Unique patterns of comorbidity in posttraumatic stress disorder from different sources of trauma

doi:10.1016/S0010-440X(96)90015-2

Comprehensive Psychiatry

Volume 37, Issue 5, September–October 1996, Pages 336-346

https://doi.org/10.1016/S0010-440X(96)90015-2 Get rights and content

Abstract

While there are many studies of comorbidity in combat veterans with posttraumatic stress disorder (PTSD), studies of PTSD from other sources of trauma (e.g., disasters, crimes, and civil violence) are just beginning to emerge. This is the first formal review comparing patterns of comorbidity in PTSD from different sources of trauma. Specific attention is given to the relative frequencies of substance abuse, depression, generalized anxiety, phobic, panic, somatization, psychotic, and personality disorders. The findings reveal that although similarities exist, the comorbidity profiles differ according to the type of trauma experienced and the population studied. Additionally, the evidence suggests that the associated psychiatric disorders are not truly comorbid, but are interwoven with the PTSD.

References (56)

J.R.T Davidson et al.
Symptom and comorbidity patterns in World War II and Vietnam veterans with posttraumatic stress disorder
Compr Psychiatry
(1990)
A Feinstein
A pre-therapeutic classification of comorbidity in chronic disease
J Chronic Dis
(1970)
B.L Green et al.
Post-traumatic stress disorder in victims of disasters
Psychiatr Clin North Am
(1994)
J.D Kinzie et al.
A three-year follow-up of Cambodian young people traumatized as children
J Am Acad Child Psychiatry
(1989)
Z Solomon et al.
Post-traumatic stress disorder: issues of comorbidity
J Psychiatr Res
(1991)
D Behar
Flashbacks and posttraumatic stress symptoms in combat veterans
Compr Psychiatry
(1987)
J Davidson et al.
A diagnostic and family study of posttraumatic stress disorder
Am J Psychiatry
(1985)
P.B Sutker et al.
Psychopathology in war-zone deployed and nondeployed Operation Desert Storm troops assigned graves registration duties
J Abnorm Psychol
(1994)
P.A Boudewyns et al.
Comorbidity and treatment outcome of inpatients with chronic combat-related PTSD
Hosp Community Psychiatry
(1991)
R.A Kulka et al.
Contractual report of findings from the National Vietnam Veterans Readjustment Study
(1988)

A.C McFarlane et al.

Multiple diagnoses in posttraumatic stress disorder in victims of a natural disaster

J Nerv Ment Dis

(1992)

J.H Shore et al.

Community patterns of posttraumatic stress disorders

J Nerv Ment Dis

(1989)

B.L Green et al.

Chronic posttraumatic stress disorder and diagnostic comorbidity in a disaster sample

J Nerv Ment Dis

(1992)

J.M Vogel et al.

Part I: Children's psychological responses to disasters

J Clin Child Psychol

(1993)

W Yule et al.

Post-traumatic stress reactions in children

J Trauma Stress

(1990)

D.K Roszell et al.

Frequency of symptoms and concurrent psychiatric disorder in Vietnam veterans with chronic PTSD

Hosp Community Psychiatry

(1991)

P.A Boudewyns et al.

Chronic combat-related PTSD and concurrent substance abuse: implications for treatment of this frequent “dual diagnosis”

J. Trauma Stress

(1991)

V.J Fischer

Combat exposure and the etiology of postdischarge substance abuse problems among Vietnam veterans

J Trauma Stress

(1991)

J.E Helzer

The impact of combat and later alcohol use by Vietnam veterans

J Psychoactive Drugs

(1984)

J.E Helzer et al.

Posttraumatic stress disorder in the general population: findings from the epidemiological catchment area survey

N Engl J Med

(1987)

B Lerer et al.

PTSD in Israeli combat veterans: effects of phenylzine treatment

Arch Gen Psychiatry

(1987)

N Breslau et al.

Post-traumatic stress disorder: the etiologic specificity of wartime stressors

Am J Psychiatry

(1987)

B.E Engdahl et al.

Comorbidity of psychiatric disorders and personality profiles of American World War II prisoners of war

J Nerv Ment Dis

(1991)

P.B Sutker et al.

MMPI profiles of veterans of WWII and Korea: former POW and combat survivor comparisons

Psychol Rep

(1991)

R.F Mollica et al.

Assessing symptom change in Southeast Asian refugee survivors of mass violence and torture

Am J Psychiatry

(1990)

G.C Loughrey et al.

Post-traumatic stress disorder and civil violence in Northern Ireland

Br J Psychiatry

(1988)

E.M Smith et al.

Acute postdisaster psychiatric disorders: identification of persons at risk

Am J Psychiatry

(1990)

W.H Sack et al.

The Khmer adolescent project. I. Epidemiologic findings in two generations of Cambodian refugees

J Nerv Ment Dis

(1994)

Cited by (133)

Beyond Distress and Fear: Differential Psychopathology Correlates of PTSD Symptom Clusters
2021, Journal of Affective Disorders
Citation Excerpt :
Nightmares are associated with other anomalous sleep experiences and positive psychotic symptoms (Koffel & Watson, 2009; Watson, 2001; Watson et al., 2015a). Because dissociative experiences also are strongly related to positive psychotic symptoms and other aspects of the thought disorder domain (Watson, 2001), flashbacks can be difficult to differentiate from primary positive psychosis, particularly if they include components such as olfactory hallucinations and paranoia (Deering et al., 1996; Lockwood & Forbes, 2014; Schillaci et al., 2009). Physiological reactivity to trauma cues shares pathological mechanisms with panic disorder (Cougle et al., 2010; Deering et al., 1996; Lockwood & Forbes, 2014).
Research suggests that re-experiencing and avoidance are “core” PTSD symptoms, but there has been little research explicating their unique connections to psychopathology other than internalizing conditions such as depression and anxiety. We aim to unpack symptom heterogeneity within PTSD by exploring associations between re-experiencing and avoidance clusters and major psychopathology domains in a dimensional metastructural framework (e.g., the Hierarchical Taxonomy of Psychopathology, or HiTOP).
We used a trauma-exposed community sample (n = 233, 66.1% female, mean age = 45 years) to compare re-experiencing and avoidance's associations with factor-analytically derived dimensions generally corresponding to HiTOP structure: Distress, Fear, Detachment, Antagonism, Disinhibition, Thought Disorder, and Compulsivity.
Both re-experiencing and avoidance were robustly related to Fear. Re-experiencing was particularly related to Distress and Thought Disorder, whereas avoidance was related to domains involving overinhibition (e.g., Compulsivity). Relative to avoidance, re-experiencing had broader and more substantial associations with psychopathology, partly as a function of its greater saturation with dysphoria.
Coverage of PTSD symptoms was limited to questionnaire measurement of re-experiencing and avoidance clusters. Results need to be replicated in samples selected for posttraumatic psychopathology.
Although they are strongly intercorrelated and both are robustly related to Fear, re-experiencing and avoidance differ substantially in their unique relations with other forms of psychopathology, and re-experiencing may be less specific to PTSD than previously thought. These differences can be used to understand the etiology and phenomenology of re-experiencing and avoidance in greater depth to inform more targeted and effective interventions for posttraumatic psychopathology.
Altered amygdala subregion-related circuits in treatment-naïve post-traumatic stress disorder comorbid with major depressive disorder
2019, European Neuropsychopharmacology
Individuals with both post-traumatic stress disorder and major depressive disorder (PTSD+MDD) often show greater social and occupational impairment and poorer treatment response than individuals with PTSD alone. Increasing evidence reveals that the amygdala, a brain region implicated in the pathophysiology of both of these conditions, is a complex of structurally and functionally heterogeneous nuclei. Quantifying the functional connectivity of two key amygdala subregions, the basolateral (BLA) and centromedial (CMA), in PTSD+MDD and PTSD-alone could advance our understanding of the neurocircuitry of these conditions. 18 patients with PTSD+MDD, 28 with PTSD-alone, and 50 trauma exposed healthy controls (TEHC), all from a cohort who survived the same large earthquake in China, underwent resting-state functional magnetic resonance imaging. Bilateral BLA and CMA functional connectivity (FC) maps were created using a seed-based approach for each participant. The analysis of covariance of FC was used to determine between-group differences. A significant interaction between amygdala subregion and diagnostic group suggested that differences in connectivity patterns between the two seeds were mediated by diagnosis. Post-hoc analyses revealed that PTSD+MDD patients showed weaker connectivity between right BLA and (a) left anterior cingulate cortex/supplementary motor area, and (b) bilateral putamen/pallidum, compared with PTSD-alone patients. Higher CMA connectivities left ACC/SMA were also observed in PTSD+MDD compared with PTSD-alone. An inverse relationship between the connectivity of right BLA with right putamen/pallidum and MDD symptoms was found in PTSD+MDD. These findings indicate a relationship between the neural pathophysiology of PTSD+MDD compared with PTSD-alone and TEHC and may inform future clinical interventions.
Agreement between clinical and MINI diagnoses in outpatients with mood and anxiety disorders
2017, Journal of Affective Disorders
Citation Excerpt :
In the current sample, this is illustrated by PTSD. PTSD often occurs as a comorbid disorder (Boudreaux et al., 1998; Deering et al., 1996), which is illustrated in our current sample; the prevalence of PTSD is lower in the group with only one diagnosis than in the total group of participants, suggesting that PTSD more is more often diagnosed together with another diagnosis. Whether a relative underdiagnosis of PTSD in psychiatric populations (Davidson and Smith, 1990; Escalona et al., 1997) can be attributed to this comorbidity, remains a question to be answered.
Standardized Diagnostic Interviews (SDIs) such as the Mini International Neuropsychiatric Interview (MINI) are widely used to systematically screen for psychiatric disorders in research. To support generalizability of results to clinical practice, we assessed agreement between the MINI and clinical diagnoses.
Agreement was assessed in a large, real life dataset (n = 7016) using concordance statistics such as sensitivity, specificity, efficiency and area under the curve (AUC).
41.5% of clinical diagnoses were mood disorders, 26.5% were anxiety disorders. Overall, we found moderate agreement between MINI and clinical diagnoses (median efficiency: 0.92, median AUC: 0.79). For mood disorders, the AUC for all participants showed a range between 0.55 and 0.81 (median: 0.73), and for anxiety disorders the AUC ranged from 0.78 to 0.88 (median: 0.83). The AUC showed better agreement for mood disorders in the single diagnosis group than in the total group (median 0.77 vs. 0.71). For anxiety disorders, the AUC for the single diagnosis group was comparable to the AUC of the total group (median: 0.81 vs. 0.83 respectively). Numbers of false positives were high for both mood and anxiety diagnoses, but less so in the single diagnosis group.
Time lag between MINI and clinical diagnosis, the availability of only the primary clinical diagnosis, and relatively high severity of the current sample are limitations of the current study.
Agreement between MINI and clinical diagnoses was moderate at best, which partly reflects the difference between the different measures used in the current study.
Altered spontaneous neuronal activity in chronic posttraumatic stress disorder patients before and after a 12-week paroxetine treatment
2015, Journal of Affective Disorders
Abnormal functional brain activity has been revealed in patients with Posttraumatic Stress Disorder (PTSD) in recent years, while the recovery neuromechanism of PTSD has not yet been elucidated. The aim of this study was to investigate the altered spontaneous brain activity in treatment-naïve chronic PTSD patients before and after 12 weeks׳ treatment with paroxetine.
Twenty-one earthquake-related PTSD patients and seventeen traumatized controls underwent a resting functional magnetic resonance imaging (Rs-fMRI) scan at baseline. Amplitude of low-frequency fluctuation (ALFF) was calculated and compared between PTSD patients and controls. Then, the PTSD group completed 12 weeks of treatment with paroxetine, and Rs-fMRI was repeated to compare with the baseline. Lastly, correlation analyses of ALFF values within altered brain areas were conducted.
Hyperactive function of visual cortex was observed in PTSD patients before and after treatment. After treatment, significantly increased ALFF values were observed in the left orbitofrontal cortex (OFC), while decreased ALFF values were found in the precuneus. Interestingly, a negative correlation between the mean ALFF values of OFC and those of precuneus and visual cortex was only observed in controls, but not in PTSD patients pre- or post-treatment.
A corresponding control condition was absent in this study.
The findings showed that manipulating regional spontaneous activity of precuneus and OFC could be a potential prognostic indicator of PTSD. However, hyperactive function of visual cortex and disrupted connections between OFC, precuneus and visual cortex did not reverse after treatment, which could be a potential target for further treatment.
Factors associated with comorbidity patterns in full and partial PTSD: Findings from the PsyCoLaus study
2014, Comprehensive Psychiatry
Subtypes of comorbid conditions and their associated trauma and clinical characteristics in full and partial PTSD were examined. Data from 289 subjects from the general population that met criteria for full or partial PTSD were analyzed. Latent class analyses (LCA) were performed to derive homogeneous patterns of DSM-IV Axis-I disorders and anti-social personality comorbid to PTSD. Logistic regression models were conducted to characterize these classes by trauma-related and clinical features. The LCA revealed three classes: (1) low comorbidity; (2) high comorbidity with primarily substance-related disorders and a higher proportion of males; and (3) more severe PTSD-symptomatology and higher comorbid anxiety disorders and depression, almost entirely represented by females. Exposure to sexual abuse was more likely in the substance-dependent class and contributed strongly to the distinction between classes. Affective disorders tended to precede the onset of PTSD in the substance-dependent class, whereas phobias were more likely to follow PTSD in the depressed–anxious class. Posttrauma onset of alcohol use disorders in the substance dependent class confirmed the self-medication hypothesis. The three classes of comorbidity and their sequence of onset with PTSD suggest different mechanisms involved in their development. Our findings suggest that PTSD-related comorbidity subtypes also apply to individuals with partial PTSD.
Negative effects of Syria’s earthquake 2023 in Aleppo city
2024, Research Square

View all citing articles on Scopus

View full text

Unique patterns of comorbidity in posttraumatic stress disorder from different sources of trauma

Abstract

Compr Psychiatry

J Chronic Dis

Psychiatr Clin North Am

J Am Acad Child Psychiatry

J Psychiatr Res

Compr Psychiatry

A diagnostic and family study of posttraumatic stress disorder

Am J Psychiatry

Psychopathology in war-zone deployed and nondeployed Operation Desert Storm troops assigned graves registration duties

J Abnorm Psychol

Comorbidity and treatment outcome of inpatients with chronic combat-related PTSD

Hosp Community Psychiatry

Contractual report of findings from the National Vietnam Veterans Readjustment Study

Multiple diagnoses in posttraumatic stress disorder in victims of a natural disaster

J Nerv Ment Dis

Community patterns of posttraumatic stress disorders

J Nerv Ment Dis

Chronic posttraumatic stress disorder and diagnostic comorbidity in a disaster sample

J Nerv Ment Dis

Part I: Children's psychological responses to disasters

J Clin Child Psychol

Post-traumatic stress reactions in children

J Trauma Stress

Frequency of symptoms and concurrent psychiatric disorder in Vietnam veterans with chronic PTSD

Hosp Community Psychiatry

Chronic combat-related PTSD and concurrent substance abuse: implications for treatment of this frequent “dual diagnosis”

J. Trauma Stress

Combat exposure and the etiology of postdischarge substance abuse problems among Vietnam veterans

J Trauma Stress

The impact of combat and later alcohol use by Vietnam veterans

J Psychoactive Drugs

Posttraumatic stress disorder in the general population: findings from the epidemiological catchment area survey

N Engl J Med

PTSD in Israeli combat veterans: effects of phenylzine treatment

Arch Gen Psychiatry

Post-traumatic stress disorder: the etiologic specificity of wartime stressors

Am J Psychiatry

Comorbidity of psychiatric disorders and personality profiles of American World War II prisoners of war

J Nerv Ment Dis

MMPI profiles of veterans of WWII and Korea: former POW and combat survivor comparisons

Psychol Rep

Assessing symptom change in Southeast Asian refugee survivors of mass violence and torture

Am J Psychiatry

Post-traumatic stress disorder and civil violence in Northern Ireland

Br J Psychiatry

Acute postdisaster psychiatric disorders: identification of persons at risk

Am J Psychiatry

The Khmer adolescent project. I. Epidemiologic findings in two generations of Cambodian refugees

J Nerv Ment Dis