ABSTRACT

The standard approach to answering questions about the prevalence of PTSD or any other disorder is to report the number of individuals who meet the full criteria for the diagnosis. In this chapter we complement the standard approach, which is presented in Chapter IV, by providing separate findings on the frequency of traumatic life events, and the cardinal symptoms of reexperiencing, avoidance, and arousal in the various study groups.

This approach provides information about frequency of traumatic life events and levels of stress symptomatology in a way that is not constrained by the formal decision rules of DSM-III-R, the official diagnostic system of the American Psychiatric Association. For a person to receive a diagnosis of PTSD using the DSM-III-R decision rules, he or she must have experienced an event outside the range of usual human experience (criterion A), have at least one of four reexperiencing symptoms (criterion B), at least three of seven avoidance symptoms (criterion C), and at least two of six arousal symptoms (criterion D). This “one from category B, three from Category C, and two from category D” approach has certain advantages in arriving at an overall yes/no diagnostic decision about PTSD. However, it has the disadvantage of not profiling the patterns of the components that make up the syndrome. Chapter III provides this dimensional rather than categorical view of PTSD.

People are often reluctant to remember or discuss traumatic events because of the painful emotions triggered by the recollections. In an effort to overcome the natural reluctance to share such events in a first-time encounter with the interviewer, multiple opportunities were provided during the interview to identify the events. As an alternative 31strategy to directly asking for a history of traumatic events, when symptoms such as unbidden daytime images or nightmares were reported the respondents were asked if these were based on real experiences.

A broad net was cast to capture the varied dimensions of trauma, including combat exposure, abusive violence, and deprivation. A comprehensive set of civilian traumatic events was surveyed as well. For each traumatic event that was identified, further probes explored the degree of personal participation in the event. For a combat soldier, hearing about an atrocity is very different from witnessing one, which is in turn different from direct participation in it.

In general the results were as expected. Both male and female theater veterans, particularly those with high war-zone-stress exposure, reported more traumatic events and more frequent reexperiencing, avoidance, and arousal symptoms. However, there were some surprise findings as well. For female theater veterans there was a stronger relationship between extent of exposure to war-zone stress and severity of symptoms than was seen for males. For Hispanic males, higher war-zone-stress exposure was associated most strongly with the one particular symptom group, that of avoidance.