The nature and course of subthreshold PTSD

Weill Cornell Medical College, Department of Psychiatry, 525 East 68th Street, Box 200, New York, NY 10065, USA.
Journal of anxiety disorders (Impact Factor: 2.68). 12/2010; 24(8):918-23. DOI: 10.1016/j.janxdis.2010.06.017
Source: PubMed

ABSTRACT This study investigated rates of subthreshold PTSD and associated impairment in comparison to no PTSD and full PTSD and prospectively followed the course of subthreshold symptoms over 3 years. 3360 workers dispatched to the WTC site following 9/11 completed clinician interviews and self-report measures at three time points each one year apart. At Time 1, 9.7% of individuals met criteria for subthreshold PTSD. The no PTSD, subthreshold PTSD, and full PTSD groups exhibited significantly different levels of impairment, rates of current MDD diagnosis, and self-reported symptoms of depression. At Time 2, 29% of the initial sample with subthreshold PTSD continued to meet criteria for subthreshold or full PTSD; at Time 3, this was true for 24.5% of the initial sample. The study lends credence to the clinical significance of subthreshold PTSD and emphasizes that associated impairment may be significant and longstanding. It also confirms clinical differences between subthreshold and full PTSD.

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    • "Notably, when left untreated, subthreshold PTSD can be stable and chronic (Cukor et al., 2010). In a longitudinal study assessing symptoms of 9/11 World Trade Center disaster recovery workers, 29.0% meeting subthreshold PTSD at baseline met criteria for subthreshold or full PTSD at one year follow-up, and 25.0% still met criteria at two year follow-up (Cukor et al., 2010). Accordingly, psychological and functional impairment associated with subthreshold PTSD may not remit on its own for a substantial minority of individuals. "
    Behaviour Research and Therapy 08/2015; 73:33-41. DOI:10.1016/j.brat.2015.07.010 · 3.85 Impact Factor
    • "Smid et al.'s (2009) meta-analysis of four studies showed 26% of participants who initially met criteria for Subthreshold PTSD (defined as meeting criteria for two of three symptom clusters) developed fully threshold symptoms at a later time. Cukor et al. (2010) examined a sample of participants longitudinally and demonstrated that approximately 11% of individuals initially classified as Subthreshold PTSD based on the Blanchard et al. (1994) definition retained this classification and approximately 9% progressed to full PTSD 4 years after the traumatic event. Lack of consistency in defining Subthreshold PTSD in the literature is a problem in that it is difficult to aggregate results across studies . "
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    ABSTRACT: Subthreshold posttraumatic stress disorder (PTSD), whether due to absence of symptom development or partial remission, is the subject of research and clinical work despite being absent from the DSM. A problem with the literature is that subthreshold definitions are inconsistent across studies and therefore aggregating results is difficult. This study compared the diagnostic hit rates and validity of commonly used definitions of Subthreshold PTSD in a single sample. Three definitions of Subthreshold PTSD were extracted from the literature and two were formed, including a model of DSM-5 PTSD-criterion sets, and a definition that requires six or more PTSD symptoms, but no particular criterion set. Participants (N = 654) with a criterion A stressor, but without full PTSD diagnosis, were included. Most individuals did not meet any definition of Subthreshold PTSD. Findings are discussed in light of previous research and need for increased understanding of the diagnostic implications of Subthreshold PTSD.
    The Journal of nervous and mental disease 07/2015; 203(8). DOI:10.1097/NMD.0000000000000332 · 1.69 Impact Factor
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    • " life and functional status ( e . g . , degree of disability across domains of health and behav - ior ) among service members ( SMs ; Schnurr et al . , 2009 ) , includ - ing those who are subthreshold , or lacking a sufficient num - ber or distribution of symptoms to meet full criteria for PTSD ( Magruder et al . , 2004 ; Grubaugh et al . , 2005 ; Cukor et al . , 2010 ) . PTSD symptom clusters include re - experiencing ( e . g . , intru - sive memories and bad dreams ) , avoidance ( e . g . , avoidance of trauma - related thoughts , feelings , activities , as well as a loss of social connection , and interest in activities ) , and hyperarousal ( e . g . , strong startle response , sleep problems , an"
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    ABSTRACT: Posttraumatic stress disorder (PTSD) symptoms can result in functional impairment among service members (SMs), even in those without a clinical diagnosis. The variability in outcomes may be related to underlying catecholamine mechanisms. Individuals with PTSD tend to have elevated basal catecholamine levels, though less is known regarding catecholamine responses to trauma-related stimuli. We assessed whether catecholamine responses to a virtual combat environment impact the relationship between PTSD symptom clusters and elements of functioning. Eighty-seven clinically healthy SMs, within 2 months after deployment to Iraq or Afghanistan, completed self-report measures, viewed virtual-reality (VR) combat sequences, and had sequential blood draws. Norepinephrine responses to VR combat exposure moderated the relationship between avoidance symptoms and scales of functioning including physical functioning, physical-role functioning, and vitality. Among those with high levels of avoidance, norepinephrine change was inversely associated with functional status, whereas a positive correlation was observed for those with low levels of avoidance. Our findings represent a novel use of a virtual environment to display combat-related stimuli to returning SMs to elucidate mind-body connections inherent in their responses. The insight gained improves our understanding of post-deployment symptoms and quality of life in SMs and may facilitate enhancements in treatment. Further research is needed to validate these findings in other populations and to define the implications for treatment effectiveness.
    Frontiers in Psychology 04/2015; 6. DOI:10.3389/fpsyg.2015.00256 · 2.80 Impact Factor
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