PTSD Compensation and Military Service (2007) / Chapter Skim
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3 Background – PTSD and Impairment
3 Background – PTSD and Impairment
Pages 70-84
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From page 70... ...
. It provides information on comorbidities, risk factors, and special considerations for veterans.1 A companion report, Posttraumatic Stress Disorder: Diagnosis and Assessment (IOM, 2006)
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Some data indicate that aging and its accompanying loss of cognitive executive function3 may increase the severity and frequency of PTSD symptoms in later life. COMORBIDITY AND FUNCTIONAL IMPAIRMENT OR DISABILITY As Posttraumatic Stress Disorder -- Diagnosis and Assessment (IOM, 2006)
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5. Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
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report that there is substantial comorbidity among generalized anxiety disorder, social anxiety disorder, and depressive disorders and that this comorbidity is associated with clinically significant impairment in social and occupational functioning. Psychiatric Comorbidity with PTSD The effect that psychiatric comorbidity with PTSD has on functional outcomes following catastrophic trauma was illustrated by a study of 182 survivors of the 1995 bombing of the Oklahoma City Murrah Federal Building (North et al., 1999)
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It might be expected that, as with comorbid psychiatric disorders, having more disorders would predict worse functional impairment, but the findings on the incremental functional risk associated with PTSD plus other disorders is mixed (see above)
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. These authors and others have proposed categories of risk factors that appear to predict the development of PTSD following traumatic events.
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Homecoming environment Lack of social support Fontana and Rosenheck, 1994; Fontana et al., 1997a; Green et al., 1990; Johnson et al., 1997; Koenen et al., 2003; Stretch, 1985; Stretch et al., 1985. Personal factors Cumulative life stress before or after the Breslau et al., 1999; Brewin et al., 2000; King traumatic event et al., 1998; Maes et al., 2001; North et al., 1999.
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Leserman and colleagues (1998) studied female patients from a gastroenterology clinic, assessing risk factors that were associated with poor health status, including pain, bed disability days, and functional disability.
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Premilitary factors that predicted homelessness directly or indirectly were birth year, physical and sexual abuse, other traumatic experiences, and placement in foster care. Other psychiatric disorders and substance abuse also had direct effects, while conduct disorder and war-zone traumas had only indirect effects.
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From page 79... ...
While different studies have examined various constellations of risk factors, some consistent themes have emerged. Some of the consistent risk factors for impairment -- in line with studies of the predictors of developing the diagnosis of PTSD -- include childhood sexual or physical abuse, and instability or turmoil in childhood families (for example, foster care, early economic deprivation, or parental alcohol consumption)
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2002. Posttraumatic stress disorder symptoms influ ence health status of deployed peacekeepers and nondeployed military personnel.
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2005. Predicting posttraumatic stress symptoms from pretraumatic risk factors: a 2-year prospective fol low-up study in firefighters.
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2005. Adverse race-related events as a risk factor for posttraumatic stress disorder in Asian American Vietnam veterans.
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1998. Posttraumatic stress disorder and comorbidity in Australian Vietnam veterans: risk factors, chronicity and combat.
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1997. Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans.
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