Low cortisol levels in PTSD are only found under certain conditions. Future research should elucidate whether low cortisol is related to gender or abuse and depends on the measurement methods used.

Current longitudinal disaster studies usually focus only on posttraumatic stress disorder (PTSD), although some studies have shown that increased risks for other disorders and comorbidity is common. To obtain an insight into the course of postdisaster psychopathology, a community sample of survivors of the Enschede fireworks disaster was followed from 2-3 weeks to 4-years postdisaster. Diagnostic interviews (Composite International Diagnostic Interview [CIDI]; World Health Organization, 1997) and childhood stressor interviews were administered at 2-years postdisaster (n = 260); the CIDI was repeated at 4-years postdisaster (n = 201, response rate 77.3%). At 2-years postdisaster many survivors (40.6%) suffered from PTSD (21.8%), specific phobia (21.5%), and/or depression (16.1%). These disorders were highly comorbid. At 4-years postdisaster, prevalence significantly diminished. Instead of full recovery, diagnostic classifications shifted in several survivors over time. This resulted in low rates of PTSD but still elevated rates of depression and specific phobia. The course of the 3 entangled disorders of PTSD, depression, and specific phobia was further studied by constructing 4 groups of survivors based on the diagnostic status at 2- and 4-years postdisaster: healthy, recovered, chronic, and delayed-onset. Initial depressive symptoms, maternal dysfunction, childhood physical abuse, and disaster exposure were found to discriminate between the groups and predict long-term psychopathology.

Background: The diagnosis of complex posttraumatic stress disorder (CPTSD) has been suggested for inclusion in the 11th version of the International Classification of Diseases (ICD-11), with support for its construct validity coming from studies employing Latent Class Analysis (LCA) and Latent Profile Analysis (LPA).Objective: The current study aimed to critically evaluate the application of the techniques LCA and LPA as applied in previous studies to substantiate the construct validity of CPTSD.Method: Both LCA and LPA were applied systematically in one sample (n = 245), replicating the setup of previous studies as closely as possible. The interpretation of classes was augmented with the use of graphical visualization.Results: The LCA and LPA analyses indicated divergent results in the same dataset. LCA and LPA partially supported the existence of classes of patients endorsing different PTSD and CPTSD symptom patterns. However, further inspection of the results with scatterplots did not support a clear distinction between PTSD and CPTSD, but rather suggested that there is much greater variability in clinical presentations amongst adult PTSD patients than can be fully accounted for by either PTSD or CPTSD.Discussion: We argue that LCA and LPA may not be sufficient methods to decide on the construct validity of CPTSD, as different subgroups of patients are identified, depending on the statistical exact method used and the interpretation of the fit of different models. Additional methods, including graphical inspection should be employed in future studies.

Research about attentional functioning following trauma has almost exclusively been performed in patient populations with combat-related posttraumatic stress disorder (PTSD). In this study the relationship between sustained attention and PTSD symptoms was examined in a community sample of survivors of a major disaster using the Paced Auditory Serial Addition Task (PASAT) and the SelfRating Scale for PTSD (SRS-PTSD) 2-3 years postdisaster. Analyses revealed low but significant partial correlations between PTSD symptoms and the least difficult subtests, ruling out the effects of age, education, depressive symptomatology, and sleep disturbances. These results demonstrate that PTSD symptoms link to attentional dysfunction 2-3 years postdisaster.Studies investigating attention in survivors of traumatic events with posttraumatic stress disorder (PTSD) have almost exclusively focused on treatment-seeking patients with combat-related trauma. Although these studies have produced mixed results, many report attentional deficits in PTSD (e.g., Gilbertson, Gurvits, Lasko, Orr, & Pitman, 2001;Sachinvala et al., 2000;Vasterling et al., 2002). Deficits in sustained attention, which cause difficulties in executing a long-lasting task, were found most frequently.Characteristics of the participants in the above mentioned studies include high symptom severity and coexisting psychopathology, especially substance abuse dis- orders. Likely, these studies may represent populations that could differ from community samples in important ways. Therefore, the purpose of the present study was to investigate sustained attention in relation to PTSD symptom severity in a community sample of inhabitants of an area afflicted by a major disaster. To our knowledge, this is the first study of attention in such a unique population. After a traumatic event the most frequently developed disorders are major depressive disorder (MDD) and PTSD. Symptoms of these disorders overlap and high comorbidity up to 40% is reported. Knowing that both disorders are characterized by symptoms of impaired attention (DSM-IV; American Psychiatric Association, 1994), we raise the question whether this symptom is independent of depressive symptoms in PTSD. Therefore, we investigated whether attention in survivors is still related to PTSD symptom severity when we control for the influence of depressive symptoms. Furthermore, to assure that worsened attentional performance is not the consequence of sleep disturbances, we also examined the effect of sleep disturbances in the relationship between PTSD symptoms

Background It is unclear whether people with post-traumatic stress disorder (PTSD) and symptoms of complex PTSD due to childhood abuse need a treatment approach different from approaches in the PTSD treatment guidelines. Aims To determine whether a phase-based approach is more effective than an immediate trauma-focused approach in people with childhood-trauma related PTSD (Netherlands Trial Registry no.: NTR5991). Method Adults with PTSD following childhood abuse were randomly assigned to either a phase-based treatment condition (8 sessions of Skills Training in Affect and Interpersonal Regulation (STAIR), followed by 16 sessions of eye-movement desensitisation and reprocessing (EMDR) therapy; n = 57) or an immediately trauma-focused treatment condition (16 sessions of EMDR therapy; n = 64). Participants were assessed for symptoms of PTSD and complex PTSD, and other forms of psychopathology before, during and after treatment and at 3- and 6-month follow-ups. Results Data were analysed with linear mixed models. No significant differences between the two treatments on any variable at post-treatment or follow-up were found. Post-treatment, 68.8% no longer met PTSD diagnostic criteria. Self-reported PTSD symptoms significantly decreased for both STAIR–EMDR therapy (d = 0.93) and EMDR therapy (d = 1.54) from pre- to post-treatment assessment, without significant difference between the two conditions. No differences in drop-out rates between the conditions were found (STAIR–EMDR 22.8% v. EMDR 17.2%). No study-related adverse events occurred. Conclusions This study provides compelling support for the use of EMDR therapy alone for the treatment of PTSD due to childhood abuse as opposed to needing any preparatory intervention.

Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) have been associated with increased rates of tobacco usage as well as with dysregulations of the hypothalamus -pituitary -adrenal (HPA) axis. At the same time tobacco also affects the HPA axis. This paper examines the relationships between PTSD, posttraumatic MDD, smoking and levels of circadian cortisol 2 -3 years postdisaster. Subjects were survivors of the Enschede fireworks disaster. The sample consisted of 38 healthy survivors, 40 subjects with PTSD, and 17 subjects with posttraumatic MDD. The Composite International Diagnostic Interview was used to determine mental disorders in accordance with DSM-IV criteria. Salivary cortisol samples were collected at home immediately upon awakening, 30 min after awakening, at noon, and at 10 p.m. Quantity of smoking was measured through self-report. The results of the study show that salivary cortisol concentrations were higher in smoking subjects. Survivors with MDD following the disaster had a flatter diurnal cortisol curve than subjects with PTSD or healthy survivors. In survivors with PTSD and healthy individuals the usual dynamic pattern of increase in cortisol past awakening was present, while we did not observe this in posttraumatic MDD. These survivors with MDD tended to use more tobacco per day, and the cortisol group differences could only be revealed when we adjusted for quantity of smoking. Smoking, which may be an important palliative coping style in dealing with posttraumatic arousal symptoms, seems to mediate the relationship between traumatic stress and the HPA-axis. D

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