Person:

McNally, Richard

Background: The diagnosis of posttraumatic stress disorder (PTSD) requires exposure to a traumatic stressor, as defined by Criterion A in the DSM criteria for PTSD. Yet, over the course of successive revisions of the diagnostic manual, the range of qualifying stressors has expanded considerably (e.g., watching terrorist attacks on television). Moreover, stressors that fall short of qualifying for even an expanded Criterion A can produce apparent PTSD. Taken together, these findings imply that people who do satisfy symptomatic criteria for PTSD following exposure to less severe stressors carry a heavy burden of risk factors. Method: To test this hypothesis, we examined whether the association between the risk factor of lower intelligence and more severe PTSD and depression symptoms would be greater among women reporting less severe CSA (n = 15) relative to women who reported moderate (n = 54) or high (n = 31) severity CSA. Results: The evidence was consistent with this hypothesis for subjects in the low and moderate severity groups, but less so for those in the high severity group. Conclusions: Lower intelligence was a more potent risk factor for posttraumatic distress among people exposed to less severe relative to moderately severe stressors.

Background: The network approach to mental disorders offers a novel framework for conceptualizing posttraumatic stress disorder (PTSD) as a causal system of interacting symptoms.

Objective: In this study, we extended this work by estimating the structure of relations among PTSD symptoms in adults reporting personal histories of childhood sexual abuse (CSA; N = 179).

Method: We employed two complementary methods. First, using the graphical LASSO, we computed a sparse, regularized partial correlation network revealing associations (edges) between pairs of PTSD symptoms (nodes). Next, using a Bayesian approach, we computed a directed acyclic graph (DAG) to estimate a directed, potentially causal model of the relations among symptoms.

Results: For the first network, we found that physiological reactivity to reminders of trauma, dreams about the trauma, and lost of interest in previously enjoyed activities were highly central nodes. However, stability analyses suggest that these findings were unstable across subsets of our sample. The DAG suggests that becoming physiologically reactive and upset in response to reminders of the trauma may be key drivers of other symptoms in adult survivors of CSA.

Conclusions: Our study illustrates the strengths and limitations of these network analytic approaches to PTSD.

ABSTRACT Background: The network approach to mental disorders offers a novel framework for conceptualizing posttraumatic stress disorder (PTSD) as a causal system of interacting symptoms. Objective: In this study, we extended this work by estimating the structure of relations among PTSD symptoms in adults reporting personal histories of childhood sexual abuse (CSA; N = 179). Method: We employed two complementary methods. First, using the graphical LASSO, we computed a sparse, regularized partial correlation network revealing associations (edges) between pairs of PTSD symptoms (nodes). Next, using a Bayesian approach, we computed a directed acyclic graph (DAG) to estimate a directed, potentially causal model of the relations among symptoms. Results: For the first network, we found that physiological reactivity to reminders of trauma, dreams about the trauma, and lost of interest in previously enjoyed activities were highly central nodes. However, stability analyses suggest that these findings were unstable across subsets of our sample. The DAG suggests that becoming physiologically reactive and upset in response to reminders of the trauma may be key drivers of other symptoms in adult survivors of CSA. Conclusions: Our study illustrates the strengths and limitations of these network analytic approaches to PTSD.

We tested whether a continuous measure of repressor coping style predicted lower posttraumatic stress disorder (PTSD) symptoms in 122 health care professionals serving in Operation Iraqi Freedom. Zero-order correlational analyses indicated that predeployment repressor coping scores negatively predicted postdeployment PTSD symptoms, (r_s = -0.29, p = 0.001), whereas predeployment Connor-Davidson Resilience Scale (CD-RISC) scores did not predict postdeployment PTSD symptoms, (r_s = -0.13, p = 0.14). However, predeployment trait anxiety was chiefly responsible for the association between repressor coping and PTSD symptom severity, (r_s = 0.38, p = 0.001). Four percent of the subjects qualified for a probable PTSD diagnosis. Although service members with relatively higher PTSD scores had lower repressor coping scores than did the other subjects, their level of predeployment anxiety was chiefly responsible for this relationship. Knowing someone's predeployment level of trait anxiety permits better prediction of PTSD symptoms among trauma-exposed service members than does knowing his or her level of repressive coping.