Pre-war vulnerability is just as important as combat-related trauma in predicting whether veterans’ symptoms of post-traumatic stress disorder (PTSD) will be long-lasting, according to new research published in Clinical Psychological Science, a journal of the Association for Psychological Science.
Researcher Bruce Dohrenwend and colleagues at Columbia’s Mailman School of Public Health and the New York State Psychiatric Institute found that traumatic experiences during combat predicted the onset of the full complement of symptoms, known as the PTSD “syndrome,” in Vietnam veterans. But other factors — such as pre-war psychological vulnerabilities — were equally important for predicting whether the syndrome persisted.
The researchers re-examined data from a subsample of 260 male veterans from the National Vietnam Veterans Readjustment Study. All of the veterans in the subsample had received diagnostic examinations by experienced clinicians that included information about the onset of the disorder and whether it was still current 11 to 12 years after the war ended.
Dohrenwend and colleagues focused on the roles of three primary factors: severity of combat exposure (e.g., life-threatening experiences or traumatic events during combat), pre-war vulnerabilities (e.g., childhood physical abuse, family history of substance abuse), and involvement in harming civilians or prisoners.
The data indicated that stressful combat exposure was necessary for the onset of the PTSD syndrome, as 98% of the veterans who developed the PTSD syndrome had experienced one or more traumatic events.
But combat exposure alone was not sufficient to cause the PTSD syndrome.
Of the soldiers who experienced any potentially traumatic combat exposures, only 31.6% developed the PTSD syndrome. When the researchers limited their analysis to the soldiers who experienced the most severe traumatic exposures, there was still a substantial proportion — about 30% — that did not develop the syndrome. This suggests that there were other factors and vulnerabilities involved for the minority of exposed who did end up developing the PTSD syndrome.
Among these factors, childhood experiences of physical abuse or a pre-Vietnam psychiatric disorder other than PTSD were strong contributors to PTSD onset. Age also seemed to play an important role: Men who were younger than 25 when they entered the war were seven times more likely to develop PTSD compared to older men. The researchers also found that soldiers who inflicted harm on civilians or prisoners of war were much more likely to develop PTSD.
The combined data from all three primary factors — combat exposure, prewar vulnerability, and involvement in harming civilians or prisoners — revealed that PTSD syndrome onset reached an estimated 97% for veterans high on all three. While severity of combat exposure was the strongest predictor of whether the soldiers developed the syndrome, pre-war vulnerability was just as important in predicting the persistence of the syndrome over the long run.
The researchers conclude that these findings have important implications for policies aimed at preventing cases of war-related PTSD.
Given the seemingly potent interaction between combat exposure and pre-war vulnerability, these results emphasize the need to keep the more vulnerable soldiers out of the most severe combat situations.
Dohrenwend and colleagues also point out that the recent conflicts in Iraq and Afghanistan, like the Vietnam War, are “wars amongst the people,” and they underline the need for research examining the circumstances in which harm to civilians and prisoners is likely to occur. Such research could provide important clues for preventing such devastating violations of the rules of war.
In addition to Dohrenwend, co-authors on this research include Thomas Yager and Ben Adams at the Mailman School of Public Health at Columbia University; and Melanie Wall of the Mailman School of Public Health and Department of Psychiatry at Columbia University, and the New York State Psychiatric Institute.
The research was supported by the National Institute of Mental Health (Grant R01-MH059309) and by grants from the Spunk Fund, Inc. and a Ruth L. Kirschstein National Research Service Award from the National Institute of Mental Health.
Resilliance factors include, seeking support from people you trust eg. friends and family, finding a support group, feeling good about one’s actions in the face of danger, having a coping strategy, or a way of getting through the bad event and the crutial part, learning from it. It is also neccesary to be able to act and respond effectively despite feeling fear.
A number of treatment techniques, sometimes combined with one another, are being used:
1. Cognitive behavioral therapy, to help people recognize their ways of
thinking, or “cognitive patterns,” that keep them stuck.
2. Exposure therapy, to help people safely face what they fear, in order to
learn to cope with it.
3. Osanetant, a medication that shows potential to aid in preventing PTSD
from developing if administered in the emergency room or battlefield.
Are there any resilience factors that may reduce the risk of PTSD? And what effective ways can be used to treat someone with PTSD?
Also, it is important to remember that just because an individual experiences killing as a traumatic event does not mean that the person will inevitability develop PTSD symptoms or a formal diagnosis of PTSD. Killing is difficult for many soldiers who may not develop PTSD, and those issues should be evaluated separately.
Individuals with PTSD usually exhibit four different types of symptoms, including:
1. Reliving or re-experiencing the event — symptoms include nightmares, intrusive thoughts, etc.
2. Avoidance — avoiding reminders of the traumatic event.
3. Emotional numbing — symptoms include feeling emotionally numb or having reduced emotional experiences.
4. Arousal symptoms are very common in returning veterans, even in those who do not meet full criteria for a PTSD diagnosis. The most frequently reported problems are increased anger or irritability and difficulty sleeping. Other arousal symptoms include constantly being on guard, having difficulty concentrating and feeling jumpy or easily startled.
These symptoms cause difficulties in social relationships — with family, dating and friendships — and occupational functioning in work or school.
Sources: Dr. Shira Maguen
What are the symptoms that individuals with PTSD exhibit?And do these symptoms cause difficulties in social relationships with family, dating and friendships?
Why are soliders from other nations/cultures seemingly immune? [Aldous_Chetwynn _ [email protected] _ 2013:02.22]
Post-traumatic stress [PTS], as it is now called, cannot be understood as a static condition in a social vacuum, which seems implied in this report (or at least this summary of its findings). More care should be taken during clinical trials and research to understand the ebb and flow of support as it relates to individuals with PTS.
Those exposed to traumatic events, whether combat-related or not, will always face issues related to these events, however minor. The key to understanding an individual’s dealings with PTS is to look at their surrounding support structure, most notably its strength (i.e. the level of honesty and empathy) and the probability of its use.
An individual with PTS will periodically need a substantial support structure, probably a combination of personal and professional. This support is the foundation of every response to the inevitable challenges of having PTS. If you are someone without this structure (as would be indicated by what this study labels “prewar vulnerability”) then you will have fewer resources on which you can rely. Prewar vulnerability is thus a symptom, not a cause.
Additionally, if the same individual has participated in or experienced acts of a severity that further distance him or herself from this support structure (e.g. civilian casualties, catastrophic injuries, rape) then the probability of use drops significantly. The fear of judgement will keep that individual from seeking the support he or she needs at the moment it is most needed – a tragic self-fulfilling prophecy.
PTS is particularly difficult for Vietnam veterans, as they were mostly individual augmentees that were shunned by the larger combat veteran community upon their return home.
Contrast this with the unit-based deployments of WWII, Korea, and Iraq/Afghanistan. One can take it a step further by contrasting WWII/Korea and Iraq/Afghanistan. Look at the percentage of veterans in a given community and the likelihood of families remaining intact, and its easy to see how the average strength of support structures is declining.
The growing civil-military divide ensure that a young man home from Afghanistan will probably not feel comfortable talking about his experience with his peers who attended college or started working instead. Thus the probability of any structure, no matter how strong, is also declining. These trends do not bode well for the next generation of American warriors who will, inevitably, be asked to shed their own and others’ blood on our behalf.