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Razavi SM, Salamati P, Rostami R. Post-traumatic stress disorder in patients with burn injuries due to sulfur mustard exposure. Burns 2016; 42:473-4. [PMID: 26790357 DOI: 10.1016/j.burns.2015.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 05/07/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Seyed Mansour Razavi
- Department of Community Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Rostami
- Psychology and Educational Department, Psychology Faculty, University of Tehran, Tehran, Iran.
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52
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Küffer AL, O'Donovan A, Burri A, Maercker A. Posttraumatic Stress Disorder, Adverse Childhood Events, and Buccal Cell Telomere Length in Elderly Swiss Former Indentured Child Laborers. Front Psychiatry 2016; 7:147. [PMID: 27630582 PMCID: PMC5005955 DOI: 10.3389/fpsyt.2016.00147] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 08/12/2016] [Indexed: 12/11/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is associated with increased risk for age-related diseases and early mortality. Accelerated biological aging could contribute to this elevated risk. The aim of the present study was to assess buccal cell telomere length (BTL) - a proposed marker of biological age - in men and women with and without PTSD. The role of childhood trauma was assessed as a potential additional risk factor for shorter telomere length. The sample included 62 former indentured Swiss child laborers (age: M = 76.19, SD = 6.18) and 58 healthy controls (age: M = 71.85, SD = 5.97). Structured clinical interviews were conducted to screen for PTSD and other psychiatric disorders. The Childhood Trauma Questionnaire (CTQ) was used to assess childhood trauma exposure. Quantitative polymerase chain reaction was used to measure BTL. Covariates include age, sex, years of education, self-evaluated financial situation, depression, and mental and physical functioning. Forty-eight (77.42%) of the former indentured child laborers screened positive for childhood trauma, and 21 (33.87%) had partial or full-blown PTSD. Results did not support our hypotheses that PTSD and childhood trauma would be associated with shorter BTL. In fact, results revealed a trend toward longer BTL in participants with partial or full PTSD [F(2,109) = 3.27, p = 0.04, η(2) = 0.06], and longer BTL was marginally associated with higher CTQ scores (age adjusted: β = 0.17 [95% CI: -0.01 to 0.35], t = 1.90, p = 0.06). Furthermore, within-group analyses indicated no significant association between BTL and CTQ scores. To the best of our knowledge, this is the first study exploring the association between childhood trauma and BTL in older individuals with and without PTSD. Contrary to predictions, there were no significant differences in BTL between participants with and without PTSD in our adjusted analyses, and childhood adversity was not associated with BTL. Possible explanations and future research possibilities are discussed.
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Affiliation(s)
- Andreas Lorenz Küffer
- Department of Psychology, Division for Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland; University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland; Department of Psychiatry, University of California in San Francisco, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Aoife O'Donovan
- Department of Psychiatry, University of California in San Francisco, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Andrea Burri
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand; Waitemata Pain Service, Department of Anaesthesia and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand
| | - Andreas Maercker
- Department of Psychology, Division for Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland; University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland
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53
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Fulton JJ, Calhoun PS, Wagner HR, Schry AR, Hair LP, Feeling N, Elbogen E, Beckham JC. The prevalence of posttraumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans: a meta-analysis. J Anxiety Disord 2015; 31:98-107. [PMID: 25768399 DOI: 10.1016/j.janxdis.2015.02.003] [Citation(s) in RCA: 429] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/25/2014] [Accepted: 02/09/2015] [Indexed: 12/20/2022]
Abstract
Literature on posttraumatic stress disorder (PTSD) prevalence among Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) veterans report estimates ranging from 1.4% to 60%. A more precise estimate is necessary for projecting healthcare needs and informing public policy. This meta-analysis examined 33 studies published between 2007 and 2013 involving 4,945,897 OEF/OIF veterans, and PTSD prevalence was estimated at 23%. Publication year and percentage of Caucasian participants and formerly active duty participants explained significant variability in prevalence across studies. PTSD remains a concern for a substantial percentage of OEF/OIF veterans. To date, most studies have estimated prevalence among OEF/OIF veterans using VA medical chart review. Thus, results generalize primarily to the prevalence of PTSD in medical records of OEF/OIF veterans who use VA services. Additional research is needed with randomly selected, representative samples administered diagnostic interviews. Significant financial and mental health resources are needed to promote recovery from PTSD.
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Affiliation(s)
- Jessica J Fulton
- Durham VA Medical Center, Durham, NC 27705, United States; VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States.
| | - Patrick S Calhoun
- Durham VA Medical Center, Durham, NC 27705, United States; VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States
| | - H Ryan Wagner
- Durham VA Medical Center, Durham, NC 27705, United States; VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States
| | - Amie R Schry
- Durham VA Medical Center, Durham, NC 27705, United States; VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States
| | - Lauren P Hair
- Durham VA Medical Center, Durham, NC 27705, United States
| | - Nicole Feeling
- Durham VA Medical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States
| | - Eric Elbogen
- Durham VA Medical Center, Durham, NC 27705, United States; VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC 27705, United States; Department of Psychiatry, UNC-Chapel Hill, Chapel Hill, NC 27516, United States
| | - Jean C Beckham
- Durham VA Medical Center, Durham, NC 27705, United States; VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States
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54
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O’Donovan A, Cohen BE, Seal K, Bertenthal D, Margaretten M, Nishimi K, Neylan TC. Elevated risk for autoimmune disorders in iraq and afghanistan veterans with posttraumatic stress disorder. Biol Psychiatry 2015; 77:365-74. [PMID: 25104173 PMCID: PMC4277929 DOI: 10.1016/j.biopsych.2014.06.015] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 06/06/2014] [Accepted: 06/23/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with endocrine and immune abnormalities that could increase risk for autoimmune disorders. However, little is known about the risk for autoimmune disorders among individuals with PTSD. METHODS We conducted a retrospective cohort study of 666,269 Iraq and Afghanistan veterans under age 55 who were enrolled in the Department of Veterans Affairs health care system between October 7, 2001, and March 31, 2011. Generalized linear models were used to examine if PTSD, other psychiatric disorders, and military sexual trauma exposure increased risk for autoimmune disorders, including thyroiditis, inflammatory bowel disease, rheumatoid arthritis, multiple sclerosis, and lupus erythematosus, adjusting for age, gender, race, and primary care visits. RESULTS PTSD was diagnosed in 203,766 veterans (30.6%), and psychiatric disorders other than PTSD were diagnosed in an additional 129,704 veterans (19.5%). Veterans diagnosed with PTSD had significantly higher adjusted relative risk (ARR) for diagnosis with any of the autoimmune disorders alone or in combination compared with veterans with no psychiatric diagnoses (ARR = 2.00; 95% confidence interval, 1.91-2.09) and compared with veterans diagnosed with psychiatric disorders other than PTSD (ARR = 1.51; 95% confidence interval, 1.43-1.59; p < .001). The magnitude of the PTSD-related increase in risk for autoimmune disorders was similar in women and men, and military sexual trauma exposure was independently associated with increased risk in both women and men. CONCLUSIONS Trauma exposure and PTSD may increase risk for autoimmune disorders. Altered immune function, lifestyle factors, or shared etiology may underlie this association.
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Affiliation(s)
- Aoife O’Donovan
- University of California, San Francisco, California, USA,San Francisco Veterans Affairs Medical Center and Northern
California Institute for Research and Education, San Francisco, California,
USA
| | - Beth E. Cohen
- University of California, San Francisco, California, USA,San Francisco Veterans Affairs Medical Center and Northern
California Institute for Research and Education, San Francisco, California,
USA
| | - Karen Seal
- University of California, San Francisco, California, USA,San Francisco Veterans Affairs Medical Center and Northern
California Institute for Research and Education, San Francisco, California,
USA
| | - Dan Bertenthal
- San Francisco Veterans Affairs Medical Center and Northern
California Institute for Research and Education, San Francisco, California,
USA
| | | | - Kristen Nishimi
- University of California, San Francisco, California, USA,San Francisco Veterans Affairs Medical Center and Northern
California Institute for Research and Education, San Francisco, California,
USA
| | - Thomas C. Neylan
- University of California, San Francisco, California, USA,San Francisco Veterans Affairs Medical Center and Northern
California Institute for Research and Education, San Francisco, California,
USA
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55
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O’Donovan A, Chao LL, Paulson J, Samuelson KW, Shigenaga JK, Grunfeld C, Weiner MW, Neylan TC. Altered inflammatory activity associated with reduced hippocampal volume and more severe posttraumatic stress symptoms in Gulf War veterans. Psychoneuroendocrinology 2015; 51:557-66. [PMID: 25465168 PMCID: PMC4374733 DOI: 10.1016/j.psyneuen.2014.11.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/20/2014] [Accepted: 11/12/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Inflammation may reduce hippocampal volume by blocking neurogenesis and promoting neurodegeneration. Posttraumatic stress disorder (PTSD) has been linked with both elevated inflammation and reduced hippocampal volume. However, few studies have examined associations between inflammatory markers and hippocampal volume, and none have examined these associations in the context of PTSD. METHODS We measured levels of the inflammatory markers interleukin-6 (IL-6) and soluble receptor II for tumor necrosis factor (sTNF-RII) as well as hippocampal volume in 246 Gulf War veterans with and without current and past PTSD as assessed with the Clinician Administered PTSD Scale (CAPS). Enzyme-linked immunosorbent assays were used to measure inflammatory markers, and 1.5Tesla magnetic resonance imaging (MRI) and Freesurfer version 4.5 were used to quantify hippocampal volume. Hierarchical linear regression and analysis of covariance models were used to examine if hippocampal volume and PTSD status would be associated with elevated levels of IL-6 and sTNF-RII. RESULTS Increased sTNF-RII, but not IL-6, was significantly associated with reduced hippocampal volume (β=-0.14, p=0.01). The relationship between sTNF-RII and hippocampal volume was independent of potential confounds and covariates, including PTSD status. Although we observed no PTSD diagnosis-related differences in either IL-6 or sTNF-RII, higher PTSD severity was associated with significantly increased sTNF-RII (β=0.24, p=0.04) and reduced IL-6 levels (β=-0.24, p=0.04). CONCLUSIONS Our results indicate that specific inflammatory proteins may be associated with brain structure and function as indexed by hippocampal volume and PTSD symptoms.
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Affiliation(s)
- Aoife O’Donovan
- University of California, San Francisco, CA, USA,San Francisco Veteran’s Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Linda L. Chao
- University of California, San Francisco, CA, USA,San Francisco Veteran’s Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Jennifer Paulson
- University of California, San Francisco, CA, USA,San Francisco Veteran’s Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, CA, USA,California School of Professional Psychology at Alliant International University
| | - Kristin W. Samuelson
- San Francisco Veteran’s Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, CA, USA,California School of Professional Psychology at Alliant International University
| | - Judy K. Shigenaga
- University of California, San Francisco, CA, USA,San Francisco Veteran’s Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Carl Grunfeld
- University of California, San Francisco, CA, USA,San Francisco Veteran’s Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Mike W. Weiner
- University of California, San Francisco, CA, USA,San Francisco Veteran’s Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Thomas C. Neylan
- University of California, San Francisco, CA, USA,San Francisco Veteran’s Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, CA, USA
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Mackintosh MA, Morland LA, Frueh BC, Greene CJ, Rosen CS. Peeking into the black box: mechanisms of action for anger management treatment. J Anxiety Disord 2014; 28:687-95. [PMID: 25124505 DOI: 10.1016/j.janxdis.2014.07.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 06/27/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022]
Abstract
We investigated potential mechanisms of action for anger symptom reductions, specifically, the roles of anger regulation skills and therapeutic alliance on changes in anger symptoms, following group anger management treatment (AMT) among combat veterans with posttraumatic stress disorder (PTSD). Data were drawn from a published randomized controlled trial of AMT conducted with a racially diverse group of 109 veterans with PTSD and anger symptoms residing in Hawaii. Results of latent growth curve models indicated that gains in calming skills predicted significantly larger reductions in anger symptoms at post-treatment, while the development of cognitive coping and behavioral control skills did not predict greater symptom reductions. Therapeutic alliance had indirect effects on all outcomes mostly via arousal calming skills. Results suggest that generalized symptom reduction may be mediated by development of skills in calming physiological arousal. In addition, arousal reduction skills appeared to enhance one's ability to employ other anger regulation skills.
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Affiliation(s)
- Margaret-Anne Mackintosh
- National Center for PTSD, - Pacific Islands Division, Department of Veterans Affairs Pacific Islands Healthcare System, 3375 Koapaka Street, Suite I-560, Honolulu, HI 96819, United States.
| | - Leslie A Morland
- National Center for PTSD, - Pacific Islands Division, Department of Veterans Affairs Pacific Islands Healthcare System, 3375 Koapaka Street, Suite I-560, Honolulu, HI 96819, United States; John Burns School of Medicine, University of Hawaii, 651 Ilalo Street, Honolulu, HI 96813, United States.
| | - B Christopher Frueh
- University of Hawaii at Hilo, 200 W. Kawili Street, Hilo, HI 96720, United States; The Menninger Clinic, 12301 Main Street, Houston, TX 77035, United States.
| | - Carolyn J Greene
- National Center for PTSD, - Dissemination & Training Division, Department of Veterans Affairs Palo Alto Healthcare System, 795 Willow Road (334-PTSD), Menlo Park, CA 94025, United States.
| | - Craig S Rosen
- National Center for PTSD, - Dissemination & Training Division, Department of Veterans Affairs Palo Alto Healthcare System, 795 Willow Road (334-PTSD), Menlo Park, CA 94025, United States; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA 94305, United States.
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57
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Finley EP. EMPOWERING VETERANS WITH PTSD IN THE RECOVERY ERA: ADVANCING DIALOGUE AND INTEGRATING SERVICES. ANNALS OF ANTHROPOLOGICAL PRACTICE 2014. [DOI: 10.1111/napa.12028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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58
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Cottingham ME, Victor TL, Boone KB, Ziegler EA, Zeller M. Apparent Effect of Type of Compensation Seeking (Disability Versus Litigation) on Performance Validity Test Scores may be due to Other Factors. Clin Neuropsychol 2014; 28:1030-47. [DOI: 10.1080/13854046.2014.951397] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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59
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Fisher MP. PTSD in the U.S. military, and the politics of prevalence. Soc Sci Med 2014; 115:1-9. [PMID: 24930003 DOI: 10.1016/j.socscimed.2014.05.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 05/27/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
Abstract
Despite the long-standing codification of posttraumatic stress disorder (PTSD) as a mental disorder, the diagnosis is a controversial one whose legitimacy is at times disputed, particularly in U.S. military contexts (e.g., McNally and Frueh 2013; McNally, 2003, 2007). These disputes often manifest in a struggle over prevalence rates. Utilizing data from in-depth interviews and relying on situational analysis methodology (Clarke, 2005), I highlight this struggle in the wake of a decade of U.S.-led war in Afghanistan and Iraq. I focus on the objects of contestation employed by public officials, veterans' advocates, and researchers to make or refute claims about PTSD prevalence. These objects of contestation include the diagnostic category and criteria; screening tools, procedures, or systems; and the individuals who express symptoms of the disorder. Based on these claims, I make two key interrelated assertions. First, PTSD is viewed by some public officials as an overly generalized or invalid diagnostic category that is often induced in or falsified by veterans or servicemembers. As such, PTSD is perceived by these stakeholders to be over-diagnosed. Compounding these perceptions are beliefs that PTSD is costly and negatively impacts military duty performance, and thus overall manpower. Second, there exist perceptions, largely on the part of veterans' advocates but also some public officials, that many servicemembers and veterans are not seeking treatment (and thus, a diagnosis) when they experience symptoms of PTSD. Thus, PTSD is perceived by these stakeholders to be under-diagnosed. Paradoxically, some public officials make both claims: that PTSD is over-diagnosed and under-diagnosed. I conclude by exploring the implications of these findings.
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Affiliation(s)
- Michael P Fisher
- University of California, San Francisco, Department of Social and Behavioral Sciences, 3333 California Street, Suite 455, San Francisco, CA 94118, USA.
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61
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Constans JI, Kimbrell TA, Nanney JT, Marx BP, Jegley S, Pyne JM. Over-reporting bias and the modified Stroop effect in Operation Enduring and Iraqi Freedom veterans with and without PTSD. JOURNAL OF ABNORMAL PSYCHOLOGY 2013; 123:81-90. [PMID: 24274375 DOI: 10.1037/a0035100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The current study investigated in a sample of Operation Enduring and Iraqi Freedom (OEF/OIF) veterans how a symptom overreporting response style might influence the association between PTSD diagnostic status and color-naming response latency for trauma-related stimuli during the Modified Stroop Task (i.e., the Modified Stroop Task effect, MST effect). It was hypothesized that, if an overreporting response style reflected feigning or exaggerating PTSD symptoms, an attenuated MST effect would be expected in overreporters with PTSD as compared with PTSD-diagnosed veterans without an overreporting style. If, however, overreporting stemmed from high levels of distress, the MST effect might be greater in overreporters compared with those with a neutral response style. The results showed that veterans with PTSD and an overreporting response style demonstrated an augmented MST effect in comparison with those with a more neutral style of response. Overreporters also reported greater levels of psychopathology, including markedly elevated reports of dissociative experiences. We suggest that dissociation-prone overreporters may misattribute emotional distress to combat experiences leading to the enhanced MST effect. Other possible explanations for these results are also discussed.
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Affiliation(s)
| | - Timothy A Kimbrell
- Division of Health Services Research, Central Arkansas Veterans Healthcare Center
| | | | - Brian P Marx
- VA National Center for PTSD, VA Boston Healthcare System
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