The internalizing and externalizing structure of psychiatric comorbidity in combat veterans. Journal of Traumatic Stress, 21, 58-65

National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA.
Journal of Traumatic Stress (Impact Factor: 2.72). 02/2008; 21(1):58-65. DOI: 10.1002/jts.20303
Source: PubMed


This study examined the latent structure of psychiatric disorders in a sample with a high prevalence of PTSD. A series of confirmatory factor analyses tested competing models for the covariation between Structured Clinical Interview for DSM-III-R diagnoses among 1,325 Vietnam veterans. The best-fitting solution was a 3-factor model that included two correlated internalizing factors: anxious-misery, defined by PTSD and major depression, and fear, defined by panic disorder/agoraphobia and obsessive-compulsive disorder. The third factor, externalizing, was defined by antisocial personality disorder, alcohol abuse/dependence, and drug abuse/dependence. Both substance-related disorders also showed significant, albeit smaller, cross-loadings on the anxious-misery factor. These findings shed new light on the structure of psychiatric comorbidity in a treatment-seeking sample characterized by high rates of PTSD.

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Available from: Terence M Keane, Jun 16, 2015
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    • "Breslau et al., 2000; Brewin et al., 2000; Kendler et al., 2002; Koenen et al., 2008; O'Donnell et al., 2004). In addition, by using factor analysis, some studies have found that PTSD and depression load onto the same higher-order factor (Anxious Misery/ Distress; Cox et al., 2002; Miller et al., 2008; Slade and Watson, 2006). And in the quantitative hierarchical model of mood and anxiety disorders proposed by Watson (2005), PTSD is grouped into the subclass of distress disorders along with MDD, suggesting that PTSD and depression share identical elements of one form of psychopathology. "
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    ABSTRACT: Posttraumatic stress disorder (PTSD) and depression are highly comorbid in association with serious clinical consequences. Nevertheless, to date, no study using latent class or latent profile analysis (LCA/LPA) has examined patterns of co-occurring PTSD and depression symptoms among natural disaster survivors, nor has the distinctiveness of DSM-5 PTSD and depression symptoms been clarified in the aftermath of trauma. This study was primarily aimed at filling these gaps. LPA was used to examine self-reported PTSD and depression symptoms in an epidemiological sample of 1196 Chinese earthquake survivors. A 4-class solution characterized by low symptoms (53.9%), predominantly depression (18.2%), predominantly PTSD (18.9%) and combined PTSD-depression (9.0%) patterns fit the data best. Demographic characteristics and earthquake-related exposures were specifically or consistently associated with the non-parallel profiles varying in physical health impairment. A sample exposed to specific traumatic events was assessed by self-report measures. The distinctiveness of DSM-5 PTSD and depression symptoms following an earthquake suggests that PTSD and depression may be independent sequelae of psychological trauma rather than a manifestation of a single form of psychopathology. The current findings support the distinction between PTSD and depression constructs, and highlight the need for identifications of natural disaster survivors at high risk for PTSD and/or depression, and interventions individually tailored to one's symptom presentations. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 07/2015; 186:58-65. DOI:10.1016/j.jad.2015.06.058 · 3.38 Impact Factor
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    • "The importance of these domains was not unexpected. Specifically, the detachment domain, which is characterized by withdrawal from interpersonal interactions and limited hedonic capacity, dovetails with previous studies highlighting associations between PTSD and depression (Cox et al. 2002; Miller et al. 2008; Slade and Watson 2006), another disorder characterized by similar features. And the contribution of the psychoticism domain in distinguishing between, and correctly classifying, PTSD and controls is in accord with the findings of prior studies that have highlighted the frequency of psychotic symptoms among individuals with PTSD (Braakman et al. 2009; Sareen et al. 2005), as well as previous research linking PSY-5 psychoticism to PTSD (Forbes et al. 2010; Miller et al. 2004). "
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    ABSTRACT: The relevance of personality traits to the study of psychopathology has long been recognized, particularly in terms of understanding patterns of comorbidity. In fact, a multidimensional personality trait model reflecting five higher-order personality dimensions-negative affect, detachment, antagonism, disinhibition, and psychoticism-is included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and represented in the Personality Inventory for DSM-5 (PID-5). However, evaluation of these dimensions and underlying personality facets within clinical samples has been limited. In the present study, we utilized the PID-5 to evaluate the personality profile elevation and composition of 150 control veterans and 35 veterans diagnosed with posttraumatic stress disorder (PTSD). Results indicated that veterans with PTSD endorsed significantly more personality pathology than control veterans, with scores on detachment and psychoticism domains most clearly discriminating between the two groups. When personality domain scores were considered as parts of each subject's personality profile, a slightly different picture emerged. Specifically, the PTSD composition was primarily characterized by detachment and negative affect, followed by disinhibition, psychoticism, and antagonism in that order of relative importance. The profile of the control group was significantly different, mostly accounted for differences in antagonism and psychoticism. Using these complementary analytic strategies, the findings demonstrate the relevance of personality pathology to PTSD, highlight internalizing features of PTSD, and pave the way for future research aimed at evaluating the role of shared maladaptive personality traits in underlying the comorbidity of PTSD and related disorders.
    Experimental Brain Research 04/2015; 233(7). DOI:10.1007/s00221-015-4273-1 · 2.04 Impact Factor
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    • "The potential need for veterans and their families to seek PTSD treatment requires clinicians who understand and can work with war-zonerelated traumas. Additionally, the high comorbidity between PTSD and other adjustment difficulties (Miller et al., 2008; Sayers et al., 2009) requires clinicians to develop competence in working with various comorbidities (especially depression "
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    ABSTRACT: Using a sample of 289 Iraq/Afghanistan veterans, this study examined the contributions of combat exposure, agency, perceived threat, and guilt to posttraumatic stress disorder (PTSD) symptoms. Regression analyses indicated the four variables (together with demographic variables) accounted for 79% of the variance in PTSD symptoms. Guilt was the most important predictor. In addition, guilt mediated between exposure and PTSD symptoms, perceived threat and PTSD symptoms, and agency and PTSD symptoms. Implications of these findings are discussed.
    01/2015; 93(1). DOI:10.1002/j.1556-6676.2015.00176.x
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