Effects of Litigation Settlements on Posttraumatic Stress Symptoms in Motor Vehicle Accident Victims

In order to investigate the effects of the initiation of litigation and its settlement on victims of motor vehicle accidents (MVAs), we followed up 132 MVA victims from an initial assessment 1 to 4 months post-MVA for 1 year. Of the 67 who had initiated litigation. 18 (27%) settled within the 12 months, while 49 still had litigation pending; 65 never initiated litigation. Those who initiated litigation had more severe injuries and higher initial levels of posttraumatic stress (PTS) symptoms. All three groups improved in major role function and had reduced PTS symptoms over the 1 year follow-up. Those whose suits were still pending, as well as those whose suits had been settled, showed no reduction in measures of anxiety or depression, whereas the nonlitigants did show improvement on these measures.     

Predictors of Acute Stress Following Motor Vehicle Accidents

The aim of this study was to investigate the predictors of acute stress following motor vehicle accidents (MVA). Sixty-two consecutive adult admissions to a hospital were assessed between two days and four weeks following a MVA. Participants were assessed for acute stress disorder (ASD) with a structured clinical interview and administered the Beck Depression Inventory (BDI), Coping Style Questionnaire, Dissociative Experiences Scale, and the Eysenck Personality Inventory. The prevalences of full and sub-syndromal ASD were 16.1% and 14.5%, respectively. BDI, history of psychiatric treatment, history of posttraumatic stress disorder (PTSD), and history of previous MVA accounted for 61% of the variance of acute stress severity. The findings indicate that predictors of acute stress severity are comparable to the predictors of PTSD and highlight the possibility of identifying those who may benefit from early treatment.     

Evaluation of Initial Posttrauma Cardiovascular Levels in Association with Acute PTSD Symptoms Following a Serious Motor Vehicle Accident

The present study examined the relationship between heart rate (HR) and blood pressure (BP) levels assessed at multiple time points posttrauma and subsequent acute posttraumatic stress disorder (PTSD) symptoms present at a 1-month follow-up. HR and BP levels were measured in 65 motor vehicle accident (MVA) survivors during Emergency Medical Service transport, upon admission to the trauma unit, for the first 20 min postadmission and on the day of discharge. Hierarchical linear modeling analyses revealed no significant relationships between cardiovascular levels and acute PTSD symptoms. Given the small sample size, these results should be interpreted with caution. However, the present results question the use of initial cardiovascular levels as predictors of subsequent acute PTSD in seriously injured MVA victims.     

Anger,Dissociation, and Posttraumatic Stress Disorder Among Female Assault Victims

The goal of the present study was to explore the relationship between anger and dissociation and their relationship to symptoms of posttrauma pathology. One hundred four female assault victims were assessed prospectively 2, 4, and 12 weeks postassault. Measures of posttraumatic stress disorder (PTSD) severity, social functioning, anger, and dissociation were obtained at all assessments. Results revealed that differentiation between symptoms that predict later PTSD and impaired social functioning first becomes evident at 4 weeks postassault. At 4 weeks postassault, anger expression was predictive of later PTSD severity, whereas dissociation was predictive of poorer later functioning.     

Effects of Attribution of Responsibility for Motor Vehicle Accidents on Severity of PTSD Symptoms, Ways of Coping, and Recovery Over Six Months

In light of Delahanty et al.'s (1997) identification of attribution of responsibility for a motor vehicle accident (MVA) as a powerful determinant of initial level of distress from the trauma and of early remission of PTSD, we reexamined data from Blanchard and Hickling's (1997) prospective follow-up of 158 MVA survivors. Despite differences between the two samples (Delahanty sample recruited from hospitals 2–3 weeks post-MVA and predominantly male; our sample recruited from outpatient care 1–4 months post-MVA and predominantly female) we replicated Delahanty's findings: those with PTSD who blame themselves for the MVA are less symptomatic initially and recover more rapidly in the first 6 months than those with PTSD who blame another party for the accident.     

The Clinical Relevance of a Partial Remission Specifier for Posttraumatic Stress Disorder

The clinical relevance of a partial remission specifier for posttraumatic stress disorder (PTSD) was examined. Using a subgroup of outpatients from the Rhode Island Methods to Improve Diagnostic Assessment and Services project who met criteria for lifetime PTSD (N = 261), participants with current PTSD, PTSD in partial remission, and PTSD in full remission were compared on various indices of impairment. A substantial number (n = 75) of patients met criteria for PTSD in partial remission (28.7%). Outpatients in partial remission of PTSD displayed comparable levels of social and employment functioning as those with current PTSD, and over half of these patients requested treatment for their symptoms. Results support the clinical utility of a partial remission specifier for PTSD.     

Complex PTSD in Victims Exposed to Sexual and Physical Abuse: Results from the DSM-IV Field Trial for Posttraumatic Stress Disorder

Two hundred thirty four participants in the DSM-IV Posttraumatic Stress Disorder (PTSD) Field Trial who reported sexual and/or physical abuse were evaluated. Participants were categorized according to type of abuse (physical, sexual, both), duration of abuse (acute versus chronic), and onset of abuse (early versus late). Separate logistic regression analyses examined the relationship between age of onset, duration, abuse type, and the complex PTSD (CP) lifetime diagnosis for women and men. Sexually abused women, especially those who also experienced physical abuse, had a higher risk of developing CP, although CP symptoms occurred at a high base rate among physically abused women. The theoretical implications and incremental clinical usefulness of targeting CP symptoms with abused populations are discussed.     

Dissociative Symptoms in Acute Stress Disorder

This study provides a profile of symptoms, and particularly dissociative symptoms, in the diagnosis of acute stress disorder (ASD) following motor vehicle accidents (MVAs). Consecutive adult non-brain-injured admissions to a major trauma hospital (N = 92) were assessed between 2 days and 4 weeks following an MVA. Presence of ASD was determined by a structured clinical interview. The occurrence of full and subsyndromal ASD was approximately 13% and 21%, respectively. The majority of those who met criteria for subsyndromal ASD did not meet the ASD criteria for dissociation. At least 80% of individuals who reported derealization also reported reduced awareness and depersonalization. This significant overlap between dissociative symptoms questions the discriminatory power and conceptual independence of the dissociative criteria. These findings suggest the need for a more refined conceptual and operational understanding of dissociative symptoms in the acute trauma stage.     

Olfactory Identification in Combat-Related Posttraumatic Stress Disorder

Recent neuropsychological conceptualizations of posttraumatic stress disorder (PTSD) implicate dysfunction of the fronto-limbic system, a brain system thought to be involved in the mediation of emotion. However, few studies have examined fronto-limbic subregions, such as the orbitofrontal cortex, in PTSD. As a measure of orbitofrontal integrity, olfactory identification was assessed in 26 Vietnam War veterans with PTSD, 25 Vietnam War veterans without mental disorders, and 17 Vietnam-era, non-war-zone veterans without mental disorders. Relative to veterans without PTSD, those diagnosed with PTSD were less proficient in odor identification and verbal learning but not on other cognitive tests sensitive to dorsolateral prefrontal and mesial temporal functioning. Results bolster prior research indicating fronto-limbic dysfunction in PTSD, and suggest involvement of the orbitofrontal region.     

Anger Regulation Deficits in Combat-Related Posttraumatic Stress Disorder

We describe a typology of regulatory deficits associated with anger in combat-related posttraumatic stress disorder (PTSD). Cognitive, arousal, and behavioral domain deficits in anger regulation were observed clinically in PTSD patients with high levels of anger who were participating in a multi-year trial of a structured anger treatment. We also describe a category of patients whose anger type we have termed ball of rage. These patients exhibit regulatory deficits in all three domains of anger regulation. We offer a conceptual framework to advance the understanding of anger associated with PTSD and to guide its effective treatment.     

Acute Psychophysiological Arousal and Posttraumatic Stress Disorder: A Two-Year Prospective Study

This study investigated the role of acute arousal in the development of posttraumatic stress disorder (PTSD). Hospitalized motor vehicle accident survivors (n = 146) were assessed for acute stress disorder (ASD) within 1 month of the trauma, 6 months later, and reassessed for PTSD 2 years posttrauma (n = 87). Heart rates (HR) were assessed on the day of hospital discharge. Participants who had PTSD 2 years posttrauma had higher HR at hospital discharge than those without PTSD. A diagnosis of ASD or a resting HR of 95 beats per minute had moderate sensitivity (74%) and specificity (91%) in predicting PTSD. These findings suggest that caution is required in using acute HR as a predictor of longer-term PTSD following trauma.     

A Concise Measure of Anger in Combat-Related Posttraumatic Stress Disorder

There is a need for a brief specific measure of anger for use in assessment of posttraumatic mental health problems. One unpublished short scale is the Dimensions of Anger Reactions (DAR; R. Novaco, 1975). This study examined the psychometric properties of the DAR using intake and 12-month data for 192 Australian Vietnam veterans with combat-related PTSD. Results showed the DAR to be unidimensional, reliable, and sensitive to change over time, and removal of two items improved the scale's properties. The DAR measures anger disposition directed towards others. Assessment of convergent validity indicated that the DAR primarily measures Trait Anger. Results suggest that the DAR is a psychometrically strong measure, potentially useful for the evaluation of anger in PTSD.     

Chronicity in Posttraumatic Stress Disorder (PTSD) and Predictors of Course of PTSD in Patients with Anxiety Disorders

The purpose of this study was to examine the course of comorbid posttraumatic stress disorder (PTSD) in 54 patients with another anxiety disorder. Using a prospective longitudinal design, the present study found that during the first 5 years of follow-up the probability of full remission from a chronic episode of PTSD was .18. Findings from this and other research confirm clinical impressions that a substantial number of people never fully remit from their PTSD even after many years. Variables associated with a longer time to remit from an episode of chronic PTSD were a history of alcohol abuse and a history of childhood trauma.     

Fear,Helplessness, and Horror in Posttraumatic Stress Disorder: Investigating DSM-IV Criterion A2 in Victims of Violent Crime

A DSM-IV diagnosis of posttraumatic stress disorder (PTSD) required for the first time that individuals must report experiencing intense fear, helplessness, or horror at the time of the trauma. In a longitudinal study of 138 victims of violent crime, we investigated whether reports of intense trauma-related emotions characterized individuals who, after 6 months, met criteria for PTSD according to the DSM-III-R. We found that intense levels of all 3 emotions strongly predicted later PTSD. However, a small number of those who later met DSM-III-R or ICD criteria for PTSD did not report intense emotions at the time of the trauma. They did, however, report high levels of either anger with others or shame.     

Treatment Preferences of Vietnam Veterans with Posttraumatic Stress Disorder

This study attempted to examine patterns over time in treatment preferences of 65 veterans who completed a 4 month inpatient posttraumatic stress disorders (PTSD) program in order to reveal potentially more beneficial types of treatment. Veterans rated the severity of their symptoms and degree of benefit of 35 different treatment components at discharge, and at 4 and 12 months follow-up. Veterans rated their symptoms as having not changed at discharge, and worsening by 4 months. Veterans initially perceived components that were high in Vietnam content, exploratory in purpose, verbal in modality, and personally focused as most effective, but by 12-month follow-up they perceived these as less effective than components that were low in Vietnam content, educative, action oriented, and externally focused. These effects were strongest among veterans with higher levels of PTSD symptomatology. Combat exposure, childhood abuse, and race were generally not significant predictors of response. These results underscore the importance of further inquiry into the relative value of rehabilitative-oriented and psychotherapeutic-oriented treatments for veterans with severe and chronic PTSD.     

The Validity of Posttraumatic Stress Disorder Among Vietnamese Refugees

The aim of this study was to examine the validity of posttraumatic stress disorder (PTSD) among Vietnamese refugees. The study population included 74 Vietnamese refugees who had resettled in the metropolitan Boston area. The previously validated Harvard Trauma Questionnaire was used to assess traumatic events and trauma-related symptoms. The number of traumatic events experienced was positively correlated with the severity of PTSD-related symptoms in this population. Internal consistency estimates and principal components analysis provided results that generally supported DSM-IV symptom dimensions of arousal, avoidance, and reexperiencing. However, the emergence of two separate dimensions of avoidance reflected the important contribution of depression to the traumatic response.     

Gender differences in responses to traumatic events: a prospective study

Gender differences in psychological responses to motor vehicle accidents were examined as part of a large-scale prospective study of PTSD. Participants were recruited from an emergency room (n = 275) and interviewed 1 week, 1 month, and 4 months later. No gender differences were seen in the prevalence or recovery from PTSD, or in symptom levels at 1- and 4 months. Women had a higher prevalence of lifetime- and postaccident generalized anxiety disorder. Gender differences were found regarding the type, but not the total number, of potentially traumatic events previously experienced. These results suggest that gender differences in responses to traumatic events are not explained by exposure as such, but rather may result from gender-specific attributes of the event.     

Personality Disorders in Veterans with Posttraumatic Stress Disorder and Depression

Little is known about the frequency of the full-range of personality disorders in outpatients with concurrent posttraumatic stress disorder (PTSD) and depression, a common and oftentimes treatment-resistant combination in clinical practice. In a group therapy outcome study, Axis I and II diagnoses were assessed with the Structured Clinical Interview for DSM-IV and the Clinician-Administered PTSD Scale to select 115 male combat veterans with PTSD and depressive disorder. Within this sample, 52 (45.2%) had one or more personality disorders--most commonly paranoid (17.4%), obsessive-compulsive (16.5%), avoidant (12.2%), and borderline (8.7%)--and 19 (16.5%) had two or more. Documenting a substantial frequency of personality disorders is a first step in devising appropriate interventions for this treatment-resistant combination of disorders.