Raina Eberly

Posttraumatic stress disorder as a consequence of the POW experience

To estimate the relative contributions of trauma and premorbid disposition in the development and persistence of posttraumatic stress disorder (PTSD) symptoms, we conducted structured psychiatric interviews of 62 former World War II POWs. Half these men satisfied DSM-III criteria for PTSD in the year following repatriation. Eighteen (29%) continued to meet the criteria for PTSD 40 years later. Family history of mental illness and preexisting psychopathology were at best only weakly correlated with persistent PTSD symptoms. The strongest predictors of PTSD were proportion of body weight lost and the experience of torture during captivity. This study demonstrates that former POWs frequently develop posttraumatic stress disorder and that for one half of those who develop the symptoms, they persist for over 40 years. Familial risk factors and preexisting psychopathology are superseded by the overwhelming nature of the trauma. The persistence of the symptoms for many years is a reflection of the severity of the trauma.

Sleep in a community sample of elderly war veterans with and without posttraumatic stress disorder

BACKGROUND Although sleep disturbances are commonly reported by individuals with posttraumatic stress disorder (PTSD), objective findings have been inconsistent, due in part to small sample sizes, comorbid psychiatric disorders, variations in the recentness of trauma exposure, and the use of PTSD subjects involved in psychiatric treatment. METHODS A community sample of elderly males (n = 59) exposed to war trauma 28-50 years ago and free from sleep-affecting medications and disorders other than PTSD completed 3 nights of polysomnography. Of these participants, 30 met criteria for current PTSD; three were receiving supportive outpatient psychotherapy. RESULTS Two statistically significant differences were observed: Those with PTSD had a higher percentage of rapid eye movement (REM) sleep and fewer arousals from non-REM sleep. The perceptions of sleep quality among the participants with PTSD were lower than the perceptions of non-PTSD participants. Although participants with untreated obstructive sleep apnea and sleep movement disorders were not included in the sample, many cases were detected on initial screening. Treatment resulted in improved sleep and increased feelings of well being. CONCLUSIONS Alterations in REM and arousals characterized PTSD in this sample. When comorbid sleep disorders were ruled out, sleep was clinically similar across the groups. Trauma-related sleep disturbances that subjects reported as arising early in the course of the disorder appear to have declined over time.

Trauma exposure, resilience, social support, and PTSD construct validity among former prisoners of war.

Abstract  Background: The aim of this study was to investigate predictors of persistent symptoms of posttraumatic stress disorder (PTSD) and to examine the construct validity of PTSD in a national sample of 270 World War II and Korean Conflict prisoners of war (POWs). Method: POWs were interviewed at two points in time (1965 and 1990). Predictors included PTSD symptomatology measured in 1965 by items from the Cornell Medical Index (CMI), severity of captivity trauma, resilience factors, and post-trauma social support. The criterion, symptomatology in the early 1990s, was evaluated with the PTSD module of the Structured Clinical Interview for DSM (SCID). Results: The CMI provided only partial coverage of PTSD criteria and appeared to provide only a general index of distress. Clustering of SCID items in two-dimensional space via multidimensional scaling analysis offers some construct validation for the DSMs differentiation of PTSD symptoms into criterion groups, although there was not a perfect match. Trauma severity is best related to PTSD symptomatology experienced in 1990, mitigated in part by greater education level and age at the time of trauma exposure. Surprisingly, 1965 distress added only a modest amount to the prediction of current distress, while post-trauma social support added none. Conclusions: These findings support previous work showing the severe psychological sequelae of POW status 40–50 years after captivity, and indicate that trauma severity during captivity is the best predictor of current PTSD symptomatology. Results also add to our understanding of the conceptual differentiation of PTSD symptoms into separate and distinct symptom clusters.

Comorbidity of psychiatric disorders and personality profiles of American World War II prisoners of war.

To characterize the effects of trauma sustained more than 40 years ago, prevalence of psychiatric disorders and personality dimensions were examined in a sample of 62 former World War II POWs. The negative effects of their experiences are reflected in their multiple lifetime diagnoses and in their current personality profiles. Fifty percent met DSM-III posttraumatic stress disorder (PTSD) criteria within 1 year of release; 18 (29%) continued to meet the criteria 40 years later at examination (chronic PTSD). A lifetime diagnosis of generalized anxiety disorder was found for over half the entire sample; in 42% of those who never had PTSD, 38% of those with recovery from PTSD, and 94% of those with chronic PTSD. Ten percent of those without a PTSD diagnosis had experienced a depressive disorder, as had 23% of those with recovery from PTSD and 61% of the POWs with chronic PTSD. The combination of depressive and anxiety disorders also was frequent in the total sample (61%). Current MMPIs of three groups with psychiatric diagnoses were compared with those of POWs who had no diagnoses and with a group of Minnesota normal men. Profile elevations for the groups, from highest to lowest, were: POWs with chronic PTSD, POWs with recovery from PTSD, POWs with other psychiatric diagnoses, POWs with no disorders, and Minnesota normal men. Symptoms of anxiety, depression, and somatic concerns combined with the personality styles of suppression and denial characterize the current adjustment of negatively affected POWs.

Prevalence and correlates of depressive symptoms among former prisoners of war

Studies of former prisoners of war (POWs) provide valuable insights into posttraumatic adaptation because they gather information from a large population who survived the traumatic experiences of military captivity. Previous studies of POWs have shown elevated rates of psychiatric symptoms and disorders. This report presents evidence from a longitudinal study of three large, representative, national samples of former POWs. The study finds that depressive symptomatology, as measured by the Center for Epidemiologic Studies Depression Scale, is elevated in World War II POWs from the Pacific and European theaters and in Korean conflict POWs. Decades later, depressive symptomatology is found to be strongly associated with prior treatment in captivity. Differences in depressive symptomatology among the three POW groups can be attributed to captivity-related factors and to buffering factors, such as age at capture and education.

An adaptational view of trauma response as illustrated by the prisoner of war experience

We propose a model of Post-Traumatic Stress Disorder (PTSD) symptoms in which they have positive evolutionary adaptational value in traumatic environments. The persistence of PTSD symptoms following return to more benign environments may result from biological changes within the organism, reflected by a primary response of increased levels of underlying traits such as Negative Affectivity. Secondary symptoms such as social withdrawal and substance abuse are conceptualized as subsequent coping with the primary trauma response. This model was tested using data on 413 former World War II Prisoners of War (POWs). The results were consistent with the model, indicating an enduring high level of Negative Affectivity as measured by scales on the MMPI. Capitivity severity scores, developed using a factor analysis of POW experience variables, were related to lifetime and current diagnoses of PTSD, generalized anxiety disorder, and major or minor depression. They were not related to schizophrenia, alcohol abuse/dependence, bipolar I and II disorders, or organic mental disorders. Elevated Negative Affectivity indicators were proportional to the captivity severity scores.

Posttraumatic Growth among American Former Prisoners of War

Posttraumatic growth was assessed in a community sample of 95 former prisoners of war studied over a 12 year period. Developmental history, personality, social support, and PTSD measures from two earlier time points were used to predict current scores on the Posttraumatic Growth Inventory (PTGI). We hypothesized positive predictive relationships between PTGI indices and trauma exposure (and corresponding distress levels), positive affect, and social support. Positive Affectivity, Constraint, and two Social Support measures followed a pattern of significant and near-significant positive correlations with PTGI total score, Relationships with Others, and Spiritual Change, suggesting multidirectional relationships among these variables. POW trauma exposure correlated with Perceived Strength. Regression analyses significantly predicted PTGI total score, Improved Relationships, and Spiritual Change. The results both lend support to and raise questions about the construct validity of the PTGI.

Structural models of captivity trauma, resilience, and trauma response among former prisoners of war 20 to 40 years after release

SummaryLong-term responses to captivity trauma were measured in a national sample of American former prisoners of war. Their responses included negative affect, positive affect, and somatic symptoms as assessed by the Cornell Medical Index in 1967 and the Center for Epidemiological Study Depression Scale in 1985. These responses were strongly associated with captivity trauma (as indexed by captivity weight loss, torture, and disease) and resilience (as indexed by age and education at capture). Symptoms reported in 1967 were related to symptoms reported in 1985, suggesting symptom stability. These results are consistent with a model of trauma response that incorporates both trauma exposure and individual resilience. The findings are interpreted within a theoretical view of trauma response as adaptive when viewed from an evolutionary perspective.

Assessment of Posttraumatic Stress Disorder in World War II Veterans.

Four posttraumatic stress disorder (PTSD) scales were compared in a community sample of 330 American former prisoners of war and combat veterans of World War II. The Mississippi Scale for Combat-Related PTSD (M-PTSD), the Minnesota Multiphasic Personality Inventory-2 Pk PTSD scale, and the Impact of Event Scale (IES) all demonstrated moderate relationships with PTSD as defined by the Structured Clinical Interview for DSM-III-R. Comparative validities were similar to those observed in Vietnam veteran samples. Confirmatory factor analysis indicated that the 3 scales loaded significantly on 1 factor. The impact of Diagnostic and Statistical Manual of Mental Disorders ( 4th ed.) PTSD criteria changes was examined and found to be minimal. Implications for the use of the M-PTSD, Pk, and IES in combat-related PTSD assessment are discussed.

Factors Related to the Long-Term Course of PTSD in Older Ex–Prisoners of War

This study examined relationships between socioenvironmental factors occurring in later-life and current and changing PTSD symptom levels in a sample of 177 community-dwelling World War II and Korean era ex–prisoners of war. Factors examined included negative life events, negative health events, social support, and death acceptance. PTSD was assessed at Time 1. PTSD and the later-life factors were then assessed 4 years later (Time 2). Cross-sectional analysis examined the relationship of the later-life factors to current PTSD symptomatology. Longitudinal analysis examined their relationship to changing PTSD symptomatology over the 4-year interval. Negative health changes, social support, and death acceptance were significantly related to current and changing PTSD symptomatology, but negative life events were not. The authors conclude that health and psychosocial factors that may occur in later-life can be related to PTSD symptom levels even many decades after a traumatic experience.