Disorders of extreme stress following war-zone military trauma: Associated features of posttraumatic stress disorder or comorbid but distinct syndromes?

Ford, Julián D.

doi:10.1037/0022-006x.67.1.3

Cited by 165 publications

(166 citation statements)

References 34 publications

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“…The measures selected for analysis in this study were chosen with the aim of capturing the essential aspects of the complex PTSD construct including dissociation, impaired self-concept, physical complaints, dysfunctional sexual behavior, internalized shame, and anger, as well as measures of personality disturbance indexed by the SNAP. The finding of a lower pathology PTSD cluster defined by normal range scores on the SNAP contrasted with two higher pathology PTSD subgroups defined by marked personality disturbance and severe and diverse symptomatology is consistent with Herman's conceptualization of the distinction between simple and complex PTSD and prior descriptive research (e.g., Ford, 1999;Zlotnick et al, 1996). Internalizers and externalizers showed higher scores than the simple PTSD group on an array of scales measuring constructs central to the concept of complex PTSD, including indices of impaired interpersonal functioning, self-harm behavior, physical complaints, identity disturbance, dysfunctional sexual behavior, internalized shame, and anger.…”

supporting

confidence: 84%

“…Although controversial, a growing number of empirical studies have supported the validity of complex PTSD and its distinction from simple PTSD (Ford, 1999; van der Kolk et al, 2005;Zlotnick et al, 1996). Yet, while personality disturbance is central to the construct of complex PTSD, no prior study has examined the personality inventory profile of individuals with the disorder, and only one published investigation has addressed the possible presence of subtypes of complex PTSD.…”

Section: Published In Final Edited Form Asmentioning

confidence: 99%

“…We had hypothesized, on the basis of Herman's (1992) conceptualization and evidence for the role of early developmental trauma and repeated traumatization in the etiology of the complex PTSD (Ford, 1999;McLean & Gallop, 2003;Resick et al, 2003;Roth et al, 1997), that internalizers and externalizers would report more extensive trauma histories and be more likely to endorse histories of childhood sexual abuse than those in the simple PTSD group. This was a severely and repeatedly traumatized sample of rape survivors who reported high rates of childhood physical and sexual abuse as well as adult criminal victimization.…”

Section: Implications For the Conceptualization Of Complex Ptsdmentioning

confidence: 99%

“…In addition, given evidence for the covariation of the internalizing disorders and the Cluster C subgroup of personality disorders characterized in DSM-IV as "anxious-fearful" (Sander-son, Wetzler, Beck, & Betz, 1994;Sanderson, Wetzler, Beck, & Betz, 1992;Zuckerman, 1999), we also expected individuals in this cluster to show elevated scores on the SNAP Avoidant, Dependent, and Obsessive-Compulsive Personality Disorder scales. , 1996), suggests that some features of complex PTSD should covary with indices of internalizing (e.g., feelings of ineffectiveness, shame, despair and hopelessness, social withdrawal, somatic complaints), whereas others should correlate more with externalizing (e.g., self-destructive and impulsive behavior, hostility).Although controversial, a growing number of empirical studies have supported the validity of complex PTSD and its distinction from simple PTSD (Ford, 1999; van der Kolk et al, 2005;Zlotnick et al, 1996). Yet, while personality disturbance is central to the construct of complex PTSD, no prior study has examined the personality inventory profile of individuals with the disorder, and only one published investigation has addressed the possible presence of subtypes of complex PTSD.…”

mentioning

confidence: 99%

“…Finally, on the basis of Herman's (1992) conceptualization of complex PTSD, and evidence for the role of early developmental trauma and repeated traumatization in the etiology of the disorder (Ford, 1999;McLean & Gallop, 2003;Resick, Nishith, & Griffin, 2003;Roth, Newman, Pelcovitz, van der Kolk, & Mandel, 1997), we hypothesized that internalizers and externalizers would report more extensive trauma histories and be more likely to endorse histories of childhood sexual abuse than those in the simple/low pathology PTSD group.…”

mentioning

confidence: 99%

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Internalizing and Externalizing Subtypes in Female Sexual Assault Survivors: Implications for the Understanding of Complex PTSD

2007

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This study replicated and extended findings of internalizing and externalizing subtypes of posttraumatic psychopathology (Miller, M. W., Greif, J. L., & Smith, A. A. (2003). Multidimensional Personality Questionnaire profiles of veterans with traumatic combat exposure: Internalizing and externalizing subtypes. Psychological Assessment, 15, 205-215; Miller, M. W., Kaloupek, D. G., Dillon, A. L., & Keane, T.M. (2004). Externalizing and internalizing subtypes of combat-related PTSD: A replication and extension using the PSY-5 Scales. Journal of Abnormal Psychology, 113,[636][637][638][639][640][641][642][643][644][645]) to a female sample of rape survivors with chronic PTSD. Cluster analyses of Schedule for Nonadaptive and Adaptive Personality (Clark, L. A. (1996). SNAP-Schedule for Nonadaptive and Adaptive Personality: Manual for administration, scoring, and interpretation. Minneapolis: University of Minnesota Press.) temperament scale profiles from 143 women with PTSD partitioned the sample into a simple PTSD cluster, defined by normal range personality scores and moderate symptomatology, and 2 more "complex" clusters distinguished by more severe tendencies towards externalizing or internalizing psychopathology. Externalizers were characterized by disinhibition, substance dependence, and Cluster B personality disorder features; internalizers by low positive temperament, high rates of major depressive disorder, and elevations on measures of schizoid and avoidant personality disorder.The human response to psychological trauma is characterized by extensive inter-individual variability in the severity, form, and expression of posttraumatic distress. Posttraumatic stress disorder (PTSD) may be the most common psychiatric syndrome to develop following trauma (Green, Lindy, Grace, & Leonard, 1992;Kulka et al., 1990), but other conditions frequently co-occur with the disorder, or develop independently of it, including other anxiety disorders and the unipolar depressive, substance-related, and personality disorders (Breslau, Davis, Andreski, & Peterson, 1991;Breslau, Davis, Peterson, Schultz, 2000;Davidson, Hughes, Blazer, & George, 1991;Golier et al., 2003;Helzer, Robins, & McEvoy, 1987;Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995;Kulka et al., 1990;Orsillo et al., 1996). Considerable interindividual variability exists in patterns of comorbidity and other manifestations of posttraumatic distress. Predominant negative affects vary widely across individuals, spanning the spectrum from anger and rage through shame and sadness. In the interpersonal domain, responses to trauma range from withdrawal/avoidance to pronounced antagonism and aggression.Two prior studies that examined the heterogeneity of posttraumatic psychopathology found evidence of qualitatively distinct personality-based subtypes of posttraumatic adjustment that differed on dimensions related to internalizing versus externalizing psychopathology (Miller, Grief, & Smith, 2003;Miller Kaloupek, Dillon, & Keane, 2004). In both studies, cluster Addre...

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supporting

confidence: 84%

Section: Published In Final Edited Form Asmentioning

confidence: 99%

Section: Implications For the Conceptualization Of Complex Ptsdmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Internalizing and Externalizing Subtypes in Female Sexual Assault Survivors: Implications for the Understanding of Complex PTSD

2007

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Stress Disorders

Cardeï¿1⁄2ï¿1⁄2a¹,

Butler²,

Spiegel³

2003

Handbook of Psychology

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Reviewed in this chapter are the concepts of stress and trauma. Included within the chapter are such mental disorders as post‐traumatic stress disorder (PTSD), complex PTSD, acute stress disorder, dissociative disorders (dissociative identity, amnesia, fugue, and depersonalization), and conversion disorder. These disorders are classified within three different sections of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders , but they are conceptualized within this chapter as sharing a common etiology and pathology (and ultimately treatment implications). Extreme stress or trauma can have only a transient effect and it may even have for some a life‐transforming positive effect (e.g., greater investment in and appreciation of life). However, for many persons it can shatter their sense of security, attachment, and safety, contributing to the development of clinically significant anxiety, dissociative, and somatoform psychopathology. The dissociative disorders have been particularly controversial but compelling systematic research has documented well their validity and clinical importance.

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