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PTSD 40 years later: Incidence and person-situation correlates in former POWs
Abstract
A statewide sample of WWII ex-POWs (N = 442) responded to questionnaires that sampled current and past difficulties with PTSD-related symptoms; an incidence of serious difficulties with these symptoms of 56% was revealed. Retrospective reports of temporal patterns revealed no consistent patterns of symptom occurrence, but, rather, a waxing and waning of difficulties over the 40-year period. Unexpectedly, measures of severity of the POW experiences did not predict current symptomatology. Rank at time of capture, however, was consistently and strongly predictive of PTSD. It is suggested that PTSD is a highly persistent phenomenon and that both situation and person variables contribute to the development and maintenance of PTSD.
... Despite such hardships, evidence suggests that this group of servicemen, as a whole, was quite resilient. Sledge, Boydstun, and Rabe (1980), studying the Air Force subset of this cohort, concluded that the extremely toxic environments to which they were subjected could have beneficial effects in addition to the damaging consequences typically reported for RPWs (e.g., Engdahl, Dikel, Eberly, & Blank, 1997;Sutker, Winstead, Galina, & Allain, 1990;Zeiss & Dickman, 1989). L. A. King et al. (2011) examined relations between an array of demographics and captivity stressors with indicators of mental distress at repatriation for the remaining Army, Navy, and Marine RPWs. ...
... The first predictors in the model were the demographic characteristics of age, education, and marital status at time of capture. Previous research with U.S. RPWs from World War II and the Korean Conflict (e.g., Dikel, Engdahl, & Eberly, 2005;Page, Engdahl, & Eberly, 1991;Speed, Engdahl, Schwartz, & Eberly, 1989;Zeiss & Dickman, 1989) suggested that these variables are protective in preventing short-and long-term psychopathology. Also, higher levels of education appeared to promote wellbeing in Israeli RPWs assessed 18 years after the Yom Kippur War (Neria, Solomon, & Dekel, 1998). ...
... As proposed, both age and education at time of capture demonstrated direct negative associations with mental distress at time of repatriation. This finding is consistent with other research on wartime captivity (e.g., Page et al., 1991;Zeiss & Dickman, 1989), in that older and more educated RPWs exhibit fewer mental health problems after their release. These demographic characteristics and qualities may be construed as personal resources that these men carried with them, to greater or lesser extent, as they entered captivity and faced weeks, months, and years of imprisonment and associated hardships. ...
A longitudinal life span model of factors contributing to later-life positive adjustment was tested on 567 American repatriated prisoners from the Vietnam War. This model encompassed demographics at time of capture and attributes assessed after return to the United States (reports of torture and mental distress) and approximately three decades later (later-life stressors, perceived social support, positive appraisal of military experiences, and positive adjustment). Age and education at time of capture and physical torture were associated with repatriation mental distress, which directly predicted poorer adjustment 30 years later. Physical torture also had a salutary effect, enhancing later-life positive appraisal of military experiences. Later-life events were directly and indirectly (through concerns about retirement) associated with positive adjustment. Results suggest that the personal resources of older age and more education and early-life adverse experiences can have cascading effects over the life span to impact well-being in both positive and negative ways.
... Data collected in a nationwide study of Vietnam veterans revealed that a significant proportion failed to recover prestress levels of functioning and exhibited psychological distress involving cognitive, affective, and physiological disturbances within the two decades following combat participation (Kulka et al., 1990). Chronic symptoms of psychological discomfort have also been reported among World War II (WWII) combat veterans (Elder & Clipp, 1989;Grinker & Spiegel, 1945) and prisoner-of-war (POW) survivors of WWII (Kluznik, Speed, Van Valkenburg, & Magraw, 1986;Sutker, Allain, & Winstead, 1993;Zeiss & Dickman, 1989) and the Korean conflict (Sutker, Winstead, Galina, & Allain, 1991). Recently, research has documented problems with anxiety, depression, and PTSD in 16%-19% of Persian Gulf War troops within the first year of return from war zone duty (Sutker, Uddo, Brailey, & Allain, 1993). ...
... Compared to personal resources and characteristics measured in this study, demographic variables did not contribute as significantly to group prediction, even though troop subsets differed in ethnicity, education, and rank, factors that have been found to be related to negative mental health outcomes to war stress in some veteran subsets (Kulka et al., 1990;Sutker et al., 1990;Ursano et al., 1981;Zeiss & Dickman, 1989). In a comprehensive review, Gibbs (1989) reported that higher education and income levels may be associated with lower postdisaster psychological distress. ...
Posttraumatic stress disorder (PTSD) can occur subsequent to war stress, but not all troops are negatively affected. A discriminant function model was used to study associations between personal and environmental resources and psychological outcomes subsequent to war zone stress. Among 775 Persian Gulf War exposed troops, 2 subsets were identified: 97 with PTSD diagnoses and 484 who had no psychological distress. A discriminant function, double cross-validated in random subsamples, classified 87% of troops, and demographic and stress severity variables did not alter results significantly. Personality hardiness commitment, avoidance coping, and perceived family cohesion emerged as consistent predictors of PTSD diagnosis. Findings suggest personal characteristics and environmental factors may alter vulnerability to negative war stress outcomes. Work is needed to identify mechanisms and causal pathways by which resource factors enhance or lower stress resistance.
... Another group that underwent starvation during World War II was prisoners of war (POWs). Studies of former POWs have documented the presence of psychiatric disorders such as posttraumatic stress disorder (PTSD; Kluznick, Speed, VanValkenburg, & Magraw, 1986;Zeiss & Dickman, 1989) and cognitive impairments influencing memory and learning (Sutker, Allain, Johnson, & Butters, 1992;Sutker, Galina, West, & Allain, 1990). One would expect to find that former POWs who had been underfed and lost large amounts of weight during captivity would show some signs of binge eating on their repatriation. ...
... It could be argued that it was the stress of being captured and held prisoner under harsh conditions that led to the substantial uncontrollable binge eating in these former POWs. Certainly, one would expect to find increased reports of PTSD and other stress-related symptoms in these men, as previous studies have shown (e.g., Kluznick et al., 1986;Zeiss & Dickman, 1989). However, binge eating is not a symptom of PTSD (American Psychiatric Association, 1987), nor has trauma alone, without food restriction or emphasis on body shape, been shown to cause binge eating. ...
Food restriction is correlated with binge eating, but evidence that restriction leads to binge eating is scanty. In this study we investigated postwar binge eating in 67 World War II combat veterans and 198 former prisoners of war. As predicted, binge eating was relatively rare in combat veterans but was significantly more prevalent in veterans who, as prisoners in German prisoner of war camps, lost significant amounts of weight during their captivity. Our data thus support the contention that starvation or dieting seems to precede binge eating.
... However, although many ex-POWs suffer from PTSD symptoms, the symptoms may fluctuate over time. According to Zeiss and Dickman (1989), time can either heal or intensify the psychological wounds of captivity, depending on an ex-POW's internal and external resources as well as life experiences after release. That is, barring an initial decline in psychological distress soon after a POW is released from captivity, no clear temporal trajectory is discernable. ...
... Based on Zeiss and Dickman's (1989) ideas, we wanted to examine the involvement of cognitive-affective representations of attachment security (memories, thoughts, images of being loved and cared for by others and confidence in others' availability and responsiveness in times of need) in the long-term trajectories of PTSD following war captivity. Such trauma occurs in circumstances where a victim cannot escape and is deliberately traumatized by another person (the captor). ...
TSaChi eiN-Dor Interdisciplinary Center (IDC) Herzliya attachment security contributes to resilience in times of stress, but it can be disrupted by traumatic events that shatter positive views of self and others. We followed israeli ex-PoWs of the Yom kippur War over 17 years and examined associations between trajectories of posttraumatic stress disorder (PTSD) and dis-ruptions in the regulatory functions of the attachment system. Fifty-nine ex-PoWs and 39 control veterans from the same war who had reported on PTSD 18, 30, and 35 years after the war performed laboratory cognitive tasks assessing activa-tion of mental representations of security in response to threat and the ability of these representations to color neutral stimuli with positive affect and reduce ac-cess to trauma-related thoughts. as compared to controls, ex-PoWs with persis-tent PTSD over the 17-year period exhibited dramatic disruptions in the soothing and healing functions of attachment security representations. These disruptions
... Iran began to release prisoners again in a large numbers after 1998 and so the rest spent 14 to 21 years in prison (26) . According to the study conducted in1989 the POWs of the Second world War stayed for a period ranging from 6-26 months (13) ; the average length of captivity the POWs held in Vietnam was five years and three months (27) ; and for Croatian POWs duration of captivity ranged from 6-9 months (28) . Regarding the Time elapsed since release the formal release of POWs took place in August, 1990 (41,000 IPOWs were released) and continued until May, 2003 (55 IPOWs) after Iraq was invaded by a coalition led by the USA (22) . ...
Objective: To find out the prevalence of anxiety and depression among Iraqi repatriated prisoners of Iran-Iraq war(IRPOWs), and the relationship with some variables.Methodology: A descriptive study was carried out from Oct. 18th, 2009 through Jan. 10th, 2010. A Snowballsampling as a non-probability sampling technique was used to recruit 92 repatriates who had visited Ministry ofHuman Rights. An instrument was constructed for this purpose. The constructed instrument consisted of sixdemographic characteristics, and fourteen items to measure the level of anxiety and depression in prisoners ofwar (POWs). Data were collected with using the constructed instrument and the process of the interview as meansfor data collection. Data were analyzed through the application of descriptive statistical analysis, which are;percentages, frequencies and inferential statistic analysis (Pearson correlation coefficient).Results: The study revealed that the majority of IRPOWs have some levels of; anxiety (62.0%) with the levels of:mild (28.3%), moderate (25.0%), and severe (8.7%); and depression (63.0%) with the levels of: mild (27.2%),moderate (29.3%), and severe (6.5%). The findings also indicated that there is no significant relationship betweenanxiety and depression relative to; current age, age at capture, duration of captivity, marital status, and level ofeducation.Recommendations: The study recommends that it is very important to establish special mental health servicescentres within the primary health care centres deal with those repatriates for counselling and in order to diagnoseand treat them and further studies in this field with follow-up studies for the POWs
... Iran began to release prisoners again in a large numbers after 1998 and so the rest spent 14 to 21 years in prison (16) . According to the study of Zeiss et al. (1985) the POWs of the Second world War stayed for a period ranging from 6-26 months (17) ; the average length of captivity the POWs held in Vietnam was five years and three months (18) ; and for Croatian POWs duration of captivity ranged from 6-9 months (19) . Regarding the Time elapsed since release the formal release of POWs took place in August, 1990 (41,000 IPOWs were released) and continued until May, 2003 (55 IPOWs) after Iraq was invaded by a coalition led by the USA (16) . ...
Objective: To find out the ways of coping to deal with stress used by the Iraqi repatriated prisoners of Iran-Iraq war, and also to find out the relationship between these ways and some demographic characteristics. Methodology: A descriptive study was carried out of Oct. 18th, 2010 through Jan. 10th, 2011. A Snowball sampling as a non-probability sampling technique was used to recruit 92 repatriates who had visited Ministry of Human Rights. An instrument was constructed for the purpose. The constructed instrument consisted of six demographic characteristics, and twenty eight items for measuring the level coping in POWs. Data were collected with using the constructed instrument and the process of the interview as means for data collection. Data were analyzed through the application of descriptive statistical analysis, which are; percentages, frequencies and inferential statistical analysis (Pearson correlation coefficient). Results: The study revealed that the majority of IRPOWs have some levels of coping that 31.5% (n= 29) of IRPOWs have weak level of coping; 64.1% (n= 59) have medium level of coping; and only 4.3% (n= 4) have good level of coping. The findings also indicated that there is no significant relationship between coping relative to; current age, age at capture, duration of captivity, marital status, and level of education. Conclusions: The present study concluded that all the IPOWS were males and married, the majority were stayed in captivity sixteen years and more, high percentage of them had Bachelor degree. The study indicated that the majority of IPOWS used the religious commitment and mediation as a mean of coping to deal with stress. Recommendations: The study recommends that it is very important to establish special mental health services centers within the primary health care centers deal with those repatriates for counseling and in order to diagnose and treat them and further studies in this field with follow-up studies for the repatriates.
... 53,54 Yet another approach proposes that an initial improvement in PTSD symptoms will occur in the aftermath of the traumatic event, but beyond this, there are no precise predictions that can be made regarding the longitudinal course of the disorder. 55 Three possible courses of PTSD were already identified by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) 56 : acute, chronic, and delayed. In the early days, Blank also proposed intermittent and reactivated PTSD as additional courses. ...
Objectives:
Several medical and psychiatric disorders have stage-based treatment decision-making methods. However, international treatment guidelines for posttraumatic stress disorder (PTSD) fail to give specific treatment recommendations based on chronicity or stage of the disorder. There is convincing evidence of a finite range of PTSD symptom trajectories, implying that different phenotypes of the disorder can be distinguished, which are highly relevant for a staging typology of PTSD.
Methods:
State-of-the-art review building on prior work on staging models in other disorders as a mapping tool to identify and synthesize toward PTSD.
Results:
We propose a four-stage model of PTSD ranging from stage 0: trauma-exposed asymptomatic but at risk to stage 4: severe unremitting illness of increasing chronicity. We favor a symptom description in various chronological characteristics based on neurobiological markers, information processing systems, stress reactivity, and consciousness dimensions. We also advocate for a separate phenomenology of treatment resistance since this can yield treatment recommendations.
Conclusion:
A staging perspective in the field of PTSD is highly needed. This can facilitate the selection of interventions that are proportionate to patients' current needs and risk of illness progression and can also contribute to an efficient framework to organize biomarker data and guide service delivery. Therefore, we propose that a neurobiologically driven trajectory-based typology of PTSD can help deduct several treatment recommendations leading to a more personalized and refined grid to strategize, plan and evaluate treatment interventions.
... Iran began to release prisoners again in a large numbers after 1998 and so the rest spent 14 to 21 years in prison (16) . According to the study of Zeiss et al. (1985) the POWs of the Second world War stayed for a period ranging from 6-26 months (17) ; the average length of captivity the POWs held in Vietnam was five years and three months (18) ; and for Croatian POWs duration of captivity ranged from 6-9 months (19) . Regarding the Time elapsed since release the formal release of POWs took place in August, 1990 (41,000 IPOWs were released) and continued until May, 2003 (55 IPOWs) after Iraq was invaded by a coalition led by the USA (16) . ...
... Iran began to release prisoners again in a large numbers after 1998 and so the rest spent 14 to 21 years in prison (26) . According to the study conducted in1989 the POWs of the Second world War stayed for a period ranging from 6-26 months (13) ; the average length of captivity the POWs held in Vietnam was five years and three months (27) ; and for Croatian POWs duration of captivity ranged from 6-9 months (28) . Regarding the Time elapsed since release the formal release of POWs took place in August, 1990 (41,000 IPOWs were released) and continued until May, 2003 (55 IPOWs) after Iraq was invaded by a coalition led by the USA (22) . ...
0891-0899 وكذلك بين العالقة لمعرفة هذين مستويات العائدين. االسرى لهؤالء الديموغرافية المواصفات وبعض اإلضطرابين المنهجية : وصفية دراسة إنجازها تم من تاريخ 09 الثاني، تشرين 2118 الثاني، كانون من العاشر الى 2101 ، أستخدام تم األحتمالية غير الطريقة الم ستندة الب البحث عينة جمع في الثلجية الكرة على الغة 82 الذين من عائد أسير زيارة في كانوا ل بغداد. في األنسان حقوق وزارة أجل من جمع المعلومات بالبحث الخاصة فقد الغرض لهذا خاص إستبيان أستخدام تم و ال المقابلة بأستعمال مختصرة من ستة من يتكون األول قسمين: ويتضمن الديموغرافية المواصفات العائديين لألسرى ، على يحتوي الثاني والقسم 01 فقر ة ل مخصصة مستويات قياس ةالكآبة القلق إضطرابي. تحليل تم المعلومات جمعت التي التحلي بتطبيق التحليلي. األحصاء وأيضا المئوية؛ والنسبة الترددات تضمن والذي الوصفي ل النتائج: (العائديين العراقيين األسرى غالبية بأن الدراسة كشفت 0221 ا بعض لديهم)% إضطراب من لمستويات (البسيط منها القلق 2922 %)؛ (والمتوسط 2.21 (والشديد %)؛ 928 الكآبة أما ،)% (فأن 0221 منهم)% اإلضطراب: بهذا مصاب (البسيط منها 2822 و)% (المتوسط 2822)% و (العالي 02. .)% أي الدراسة تجد ولم هذ بين ما أحصائية عالقة ين اإلضطراب ين و أ لألسرى اليموغرافية المواصفات من ي العائديين. التوصيات: أوصت ب الدراسة ضم مرا ضمن النفسية للصحة خاصة مراكز األ الصحية العناية كز ل ولية ومتابعة معرفة و عالج العائديين، األسرى هؤالء وكذلك ب باألستمرار العمل لم الدراسات أنجاز الصحية حاالتهم تطور تابعة ال جسمي ة و ال نفسي ة. Abstract: Objective: To find out the prevalence of anxiety and depression among Iraqi repatriated prisoners of Iran-Iraq war (IRPOWs), and the relationship with some variables. Methodology: A descriptive study was carried out from Oct. 18th, 2009 through Jan. 10th, 2010. A Snowball sampling as a non-probability sampling technique was used to recruit 92 repatriates who had visited Ministry of Human Rights. An instrument was constructed for this purpose. The constructed instrument consisted of six demographic characteristics, and fourteen items to measure the level of anxiety and depression in prisoners of war (POWs). Data were collected with using the constructed instrument and the process of the interview as means for data collection. Data were analyzed through the application of descriptive statistical analysis, which are; percentages, frequencies and inferential statistic analysis (Pearson correlation coefficient). Results: The study revealed that the majority of IRPOWs have some levels of; anxiety (62.0%) with the levels of: mild (28.3%), moderate (25.0%), and severe (8.7%); and depression (63.0%) with the levels of: mild (27.2%), moderate (29.3%), and severe (6.5%). The findings also indicated that there is no significant relationship between anxiety and depression relative to; current age, age at capture, duration of captivity, marital status, and level of education. Recommendations: The study recommends that it is very important to establish special mental health services centres within the primary health care centres deal with those repatriates for counselling and in order to diagnose and treat them and further studies in this field with follow-up studies for the POWs.
... For instance, military rank has recently been shown to have an impact on an individual's propensity to develop post-traumatic stress disorder (PTSD) postdeployment, symptom severity and outcome after treatment. [1][2][3][4][5] Much research has been devoted to understanding how human and nonhuman primates acquire information through the observation of a conspecific [6][7][8][9][10][11] ; yet, research on the social transmission of fear in nonprimate mammals has only more recently emerged. [12][13][14][15][16][17][18][19][20][21][22][23] A parallel, yet highly related, area of research has long showed that rats can acquire another type of information through conspecific interactions: social transmission of food preference (STFP). ...
Direct exposure to stimuli in their environment is not the only way that animals learn about important information. Individuals can infer fear from a social context through observation. Like humans, rats are very social animals, and may learn to infer information about their environment through their interactions with conspecifics. Here, we first review different models for social transmission of information in rodents. Second, we examine different modes of communication that are important to social learning. Then, we cover the different proximate factors that are thought to modulate the social transmission of information. Next, we identify social and environmental conditions that impact social learning, and finally, we conclude by revisiting social transmission through the lens of the Tinbergen framework. © 2018 John Wiley & Sons Ltd and International Behavioural and Neural Genetics Society
... In what might now be considered a form of post-traumatic stress disorder (PTSD), there could be many effects that could last decades, including isolation, guilt, and obsessive behaviors. Studies that compared Vietnam War veterans with those from World War II have shown that PTSD can be long lasting (Query et al. 1986;Zeiss and Dickman 1989). For veterans, there was often anxiety about one's place in a world that was healing divisions when one's own role in the conflict was seen as problematic. ...
... VeÊina vojnika neÊe odmah po povratku s bojiπta osjetiti posljedice, no ipak su u riziËnoj skupini za razvoj poteπkoÊa u svakodnevnom funkcioniranju uzrokovanih ratnim iskustvima. Posljedice se mogu oËitovati neposredno nakon traumatskog iskustva, ali i godinama nakon prvotnog izlaganja (Ford i sur., 2004;Zeiss i Dickman, 1989). Unutar mjesec dana nakon proaeivljenog traumatskog do-gaaja mogu se javiti simptomi akutnog stresnog poremeÊaja, poput pojaËanog znojenja, lupanja srca, crvenila, ponekad djelomiËnog ili potpunog zaboravljanja dogaaja ili pak uËestala prisjeÊanja na traumatski dogaaj u mislima ili snovima, posebno nakon izloaeenosti nekim podsjetnicima na sam dogaaj (situacije, osobe) te osjeÊaj krivnje (Delahanty i Nugent, 2006;Morris i Rao, 2013;Olff, Sijbrandij, Opmeer, Carlier i Gersons, 2009). ...
It is very well known that soldiers face diverse and severe stressors during active combat, but the impact of these stressors on one’s psychological wellbeing, social relationships, and quality of life does not end with the conclusion of the armed conflict. This book presents the findings of several studies investigating psychosocial characteristics of Croatian Homeland War veterans, the nature of their war and post-war experiences, and the potential long-term effects of these experiences on their personal and social life. Our goal was to enable setting a groundwork for a more efficient system of psychosocial aid, in hope to eventually increase the well-being of this population.
The first chapter features a brief overview of the Croatian Homeland War through relevant numbers, dates and specific information related to the formation and structure of the Croatian Army. The second chapter addresses the issue of long-term psychological consequences of active combat. It presents findings from research on the relationship between combat exposure, coping strategies, emotional competence, regulation and control, quality of life and posttraumatic stress symptoms in Homeland War veterans. The third chapter focuses on intergroup (relations between veterans and other social groups) and intragroup dynamic (relationships within the veterans’ population), as well as their impact on social capital. The final chapter presents the results of a survey examining preferred activities among veterans, focusing on their true needs and interests.
By understanding these processes and taking into account the specificities of the Homeland War and Croatian War veterans’ status, we tried to define key issues that are important for designing programs that will provide support for veterans at both individual and group levels and ensure the improvement of the quality of their personal and social life. The lack of recognition and understanding of the consequences of the Homeland War has caused numerous oversights in institutional policies and public image of war veterans, but there is always a possibility and hope that we can do more. We hope our findings will empower Homeland War veterans to focus their potential for cooperation and compassion toward increasing their personal wellbeing, as well as the wellbeing of their comrades and their families, leaving a positive impact on the whole community. In both institutionally sanctioned or individually motivated activities and programs it is important to rely on sound scientific foundations. We believe this study can be a reference for such future endeavors.
... To date, there is conflicting em pirical evidence regarding the course of combat-induced PTSS. Some prospective (e.g., Zerach et al., 2013) and retrospective (e.g., Zeiss and Dickman, 1989) studies among war veterans point to a general gradual decrease in PTSS. However, other studies have observed heterogeneous trajectories of PTSD with symptoms increasing and decreasing over time (e.g., Solomon and Mikulincer, 2006). ...
Objective
Little is known about trajectories of posttraumatic stress symptoms (PTSS) among former prisoners of war (ex-POWs) and the predictors of those trajectories. This study aimed to assess long-term PTSS trajectories among ex-POWs and comparable veterans and the role of hardiness and sensation seeking in predicting PTSS trajectory.
Method
A sample of 189 Israeli ex-POWs and 160 comparable combatants participated in a 17 year longitudinal study with three waves of measurements following the 1973 Yom Kippur War (T1: 1991, T2: 2003, T3: 2008). Participants completed validated self-report measures.
Results
Latent growth mixture modeling (LGMM) identified four longitudinal PTSS trajectories. Among ex-POWs, the majority of participants were classified in trajectories with "low-increasing" or "medium-increasing" levels of PTSS. Among the comparable veterans, however, the majority of participants were classified in a trajectory with "low" levels of PTSS. Ex-POWs with high levels of hardiness were less likely to belong to the "high" or "medium-increasing" PTSS trajectories, compared to the low-fluctuating trajectory.
Conclusions
The long-term course of PTSS is heterogeneous among both veterans and ex-POWs, with chronic and increasing symptom patterns being more prevalent amongst ex-POWs. Ex-POWs should be considered an at-risk population for exacerbated PTSS trajectories that is related to hardiness personality construct.
... In longitudinal studies of WWII POWs, PTSD rates have been found to range from 48% to 60% immediately after the war, decreasing to 29-48% 40 years later (Speed et al., 1989;Zeiss and Dickman, 1989;Beal, 1995). These figures are in line with the findings of Shlosberg and Strous (2005), who investigated the presence of PTSD in a cohort of Yom Kippur War veterans. ...
... In the study by Potts higher levels of posttraumatic stress were associated with poorer physical health. Studies of former south-east Asian POWs revealed high rates of PTSD: current PTSD 56% [24], 59% [25], 70% [26] and 85% [27]; lifetime PTSD 67% [28], 78% [26] and almost 80% [29]. This is much higher than the 11% found in this investigation. ...
Objective: Studying the rates of posttraumatic stress disorder (PTSD) in people who experienced World War II, but who have subsequently lived in different environments is a way of looking at the impact of recovery environment on PTSD. Immigrants had less support in terms of the social cohesion in their home country, but were not subjected to the same triggers of war-related intrusions.
Method: Posttraumatic stress disorder was investigated in citizens from the Netherlands who emigrated to Australia in the post-World War II years (n = 251). Immigrants born between 1920 and 1930 (n = 171) were compared with a same-aged group living in Holland (n = 1461) for stressful war experiences and the extent of PTSD.
Results: Those who had been exposed to the most severe war stress were over-represented in the immigrant group. Immigrants with current PTSD more often stated that motives for migration were threat of a third world war, disappointment with Dutch society and personal problems. We were unable to demonstrate specific effects of emigration on the prevalence of current PTSD.
Conclusions: This study suggests that exposure to severe war stress promoted the need to emigrate. The comparable PTSD scores of the groups of war victims living in Australia and the Netherlands support the notion that extreme war stress may be considered the primary determining factor in the development of PTSD, and that actual post-war living circumstances are, in the long term, of subordinate importance.
... However, severe traumatic events like war trauma may also have long-term effects: occupational and social functional impairment, health problems, high comorbidity with other psychiatric disorders, and reduced quality of life even several decades after the war (Aldwin, Levenson, & Spiro, 1994;Hoge & Warner, 2014;Sareen et al., 2007;Wisco et al., 2014). In rare studies examining the long-term consequences of war-related PTSD symptoms, Zeiss and Dickman (1989) found that 56% of former prisoners during World War II have reported that they still experience PTSD symptoms even 40 years after the trauma, while Aldwin et al. (1994) found lifelong negative consequences of combat exposure in early adulthood on PTSD symptoms nearly 50 years after the trauma. These studies evidenced that combat-related PTSD is a highly persistent phenomenon, and may have a significant impact on one's wellbeing several decades after experiencing the traumatic event. ...
Many soldiers encounter difficulties while transitioning from military to civilian life. Such severe traumatic events may also have long-term effects. Previous studies have shown a strong relationship between coping strategies and posttraumatic stress disorder (PTSD) symptoms. The aim of this study was to investigate how veterans who were exposed to war trauma 20 years ago now deal with everyday life stressors, and how their current coping strategies relate to the four-factor model of PTSD. A total of 220 male Croatian Homeland War Veterans between the ages of 38 and 75 participated. Questionnaires included Combat Exposure Scale, Posttraumatic Stress Disorder Checklist - Military Version and Ways of Coping Questionnaire. Results showed positive association between dysphoria and escape-avoidance coping strategy and negative association between dysphoria and positive reappraisal coping strategy. Given that dysphoria symptoms are associated with the chronicity of PTSD and poorer response to PTSD therapy treatment in war veterans, our results underscore the importance of treating dysphoria symptoms and promoting engagement coping strategies for this population.
... To date, there is conflicting empirical evidence regarding the course of captivity-induced PTSD. While most studies point to a gradual decrease in the number of PTSS (e.g., Zeiss & Dickman, 1989), other studies have observed a fluctuating course with symptoms increasing and decreasing over time (e.g., Port, Engdahl, & Frazier, 2001). A prospective study by our team found an incline in PTSD rates over a 17-year period among Israeli ex-POWs, (Solomon, Horesh, Ein-Dor, & Ohry, 2012). ...
Objectives:
This prospective study aims to assess the role of fathers' posttraumatic stress disorder (PTSD) symptoms (PTSS), the course of these symptoms over the years, and the relationship between these symptoms and their adult offspring's own PTSS and level of differentiation of self.
Method:
A sample of 123 Israeli father-child dyads (79 ex-prisoners of war [ex-POWs] dyads and a comparison group of 44 veterans' dyads) completed self-report measures. The fathers participated in 2 waves of measurements (1991 and 2008), while the offspring took part in 2013-2014.
Results:
Increase in the fathers' PTSS over the years was related to high levels of his offspring's PTSS. Among ex-POWs' offspring, self-differentiation mediated the association between the father's PTSS and offspring's PTSS. Thus, a greater increase in the ex-POWs' PTSS over time was correlated to lower levels of the offspring's self-differentiation, which in turn was correlated to higher rates of PTSS.
Conclusion:
Veterans' PTSS as well as offspring's self-differentiation are mechanisms of the intergenerational transmission of captivity trauma.
... Iran began to release prisoners again in a large numbers after 1998 and so the rest spent 14 to 21 years in prison (26) . According to the study conducted in1989 the POWs of the Second world War stayed for a period ranging from 6-26 months (13) ; the average length of captivity the POWs held in Vietnam was five years and three months (27) ; and for Croatian POWs duration of captivity ranged from 6-9 months (28) . Regarding the Time elapsed since release the formal release of POWs took place in August, 1990 (41,000 IPOWs were released) and continued until May, 2003 (55 IPOWs) after Iraq was invaded by a coalition led by the USA (22) . ...
... Iran began to release prisoners again in a large numbers after 1998 and so the rest spent 14 to 21 years in prison (16) . According to the study of Zeiss et al. (1985) the POWs of the Second world War stayed for a period ranging from 6-26 months (17) ; the average length of captivity the POWs held in Vietnam was five years and three months (18) ; and for Croatian POWs duration of captivity ranged from 6-9 months (19) . Regarding the Time elapsed since release the formal release of POWs took place in August, 1990 (41,000 IPOWs were released) and continued until May, 2003 (55 IPOWs) after Iraq was invaded by a coalition led by the USA (16) . ...
Objective: To find out the ways of coping to deal with stress used by the Iraqi repatriated prisoners of Iran-Iraq war, and also to find out the relationship between these ways and some demographic characteristics. Methodology: A descriptive study was carried out from Oct. 18th, 2010 through Jan. 10 th , 2011. A Snowball sampling as a non-probability sampling technique was used to recruit 92 repatriates who had visited Ministry of Human Rights. An instrument was constructed for the purpose. The constructed instrument consisted of six demographic characteristics, and twenty eight items for measuring the level coping in POWs. Data were collected with using the constructed instrument and the process of the interview as means for data collection. Data were analyzed through the application of descriptive statistical analysis, which are; percentages, frequencies and inferential statistic analysis (Pearson correlation coefficient). Results: The study revealed that the majority of IRPOWs have some levels of coping that 31.5% (n= 29) of IRPOWs have weak level of coping; 64.1% (n= 59) have medium level of coping; and only 4.3% (n= 4) have good level of coping. The findings also indicated that there is no significant relationship between coping relative to; current age, age at capture, duration of captivity, marital status, and level of education. Conclusions: The present study concluded that all the IPOWS were males and married, the majority were stayed in captivity sixteen years and more, high percentage of them had Bachelor degree. The study indicated that the majority of IPOWS used the religious commitment and mediation as a mean of coping to deal with stress. Recommendations: The study recommends that it is very important to establish special mental health services centres within the primary health care centres deal with those repatriates for counselling and in
... Because PTSD is a chronic waxing and waning disorder (Bromet et al., 1998;Dirkzwager et al., 2001;Johnson et al., 2004;Yule et al., 2000;Zeiss & Dickman, 1989;Zlotnick et al., 2004), there appears to be considerable variability in symptom patterns (Solomon, 1989) over time. If having a diagnosis of PTSD is a requirement for a legal proceeding of some sort, a person exposed at an earlier point in time might not, at the time of the proceeding, meet the formal criteria for a diagnosis of PTSD. ...
... To date, there is conflicting empirical evidence regarding the course of captivity-induced PTSD. While most studies point to a gradual decrease in the number of posttraumatic symptoms (e.g., Zeiss and Dickman, 1989), other studies observed a fluctuating course with symptoms increasing and decreasing over time (e.g., Port et al., 2001). A prospective study among Israeli ex-POWs found that 34.7% of ex-POWs and only 2.5% of the matched veterans group met PTSD criteria 35 years after the war, with prior fluctuations. ...
Background:
The aversive impact of combat and parents' combat-induced posttraumatic stress disorder (PTSD) on young children has been examined in a few studies. However, the long-term toll of war captivity on the secondary traumatization (ST) of adult offspring remains unknown. This study aimed to assess the longitudinal associations between former prisoners of war (ex-POWs), PTSD, depressive symptoms and their adult offsprings ST.
Method:
A sample of 134 Israeli father-child dyads (80 ex-POWs dyads and a comparison group of 44 veterans'dyads) completed self-report measures. The fathers participated in three waves of measurements following the Yom Kippur War (T1: 1991, T2: 2003, and T3: 2008), while the offspring took part in T4 (2013).
Results:
Offspring of ex-POWs with PTSD at T3 reported more ST symptoms than offspring of ex-POWs without PTSD and controls. Ex-POWs' PTSD hyper-arousal symptom cluster at T3 was positively related to offsprings ST avoidance symptom cluster. Offspring of ex-POWs with chronic and delayed PTSD trajectories reported more ST symptoms than offspring of ex-POWS and controls with resilient trajectories. Ex-POWs' PTSD and depression symptoms at T1, T2 and T3 mediated the link between war captivity (groups) and offsprings ST in T4.
Limitations:
The use of self-report measures that did not cover the entire span of 40 years since the war, might may bias the results.
Conclusions:
The intergenerational transmission of captivity related trauma following the Yom Kippur War was exemplified. ST symptoms among ex-POWs' adult offspring are closely related to their father' PTSD and related depressive symptom comorbidity.
... Although many ex-POWs may suffer from PTSD symptoms, these symptoms may fluctuate over time. According to Zeiss and Dickman (1989), time can either heal or intensify the psychological wounds of captivity, depending on an ex-POW's internal and external resources as well as life experiences after repatriation. ...
As most research devoted to the aftermath of war captivity discusses physical and intrapersonal ramifications, the interpersonal domain is left largely underrepresented in research. Our aim in this chapter is to shed light on this realm of psychosocial deficit. Indeed, throughout this chapter we highlight the manner in which various dimensions of interpersonal pernicious and malicious conduct during captivity are weaved into a tapestry of dysfunctional interpersonal relationships in the life that is to come after repatriation. In order to accomplish this we first elaborate in some detail the ingenuity of torture and misconduct of war captivity. Next, we address multifarious dimensions of interpersonal disruption that POWs may undergo after repatriation. Throughout the chapter we provide findings from a longitudinal study that has examined such aspects in a prospective cohort of Israeli ex-POWs who fell captive in 1973 in Egypt and Syria. Concomitantly we survey various interpersonal aspects that include attachment injury, marital and familial adjustment, loneliness and betrayal following captivity. Once these dimensions of post-repatriation become evident, it is then simple to see the devastation that war captivity instills in concentric circles of interpersonal relationships: family, friend, society and state. It is from these realizations that we suggest directions for researchers, clinicians, and policy makers to work towards the mending of interpersonal bonds, the communalization of trauma, and reinstatement of trust. Hopefully with such efforts where detachment was, there attachment will once again be, and where loneliness reigned there connection will once again rule.
... However, the literature is still lagging with regard to the longitudinal course of PTSD within the older adult population (Cook, Naseem, & Thorp, 2015). For instance, in older adults over a lifetime symptoms may wax and wane (e.g., Port, Engdahl, & Frazier, 2001;Zeiss, Dickman, & Dickman, 1989) or symptoms may be delayed/not fully developed until older adulthood (e.g., Hiskey, Luckie, Davies, & Brewin, 2008). Consequently, the older adult SUD/PTSD population requires increased research and clinical attention. ...
The U.S. population is aging, and many older adults are projected to struggle with substance use disorder (SUD) and trauma issues. However, to date no studies exist of the national SUD treatment landscape with regard to specialized services for older adults and trauma counseling. To address this literature gap, data were surveyed from the 2009 to 2011 administration of the National Survey of Substance Abuse Treatment Services (N-SSATS) regarding facilities that offered specialized services for both geropsychological and trauma counseling care (n 854). Results underscore that treatment availability for this specialized population is scarce throughout most of the U.S., and no more than 1 quarter of these treatment facilities are accredited by a major body such as JCAHO or CARF. Suggestions for improving treatment accessibility nationwide, better matching the treatment orientations to the geropsychological SUD population, and curriculum matters for clinical and counseling psychology training programs are all discussed.
... 69,70 It seems that exposure to longer potentially traumatic events is associated with a greater severity of PTSD symptoms. 71 Other characteristics that seem to increase the likelihood of psychological harm include an effect of surprise as well as being trapped or exposed to the point of exhaustion. 30 One overview of the literature on PTSD, 36 among others, supported the idea of dividing traumatic events into two categories. ...
... Retrospective studies are most common among the literature on symptom presentation, although these types of studies have obvious limitations when compared with longitudinal data. Nearly 25% of a sample of WWII POWs reported that they had experienced difficulties with PTSD symptoms continuously, while 62% indicated they were periodically troubled by these symptoms over the course of 40 years (Zeiss and Dickman, 1989). Another study with former WWII POWs indicated that 67% had PTSD at some point in their lifetimes, with approximately 29% fully recovered, 39% reporting mild symptoms, 24% reporting moderate symptoms, and 8% reporting no improvement or worsening of symptoms (Kluznik et al., 1986). ...
... More specifically to trauma, the characteristics of potentially traumatic stimuli include the severity of the exposure (Brewin, Andrews & Valentine, 2000;Brunet, Sergerie, & Corbo, 2006), the degree of similarity of the event with a previously traumatic event (Briere, 1997), predictability (Barlow, 2002), and the duration of the event (Lane, 1993(Lane, , 1991Paton, 1989; indeed, it seems that longer events are associated with a greater severity of PTSD symptoms (Zeiss, & Dickman, 1989). Other characteristics that seem to increase the likelihood of psychological harm include an effect of surprise, as well as being trapped or exposed to the point of exhaustion (Herman, 1997). ...
... Recently traumatized older adults may present different symptom profiles, as suggested by Goenjian et al. (1994), who found that although overall PTSD severity was comparable in older and younger earthquake survivors, older individuals exhibited relatively higher hyperarousal symptoms and lower reexperiencing symptoms. PTSD symptom expression may vary across time (e.g., Kato, Asukai, Miyake, Minakawa, & Nishiyama, 1996;Maercker, Gäbler, & Schützwohl, 2013;Port, Engdahl, & Frazier, 2001;Scott, Poulin, & Silver, 2013;Zeiss & Dickman, 1989), and symptoms may re-emerge or worsen because of life events such as retirement or loss of a spouse (Hiskey, Luckie, Davies, & Brewin, 2008;Port, Engdahl, Frazier, & Eberly, 2002;Schnurr, Lunney, Sengupta, & Spiro, 2005). Age differences in PTSD prevalence and clinical presentation may depend on demographic factors (e.g., Norris, Kaniasty, Conrad, Inman, & Murphy, 1992). ...
Assessment of posttraumatic stress disorder (PTSD) in older adults has received limited investigation. The purpose of this study was to compare the severity of PTSD symptoms in treatment-seeking older and younger U.S. veterans with PTSD. Participants were 360 male and 284 female veterans enrolled in 2 separate clinical trials of psychotherapy for PTSD. About 4% of the participants were age 60 years or older. Symptoms were assessed before treatment using clinician-rated and self-report measures. For men, only numbing symptoms were lower in older veterans; this was so in clinician ratings, d = 0.76, and self-reports, d = 0.65. For women, clinician-rated hyperarousal symptoms were lower in older veterans, d = 0.57. Clinician-rated and self-reported symptoms were strongly related, Bs = 0.95 and 0.80 in the male and female samples, respectively. Among men, clinician-rated and self-reported reexperiencing and hyperarousal symptoms were associated only in younger veterans. Accurate assessment of PTSD symptoms in older adults is essential to identifying and implementing effective treatment. Our findings suggest that some symptoms may be lower in older men, and that some symptoms of PTSD may be underdetected in older women. Future research should assess the combined effect of gender and age on PTSD symptom presentation.
... First, the Israeli prisoners were held for periods ranging from six weeks to eight months, whereas the American POWs in the Far East, for example, were held for several years, during which they were subjected to prolonged and repeated torture under extremely harsh physical conditions and deprivation (Goldstein, van Kammen, Shelly, Miller, & van Kammen, 1987;Sutker & Allain, 1996). These differences may explain the relatively low rates of PTSD among the participants in our sample compared with the 30% through 76% among veterans examined 40 to 50 years after World War II (Zeiss & Dickman, 1989;Sutker & Allain, 1996). ...
This study examined marital adjustment and relations among couples where husbands had been a prisoner-of-war (i.e., POW) and couples where husbands were veterans, but not POWs. The study also examined the relative contribution of the husband's post-traumatic stress disorder (i.e., PTSD) and POW experience to both spouses' marital adjustment. Results from 157 couples (85 former POWs and spouses as well as 72 veterans but not POWs and their spouses as controls) indicated that former POW couples had lower marital adjustment, sexual satisfaction, and self-disclosure, and higher verbal abuse than the control couples. Captivity indirectly influenced the husband's marital adjustment through his PTSD. In turn, PTSD had an indirect effect on both spouses' marital adjustment, fully mediated through marital relations variables.
... Most of what is known about the long-term effects of service relates specifically to combat or imprisonment and resulting psychological distress, PTSD symptom clusters, or mortality rates. There is evidence of persistent, and even intensified, effects of service during World War II on veterans after 5 years (e.g., Futterman and Pumpian-Mindlin 1951), 15 years (e.g., Archibald et al. 1962), 20 years (e.g., Archibald and Tuddenham 1965), 30 years (e.g., Klonoff et al. 1976), 40 years (e.g., Kluznick et al. 1986;Schrueder, Kleijn, and Rooijmans 2000;Spiro et al. 1994;Zeiss and Dickman 1989), and 50 years (e.g., Dirkzwager, Bramser, and Van Der Ploeg 2001;Hunt and Robbins 2001a;Port, Engdahl, and Frazier 2001). The incidences of these effects and the processes and mechanisms that drive them, however, have not been clearly explicated. ...
Most scholarship on aging is based on cohorts born early in the 20th century, and these cohorts have had significant experience with war. Wartime experiences may therefore be critical but largely hidden variables underlying current scientific knowledge about aging. Evidence marshaled in this article illustrates the powerful insights gained when research on this topic is guided by life-course propositions and data. It reveals how wartime military service, especially during World War 11, affected the short- and long-ranging development of recruits. It also highlights the need to better account for the potential legacies of service for physical, psychological, and social functioning in late life. These matters will become increasingly important as sizable World War 11 and Korean veteran populations move through advanced old age, and as the Vietnam veteran population moves into old age. Systematic attention to the effects of wartime service is necessary to determine the degree to which contemporary knowledge about aging can be generalized to future cohorts.
PTSD is not just a short-term or acute response to significant trauma. For many individuals diagnosed with PTSD, the disorder becomes recurrent and/or chronic affecting the individual throughout their life. The negative effects of PTSD on the ability to function normally (a major part of the diagnostic criteria) can lead to the loss of an individual’s support system as well as the loss of access to care. An individual with PTSD is more likely than most others to have comorbid problems with chronic pain, substance abuse, and depression, problems that affect response to care and require disease-specific therapy. The United States is currently experiencing widespread epidemics of opiate overdose and suicide, negative factors that affect a large cohort of the population diagnosed with PTSD. At times of stress and/or re-traumatization, individuals diagnosed with PTSD are likely to go through periods of functional and psychiatric decompensation. A designed treatment protocol is presented emphasizing the need to protect the patient from danger to self and others, as well as the need to provide and maintain support systems during the period of decompensation.
This study aims to establish the effect of self-perceived social support on the intensity of Post-Traumatic Stress Disorder (PTSD) symptoms and Mental Health-Related Quality of Life (MHRQoL) in veterans more than two decades after exposure to trauma in the Homeland War in Croatia, which took place from 1990 to 1995. The sample comprised 259 Croatian Homeland War veterans diagnosed with PTSD, with at least 6 months of combat experience. Among them, 90 subjects had also experienced imprisonment in enemy prison camps (at least 1 month of captivity). The subjects were evaluated using the questionnaire on self-perceived social support, sociodemographic questionnaire, PTSD self-report checklist (PCL-5) and Short Form (SF-36) Health Survey questionnaire. A general regression model analysis was performed to determine whether social support affected patients' MHRQoL and intensity of the PTSD symptoms. The obtained results showed that veterans who had a more positive perception of social support after the events of the war had less intense PTSD symptoms and better MHRQoL. Furthermore, captivity and socioeconomic status were shown to be important predictors of PTSD and MHRQoL. The nonimprisoned veteran group was more likely to develop more severe PTSD symptoms and have poorer MHRQoL compared to the group of former prisoners of war (ex-POWs). This could be due to better postwar care and social support, which ex-POWs received after their release from captivity.
Notre problématique s'articule sur deux approches théoriques, à savoir la psychologie interculturelle francophone et la psychologie clinique interculturelle du trauma. En effet, nous étudions l'édification d'une métabolisation structurelle au profit d'une métabolisation expérientielle chez le sujet. Pour cela, nous interrogeons spécifiquement dans ce travail le lien entre l'interculturation positive et le dépassement d'un trauma. En effet, ces deux concepts nous semblent a minima reliés par la notion de "mise en sens" nécessaire face à l'effraction d'une altérité radicale, qu'elle vienne d'un agresseur, ou d'une rencontre avec une culture radicalement Autre. Nous questionnons la corrélation entre l'interculturation positive et dépassement du traumatisme à la lumière de nombreuses variables : contexte personnel, dispositions et processus psychiques, facteurs environnementaux…Une étude préliminaire (N = 10) et une première série d'entretiens qualitatifs (N = 13) nous ont permis d'élaborer un questionnaire quantitatif. Nos résultats (N = 191) démontrent un lien entre l'interculturation positive et le dépassement du traumatisme (rhô=.217, p=.003), lien modulé principalement par l'estime de soi et l'aptitude aux relations. Nous proposons des recommandations cliniques pour l'élaboration d'un Tiers-espace thérapeutique créatif et interculturalisé venant soutenir la recherche de sens de ceux confrontés à l'effraction de l'altérité radicale de la mort, faisant de l'approche interculturelle un engagement socio-géopolitique bienveillant au service d'une clinique victimaire engagée, réflexive et consciente
This review presents recent empirical developments on posttraumatic stress disorder (PTSD) in older adults, highlighting some of the most interesting lines of investigation that have taken place over the past few years. The majority of the extant literature has focused on male veterans or former prisoners of war, Caucasians, and those from the United States. Major advances have taken place in terms longitudinal investigations of representative samples of veterans and their health and functioning in relation to traumatic exposure. The current review explores the prevalence and impact, course and associated consequences, as well as available treatment for older adult survivors of traumatic experiences in an effort to increase education and awareness to improve overall health and functioning among this population.
Objective:
We investigated the incidence of first-onset psychiatric disorders among Ohio Army National Guard members and the sociodemographic and military factors associated with these incident disorders. We aimed to identify potential risk factors and mitigating factors for a range of psychiatric disorders in a representative military sample.
Methods:
We analyzed data on a representative sample of 528 Ohio Army National Guard members who were assessed in person annually for first-onset psychiatric disorders from 2008 through 2012 using structured clinical interviews. We used a multivariable discrete-time Cox proportional hazard model to determine risk factors of first-onset anxiety or mood disorders.
Results:
The annualized incidence rate of any first-onset psychiatric disorder was 9.8 per 100 person-years at risk. Alcohol use disorder and major depressive disorder had the highest incidence rates among the unique disorders under study (5.0 and 4.2 per 100 person-years at risk, respectively). We found an association between respondents endorsing past-year deployment and a 29% increase in the risk of incident anxiety or mood disorder, whereas the past-year experience of any non-deployment traumatic event was associated with a 32% increase in risk of incident anxiety or mood disorder.
Conclusion:
Soldiers experience a substantial burden of first-onset alcohol use disorder and major depressive disorder annually; the experience of non-deployment-related traumatic events contributes substantially to increasing risk, suggesting that any effort aimed at mitigating mood and anxiety disorders in this population must consider the soldier's life experience and military experience.
In 1980, the APA added PTSD to the third edition of its DSM-III nosologic classification scheme. The DSM-III chose to define PTSD as a final common pathway occurring in response to many different types of catastrophic stressors, including burn injury, concentration camps, combat, and natural disasters. In fact, this approach was in opposition to the idea of the uniqueness of individual traumas such as “Vietnam syndrome” or “post-rape syndrome”. Although a controversial diagnosis when first introduced, the concept of PTSD is today regarded as having filled an important gap in neuropsychiatric theory and practice. The DSM-III diagnostic criteria for PTSD were revised in DSM-IIIR (1987) and DSM-IV (APA, 1994). Diagnostic criteria for PTSD include a history of exposure to a “traumatic event” and symptoms from each of three symptom clusters: intrusive recollections, avoidant/numbing symptoms and hyperarousal symptoms. Another criterion concerns duration of symptoms (see Tab. 7.1). There are three subtypes of PTSD. The first is the acute subtype which corresponds to duration of symptoms of less than 3 months. The second is the chronic subtype which corresponds to a duration of symptoms of more than 3 months. The third subtype has a delayed onset, which corresponds to onset of symptoms at least 6 months following the stressor, but may be much later. Indeed, there have been cases in which PTSD re-emerged after 20, or even 40 years. PTSD is unique among other psychiatric diagnoses because of the great importance placed upon the etiologic agent, the traumatic stressor. In fact, one cannot make a diagnosis unless the patient has actually met the stressor criterion that means that he or she has been exposed to a historical event that is considered traumatic. Another hallmark is the alternation between re-experiencing and avoiding trauma-related memories. The memories that are particularly associated with PTSD appear rapidly and spontaneously, often intruding into consciousness with high frequency. The intrusive memories may consist of images accompanied by high levels of physiological arousal and are experienced as re-enactments of the original trauma (flashbacks). Flashbacks are qualitatively different from memories of the trauma which are retrievable through a normal search of long-term memory. They may be distinguished from normal memories by the original intensity of the emotions that accompany the flashbacks (Terr, 1991; Van der Kolk & Fisler, 1995).
We studied the prevalence of long-term posttraumatic stress disorder (PTSD) symptoms in a population of men from Alsace-Lorraine who were forcibly drafted into the German armed forces during World War II (WW II), subsequently taken prisoners on the Russian front, and kept in Soviet captivity until repatriation to France several months or years later. They can be considered a homogeneous group with respect to age and their cultural and geographical backgrounds.
Objectives. Psychological consequences of natural disasters are outlined in the paper, and a variety of factors affecting the development and persistence of the posttraumatic stress disorder (PTSD) are discussed. Review. The prevalence of PTSD resulting from cataclysms varies depending on the time interval between traumatic experiences and the diagnosis, as well as on the extent and duration of damage. Significant factors increasing the riskfor PTSD include: intensity and suddenness of the disaster, loss or irreversible damage to the flat/house, and death of relatives due to the disaster. Conclusions. PTSD symptoms persist longer in individuals who received neither economic nor psychological support.
Being a prisoner of war (POW) is one of the most traumatic experiences to which individuals may be subjected. The literature shows that exposure to war captivity may result in long lasting scars manifested in psychological, somatic, cognitive, and functional impairment, including PTSD reactions. However, there is a wide variability in these distress reactions among POWs. The question is do personality characteristics account for the variability in psychosocial responses to war captivity? The present chapter examines the unique and combined contribution of three personal resources: Sensation seeking, attachment, and hardiness to mitigate the negative effects of captivity, as manifested in PTSD.
This chapter focuses on dementia, its diagnosis and the related characteristics. There is currently no effective treatment for stopping or reversing the impairment caused by degenerative forms of dementia. Affected persons eventually become bedridden, unable to swallow, and completely dependent on others for their care. Persons close to someone with dementia typically perceive the declines in the repertoire as major changes in "personality". However, the treatment of the behavior problems that develop in dementia has been dominated by the use of antipsychotic and atypical antipsychotic medications. The challenging behaviors that develop over the course of degenerative dementia continue to result in patients receiving restrictive pharmacological and mechanical restraint. Hence, within the field of the care of persons with dementia, there is increasing recognition of the need for the development of restraint-free interventions.
This chapter focuses on older adult trauma survivors. Information is presented on prevalence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD); course, functional impairment, suicide risk, and health care utilization in older adults with PTSD; and the impact of demographic factors such as gender, ethnicity, and race on PTSD in older individuals. In general, rates of ASD and PTSD are lower in older adults compared to other age groups. PTSD in older adults has been linked to suicidal ideation and attempts, functional impairment, physical health, and increased healthcare utilization. Although delayed onset of PTSD has been empirically verified in some military samples with World War II veterans and younger adult civilians, it is rare in the absence of any prior symptoms and might more accurately be labeled "delayed recognition." More information on trauma and PTSD in diverse populations of older adults is needed, such as racial and ethnic minorities, those with severe physical or mental impairment, noncommunity-residing groups, and those from nonindustrialized countries.
It is apparent from clinical experience and the literature that persons, who experience severe physical or mental trauma, are susceptible to premature aging (or psychological symptomatology). Long-term follow-up of repatriated prisoners of war also confirm this observation. Coping with physical and mental sequelae of captivity means a constant struggle to maintain some kind of homeostasis. Often, this delicate equilibrium fails. Claude Bernard stated that To have a free life, independent of the external environment, requires a constant internal environment (Bernard, 1957, P. 8). This is the underlying principle of homeostasis. When it collapses due to wear and tear processes, premature aging/morbidity process takes place.
Characteristic features of post-traumatic stress disorder (PTSD) include intrusive memories, avoidance, memory and concentration difficulties, and hyperalertness. Neuropsychological investigations of individuals with PTSD have suggested global and specific impairments of performance on standardized tests of memory. The use of the Emotional Stroop test has shown that trauma- related words are a sensitive measure of clinical state in PTSD patients. The Stroop paradigm has also shown that patients with PTSD appear to be characterized by implicit, explicit and autobiographical memory impairment. Available treatments for chronic post-traumatic stress disorder include cognitive-behaviour therapy, psychodynamic therapy and pharmacotherapy. Whereas drug treatment alone can rarely alleviate the suffering in PTSD, it appears to be most useful as an adjunct to psychotherapy. Tricyclic antidepressants are generally thought to be effective in alleviating symptoms, including nightmares, depression, sleep disorders and startle reactions, but are less able to relieve numbing. On the other hand, selective re-uptake blockers may be effective in decreasing numbing. However, rigorous clinical trials with double-blind placebo-controlled designs need to be performed to confirm these results. With new scientific discoveries in the understanding of PTSD, a new generation of pharmacological treatment is likely to emerge.
Assessment of PTSD in older adults is still in its infancy despite reflections on this subject in past literature. Factors that influence assessment are: traumas that occurred long in the past, lower prevalence, the fact that older people complain less, more misinterpretation of avoiding and intrusion, more somatic comorbidity and higher risk of cognitive impairment. The Clinician Administered PTSD Scale (CAPS) is mostly used to diagnose PTSD, but less researched in older age. Only two screening instruments have been validated, the PTSD Checklist (PCL) and the Self Rating Inventory for PTSD (SRIP), but cross-validation has still to be done. The PCL scale has been used more often and is also suitable for clinician rating, which is considered more appropriate for older adults. Biological measures have not yet been adapted for assessment in the complex biological systems of older age. Multimethod assessment is becoming more important and can address many of the difficulties in this field. Finally, much can be learned from knowledge already acquired from younger adults.
ously rapid succession and telecast and watched repeatedly around the world. Catastrophic events of war and organized violence, including terrorism, dramatically disrupt the fabric and order of a society, presenting vivid proof of the vulnerability of its members, threatening psychological adaptation and mental health, and cultivating a culture of fear. Research documents high rates of psychological difficulties in the majority of individuals exposed to such events, including depression, anxiety, guilt, pathological grief reactions, restlessness, sleep disturbances, psychosomatic com plaints, and posttraumatic stress disorder. The relatively new diagnosis of Posttraumatic Stress Disorder, or PTSD, has received much attention in analysis of the mental health impact of the events of September 11. In this paper, research on PTSD is reviewed and related to the terrorist attacks of September 11, and some
Résumé : Cet article dresse une synthèse des données épidémiologiques concernant les Etats de stress post-traumatiques. Après une présentation des taux d'exposition et de la prévalence du PTSD en population générale, est introduite la question des victimes d'expériences traumatiques spécifiques. Selon le type de traumatisme subi, la prévalence du PTSD varie de manière substantielle. Sont présentés, les résultats d'études relatives aux situations de guerre menées sur les militaires et les populations civiles, notamment les enfants et les adolescents. Sont ensuite présentés les résultats d'études relatives aux agressions, telles que les actions terroristes et les agressions sexuelles, notamment celles commises contre des mineurs. Enfin, sont présentés les résultats d'études relatives aux catastrophes naturelles ou industrielles et aux accidents, particulièrement les accidents de la route.
Severity of trauma as a predictor of long-term psychological functioning was examined in 55 tortured political ex-prisoners in Turkey. The assessments included semistructured interviews and measures of anxiety, depression, and posttraumatic stress disorder. The severity of torture was assessed by measures of number of types of torture, number of exposures to torture, duration of captivity, and perceived distress. The survivors reported a mean of 23 different forms of torture and a mean total of 291 exposures to torture during their captivity. Despite severity of trauma, the number of exposures to torture did not predict posttorture psychological problems, whereas ratings of perceived distress did. Implications of these findings for theory and classification of psychological trauma and for legal practices concerning torture survivors are discussed.
A cognitive theory of posttraumatic stress disorder (PTSD) is proposed that assumes traumas experienced after early childhood give rise to 2 sorts of memory, 1 verbally accessible and 1 automatically accessible through appropriate situational cues. These different types of memory are used to explain the complex phenomenology of PTSD, including the experiences of reliving the traumatic event and of emotionally processing the trauma. The theory considers 3 possible outcomes of the emotional processing of trauma, successful completion, chronic processing, and premature inhibition of processing We discuss the implications of the theory for research design, clinical practice, and resolving contradictions in the empirical data.
This study aimed to provide preliminary evidence for, and explore potential antecedents and correlates of, a phenomenon observed in aging combat veterans termed late-onset stress symptomatology (LOSS). LOSS is a hypothesized phenomenon among older veterans who (a) experienced highly stressful combat events in early adulthood; (b) functioned successfully throughout their lives, with no chronic stress-related disorders; but (c) begin to register increased combat-related thoughts, feelings, reminiscences, memories, or symptoms commensurate with the changes and challenges of aging, sometimes decades after their combat experiences. Using a qualitative focus group methodology with 47 World War II, Korean Conflict, and Vietnam War veterans, the authors obtained preliminary evidence for the presence of LOSS as defined, identified some of its features, revealed some normative late-life stressors that may precipitate LOSS, and uncovered potential intrapersonal risk and resilience factors for LOSS. The authors present illustrative quotations from the group discussions and discuss the implications and future directions of this research.
Through the memory of British POWs held in forced labor at IG Farben's Auschwitz plant, this article provides unique, even "privileged", insight into an important aspect of the Holocaust. It relies upon Nuremberg statements, recently accessible German documents, International Red Cross materials, and questionnaire responses. Confronted with palpable evidence of Nazi criminality, the British extended a helping hand to the Jewish inmates at the Auschwitz-Monowitz concentration camp, sounded the alarm about their ongoing mass murder to the International Red Cross and to the British Government, and challenged the Nazi racial hierarchy imposed at IG Auschwitz. Although themselves not immune to an anemic form of antisemitism, their behavior stood in marked contrast to that of German bystanders.
There appears to be a high incidence of posttraumatic stress disorders (PTSD) in Vietnam veterans, yet there is little available information on the reliability and validity of any approach to the assessment of these combat-related stress disorders. The present study was designed to determine if responses to the presentation of mild combat stimuli would distinguish the following 3 carefully matched groups of veterans (N = 30): (a) veterans (mean age 35 yrs) with an exclusive diagnosis of PTSD, (b) inpatients (mean age 36 yrs) on a psychiatry ward who clearly did not have PTSD, and (c) Vietnam veterans (mean age 35 yrs) with combat experience who were well-adjusted at the time of the study. Behavioral, physiological, and self-report measures of anxiety obtained through this laboratory-based assessment clearly distinguished the PTSD Ss from the remaining 2 groups. The utility of this tripartite assessment approach for the reliable identification of PTSD secondary to combat is discussed. (13 ref)
I.
DURING WORLD War II and shortly afterward, the problem of "combat fatigue," or gross stress reaction was studied intensively. Lewis and Engle's Wartime Psychiatry, published in 1954, reviewed 1,166 articles by 1,431 authors. In this massive literature there was some disagreement as to whether or not the combat fatigue syndrome should be differentiated from psychoneurosis, but nearly all investigators concurred in viewing it as a transient state. The Gray Manual, published in 19521 and representing the consensus at that time, listed five diagnostic criteria: (1) unusual stress; (2) previous normal personality; (3) reversibility; (4) possible progress to one of the neurotic reactions; (5) if persistent reaction, "this term is to be regarded as a temporary diagnosis to be used only until a more definite diagnosis is established" (reference 1, p 40). However, there was no provision or official name for the persistence
This study investigates the long term or residual effects resulting from severe and extended exposure to stress. The samples were prisoners of war who were intended in Japan (high stress group) or Europe (low stress group) during the Second World War. They were examined in the following three areas: neuropsychological, psychiatric, and physical/neurological. Significant differences were found in all three spheres between the two groups. Second, to examine further the effect of length of internment on these variables, the low stress group was divided into long term and short term internment duration groups, and then the three groups were compared. Significant differences were found among these three groups. These results are discussed in relation to a traditional model of explanation.
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.
At age 36, Vietnam veterans in the high school class of 1963 reported significantly more problems related to nightmares, loss of control over behavior, emotional numbing, withdrawal from the external environment, hyperalertness, anxiety, and depression than did their classmates matched with them on 51 high school characteristics. These problems correspond closely to the disorder labeled post-traumatic stress disorder (PTSD) by the American Psychiatric Association. PTSD was associated with other family, mental health, and social interaction problems. Some environmental variables--e.g., the presence of a spouse or being a churchgoer--were associated with reduced levels of PTSD or with reductions in the degree of association between combat and PTSD. The direction of cause and effect in these associations cannot be ascertained from our data, but it seems plausible to postulate that support factors can and do help some Vietnam veterans with PTSD.
Post-traumatic stress disorder (PTSD) is a diagnosis that has been the subject of considerable criticism in the clinical literature. Of primary concern has been the question of whether PTSD is a disorder that can be discriminated reliably from already existing diagnoses, such as depression, dysthymia, or generalized anxiety disorder. This paper reviews the evidence that surrounds this controversy and employs the guidelines for validating a diagnosis established by Robins and Guze (1970) as the framework for the review. A second purpose of this paper is to present a multiaxial approach for the assessment of PTSD. This approach includes the use of structured interviews, psychometrics, and a psychophysiological assessment procedure. Studies that support the reliability and validity of the components of the multiaxial method are reviewed.
The authors performed structured psychiatric examinations of 188 former prisoners of war (POWs). Sixty-seven percent had had posttraumatic stress disorder. Of those affected, 29% had fully recovered, 39% still reported mild symptoms, 24% had improved but had moderate residual symptoms, and 8% had had no recovery or had deteriorated. Presence of posttraumatic stress disorder was not significantly correlated with other mental disorders. Delayed onset was not seen. The findings confirm the DSM-III concept of and criteria for posttraumatic stress disorder.
The authors reviewed the case records of a random sample of 126 Australian Vietnam veteran inpatients, recorded the diagnostic and background data, and made new DSM-III diagnoses. Neurotic disorders accounted for 49% of the primary or secondary diagnoses. Only 10% of the overall sample had a primary diagnosis of posttraumatic stress disorder but 27% of the veterans who had seen combat had a primary diagnosis of the disorder. Twenty-nine percent of the overall sample were given a primary diagnosis of alcohol abuse or dependence. The early developmental environment of the overall sample frequently included poor parent-child relationships, high rates of parental separation, and family histories dominated by parental alcohol abuse.
Mortality through 1975 in US Army veterans released from prisoner-of-war camps following World War II (Europe, Pacific) and the Korean conflict and in several non-prisoner groups is compared using death rates and standard mortality ratios. The World War II Pacific and Korean conflict experience reveal increased risk of dying among former prisoners which, though diminishing with time, persist for 9 and 13 years, respectively. Mortality from tuberculosis and from trauma contributes to the increase among Pacific ex-prisoners, while for Korea the increase is limited to trauma. An excess of deaths due to cirrhosis of the liver in all three former prisoner groups appeared from about the 10th follow-up year. While the reported mortality experience for World War II spans 30 calendar years and for Korea 22 years, no evidence of increased aging among former prisoners of war is seen in mortality from the chronic and degenerative diseases.
While there are similarities between the combat patients and the non-combat controls, a clear-cut picture emerges of the combat veteran syndrome with a severely disabling condition involving startle reactions, sleep difficulties, dizziness, blackouts, avoidance of activities similar to combat experience, and internalization of feelings. He is not however psychotic.
The achievements of the medical and allied professions especially in dealing with the acute combat cases have been valuable but less and less interest is being shown to this particular group of veterans. In many hospitals and clinics there is no official record kept as to whether a patient was ever in combat. It is suggested that if we are to continue to study this group of patients we must at least keep track of them. Particularly with the recent emphasis on "here and now" in psychotherapy a combat veteran's tendency to avoid discussing his traumatic combat experiences may easily create a tacit agreement between the therapist and the veteran to avoid the subject. We suggest that a continuing and broadening attack on the psychological aspects of these problems is indicated. Such a study will help to clarify our concept of psychoneurosis in general and contribute to the maintenance and improvement of these men.
This paper presents a summary of our experiences with a large group of cases of traumatic war neurosis during the 5-year period since the end of the war. We have made certain observations that have been hitherto unreported and that we feel have both theoretical and practical therapeutic significance.
1. Traumatic war neuroses occur in non-combatant military personnel located in a combat area with a relatively high degree of frequency. This group is vulnerable because they are exposed to traumata without the possibility of effective motor discharge of the emotions thereby engendered.
2. Guilt about killing or assailing defenseless enemy personnel, either military or civilian, is an important factor in the precipitation of a traumatic war neurosis. In such instances the superimposed military code (superego) yields to the earlier and stronger civilian prohibition against violence toward others.
3. Traumatic war neurosis can and does occur in conjunction with physical injury. Separation from the unit because of physical injury removes the influence of group morale, which serves as a deterrent to neurotic breakdown.
4. Physical injury or medical or surgical disorder that leads to enforced immobilization seems to encourage the development of the traumatic war neurosis by depriving the individual of the possibility of discharge of tension through motor activity.
5. Speech disturbances such as stammering can occur in cases of traumatic war neurosis without any evidence of this disorder having existed previously.
6. An overidealization of the pretraumatic history occurs in cases of traumatic war neurosis. This is viewed as a defensive maneuver of the ego in its effort to find some stable point in a world that has become overwhelming and threatening to the patient.
7. The monotonous repetition of the traumatic war experiences and combat dreams in cases of traumatic war neurosis is caused by the transformation of the world into a threatening place. The patient reacts to civilian life as if he were still in combat.
8. Changes in the details of the repetitive traumatic experiences and the combat dreams are significant indicators of the points at which the traumatic experiences are linked with pretraumatic experiences.
9. In our experience, the use of intravenous narcosis or hypnosis has not been particularly helpful in cases of chronic traumatic war neurosis. This is due to the need for developing a firm relationship with the patient because of his feeling regarding the threatening nature of his environment and the people therein.
10. We have differentiated 2 character groups among our cases of traumatic war neurosis, according to their pretraumatic adjustment. We have characterized them as alloplastic and autoplastic, or outgoing and inhibited. In the alloplastic, therapy is usually relatively short and consists essentially of relating combat experiences to present feelings and attitudes. In the autoplastic, a further step can be taken beyond this in that the traumatic experiences are related not merely to their present feelings and attitudes but also to the pretraumatic experiences. We feel that this differentiation is important particularly from a practical therapeutic point of view.