Confirmation of Concurrent Illnesses in Posttraumatic Stress Disorder (original) (raw)
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Comorbidity of psychiatric disorders and posttraumatic stress disorder
The Journal of clinical psychiatry, 2000
Posttraumatic stress disorder (PTSD) commonly co-occurs with other psychiatric disorders. Data from epidemiologic surveys indicate that the vast majority of individuals with PTSD meet criteria for at least one other psychiatric disorder, and a substantial percentage have 3 or more other psychiatric diagnoses. A number of different hypothetical constructs have been posited to explain this high comorbidity; for example, the self-medication hypothesis has often been applied to understand the relationship between PTSD and substance use disorders. There is a substantial amount of symptom overlap between PTSD and a number of other psychiatric diagnoses, particularly major depressive disorder. It has been suggested that high rates of comorbidity may be simply an epiphenomenon of the diagnostic criteria used. In any case, this high degree of symptom overlap can contribute to diagnostic confusion and, in particular, to the underdiagnosis of PTSD when trauma histories are not specifically obt...
Posttraumatic Stress Disorder and Health Status
The Journal of ambulatory care management, 2006
This article examines the association between self-reported prevalence of posttraumatic stress disorder (PTSD) and health status in a sample of 2425 male Department of Veterans Affairs (VA) ambulatory care patients who participated in the Veterans Health Study. Participants were recruited at 1 of 4 VA outpatient clinics in the Boston area. They completed self-report measures of PTSD (using the PTSD Checklist and measures of exposure to traumatic events), depression (using the Center for Epidemiologic Studies-Depression scale), and health status (using the Short-Form-36) and a medical history interview assessing 22 conditions and a history of psychiatric treatment. The screening prevalence of PTSD was 20.2% among all patients (24.3% among those exposed to traumatic events); another 15.5% met the criteria for depression but not PTSD. The health status of patients with either PTSD or depression was significantly worse than that of patients with neither disorder, even after controlling for age, education, and number of comorbid medical conditions. Patients with PTSD reported more medical conditions than did other patients. Patients with PTSD currently in mental health treatment had worse health status than did those who reported no treatment; the health status of patients who reported past mental health treatment was generally comparable to that of those with no treatment. The prevalence and comorbidity of PTSD among this sample of VA ambulatory care patients were higher than previously reported among samples of community-residing adults. The association of PTSD with health status was substantial, suggesting that the burden of PTSD is at least comparable to, and may be worse than, that of depression. Mental health treatment alleviated some of this burden. The potential impact of PTSD on health status should be more widely recognized.
Psiquiatria Biologica, 2010
Comorbid posttraumatic stress disorder (PTSD) and depression is common in refugee groups; however, little is known about the predictors and correlates of comorbidity in treatment-seeking refugees. Participants in this study were 134 refugees resettled in Switzerland. Most participants were from Turkey, Iran, and Sri Lanka, and 92.7% had been exposed to torture. Self-report measures were implemented to assess PTSD, depression, mental and physical health-related quality of life (QoL), as well as pre-and postmigration experiences. Findings indicated that approximately half the sample met criteria for PTSD and depression, 33.6% met criteria for depression only, and only 2.2% met criteria for PTSD only. Several variables emerged as predictors of comorbidity in contrast to no diagnosis: female gender, odds ratio (OR) = 0.17; age, OR = 0.93; time in Switzerland, OR = 1.16; and trauma exposure, OR = 1.19. Postmigration stress was also associated with greater likelihood of comorbidity compared with no diagnosis, OR = 1.32, and a single diagnosis, OR = 1.14. Further, dual diagnosis was associated with significantly poorer mental health-related and physical health-related QoL (mental health-related QoL: dual diagnosis vs. single diagnosis, d = −0.52 and dual diagnosis vs. no diagnosis, d = −1.30; physical health-related QoL: dual diagnosis vs. single diagnosis, d = −0.73 and dual diagnosis vs. no diagnosis: d = −1.04). Findings indicated that comorbidity was highly prevalent in this sample of treatment-seeking refugees and was associated with a substantial impairment burden. Psychological interventions for refugees should consider the dual impact of PTSD and depression symptoms to optimally decrease distress and improve QoL in this vulnerable group.
Concerns Over Divergent Approaches in the Diagnostics of Posttraumatic Stress Disorder
Psychiatric Annals, 2016
Since the inception of posttraumatic stress disorder (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III), there has been an ongoing polemic debate about the veracity, assessment, neurobiology, and longitudinal course of the disorder. As a consequence, its clinical utility has been the subject of a significant amount of conflicting opinion due to the competing interests involving clinicians, insurance companies, victim's groups, and governments. This article reviews some of the current divergent approaches in the diagnosis of PTSD, including the debate on the condition itself, claims that it is overdiagnosed, the usefulness of the "A" criterion, equivalence of cluster criteria, the role of combat and civilian PTSD, the role of biomarkers, incongruences in diagnostic practice, and the need for a consistent approach that ensures diagnostic congruence. Critical drivers of divergent diagnostic systems are that they should not produce significantly different rates or produce high levels of discordance. However, one of the concerns is that the anticipated International Statistical Classification of Diseases and Related Health Problems, eleventh edition (ICD-11) has moved away from this primary aim and taken a markedly divergent approach that is incompatible with the advancement of consensus within this critical field. This article explores some of the primary arguments and evidence cited for this approach in ICD-11 and recent changes in DSM-5.
Posttraumatic Stress Disorder in the National Comorbidity Survey
Archives of General Psychiatry, 1995
Background: Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated lifetime prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode. Methods: Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey. Results: The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years. Conclusions: Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent.
Guidelines for differential diagnoses in a population with posttraumatic stress disorder
Professional Psychology: Research and Practice, 2009
In a large posttraumatic stress disorder (PTSD) and depression treatment outcome study, thorough diagnostic assessments of veterans at pretreatment, posttreatment, and 3 follow-up times were completed. The research team that reviewed these assessments encountered several challenges in the differential diagnosis of PTSD because of high comorbidity and symptoms shared with or resembling other disorders. For example, how do mental health professionals distinguish symptoms of agoraphobia from avoidance and hypervigilance symptoms of PTSD? When are hallucinations symptomatic of PTSD (e.g., flashbacks) versus a nonpsychotic near-death experience or an independent psychotic disorder? How do mental health professionals differentiate overlapping symptoms of PTSD and depressive disorders? To help make reliable diagnoses, the team developed clarifying questions and diagnostic guidelines, which may prove useful to other clinicians and researchers working with PTSD populations.
Assessment of post-traumatic stress disorder and comorbidity
Military medicine
The symptoms of lifetime post-traumatic stress disorder (PTSD) and comorbid diagnoses were compared among 502 combat-experienced soldiers under examination for compensation-related purposes to confirm or deny the diagnosis of PTSD and 196 soldiers with combat experience without any psychiatric disorder. The two groups were matched with regard to duration of combat experience, time between combat experience and the study, age, marital status, and education. PTSD was diagnosed by psychiatrists with a structured clinical interview according to the research version of the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders. The psychologists applied the Mississippi Scale for Combat-Related PTSD, Watson's criteria for PTSD, the Minnesota Multiphasic Personality Inventory version 201, and the Trauma Questionnaire. Also, a very detailed heteroanemnestic questionnaire was completed by social workers. Medical documentation and data from ...