSD also are discussed. Based on current literature, implications for future research on etiological factors in combat-related PTSD are presented.

Statistical Analysis for Single-Case Designs: Evaluating Outcome of Imaginal Exposure Treatment of Chronic PTSD

A recently developed statistical method for single-case subject designs based on classical test theory was used to examine the efficacy of imaginal exposure treatment for posttraumatic stress disorder (PTSD) in four Vietnam veterans. The method was sensitive to intraindividual changes across different outcome measures even when relatively few data points were available. Two veterans clearly improved from exposure and maintained their gains at 3-and 15-month follow-ups. One veteran improved marginally, whereas one veterans symptoms worsened. Changes in heart rate monitored over the first two imaginal exposures indicated that veterans with greater heart-rate habituation responded better to exposure than did veterans with less or no habituation. The results suggest that the statistical method illustrated here has some advantages over other methods (e.g., visual inspection, time-series analysis) for examining clinical interventions in single-case designs.

Combat-related post-traumatic stress disorder etiology: replicated findings in a national sample of Vietnam-era men.

To examine the generality of recent findings on PTSD etiology in help-seeking Vietnam combat veterans, replication was attempted with data from a national study of Vietnam-era men that included combat veterans. Use of a Guttman scaling technique for assessing combat exposure was found to be robust for use with a national nonclinical sample as well. In addition, multiple regression analysis was used to examine predictive relationships between premilitary adjustment, military adjustment, combat exposure, and post-traumatic stress disorder (PTSD). Results obtained from the national sample showed the same patterning as that reported from the smaller clinical sample. Combat exposure was related significantly to PTSD symptomatology, while premilitary adjustment was not. A previously identified discriminant function, composed of psychological symptoms not found in the DSM III criteria for PTSD, also was cross-validated.

Post-traumatic stress disorder in Vietnam combat veterans: Effects of traumatic violence exposure and military adjustment

Thirty high-combat Vietnam veterans with a diagnosis of Post-traumatic Stress Disorder (PTSD) were compared with a second group of 30 high-combat Vietnam veterans without evidence of PTSD on measures of military adjustment and exposure to traumatic violence during combat. Military adjustment was assessed for precombat and combat service periods and included measures of alcohol and drug use, disciplinary actions, and social support. The PTSD-positive group reported significantly greater exposure to traumatic violence and more distress at having observed and participated in such acts than did the PTSD-negative group. Multiple regression analysis revealed the five traumatic violence frequency and distress scales to be significant predictors of severity of PTSD symptoms. Group differences were not attributable to premilitary demographic or social adjustment variables. Analyses of covariance demonstrated that both groups increased their drug and alcohol use and reported fewer social supports from precombat to combat periods. Results support the residual stress model of PTSD etiology, implicating trauma as the major contributing factor in the disorder.

Assessment issues involving the families of trauma victims

This paper reviews the empirical literature on the clinically significant problems found within families containing a member with post-traumatic stress disorder. Recommendations are made regarding specific instruments that can be useful for evaluating marital and familial adjustment. Assessment issues concerning the need to weigh historical relationship factors vis-á-vis the influences of a traumatized family member are discussed. A “multiple-gating” model is presented for assessing different aspects of family dysfunction, and suggestions for future research and clinical directions are offered.

Combat-related posttraumatic stress disorder in a nonpsychiatric population

Abstract Forty Vietnam-era combat veterans who were not currently, and had a largely negative history for, seeking psychiatric or psychological attention for posttraumatic stress disorder (PTSD) were diagnosed using DSM-III criteria. Twenty of the veterans met DSM-III criteria for posttraumatic stress disorder (PTSD) and these subjects were compared with the remainder of the sample. Subjects completed structured interviews concerning premilitary, substance abuse, homecoming variables, and the Minnesota Multiphasic Personality Inventory (MMPI). Results showed that the PTSD positive veterans reported a greater degree of substance abuse while in Vietnam. It was also suggested that a greater number of negative homecoming experiences characterized the PTSD-positive group. Specifically, this group reported a greater amount of cynicism, alienation, physical neglect, and demeaning experiences during the first six months following homecoming. The two groups did not differ on selected premilitary adjustment variables or attitudes toward the war. Results from the MMPI support its utility in assessing PTSD with a nonpsychiatric population. Results are discussed in relation to etiology and directions for future research.

Contingency management of food misbehavior in a psychiatric patient with diabetes

A contingency management procedure was instituted with a hospitalized 52-year-old male psychiatric patient to alter behavior associated with an exacerbated diabetic condition. A ten-day baseline indicated consistently elevated urine sugar levels and that the patient frequently violated his prescribed low sugar diet by stealing, trading and hoarding high sugar foods. Beginning in baseline, the patient was instructed to measure his urine sugar levels and post the results on a chart next to his bed. During two of the intervention procedures used in the additive design, the patient could earn coupon booklets from the hospital commissary if his daily average urine sugar levels were less than a set criterion. Two such criteria were employed before the reinforcement contingencies were faded. By the end of the intervention, urine sugar levels were under control and follow-up measures six months post-treatment indicated durable treatment effects.