Teresa Kucala

The PTSD interview: Rationale, description, reliability, and concurrent validity of a DSM-III-based technique

This paper describes the PTSD Interview (PTSD-I). It was developed to meet four specifications: (a) close correspondence to DSM-III standards; (b) binary present/absent and continuous severity/frequency outputs on each symptom and the entire syndrome; (c) administrable by trained subprofessionals; and (d) substantial reliability and validity. It was written to meet the first three criteria. It demonstrated very high internal consistency (alpha = .92) and test-retest reliability (Total score r = .95; diagnostic agreement = 87%). It correlated strongly with parallel DIS criteria (Total score vs. DIS diagnosis rbis = .94, sensitivity = .89, specificity = .94, overall hit rate = .92, and kappa = .84). Earlier studies revealed correlations with a military stress scale and Keane et al.s MMPI PTSD subscale. It is apparently the only PTSD instrument that meets all of the above criteria.

Differences between posttraumatic stress disorder patients with delayed and undelayed onsets.

In an effort to determine whether they differ from one another in important ways, the authors compared posttraumatic stress disorder (PTSD) victims who reported delayed onsets with those who claimed undelayed onsets of PTSD symptom self-ratings, MMPI clinical and validity scale scores, stress histories, and repression measures. The number and the sizes of the differences did not exceed chance expectations and did not support the establishment of separate delayed- and undelayed-onset PTSD categories in the diagnostic manual, nor did they support the hypotheses that the delay, when it appears, is attributable to the magnitude of the trauma, the severity of the symptoms, repression, or a limited stress history.

The Definition of Posttraumatic Stress Disorder in Alcoholic Vietnam Veterans: Are the DSM-III Criteria Necessary and Sufficient?

The authors evaluated the validities of the DSM-III elements defining posttraumatic stress disorder (PTSD) in alcoholic Vietnam veterans by studying the relationships of each to qualification for a PTSD diagnosis under DSM-III standards, the history of a major stressor (3 or more months of combat), and the presence/absence of enough other problems to meet the symptomatic DSM-III requirements for this diagnosis. Elements dealing with the reexperiencing of traumas, diminished pleasure, detachment from others, hyperalertness, sleep disturbance, guilt over behaviors required for survival, and avoidance of stimuli reminiscent of traumas showed substantial correlations with eligibility for a PTSD diagnosis. However, items dealing with emotional expressiveness, response to intimacy, survival guilt, impaired memory, and trouble concentrating either failed to correlate with qualification for a PTSD diagnosis or yielded marginal results. One (“lacking direction”) of 10 additional symptoms sometimes termed as “post-Vietnam syndrome” behaviors correlated with eligibility for a PTSD diagnosis as well. The present results and those described in earlier studies suggest that several modifications in the DSM-III definition of PTSD are desirable.

ANHEDONIA AND DEATH

The Anhedonia Scale scores of 39 persons who later committed suicide, people who later died of natural causes, and survivors were compared. The results were equivocal, but suggested that suicides are characterized by low anhedonia and individuals who die premature natural deaths show high anhedonia levels.

The relationships of post-traumatic stress disorder to adolescent illegal activities, drinking, and employment

The authors compared the self-reported incidences of adolescent legal problems, drinking, employment, and church attendance in psychiatric patients (N = 116) with and without post-traumatic stress disorder (PTSD) and normals (N = 28). The differences did not exceed chance expectations. The data raise doubts about the validity of the theory that PTSD is at least partially a result of pre-traumatic personality maladjustment.

The relationships of anhedonia and the process-reactive dimension to season of birth and infectious disease incidence in schizophrenia.

This project was designed to test two hypotheses drawn from a new formulation explaining the exaggerated winter birthrate among hospitalized schizophrenics. The first is that the supposed exaggerated winter birthrate among process schizophrenics actually represents a reduction in spring-fall births caused by prenatal exposure to infectious diseases during the preceding winter— i.e., a high prenatal death rate in process preschizophrenic fetuses. The second is that the level of negative symptoms in survivors at risk for schizophrenia who were born after winters with high infectious disease rates is exaggerated. The findings provided some tentative support for this formulation. Compared with counterparts born after low-disease winters, schizophrenics born after winters with high disease incidences tended to show lower (more reactive) scores on a measure of the process-reaction dimension but higher anhedonia scores.

Prediction of the Wais scores from the 1973 Henmon‐Nelson revision

Administered the 1973 revision of the Henmon-Nelson and the WAIS to 100 psychiatric patients. The correlation of Henmon-Nelson raw scores with WAIS Full Scale scaled score was .83, which compared favorably with correlations run between several other short IQ tests and the WAIS in similar samples drawn from the same setting in earlier studies. However, the Henmon-Nelson did not appear able to estimate the WAIS IQs of low-intelligence Ss or aged persons with consistent accuracy. The validities of short IQ tests and current practices in the selection of WAIS surrogates were discussed.

A comparison of abstractive and nonabstractive deficits in schizophrenics and psychiatric controls.

Chapman and Chapman (Disordered Thought in Schizophrenia, Appleton-Century-Crofts, New York, 1973) have suggested that findings of abstract thinking deficits in schizophrenia could be functions of control task artifacts. This paper describes two projects in which the abilities of schizophrenics and psychiatric hospital controls who had been closely matched on a wide variety of vocabulary and nonvocabulary control tasks to perform several types of abstract thinking tasks were compared. No differences on the mean scores of the schizophrenic and control patients appeared on four of five measures used. On the fifth, a logical reasoning test, the schizophrenics were inferior to controls. The results suggest that many of the differences reported earlier between schizophrenics and nonschizophrenics on abstraction tasks may result from the heavy reliance of researchers on vocabulary as a control matching test, and its peculiar resistance to deterioration in schizophrenia. The results also suggest that inability to abstract may not be a major specific deficit for schizophrenics, but that inability to use logic properly may be.

Two Studies of Reported Pretraumatic Stressors' Effect on Posttraumatic Stress Disorder Severity

We contrasted in two studies the effects of military trauma on Vietnam veterans who reported high and low premilitary stress. In the first, we administered the Posttraumatic Stress Disorder Interview (PTSD-I), a premilitary modification of the Social Readjustment Rating Scale, and the Military Stress Scale to hospitalized veterans. Premilitary stress appeared to reduce the impact of combat on several trauma-reexperiencing ratings, although the relevant evidence was inconsistent. In the second study, the premilitary stress main effects and the premilitary stress/combat interactions on four PTSD-I factors were nonsignificant. Thus, the severities of most PTSD symptoms increased with trauma intensity, but not with milder premilitary stress. The inconsistent data on the impact of pretraumatic stress on the trauma severity/PTSD relationships suggest further study.

Childhood stress disorder behaviors in veterans who do and do not develop posttraumatic stress disorder

The purpose of this study was to test a variation of the stress-evaporation theory, which maintains that posttraumatic stress disorder (PTSD) symptoms are simply exacerbations of behaviors present before the trauma. Retrospective childhood self-ratings were made by 63 PTSD patients, 53 psychiatric controls, and 28 normals on 13 PTSD-like symptoms. The results did not support the hypothesis, and they give more support to the residual-stress model than to the stress-evaporation theory.