Journal of Traumatic Stress

Post-traumatic stress disorder is a legacy of the Vietnam War. Perhaps as many as a half-million U.S. veterans suffer from the problem to some degree. Hospitalized U.S. veterans, diagnosed as suffering from PTSD were given the Internalized Shame Scale, the Beck Depression Inventory, and the Rosenberg Self-Esteem Scale. Hospitalized veterans suffering from (1) depression and (2) substance abuse were also given these instruments and the resulting data were compared. Veterans suffering from PTSD scored higher on Internalized Shame and on Depression than did the Substance Abuse group and scored higher numerically on Depression than did the Depression group itself. All groups were compared on factors related to Shame, Inferiority and Alienation. Data indicated that the PTSD group scored numerically highest on both factors. Results are discussed in accordance with current Shame induction theory.

Nine months after the residential stage of Koach, participants were asked to evaluate the program's effectiveness. Most of the veterans reported improvement in the areas queried, and especially in social relations, and nearly all of them stated that they would recommend the program to other veterans. The commander-therapists became the major source of help for these veterans following the Koach project, and about half reported that they participated regularly in self-help groups. Most of the participants acquired coping techniques that continued to serve them 9 months after the end of the residential stage of Koach. One of the more important measures of Koach was thought to be the veterans' own evaluations of the project, their assessment of the project's success in achieving its aims, and their satisfaction with it. In this article we will present the subjects' evaluations of treatment effectiveness as expressed in behavioral and emotional changes that they attributed to the treatment.

We introduce the ‘Fragebogen zu Dissoziativen Symptomen’ (FDS), a German adaptation of the Dissociative Experience Scale (DES) which was developed to screen for dissociation within an ICD-10 framework. In addition to the original 28 DES items, the FDS contains 16 items covering dissociative phenomena included in the ICD-10, particularly pseudoneurological conversion symptoms. The psychometric properties of the FDS were studied in 927 clinical and nonclinical subjects from different diagnostic groups and compared to results of American studies. The scale had good test-retest reliability of .88, high internal consistency (split-half = .90, Cronbach's alpha = .94) and good construct validity. These results indicate that the FDS may be a valuable screen for dissociative psychopathology in German-speaking countries.

Structural equation modeling is used to evaluate a network of causal hypotheses concerning the relationships of premilitary vulnerabilities, military entry conditions, war zone experiences, and dissociative reactions with current symptoms of PTSD and general psychiatric distress. The analyses are directed toward resolving three general issues: (1) the relative contributions of premilitary vulnerabilities and exposure to traumatic events to the development of PTSD, (2) the features of the causal network that are distinctive to the development of PTSD as compared to general psychiatric symptoms, and (3) the major pathways mediating causation among the variables in the model. 381 Vietnam theater veterans who sought treatment from VA's new PTSD Clinical Teams Program and who provided complete data constituted the sample for the study. War zone experiences were the variables that contributed most strongly to the development of both PTSD and general psychiatric symptoms. Combat exposure, however, contributed directly to PTSD symptoms but not to general psychiatric symptoms. The overall fit of the model to the data proved to be quite satisfactory for both PTSD and general psychiatric symptoms, accounting for 59% and 60% of the variance, respectively.

In order to examine the association between the experience of violent events, trauma, and post-traumatic stress disorder among women drug users, 105 women in treatment for addictive disorders were interviewed. One hundred four of the study participants reported trauma in 1 or more of 14 categories of traumatic events, 59% of whom reported symptoms consistent with a diagnosis of posttraumatic stress disorder. Among those with PTSD, 97% reported one or more violent traumas as compared with 73% of those without PTSD. The likelihood of PTSD was strongly associated with the number of violent traumas reported by a woman. Women in recovery from drug addiction are likely to have a history of violent trauma and are at high risk for post-traumatic stress disorder. Screening for PTSD among women with an addictive disorder should become part of the diagnostic and treatment routine.

This clinical report describes symptoms of psychological and physical distress and psychiatric disorders in 24 Army Reservists who served war zone graves registration duty in support of Operation Desert Storm. Troops underwent comprehensive assessment for evidence of psychopathology that might be associated with war zone duty as one component of a debriefing protocol scheduled during regular drill exercises eight months after their return to the United States. Troops endorsed items suggestive of high war zone stress exposure, common symptoms of anxiety, anger, and depression, and multiple health and somatic concerns. Almost half of the sample met criteria for post-traumatic stress disorder, and diagnosis of this disorder was strongly associated with evidence of depressive and substance abuse disorders. The gruesome aspects of body recovery and identification in a war zone setting were cited as stressor elements of significant negative impact.

Dreams following trauma have been suggested to aid emotional adaptation, yet trauma-related nightmares are a diagnostic symptom of Posttraumatic Stress Disorder (PTSD). There is little published data relating dreams to PTSD soon after trauma. We assessed dreams and PTSD in 60 injured patients after life-threatening events and obtained follow-up assessments in 39 of these participants 6 weeks later. Ten of 21 dream reports from morning diaries were rated and described as similar to the recent traumatic event. The participants reporting these distressing “trauma dreams” had more severe concurrent PTSD symptoms than those reporting other categories of dreams and had more severe initial and follow-up PTSD than those without dream recall. These findings along with our preliminary longitudinal observations relating changes in dream patterns to outcome, suggest a relationship of dream characteristics and early adaptive versus maladaptive patterns of processing traumatic memory.