Karni Ginzburg

Comorbidity of posttraumatic stress disorder, anxiety and depression: a 20-year longitudinal study of war veterans.

BACKGROUND This study aims to: (a) follow-up the prevalence of comorbidity of posttraumatic stress disorder (PTSD), anxiety and depression; (b) determine the chronological relations between these disorder; and (c) examine whether PTSD comorbid with anxiety and depression is implicated in more impaired functioning than PTSD by itself. METHODS 664 war veterans were followed up 1, 2, and 20 years after their participation in the 1982 Lebanon War. Comorbidity was assessed by self reported PTSD, anxiety, and depression symptoms; impairment in psychosocial functioning was assessed by self reported problems in occupational, social, sexual and family functioning. RESULTS At each point of assessment, rates of triple comorbidity (PTSD, anxiety and depression; 26.7-30.1%) were higher than rates of PTSD, either by itself (9.3-11.1%), or comorbid with depression (1.2-4.5%) or anxiety (2.9-4.5%). PTSD predicted depression, anxiety, and comorbid disorders, but not vice versa. At time 1 and 2 assessments, triple comorbidity was associated with more impaired functioning than PTSD alone. In addition, triple comorbidity at Time 2 was associated with more impaired functioning than double comorbidity. LIMITATIONS Since measurements did not cover the entire span of 20 years since the war, the entire spectrum of changes could not be monitored. CONCLUSIONS Almost one half of war veterans would endorse a lifetime triple comorbidity, and those who do, are likely to have more impaired functioning. The findings support the perspective that views PTSD as the dominant disorder following traumatic events, which impels the development of comorbid anxiety and depression.

Quantitative testing of pain perception in subjects with PTSD--implications for the mechanism of the coexistence between PTSD and chronic pain.

&NA; Post‐traumatic stress disorder (PTSD) often co‐occurs with chronic pain. Neither the underlying mechanism of this comorbidity nor the nature of pain perception among subjects with PTSD is well defined. This study is the first systematic and quantitative evaluation of pain perception and chronic pain in subjects with PTSD. The study group consisted of 32 outpatients with combat‐ and terror‐related PTSD, 29 outpatients with anxiety disorder and 20 healthy controls. Quantitative somatosensory testing included the measurement of warm, cold, light touch and heat‐pain thresholds and responses to acute suprathreshold heat and mechanical stimuli. Chronic pain was characterized, and levels of PTSD and anxiety symptomatology were assessed by self‐report questionnaires. Subjects with PTSD exhibited higher rates of chronic pain, more intense chronic pain and more painful body regions compared with the other two groups. PTSD severity correlated with chronic pain severity. Thresholds of subjects with PTSD were significantly higher than those of subjects with anxiety and healthy controls, but they perceived suprathreshold stimuli as being much more intense than the other two groups. These results suggest that subjects with PTSD exhibit an intense and widespread chronic pain and a unique sensory profile of hyposensitivity to pain accompanied by hyper‐reactivity to suprathreshold noxious stimuli. These features may be attributed to the manner with which PTSD subjects emotionally interpret and respond to painful stimuli. Alternatively, but not mutually exclusive, the findings may reflect altered sensory processing among these subjects.

Evidence for a Dissociative Subtype of Post-Traumatic Stress Disorder Among Help-Seeking Childhood Sexual Abuse Survivors

ABSTRACT This study examined evidence for a dissociative subtype of post-traumatic stress disorder (PTSD) among women seeking psychotherapy for childhood sexual abuse (CSA). One hundred and twenty-two women seeking treatment for CSA completed a battery of questionnaires assessing PTSD, dissociative symptoms, and child maltreatment. Using signal detection analysis, we identified high and low dissociation PTSD subgroups. A constellation of three PTSD symptoms-hypervigilance, sense of foreshortened future, and sleep difficulties–discriminated between these two subgroups (OR = 8.15). Further evidence was provided by the finding of a nonlinear relationship between severity of childhood maltreatment and dissociation in the women with PTSD. These results provide support for a dissociative subtype of PTSD that may stem from more severe childhood experiences of neglect and abuse.

World Assumptions and Combat-Related Posttraumatic Stress Disorder

The authors examined the association between (a) personal world assumptions and (b) combat stress reactions (CSRs), posttraumatic stress disorder (PTSD), and PTSDs course among three groups of Israeli veterans: 109 veterans who suffered from CSR on the battlefield, 98 decorated veterans, and 189 control participants. Participants completed standardized questionnaires that measured PTSD and world assumption. Both CSR and chronic PTSD were associated with lower levels of self-worth and beliefs about the benevolence of people. In addition, the authors found a linear association between self-worth perceptions and levels of mental status. The authors examined the results of the study considering the extraordinary characteristics and meaning of war.

Shame, guilt, and posttraumatic stress disorder in adult survivors of childhood sexual abuse at risk for human immunodeficiency virus: outcomes of a randomized clinical trial of group psychotherapy treatment.

This study evaluated the effectiveness of group psychotherapy in reducing levels of shame and guilt in adult survivors of childhood sexual abuse at risk for HIV, and whether such reductions would mediate the effects of treatment on posttraumatic stress disorder (PTSD) symptoms. One hundred sixty-six women were randomized into 3 conditions: a trauma-focused group, a present-focused group, and a waitlist group. Women received 6 months of treatment and were assessed at pretreatment (T1), immediately posttreatment (T2), and 6 months posttreatment (T3). Both treatment conditions resulted in reduced shame and guilt. The treatment effect on PTSD symptoms was mediated by changes in shame, but it was not associated with changes in guilt. These findings suggest that, when treating childhood sexual abuse survivors’ PTSD, it is important to address the negative self-appraisals, such as shame, that commonly accompany such symptoms.

Battlefield functioning and chronic PTSD: associations with perceived self efficacy and causal attribution

This study has two aims: (1) to examine the associations between battlefield functioning and perceived self efficacy (PSE) and attributional style; (2) to examine the unique and cumulative contributions of battlefield functioning, PSE, and attributional style to long term PTSD. The subjects were three groups of Israeli veterans of the 1973 Yom Kippur, who differed in their battlefield functioning: 112 combat stress reaction (CSR) casualties, 98 veterans who received medals for bravery, and 189 controls. The subjects filled out a series of questionnaires that assessed PTSD, PCE, attributional style and PTSD, two decades after the war. CSR casualties exhibited the lowest level of PSE, decorated veterans the highest. The three groups also differed in locus of control, with different attribution for failure. Discriminant analysis of PTSD and non-PTSD veterans showed that sociodemographic background, battlefield performance, PSE and attributional style classified 81% of all veterans correctly. The implications of these findings are discussed.

Sensation seeking, wartime performance, and long-term adjustment among Israeli war veterans

The current study explored the implications of sensation seeking in immediate and long term adjustment to war-related traumatic events. More specifically, the associations between sensation seeking, performance under war stress and long term emotional adjustment were examined. Three groups of Israeli veterans of the 1973 Yom Kippur war were studied: 112 combat stress reaction (CSR) casualties, 98 veterans who received medals for bravery and 189 controls. Eighteen years after the war subjects filled out a battery of questionnaires. Findings indicated that sensation seeking plays a significant role in both performance during the war and subsequent long-term adjustment. Decorated war veterans were found to be higher-sensation seekers than CSR casualties and controls. In addition, high-sensation seekers suffered from lower levels of war-related intrusion and avoidance tendencies and PTSD symptoms than low-sensation seekers. The implications of these findings are discussed.

Body awareness: differentiating between sensitivity to and monitoring of bodily signals

Sensitivity to bodily signals is the tendency to be aware of bodily states and to identify subtle bodily reactions to internal and environmental conditions. Monitoring these signals is a top-down process, describing individuals’ tendency to actively scan their bodies in order to detect cues for their physical condition. Two studies examined the relations between these constructs and their adaptivity among young adults. In Study 1, 180 young adults completed questionnaires assessing sensitivity, monitoring, and hypochondriac tendency. In Study 2, 205 students reported their levels of sensitivity, monitoring, pain catastrophizing, and trait anxiety. Although monitoring and sensitivity were correlated, when controlling for their shared variance, only monitoring was associated with high hypochondriac tendency and anxiety. In addition, the adaptivity of sensitivity to bodily signals was dependent on both level of monitoring of bodily signals and pain catastrophizing. That is, pain catastrophizing moderated the effect of sensitivity and monitoring on anxiety. These findings suggest that the adaptivity of sensitivity is determined by the mode of attention characterizing the individual engaged in this process.

PTSD and world assumptions following myocardial infarction: a longitudinal study.

The study aims to examine the association between exposure to trauma, posttraumatic stress disorder (PTSD), and world assumptions. The study included 3 groups of subjects: PTSD myocardial infarction (MI) patients, non-PTSD MI patients, and matched controls. World assumptions were examined twice: within a week of the patients MI (Time 1) and 7 months later (Time 2). The findings indicate that world assumptions are not related to exposure to trauma but are associated with PTSD.

Long-term adjustment among Israeli war veterans: the role of attachment style

This study examines the role of attachment in the long-term adjustment of Israeli veterans. The sample of participants comprised three groups of Israeli veterans who fought in the 1973 Yom Kippur War: 112 combat stress reaction (CSR) casualties, 98 veterans who received medals for bravery, and 189 controls. The CSR casualties reported higher levels of emotional distress than did participants in the two other groups. CSR veterans also showed the lowest levels of secure attachment characteristics. Additionally, the findings revealed different relationships between the avoidant style of attachment and emotional distress measures across the research groups. The implications of these findings are discussed according to two theoretical models of attachment.