Internalizing and externalizing personality styles and psychopathology in OEF–OIF veterans

Abstract

Previous research with other trauma populations demonstrated that internalizing and externalizing personality styles are associated with different PTSD comorbidities. The present study tested this association in two distinct Operation Enduring Freedom-Operation Iraqi Freedom (OEF/OIF) combat samples. Cluster analysis was used to categorize subtypes, which were compared on measures of PTSD, depression, anxiety, and substance use. Internalizers showed the highest rates of PTSD and depression. Externalizers had higher rates of alcohol problems in one sample only, whereas the other sample showed more substance misuse. In general, these findings suggest that this method of classifying trauma survivors is useful in OEF/OIF populations. Results suggest some differences across this population in terms of how substance use issues are expressed in externalizers.

Clinical Phenomenology of Childhood Abuse–Related Complex PTSD in a Population of Female Patients: Patterns of Personality Disturbance

“…In rape-related chronic PTSD outpatients, of whom at least half had a history of child abuse, a cluster analysis using temperament scales identified three subtypes: a simple PTSD subtype low in neuroticism and two subtypes with more Complex PTSD high in neuroticism (i.e., internalizers characterized by high introversion, and externalizers with prominent disinhibition) (Miller & Resick, 2007). These findings are largely in line with findings for male war veteran populations (e.g., Flood et al, 2010;Forbes et al, 2010;Miller, Greif, & Smith, 2003;Miller, Kaloupek, Dillon, & Keane, 2004;Rielage, Hoyt, & Renshaw, 2010). Allen et al (1999) used a DSM-IV Axis II questionnaire in a cluster analysis of severely traumatized female inpatients and identified an adaptive subtype and four nonadaptive subtypes: withdrawn, alienated, suffering, and aggressive.…”

How do components of evidence-based psychological treatment cluster in practice?

“…Cluster analysis is an atheoretical technique used to validate classification measures (Burns, Kubilus, Bruel, & Harden, 2001), and to group variables according to similarity of characteristics (Aldenderfer & Blashfield, 1984). Cluster analysis has been used to identify patient typologies (McDermott & Weiss, 1995;Rielage, Hoyt, & Renshaw, 2010;Walker, Baber, Garber, & Smith, 2008), sets of genes with similar expression patterns (Hastie et al, 2000), and groups that may benefit from specific interventions (Beitchman et al, 2001;Hodges & Wotring, 2000;Lipkovich, Houston, & Ahl, 2008). In this study, the goal of the cluster analysis was to classify evidence-based CPCs according to clinician responses to determine which CPCs clustered together and whether CPCs would cluster according to EBPT designations.…”

Providing Treatment Services for PTSD at an Army FORSCOM Installation

“…Rather, SSG Lima was referred to symptom-specific treatments that focused on comorbid insomnia and alcohol abuse. Addressing these comorbidities may be particularly important for servicemembers with prominent characteristics toward internalizing or externalizing distress (see Rielage et al, 2010). SSG Lima was enrolled in a brief sleep therapy group (Thompson, Franklin, & Hubbard, 2008) focused on nightmares and other sleep disruptions associated with traumatic combat experiences.…”

“…E-mail: colette.candy@us.army.mil continue, servicemembers also face greater risk of PTSD as they deploy multiple times (Kline et al, 2010). In addition, servicemembers with PTSD show high rates of comorbidity (see Rielage, Hoyt, & Renshaw, 2010), including diagnoses of substance abuse (Erbes, Westermeyer, Engdahl, & Johnsen, 2007) and depression (Wells et al, 2010). Thus, an increasing number of servicemembers and veterans are seeking care for PTSD and related sequelae after returning from deployment (Seal et al).…”