Disorders of Extreme Stress Following War-Zone Military Trauma: Associated Features of Posttraumatic Stress Disorder or Comorbid but Distinct Syndromes?

• Published in: Journal of consulting and clinical psychology 1999-02, Vol.67 (1), p.3-12
• Main Author: Ford, Julian D
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Aged; Anxiety disorders. Neuroses; Biological and medical sciences; Bipolar Disorder - diagnosis; Combat Experience; Comorbidity; Comparison; Diagnosis, Differential; Disorders; Distress; Emotional Trauma; Extremes; Human; Humans; Interview, Psychological - standards; Male; Medical History Taking; Medical sciences; Middle Aged; Military Veterans; Morbidity; Multivariate Analysis; Odds Ratio; Personality Disorders - diagnosis; Post traumatic stress disorder; Posttraumatic Stress Disorder; Psychiatric Status Rating Scales - standards; Psychology. Psychoanalysis. Psychiatry; Psychometrics; Psychopathology. Psychiatry; Risk Factors; Severity of Illness Index; Stress; Stress Disorders, Post-Traumatic - classification; Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - epidemiology; Stress Reactions; Stress, Physiological - diagnosis; Stress, Physiological - epidemiology; Stress, Physiological - psychology; Syndrome; USA; Veterans; Veterans - psychology; War; Warfare
• ISSN: 0022-006X; 1939-2117
• DOI: 10.1037/0022-006X.67.1.3

Disorders of extreme stress not otherwise specified (DESNOS) and posttraumatic stress disorder (PTSD) were found to be comorbid but distinct among military veterans seeking inpatient PTSD treatment: 31% qualified for both conditions, 29% were diagnosed PTSD only, 26% were classified DESNOS only, and 13% met criteria for neither. PTSD diagnosis was associated with elevated levels of war-zone trauma exposure and witnessing atrocities and with impairment on the Mississippi Scale for Combat-Related PTSD and the Penn Inventory. DESNOS classification (but not PTSD) was associated with (a) early childhood trauma and participation in war-zone atrocities, (b) extreme levels of intrusive trauma reexperiencing, (c) impaired characterological functioning (object relations), and (d) use of intensive psychiatric services. PTSD and DESNOS may be comorbid but distinct posttraumatic syndromes and, as such, warrant careful clinical and scientific investigation.