Tuesday, November 27, 2012

Traumatic Childhood Predicts Adult PTSD in Soldiers


In nearly every client I have seen in my short time as therapist, survivors of sexual trauma had really messed up childhoods - those with "good enough" childhoods recover quickly from rape or assault compared to those who were molested, neglected, or emotionally/verbally abused as children.

New research suggests this is also true for soldiers who suffer from posttraumatic stress disorder (PTSD) - the ones who had traumatic or troubled childhoods are much more likely to develop PTSD as a result of their combat exposure.

Full abstract is at the bottom - the article is pay-walled.

Embattled childhoods may be the real trauma for soldiers with PTSD

Posted On: November 19, 2012

New research on posttraumatic stress disorder (PTSD) in soldiers challenges popular assumptions about the origins and trajectory of PTSD, providing evidence that traumatic experiences in childhood - not combat - may predict which soldiers develop the disorder.

Psychological scientist Dorthe Berntsen of Aarhus University in Denmark and a team of Danish and American researchers wanted to understand why some soldiers develop PTSD but others don't. They also wanted to develop a clearer understanding of how the symptoms of the disorder progress.

"Most studies on PTSD in soldiers following service in war zones do not include measures of PTSD symptoms prior to deployment and thus suffer from a baseline problem. Only a few studies have examined pre- to post-deployment changes in PTSD symptoms, and most only use a single before-and-after measure," says Berntsen.

The team aimed to address these methodological issues by studying a group of 746 Danish soldiers and evaluating their symptoms of PTSD at five different timepoints. Their study is published in Psychological Science, a journal of the Association for Psychological Science.

Five weeks before the soldiers were scheduled to leave for Afghanistan, they completed a battery of tests including a PTSD inventory and a test for depression. They also completed a questionnaire about traumatic life events, including childhood experiences of family violence, physical punishment, and spousal abuse.

During their deployment, the soldiers completed measures related to the direct experience of war: perceptions of war zone stress, actual life-threatening war experiences, battlefield wounds, and the experience of actually killing an enemy.

The researchers continued to follow the soldiers after their return home to Denmark, assessing them a couple weeks after their return, two to four months after their return, and seven to eight months after their return.

What Berntsen and her colleagues found challenges several widely held assumptions about the nature of PTSD.

Rather than following some sort of "typical" pattern in which symptoms emerge soon after a particularly traumatic event and persist over time, Berntsen and colleagues found wide variation in the development of PTSD among the soldiers.

The vast majority of the soldiers (84%) were resilient, showing no PTSD symptoms at all or recovering quickly from mild symptoms.

The rest of the soldiers showed distinct and unexpected patterns of symptoms. About 4% showed evidence of "new-onset" trajectory, with symptoms starting low and showing a marked increase across the five timepoints. Their symptoms did not appear to follow any specific traumatic event.

Most notably, about 13% of the soldiers in the study actually showed temporary improvement in symptoms during deployment. These soldiers reported significant symptoms of stress prior to leaving for Afghanistan that seemed to ease in the first months of deployment only to increase again upon their return home.


What could account for this unexpected pattern of symptoms?

Compared to the resilient soldiers, the soldiers who developed PTSD were much more likely to have suffered emotional problems and traumatic events prior to deployment. Childhood experiences of violence, especially punishment severe enough to cause bruises, cuts, burns, and broken bones actually predicted the onset of PTSD in these soldiers. Those who showed symptoms of PTSD were more likely to have witnessed family violence, and to have experienced physical attacks, stalking or death threats by a spouse. They were also more likely to have past experiences that they could not, or would not, talk about. And they were less educated than the resilient soldiers.

According to Berntsen and colleages, all of these factors together suggest that army life - despite the fact that it involved combat – offered more in the way of social support and life satisfaction than these particular soldiers had at home. The mental health benefits of being valued and experiencing camaraderie thus diminished when the soldiers had to return to civilian life.

The findings challenge the notion that exposure to combat and other war atrocities is the main cause of PTSD.

"We were surprised that stressful experiences during childhood seemed to play such a central role in discriminating the resilient versus non-resilient groups," says Berntsen. "These results should make psychologists question prevailing assumptions about PTSD and its development."

Full abstract:

Peace and War

Trajectories of Posttraumatic Stress Disorder Symptoms Before, During, and After Military Deployment in Afghanistan

  1. David C. Rubin1,4
+ Author Affiliations
  1. 1Center on Autobiographical Memory Research, Department of Psychology and Behavioral Sciences, Aarhus University
  2. 2Department of Military Psychology, Royal Danish Defense College
  3. 3Veteran Center, Danish Defense, Ringsted, Denmark
  4. 4Department of Psychology & Neuroscience, Duke University
  1. Dorthe Berntsen, Department of Psychology and Behavioral Sciences, Center on Autobiographical Memory Research, Aarhus University, Nobelparken, Jens Chr. Skousvej 4, 8000 Aarhus C, Denmark E-mail: dorthe@psy.au.dk

Abstract

In the study reported here, we examined posttraumatic stress disorder (PTSD) symptoms in 746 Danish soldiers measured on five occasions before, during, and after deployment to Afghanistan. Using latent class growth analysis, we identified six trajectories of change in PTSD symptoms. Two resilient trajectories had low levels across all five times, and a new-onset trajectory started low and showed a marked increase of PTSD symptoms. Three temporary-benefit trajectories, not previously described in the literature, showed decreases in PTSD symptoms during (or immediately after) deployment, followed by increases after return from deployment. Predeployment emotional problems and predeployment traumas, especially childhood adversities, were predictors for inclusion in the nonresilient trajectories, whereas deployment-related stress was not. These findings challenge standard views of PTSD in two ways. First, they show that factors other than immediately preceding stressors are critical for PTSD development, with childhood adversities being central. Second, they demonstrate that the development of PTSD symptoms shows heterogeneity, which indicates the need for multiple measurements to understand PTSD and identify people in need of treatment.
Citation:
Berntsen, D., Johannessen, KB, Thomsen, YD, Bertelsen, M, Hoyle, RH, and Rubin, DC. (2012, Nov 5). Peace and War: Trajectories of Posttraumatic Stress Disorder Symptoms Before, During, and After Military Deployment in Afghanistan. Psychological Science, Epub ahead of publication.
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