Mary C. Grace

Chronic posttraumatic stress disorder and diagnostic comorbidity in a disaster sample

Research has indicated significant comorbid psychopathology with chronic posttraumatic stress disorder (PTSD) in samples of war veterans. The present paper examines the issue of comorbidity in a disaster sample to learn whether findings from veterans generalized to this event. A total of 193 subjects exposed to the Buffalo Creek dam collapse of 1972 were examined 14 years later using diagnoses derived from the Structured Clinical Interview for DSM-III (SCID). Past and present PTSD was found in a significant portion of the sample. Major depression was the next most common diagnosis and was highly related to PTSD. Anxiety disorders were also common. The overlap with other diagnoses was quite similar to that found in a sample of Vietnam veterans we studied earlier, except that the disaster sample had fewer dysthymic disorders, substance abusers, and antisocial personality disorders. Possible explanations for comorbidity in chronic PTSD were discussed and it was suggested that the morphology of PTSD may be quite stable in at least some other nonveteran trauma populations.

Posttraumatic stress disorder. Toward DSM-IV.

This report raises conceptual issues about the validity of the posttraumatic stress disorder diagnosis as described in DSM-III. The helpfulness of DSM-III is acknowledged, but gaps in that classification are noted. These are organized into three areas: the etiology of the disorder, its natural history, and diagnostic specificity. Suggestions are made for conceptualizing these issues and for research that needs to be undertaken to help resolve them. The authors urge more theoretical and empirical attention to these important issues in the upcoming years, so that later diagnostic descriptions and understandings will be more precise.

Multiple diagnosis in posttraumatic stress disorder. The role of war stressors.

Prior studies have shown that posttraumatic stress disorder (PTSD) in Vietnam veterans is associated with various aspects of war stressors and that other diagnoses often co-occur with PTSD in this population. The present report examines the prediction of other diagnoses, in combination with PTSD, from a variety of war stressor experiences in a broad sample of veterans recruited from clinical and nonclinical sources. The results show that PTSD with panic disorder is better explained by war stressors than other diagnostic combinations and that high-risk assignments and exposure to grotesque deaths were more salient than other stressor experiences in accounting for different diagnostic combinations. Implications of the findings for PTSDs placement in the DSM-III-R and for psychological and pharmacological treatments were discussed.

Race differences in response to combat stress

A number of authors have written poignantly about the Black experience in the Vietnam war; however, very little research has addressed this topic. The present report studied race differences in preservice, stressor, and outcome variables in a community sample of 181 war veterans. Blacks reported higher levels of stressors and outcome, particularly for PTSD-related symptoms. The results suggested that the relationship between stressors and outcome can be defined by a common regression line for Blacks and Whites, and that the high symptom levels observed for Blacks in the sample were accounted for by higher levels of stressors during their war experience. The cognitive coping mode of avoidance did not conform to this pattern and showed higher levels for Blacks even controlling for other factors. Potential cultural origins of this difference were noted.

War stressors and symptom persistence in posttraumatic stress disorder

Abstract This study focused on delineating aspects of war stressors associated with risk for posttraumatic stress disorder in Vietnam veterans. Findings from 191 Vietnam war veterans are presented, addressing which elements of the war experience predicted PTSD in remission or persistent PTSD. Some experiences, like loss and injury, predicted having had PTSD symptoms in the past, while other experiences, such as exposure to grotesque death, predicted current (persistent) PTSD. Discriminant analysis showed that the more extreme/intense the stressor experiences, the higher the risk for developing PTSD and for persistent symptoms. These findings provide empirical support for the PTSD diagnosis and additional data for refining the PTSD stressor criterion.

The Buffalo Creek Disaster

The collapse of the Buffalo Creek dam and subsequent flood disaster has received a great deal of attention in the literature since its occurrence in 1972. Previous reports of that disaster covered its legal (Stern, 1976), sociological (Erikson, 1976), and psychological (Gleser, Green, & Winget, 1981; Titchener & Kapp, 1976) aspects.

Somatic Reenactment in the Treatment of Posttraumatic Stress Disorder

Somatic reenactments, like other intrusive symptoms in post-traumatic stress disorder, such as flashbacks and nightmares, reproduce the mental content of traumatic events. Four cases are presented from survivors of military trauma and civilian catastrophes. The patients were part of larger research projects carried out by the University of Cincinnati Traumatic Stress Study Center. Understanding such symptoms as repetitions of the trauma itself proved useful therapeutically, especially in consolidating the working alliance.

Conceptual Issues in Research with Survivors and Illustrations from a Follow-Up Study

The purpose of the present chapter is twofold. First, we would like to set out some general issues in doing research with survivors of extreme stress events. Initially, we will touch on the subjective narrative as a source of empirical data. We will then propose that there are two different genres of questions that are being asked in trauma research at the present time. The nature of these will be delineated along with more specific subquestions. Next, a set of methodologic considerations that may reduce the generalizability of findings from any particular sample of survivors will be briefly discussed.

Learning during group dynamics training: the effects of silent versus traditional training formats.

According to practicing group psychotherapists, the two most valued components of training for group psychotherapy are: (1) the opportunity to conduct a therapy group under supervision, and (2) participation in experiential training (Dies 1974). It is no wonder, then, that a large spectrum of experiential training models has emerged (Lakin, Lieberman, and Whitaker 1969). What is learned from the various models relates to the milieu, the leader, and the group composition (Stone and Green 1978), and in part depends on the particular training format. In contrast to descriptions of training, however, is the relatively limited formal evaluation of the learning which occurs in these programs. This paper will focus on an evaluation of the learning which took place during the group dynamics component of group psychotherapy training. The effect on learning of variations in format in which the leader is either silent or explicates group processes was tested.