Chronic Posttraumatic Stress Disorder and Diagnostic Comorbidity in a Disaster Sample

Alcohol abuse in individuals exposed to trauma: A critical review.

“…Green, Lindy, Grace, and Leonard (1992) Spitzer, Williams, & Gibbon, 1987). A current PTSD diagnosis was statistically related to an alcohol abuse diagnosis, suggesting that participants who were experiencing significant flood-related PTSD symptoms at the follow-up were also likely to be abusing alcohol.…”

“…For example, the community study by Cottler et al (1992) showed heavy alcohol use to be significantly associated with prior exposure to combat but not to other forms of traumatic events. Similarly, Green et al (1992) made a post hoc comparison of data from two comorbidity studies and showed that comorbid alcoholism and PTSD diagnoses were higher in a sample of combat veterans than in a sample of individuals exposed to a natural disaster. However, methodological limitations preclude interpreting these results as firmly supporting the notion that combat is more likely to lead to alcohol abuse plus PTSD than is a natural disaster.…”

“…However, methodological limitations preclude interpreting these results as firmly supporting the notion that combat is more likely to lead to alcohol abuse plus PTSD than is a natural disaster. Differences in the methodologies used in the two studies, and differences in demographic characteristics of the samples, might explain the observed variability in comorbidity rates (Green et al, 1992). First, the study with combat veterans (Green et al, 1989) used the SADS (Endicott & Spitzer, 1978) to establish diagnoses, whereas the study with individuals exposed to a flood (Green et al, 1992) used the SCID (Spitzer et al, 1987), thus making direct comparisons across the two studies difficult to interpret given the slightly different diagnostic criteria used on the SADS and SCID (Green et al, 1992).…”

“…For example, should it be found that PTSD due to combat is more highly associated with subsequent alcohol abuse than PTSD following sexual assault, it should be kept in mind that these two types of trauma tend also to occur disproportionately across gender, with men more likely to be exposed to combat and women more likely to experience sexual assault (Norris, 1992). Thus, comparison of rates of alcohol abuse in patients with PTSD must be made with base rates by gender before any definitive statements can be made about the relative prevalences of comorbid PTSD and alcohol abuse in individuals who have been exposed to various types of trauma (Green et al, 1992).…”

Internalizing and Externalizing Subtypes in Female Sexual Assault Survivors: Implications for the Understanding of Complex PTSD

“…Posttraumatic stress disorder (PTSD) may be the most common psychiatric syndrome to develop following trauma (Green, Lindy, Grace, & Leonard, 1992;Kulka et al, 1990), but other conditions frequently co-occur with the disorder, or develop independently of it, including other anxiety disorders and the unipolar depressive, substance-related, and personality disorders (Breslau, Davis, Andreski, & Peterson, 1991;Breslau, Davis, Peterson, Schultz, 2000;Davidson, Hughes, Blazer, & George, 1991;Golier et al, 2003;Helzer, Robins, & McEvoy, 1987;Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995;Kulka et al, 1990;Orsillo et al, 1996). Considerable interindividual variability exists in patterns of comorbidity and other manifestations of posttraumatic distress.…”