Anxiety Disorders: Solomon Z

Foa EB, Cahill SP, Boscarino JA, Hobfoll SE, Lahad M, McNally RJ, Solomon Z. · Department of Psychiatry, University of Pennsylvania, 3535 Market Street 6th Floor, Philadelphia, PA 19104, USA. · Neuropsychopharmacology. · Pubmed #16012536 links to  free full text

Abstract: The terrorist attacks of September 11, 2001, and the constant threat of imminent terrorist activity have brought into the forefront the urgent need to prepare for the consequences of such attacks. Such preparation entails utilization of existing knowledge, identification of crucial gaps in our scientific knowledge, and taking steps to acquire this knowledge. At present, there is little empirical knowledge about interventions following terrorism and absolutely no available empirical knowledge about interventions following bioterrorism. Therefore, this paper reviews knowledge about (1) reactions following the September 11 terrorist attacks in New York City and other places, (2) the practical experiences accumulated in recent years in countries (eg, Israel) that have had to cope with the threat of bioterrorism and the reality of terrorism, and (3) interventions for acute and chronic stress reactions following other types of traumatic events (eg, rape, war, accidents). Our review found several treatments efficacious in treating individuals for acute and chronic post-traumatic stress disorder (PTSD) related to other traumatic events that will likely be efficacious in treating PTSD related to terrorist attacks. However, there were significant gaps in our knowledge about how to prepare populations and individuals for the possibility of a terrorist attack and what interventions to apply in the immediate aftermath of such an attack. Accordingly, we conclude the paper with several questions designed to guide future research.

Isserlin L, Zerach G, Solomon Z. · Department of Psychiatry, University of Western Ontario. London, Canada. · Am J Orthopsychiatry. · Pubmed #19123763 No free full text.

Abstract: Toward the development of a unifying diagnosis for acute stress responses this article attempts to find a place for combat stress reaction (CSR) within the spectrum of other defined acute stress responses. This article critically compares the diagnostic criteria of acute stress disorder (ASD), acute stress reaction (ASR), and CSR. Prospective studies concerning the predictive value of ASD, ASR, and CSR are reviewed. Questions, recommendations, and implications for clinical practice are raised concerning the completeness of the current acute stress response diagnoses, the heterogeneity of different stressors, the scope of expected outcomes, and the importance of decline in function as an indicator of future psychological, psychiatric, and somatic distress.

Hobfoll SE, Watson P, Bell CC, Bryant RA, Brymer MJ, Friedman MJ, Friedman M, Gersons BP, de Jong JT, Layne CM, Maguen S, Neria Y, Norwood AE, Pynoos RS, Reissman D, Ruzek JI, Shalev AY, Solomon Z, Steinberg AM, Ursano RJ. · Summa-Kent State University, Center for the Treatment and Study of Traumatic Stress, Akron, OH 44310, USA. · Psychiatry. · Pubmed #18181708 No free full text.

Abstract: Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid-term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope.

Solomon Z. · Tel Aviv University, Ramat Aviv, Israel. · J Clin Psychiatry. · Pubmed #11495090 No free full text.

Abstract: The constant threat to life and gruesome sights and sounds of war take their toll on the soldier psychologically as well as physically. A significant number of war veterans suffer from a wide range of debilitating psychological symptoms that vary in duration. For some the symptoms are transient, while for others profound and prolonged psychological and somatic sequelae manifest in the form of posttraumatic stress disorder (PTSD) and other comorbid conditions. This article reviews current understanding regarding combat stress reaction--often the first indicator of psychological breakdown--and posttraumatic sequelae. The longer-term detrimental consequences of PTSD and the impact of secondary traumatization. reactivation, and delayed-onset PTSD are also addressed.

Solomon Z, Horesh D, Ein-Dor T. · Bob Shappell School of Social Work, Tel Aviv University, Tel Aviv, Israel. · J Clin Psychiatry. · Pubmed #19573481 No free full text.

Abstract: OBJECTIVE: The aim of this study was to examine the long-term trajectories and interrelationships of posttraumatic stress disorder (PTSD) symptom clusters (intrusion, avoidance, and hyperarousal) in clinical and nonclinical groups of war veterans. METHOD: Six hundred seventy-five Israeli veterans from the 1982 Lebanon War were assessed. The clinical group consisted of 369 who had combat stress reaction (CSR) during the war, and the nonclinical group consisted of 306 veterans with no antecedent CSR. The 2 groups were matched in age, education, military rank, and assignment. They were prospectively evaluated 1, 2, and 20 years after the war. RESULTS: The clinical group endorsed a higher number of symptoms than the nonclinical group, both cross-sectionally and across time. In both the clinical and nonclinical groups, the clusters of intrusion, avoidance, and hyperarousal were interrelated at any given point in time and across 20 years. In both groups, avoidance was found to be a particularly stable symptom cluster over time. Finally, hyperarousal levels 1 year after the war were found to play an important role in both groups, as they predicted future avoidance and intrusion symptoms. CONCLUSIONS: The findings of this study suggest that PTSD is not a monolithic disorder, as symptom clusters differ in several important aspects. Also, the course and severity of symptoms differ between clinical and nonclinical groups. Finally, practitioners are encouraged to focus on the identification and treatment of early hyperarousal due to its prominent role in the development of other PTSD symptoms.

Solomon Z, Helvitz H, Zerach G. · Tel-Aviv University, Tel-Aviv, Israel. · Aging Ment Health. · Pubmed #19484604 No free full text.

Abstract: OBJECTIVES: To examine the contribution of posttraumatic stress disorder (PTSD) and physical health to subjective age among war veterans. METHOD: The sample included 502 veterans of the first Lebanon War who were assessed 20 years after the war by a series of self-report questionnaires. Data analyses included descriptive statistics, hierarchical and logistic regressions. RESULTS: Veterans with PTSD reported older subjective age than veterans without PTSD. Furthermore, both PTSD and general physical health contributed to subjective age, above and beyond chronological age and negative life events. Among the physical health problems, memory problems and weight gain were found to contribute to older age identity. In addition, the relation between general physical health and subjective age was stronger among veterans without PTSD than among veterans with PTSD. DISCUSSION: Possible explanations, clinical implications for integrative therapy for elderly PTSD victims, and recommendations for future research are presented.

Solomon Z, Dekel R, Zerach G, Horesh D. · The Adler Research Center for Child Welfare and Protection, Tel Aviv University, Tel Aviv, Israel. · J Marital Fam Ther. · Pubmed #19161584 No free full text.

Abstract: War captivity is a highly traumatic experience which sometimes has deleterious effects on both ex-POWs and their wives. This study examined the relationships between posttraumatic stress disorder (PTSD) symptoms and differentiation among male ex-prisoners of war (ex-POWs; n = 103), their wives (n = 82), and comparable controls. Results show that ex-POWs and their wives endorsed more PTSD symptoms than controls. Ex-POWs endorsed more cut-off and fusion than controls, while their wives endorsed only more fusion than control wives. Finally, the relationship between differentiation and PTSD was found to be stronger among ex-POW couples than among control couples. The unique characteristics of war captivity and the relationships between avoidance symptoms and cut-off were suggested as possible explanations.

Bleich A, Gelkopf M, Berger R, Solomon Z. · NATAL-The Israel Trauma Center for Victims of Terror and War, Israel. · Isr Med Assoc J. · Pubmed #19160946 links to  free full text

Abstract: BACKGROUND: Detrimental effects of military service among the civilian Palestinian population have been reported in soldiers. OBJECTIVES: To examine the frequency and type of stressors encountered by soldiers in close contact with the CPP and its relationship with post-traumatic symptomatology. We also investigated coping methods and the preferred types of professional help. METHODS: Using random digit dialing methodology we conducted a phone survey of veteran soldiers, men (n=167) and women (n=59) in close contact with the CPP; the comparison group comprised male veteran soldiers with no CPP exposure (n=74). We used focus groups to develop context-related measures to assess exposure to violent incidents, coping modes and preferred modes of professional assistance. We included measures of traumatic exposure, post-traumatic stress symptoms and post-traumatic stress disorder. RESULTS: Soldiers who served among the CPP had greater exposure to traumatic events and to civilian-related violent incidents (more than half as victims, and a third as perpetrators); and 17.4% perceived their behavior as degrading civilians. Primary traumatic exposure, perceived health problems and avoidance coping were found to be risk factors for PTS and PTSD. Involvement in incidents that may have degraded Palestinian civilians predicted PTS. CONCLUSIONS: Friction with the CPP in itself does not constitute a risk factor for psychopathology among soldiers. However, contact with this population entails more exposure to traumatic events, which may cause PTS and PTSD. Furthermore, a relative minority of soldiers may be involved in situations that may degrade civilians, which is a risk factor for PTS. To avoid violent and sometimes degrading behaviors, appropriate psycho-educational and behavioral preparation should be provided.

Hamama-Raz Y, Solomon Z, Cohen A, Laufer A. · School of Social Work, Ariel University Center of Samaria, Israel. · J Trauma Stress. · Pubmed #19107729 No free full text.

Abstract: Exposure to political terror and its psychological toll were assessed in 276 Israeli Palestinian and 1,469 Jewish adolescents using self-report questionnaires. Israeli Palestinians displayed more posttraumatic symptoms, higher levels of objective exposure to terror, more negative life events, lower ability to forgive, and a higher need for vengeance than their Jewish counterparts. Although the two groups did not differ in fear levels, Israeli Palestinians expressed more favorable attitudes toward peace. Ethnicity played a major role in explaining the variance of posttraumatic symptomatology. Israeli Palestinians displayed increased vulnerability to mental distress when compared to their Jewish counterparts. The unique roles of subjective fear, attitudes towards peace, forgiveness, and revenge among Israeli Palestinians are discussed.

Levine SZ, Laufer A, Hamama-Raz Y, Stein E, Solomon Z. · Department of Criminology, Bar Ilan University, Ramat Gan, Israel. · J Trauma Stress. · Pubmed #18956452 No free full text.

Abstract: To address gaps in the literature, this study examined the components of posttraumatic growth, and the relationship between growth and posttraumatic stress disorder (PTSD). Participants were from a pooled sample of 4,054 Israeli adolescents exposed to terror of whom 210 (5.5%) met criteria for PTSD. Measures included the Child Post-Traumatic Stress Reaction Index and Posttraumatic Growth Inventory. Principal components analysis showed two correlated components of outward and intrapersonal growth. Regression modeling showed that the relationship between the growth and PTSD measures was linear and curvilinear (inverted-U). These results replicated accounting for heterogeneity in PTSD, exposure and subsamples. Collectively, the results imply that posttraumatic growth in adolescence is characterized by two robust components, and is greatest at moderate posttraumatic stress levels.

Solomon Z, Dekel R, Zerach G. · Bob Shappell School of Social Work, Tel Aviv University, Israel. · J Fam Psychol. · Pubmed #18855502 No free full text.

Abstract: This study examined (a) the relationships between posttraumatic stress disorder (PTSD) symptom clusters and marital intimacy among Israeli war veterans and (b) the role of self-disclosure and verbal violence in mediating the effects of PTSD avoidance and hyperarousal symptoms on marital intimacy. The sample consisted of 219 participants divided into 2 groups: ex-prisoners of war (ex-POWs; N = 125) and a comparison group of veterans who fought in the same war but were not held in captivity (N = 94). Ex-POWs displayed higher levels of PTSD symptoms and verbal violence and lower levels of self-disclosure than did controls. Although ex-POWs and controls did not differ in level of marital intimacy, they did, however, present a different pattern of relationships between PTSD clusters and intimacy. In ex-POWs, self-disclosure mediated the relations between PTSD avoidance and marital intimacy. Verbal aggression was also found via indirect effect of hyperarousal on marital intimacy. The results point to the importance of self-disclosure and verbal violence as interpersonal mechanisms for the relations between posttraumatic symptoms on marital intimacy of ex-POWs.

Solomon Z, Dekel R. · Tel-Aviv University, Adler Center, POB 39040, Tel Aviv 61390, Israel. · Fam Process. · Pubmed #18605125 No free full text.

Abstract: This prospective study examined the relative contribution of loneliness and posttraumatic stress disorder (PTSD) to marital adjustment among Israeli veterans of the 1973 Yom Kippur war. Specifically, we examined the mediating role of loneliness as measured in 1991 in the association between PTSD as measured in 1991 and marital adjustment as measured in 2003. Our sample consisted of 225 participants divided into 2 groups: ex-prisoners of war (ex-POWs) (N = 122) and a comparison group comprised of veterans who fought in the same war but who had not experienced captivity (N = 103). The findings demonstrate that ex-POWs display lower levels of marital adjustment and higher levels of PTSD than controls. Loneliness was found to mediate the relationship between PTSD as measured in 1991 and marital adjustment as measured in 2003 for both ex-POWs and controls. Further, for ex-POWs, loneliness contributes to marital adjustment above and beyond the contribution of PTSD as measured in 2003. The theoretical implications of loneliness for the marital relationships of traumatized ex-POWs are discussed.

Defrin R, Ginzburg K, Solomon Z, Polad E, Bloch M, Govezensky M, Schreiber S. · Department of Physical Therapy, School of Allied Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel. · Pain. · Pubmed #18585862 No free full text.

Abstract: Post-traumatic stress disorder (PTSD) often co-occurs with chronic pain. Neither the underlying mechanism of this comorbidity nor the nature of pain perception among subjects with PTSD is well defined. This study is the first systematic and quantitative evaluation of pain perception and chronic pain in subjects with PTSD. The study group consisted of 32 outpatients with combat- and terror-related PTSD, 29 outpatients with anxiety disorder and 20 healthy controls. Quantitative somatosensory testing included the measurement of warm, cold, light touch and heat-pain thresholds and responses to acute suprathreshold heat and mechanical stimuli. Chronic pain was characterized, and levels of PTSD and anxiety symptomatology were assessed by self-report questionnaires. Subjects with PTSD exhibited higher rates of chronic pain, more intense chronic pain and more painful body regions compared with the other two groups. PTSD severity correlated with chronic pain severity. Thresholds of subjects with PTSD were significantly higher than those of subjects with anxiety and healthy controls, but they perceived suprathreshold stimuli as being much more intense than the other two groups. These results suggest that subjects with PTSD exhibit an intense and widespread chronic pain and a unique sensory profile of hyposensitivity to pain accompanied by hyper-reactivity to suprathreshold noxious stimuli. These features may be attributed to the manner with which PTSD subjects emotionally interpret and respond to painful stimuli. Alternatively, but not mutually exclusive, the findings may reflect altered sensory processing among these subjects.

Solomon Z, Zur-Noah S, Horesh D, Zerach G, Keinan G. · The Adler Research Center for Child Welfare and Protection, Bob Shapel School of Social Work, Tel Aviv University, Tel Aviv, Israel. · J Trauma Stress. · Pubmed #18553410 No free full text.

Abstract: This study examines the contribution of prewar life events, war exposure, and postwar life events to combat-induced psychopathology among 425 Israeli War veterans from the Lebanon War. Data was collected at two time points (1983 and 2002). The sample included veterans with and without combat stress reaction (CSR). Battle intensity and subjective experience of risk in war were associated with CSR. Negative childhood life events, CSR, PTSD in 1983 and postwar negative life events were associated with PTSD in 2002. Furthermore, a path analysis revealed that CSR mediated the relation between battle intensity and PTSD in 2002. Our findings suggest that stressful life events throughout the life cycle contribute significantly to veterans' posttraumatic symptomatology, above and beyond combat exposure.

Gelkopf M, Solomon Z, Berger R, Bleich A. · Department of Community Mental Health, Faculty of Social Health Sciences, University of Haifa, Haifa, Israel. · Acta Psychiatr Scand. · Pubmed #18331581 No free full text.

Abstract: OBJECTIVE: Since September 2000 Israeli society has been subjected to numerous deadly terror attacks. Few studies have studied the comparative mental health vulnerability of minorities and majorities to continuous terror attacks. METHOD: Two telephone surveys (N = 512 and 501) on two distinct representative samples of the Israeli population after 19 months and after 44 months of terror. The Arab minority and Jewish majority were compared on measures of exposure to terrorism, posttraumatic stress symptomatology, feeling depressed, coping, sense of safety, future orientation, and previous traumatic experiences. RESULTS: After 19 months of terrorist attacks Arab Israelis and Jewish Israelis reacted roughly similarly to the situation, however after 44 months of terror, posttraumatic symptom disorder in the Arab population increased three-fold, posttraumatic symptomatology doubled and resiliency almost disappeared. CONCLUSION: We suggest that certain conditions inherent to political conflict situations may potentially put minorities at risk and may only be observable as terrorism-related stressors become chronic.

Solomon Z, Dekel R, Mikulincer M. · The Adler Research Center for Child Welfare and Protection, Tel Aviv University, Israel. · Psychol Med. · Pubmed #18257940 No free full text.

Abstract: BACKGROUND: Victims of war captivity sometimes suffer from complex post-traumatic stress disorder (PTSD), a unique form of PTSD that entails various alterations in personality. These alterations may involve changes in attachment orientation. METHOD: The sample comprised two groups of veterans from the 1973 Yom Kippur War: 103 ex-prisoners of war (ex-POWs) and 106 comparable control veterans. They were assessed at two points in time, 18 years and 30 years after the war. RESULTS: Ex-POWs suffered from more post-traumatic symptoms than controls at both measurements points and these symptoms increased only among ex-POWs from Time 1 to Time 2. In addition, both attachment anxiety and attachment avoidance increased with time among ex-POWs, whereas they decreased slightly or remained stable among controls. Finally, the increases in attachment anxiety and avoidance were positively associated with the increase in post-traumatic symptoms among both study groups. Further analyses indicated that early PTSD symptoms predicted later attachment better than early attachment predicted later PTSD symptoms. CONCLUSIONS: The results suggest that: (1) complex traumas are implicated in attachment orientations and PTSD symptoms even many years after captivity; (2) there is an increase in attachment insecurities (anxiety, avoidance) and an increase in PTSD symptoms decades after the captivity; (3) and post-traumatic stress symptoms predict attachment orientations better than attachment orientations predict an increase in PTSD symptoms.

Elklit A, Shevlin M, Solomon Z, Dekel R. · Department of Psychology, University of Aarhus, Aarhus, Denmark. · J Trauma Stress. · Pubmed #17598140 No free full text.

Abstract: The factor structure of the World Assumptions Scale (WAS) was assessed by means of confirmatory factor analysis. The sample was comprised of 1,710 participants who had been exposed to trauma that resulted in whiplash. Four alternative models were specified and estimated using LISREL 8.72. A correlated 8-factor solution was the best explanation of the sample data. The estimates of reliability of eight subscales of the WAS ranged from .48 to .82. Scores from five subscales correlated significantly with trauma severity as measured by the Harvard Trauma Questionnaire, although the magnitude of the correlations was low to modest, ranging from .08 to -.43. It is suggested that the WAS has adequate psychometric properties for use in both clinical and research settings.

Solomon Z, Dekel R. · Adler Research Center, Tel Aviv University, Ramat Aviv, Israel. · J Trauma Stress. · Pubmed #17597131 No free full text.

Abstract: In this article, the authors present a prospective study that dealt with pathological (posttraumatic stress disorder; PTSD) and salutary (posttraumatic growth; PTG) outcomes of captivity and the correlates of those outcomes among a sample of ex-prisoners of war (POWs) and a control group of combat veterans. Posttraumatic stress disorder and its correlates were assessed in 1991 and 2003, and PTG was assessed in 2003. The results indicate that ex-POWs exhibited higher levels of PTSD and PTG than did the controls. In addition, both linear and quadratic associations between PTSD and PTG were found. The authors discuss some unresolved issues related to assessment of PTG and salutary outcomes, and outline directions for future research.

Rosenberg A, Heimberg RG, Solomon Z, Levin L. · Temple University, Philadelphia, PA 19122-6085, United States. · J Anxiety Disord. · Pubmed #17582733 No free full text.

Abstract: Preliminary investigations of disasters, including terrorism, have identified degree of exposure as a highly reliable predictor of trauma symptoms. However, this effect has not been consistently demonstrated in studies conducted in Israel. One explanation for this may be found in the different mechanisms that influence the relationship between exposure and symptoms in situations of recurrent versus one-time terror events. We examined traumatic symptoms and response to life events as variables which may be affected by repeated exposure to violence. Students from Tel Aviv University (n=65) and the College of Judea and Samaria, in the West Bank (n=47), completed measures of exposure to terrorism, trauma symptoms, life event stress reactions, and psychopathology. As in previous studies, no relationship between the overall degree of terror-related exposure and trauma symptoms was found for either group. General level of anxiety mediated the relationship between terror-related trauma symptoms and life event stress reactions. For the Ariel group, exposure to terror was related to anxiety and hostility. Direct terror-related exposure was negatively related to life event stress for the Tel Aviv group. In summary, our findings suggest that the exposure-symptom relationship may function differently in a context of ongoing threat than in a context of single-event terror.

Solomon Z, Horesh D. · Adler Research Center for Child Welfare and Protection, Tel Aviv University, Tel Aviv, Israel. · Am J Orthopsychiatry. · Pubmed #17535115 No free full text.

Abstract: This study assesses differences in PTSD rates according to different sets of diagnostic criteria. Two samples have been studied: one comprised of 286 combat stress reaction (CSR) casualties and 218 non-CSR veterans from the Lebanon war (Study 1); the other of 95 ex-POWs and 101 non-POWs from the Yom Kipur war (Study 2). Participants were administered two versions of the PTSD inventory based on different Diagnostic and Statistical Manual of Mental Disorders (DSM) editions: DSM-III and DSM-IV in Study 1 and DSM-III-R and DSM-IV in Study 2. PTSD rates declined when criteria of more recent DSM editions were applied. In addition, findings clearly demonstrate the importance of the dysfunction criterion (F) in PTSD. The highly complex nature of the PTSD diagnosis is discussed, as well as the important role of dysfunction and distress.

Solomon Z, Mikulincer M. · Adler Research Center, Tel-Aviv University, Tel Aviv, Israel. · J Consult Clin Psychol. · Pubmed #17469889 No free full text.

Abstract: The study assesses posttraumatic intrusion, avoidance, and social functioning among 214 Israeli combat veterans from the first Lebanon War with and without combat stress reaction (CSR) 1, 2, 3, and 20 years after the war. CSR veterans reported higher intrusion and avoidance than did non-CSR veterans. With time, there was a decline in these symptoms. In addition, intrusion and avoidance were associated with problems in social functioning on a given year, and they longitudinally predicted social dysfunction 2, 3, and 20 years after the war. CSR veterans presented stronger temporal covariations between intrusion-avoidance and social functioning. The findings suggest that CSR is a marker for future psychopathology and point to the role of avoidance in social dysfunction.

Hantman S, Solomon Z. · Tel-Hai Academic College, Tel-Hai (Upper Galilee), Israel. · Soc Psychiatry Psychiatr Epidemiol. · Pubmed #17384892 No free full text.

Abstract: BACKGROUND: The current study aims to determine whether elderly Holocaust survivors are affected differently from non-survivors by the adversity of aging and cancer. METHOD: Holocaust survivors and non-survivors suffering from cancer, were assessed tapping PTSD, psychiatric symptomatology, psychosocial adjustment to illness and coping with the aftermath of the Holocaust. RESULTS: Findings indicate a significant difference between survivors and non-survivors in post-traumatic symptoms and their intensity, survivors endorsing significantly more PTSD symptoms. Survivors were classified into 3 sub-groups, namely "Victims," "Fighters," and "Those who made it". "Victims" reported the highest percentage of persons who met PTSD, psychiatric symptomatology and difficulty coping with the problems of old age. CONCLUSIONS: The diversity of responses points to heterogeneity of long-term adaptation and adjustment among Holocaust survivors and similar response to subsequent adversity.

Dekel R, Solomon Z. · School of Social Work, Bar-Ilan University, Ramat-Gan, Israel. · J Fam Psychol. · Pubmed #17176208 No free full text.

Abstract: In this study, the authors examined the marital adjustment, spousal aggression, and sexual satisfaction of prisoners of war (POWs) 3 decades after their release. More specifically, the authors examined the extent to which impaired marital relations among former POWs are an outcome of their captivity or of the posttraumatic stress disorder (PTSD) that some of them developed. The authors compared 25 former POWs with PTSD, 85 former POWs without PTSD, and 104 control veterans. The findings reveal that the marital problems of former POWs are more related to PTSD than to their captivity. PTSD is related to decreased marital satisfaction, increased verbal aggression, and heightened sexual dissatisfaction among former POWs.

Ginzburg K, Solomon Z, Dekel R, Bleich A. · Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel. · J Nerv Ment Dis. · Pubmed #17164634 No free full text.

Abstract: Since dissociation has been recognized as a marker of posttraumatic processes, this study examines the chronological relations between dissociation and stress reactions (acute stress disorder, ASD, and posttraumatic stress disorder, PTSD) following myocardial infarction (MI). One hundred sixteen MI patients were examined twice: within 1 week of the trauma (time 1) and 7 months later (time 2). Sixty-seven matched controls were studied in a parallel interval. ASD was assessed at time 1, PTSD at time 2, and dissociative tendencies at both times. ASD and PTSD were moderately associated with levels of dissociation. In addition, while the MI patients did not differ from the controls in level of dissociation, both in time 1 and time 2, among the MI group, PTSD was associated with an increase in dissociation. These findings may reflect either the development of two comorbid entities, or a presentation of a dissociative subtype of PTSD.

Solomon Z, Shklar R, Singer Y, Mikulincer M. · Bob Shappell School of Social Work, Tel Aviv University, Tel Aviv, Israel. · J Nerv Ment Dis. · Pubmed #17164632 No free full text.

Abstract: During the war or shortly thereafter, the most common manifestation of combat induced psychopathology is combat stress reaction (CSR). The long-term consequences of CSR have so far received little scientific attention. The aim of this study was to examine whether CSR is a marker for long-term PTSD and other psychiatric comorbidities. Two groups of veterans from the 1982 Lebanon war were assessed 20 years after the war: one comprised 286 CSR casualties and the other comprised 218 matched non-CSR soldiers. Participants were assessed for PTSD, psychiatric symptomatology, social functioning, physical health, and postwar life events. Twenty years after the war, veterans with antecedent CSR reported more PTSD, psychiatric symptomatology and distress, social dysfunction, and health problems than did non-CSR veterans. We conclude that CSR should be seen as a marker for long-term psychiatric distress and impairment. In addition, the implications of combat-related trauma are broad and varied, and go beyond the narrow scope of PTSD.