PTSD symptoms among male Vietnam veterans: Prevalence and associations with diagnostic status.

Abstract

The present study examined reported rates of specific posttraumatic stress disorder (PTSD) symptoms in a veteran sample and the extent to which specific symptoms predicted PTSD diagnostic status. A sample of 1325 unmedicated male Vietnam veterans were interviewed using the Structured Clinical Interview for the Diagnostic and Statistical Manual, 3rd edition revised (DSM–III–R) by doctoral-level clinicians. Of the total sample, 798 met diagnostic criteria for current PTSD, 189 met criteria for a lifetime diagnosis of PTSD, and 338 did not meet criteria for either current or lifetime PTSD. Overall, participants endorsed a median of 9, and a mean of 8.4 (SD = 5.4) out of 17 possible PTSD symptoms. The most frequently endorsed symptoms among participants meeting criteria for current PTSD were hypervigilance and detachment from others, followed by intrusive recollections and sleep difficulties. The symptoms with the greatest diagnostic sensitivity in this sample were hypervigilance and detachment from others and those with the greatest diagnostic specificity were flashbacks and nightmares. Intrusive recollections and interpersonal detachment were the overall best predictors of current PTSD diagnostic status. Psychiatric comorbidity was associated with increased overall symptom endorsement rather than the presence of a different pattern of symptom distribution. The finding that hyperarousal and detachment symptoms are more strongly associated with PTSD diagnosis is consistent with reports from other studies conducted with veterans and other trauma-exposed samples. However, certain symptoms were found to occur at higher rates than have been reported in different populations with PTSD.

Examining the diagnostic utility of the DSM‐5 PTSD symptoms among male and female returning veterans

“…Both irritable or aggressive behaviors (E1) and inability to recall important aspects of the trauma (D1) demonstrated poor diagnostic utility across all indices. Findings for D1 are consistent with the broader literature (Armour et al., ; Holowka et al., ; Keane et al., ). Therefore, it may be appropriate to remove these symptoms from the diagnosis.…”

“…Although many of our findings were consistent with Holowka et al. () investigation of DSM‐III‐R PTSD symptoms, there were notable differences. However, Holowka et al.…”

“…In this study, we examined the diagnostic utility of each DSM‐5 PTSD symptom, expanding on Holowka et al. () work in several ways. First, we included both male and female participants because research suggests that men and women may have different PTSD symptom profiles (Fullerton et al., ; Green, ; Zlotnick, Zimmerman, & Wolfsdorf, ), suggesting that the diagnostic utility of each PTSD symptom may vary by gender.…”

“…In this study, we examined the diagnostic utility of each DSM-5 PTSD symptom, expanding on Holowka et al (2012) work in several ways.…”

“…Finally, we examined whether ICD-11 criteria reduced psychiatric comorbidity. Holowka et al (2012), of the six ICD-11 PTSD symptoms, we hypothesized that nightmares (B2) and hypervigilance (E3) would demonstrate the highest QSN, and that nightmares (B2) and flashbacks (B3) would demonstrate the highest QSP. Based on the ICD-11 committee's rationale, we hypothesized that ICD-11 symptoms would demonstrate strong QSP.…”