Delayed Onset of Posttraumatic Stress Disorder Among Male Combat Veterans: A Case Series

Abstract

Environmental stressors, coupled with age-related neurodegeneration, may potentially contribute to the late-life recrudescence or emergence of PTSD symptoms in veterans exposed to combat-related trauma.

Delayed-Onset Posttraumatic Stress Disorder: A Systematic Review of the Evidence

“…The most convincing evidence for delayed-onset PTSD was from three motor vehicle accident victims who were under continuing medical care for their physical injuries prior to onset, making detection of symptoms in the posttrauma period more likely if present (12,13). In the six studies describing elderly war veterans with very long intervals to first onset, 18 of the 22 cases were corroborated by someone else, in most cases a relative and usually the spouse (15,19,20). Given the age of the veterans, this does not rule out the possibility of episodes in the early months or years posttrauma that might have gone undisclosed or been forgotten, a limitation noted in two studies (20,15).…”

“…Of the 10 studies that met inclusion criteria for review (12)(13)(14)(15)(16)(17)(18)(19)(20)(21), seven reported delayed-onset PTSD in relation to war experiences (14)(15)(16)(17)(19)(20)(21) and three in relation to motor vehicle accidents (12,13,18). Four of the studies used DSM-IV diagnostic criteria, which include clinically significant distress or impairment in social, occupational, or important areas of functioning (criterion F).…”

“…Close inspection of the text indicated clear evidence of impairment in all studies, including the six that used earlier versions of DSM in which the diagnostic criteria did not require impairment. Overall, the war experience articles described 23 cases, with 15 accounted for by one article (20). With one exception (21), the cases were of elderly veterans of World War II or the Korean War (age range=63-86 years) with PTSD onsets delayed by at least 30 years.…”

“…In the six studies describing elderly war veterans with very long intervals to first onset, 18 of the 22 cases were corroborated by someone else, in most cases a relative and usually the spouse (15,19,20). Given the age of the veterans, this does not rule out the possibility of episodes in the early months or years posttrauma that might have gone undisclosed or been forgotten, a limitation noted in two studies (20,15). The corroborative evidence suggests at least that the veterans in question had long relatively symptom-free periods before onset in old age.…”

Posttraumatic Stress Disorder: Current Concepts and Controversies

“…Case studies suggest that this form of PTSD may arise in elderly individuals as they begin to cognitively decline (Johnston 2000;Mittal et al 2001;Ruzich et al 2005;van Achterberg et al 2001). A vivid example concerned a 95-year-old woman who had probable Alzheimer's disease (van Achterberg et al 2001).…”