Abstract:Environmental stressors, coupled with age-related neurodegeneration, may potentially contribute to the late-life recrudescence or emergence of PTSD symptoms in veterans exposed to combat-related trauma.
“…The most convincing evidence for delayed-onset PTSD was from three motor vehicle accident victims who were under continuing medical care for their physical injuries prior to onset, making detection of symptoms in the posttrauma period more likely if present (12,13). In the six studies describing elderly war veterans with very long intervals to first onset, 18 of the 22 cases were corroborated by someone else, in most cases a relative and usually the spouse (15,19,20). Given the age of the veterans, this does not rule out the possibility of episodes in the early months or years posttrauma that might have gone undisclosed or been forgotten, a limitation noted in two studies (20,15).…”
Section: Case Studiesmentioning
confidence: 98%
“…Of the 10 studies that met inclusion criteria for review (12)(13)(14)(15)(16)(17)(18)(19)(20)(21), seven reported delayed-onset PTSD in relation to war experiences (14)(15)(16)(17)(19)(20)(21) and three in relation to motor vehicle accidents (12,13,18). Four of the studies used DSM-IV diagnostic criteria, which include clinically significant distress or impairment in social, occupational, or important areas of functioning (criterion F).…”
Section: Case Studiesmentioning
confidence: 99%
“…Close inspection of the text indicated clear evidence of impairment in all studies, including the six that used earlier versions of DSM in which the diagnostic criteria did not require impairment. Overall, the war experience articles described 23 cases, with 15 accounted for by one article (20). With one exception (21), the cases were of elderly veterans of World War II or the Korean War (age range=63-86 years) with PTSD onsets delayed by at least 30 years.…”
Section: Case Studiesmentioning
confidence: 99%
“…In the six studies describing elderly war veterans with very long intervals to first onset, 18 of the 22 cases were corroborated by someone else, in most cases a relative and usually the spouse (15,19,20). Given the age of the veterans, this does not rule out the possibility of episodes in the early months or years posttrauma that might have gone undisclosed or been forgotten, a limitation noted in two studies (20,15). The corroborative evidence suggests at least that the veterans in question had long relatively symptom-free periods before onset in old age.…”
The discrepant findings in the literature concerning prevalence can be largely, but not completely, explained as being due to definitional issues. Little is known about what distinguishes the delayed-onset and immediate-onset forms of the disorder. Continuing scientific study of delayed-onset PTSD would benefit if future editions of DSM were to adopt a definition that explicitly accepts the likelihood of at least some prior symptoms.
“…The most convincing evidence for delayed-onset PTSD was from three motor vehicle accident victims who were under continuing medical care for their physical injuries prior to onset, making detection of symptoms in the posttrauma period more likely if present (12,13). In the six studies describing elderly war veterans with very long intervals to first onset, 18 of the 22 cases were corroborated by someone else, in most cases a relative and usually the spouse (15,19,20). Given the age of the veterans, this does not rule out the possibility of episodes in the early months or years posttrauma that might have gone undisclosed or been forgotten, a limitation noted in two studies (20,15).…”
Section: Case Studiesmentioning
confidence: 98%
“…Of the 10 studies that met inclusion criteria for review (12)(13)(14)(15)(16)(17)(18)(19)(20)(21), seven reported delayed-onset PTSD in relation to war experiences (14)(15)(16)(17)(19)(20)(21) and three in relation to motor vehicle accidents (12,13,18). Four of the studies used DSM-IV diagnostic criteria, which include clinically significant distress or impairment in social, occupational, or important areas of functioning (criterion F).…”
Section: Case Studiesmentioning
confidence: 99%
“…Close inspection of the text indicated clear evidence of impairment in all studies, including the six that used earlier versions of DSM in which the diagnostic criteria did not require impairment. Overall, the war experience articles described 23 cases, with 15 accounted for by one article (20). With one exception (21), the cases were of elderly veterans of World War II or the Korean War (age range=63-86 years) with PTSD onsets delayed by at least 30 years.…”
Section: Case Studiesmentioning
confidence: 99%
“…In the six studies describing elderly war veterans with very long intervals to first onset, 18 of the 22 cases were corroborated by someone else, in most cases a relative and usually the spouse (15,19,20). Given the age of the veterans, this does not rule out the possibility of episodes in the early months or years posttrauma that might have gone undisclosed or been forgotten, a limitation noted in two studies (20,15). The corroborative evidence suggests at least that the veterans in question had long relatively symptom-free periods before onset in old age.…”
The discrepant findings in the literature concerning prevalence can be largely, but not completely, explained as being due to definitional issues. Little is known about what distinguishes the delayed-onset and immediate-onset forms of the disorder. Continuing scientific study of delayed-onset PTSD would benefit if future editions of DSM were to adopt a definition that explicitly accepts the likelihood of at least some prior symptoms.
“…Case studies suggest that this form of PTSD may arise in elderly individuals as they begin to cognitively decline (Johnston 2000;Mittal et al 2001;Ruzich et al 2005;van Achterberg et al 2001). A vivid example concerned a 95-year-old woman who had probable Alzheimer's disease (van Achterberg et al 2001).…”
Section: Does Traumatic Stress Cause Brain Damage?mentioning
The diagnosis of posttraumatic stress disorder (PTSD) sometimes is raised in compensation claims, in tort settings, and in other medical-legal settings. Accordingly, health-care and legal professionals working in these areas need to be familiar with the current findings and controversies concerning the disorder. The purpose of this article is twofold. First, we review the most important findings concerning the clinical features, etiology, and treatment of PTSD. Second, we examine six major controversies concerning the disorder that are relevant to psychologists and other medical-legal practitioners: (a) the issue of what qualifies as a traumatic stressor, (b) the question of whether traumatic stress causes brain damage, (c) the validity of the concept of delayed-onset PTSD, (d) the recovered memory controversy, (e) the question of whether PTSD can arise when the person has no memory of the trauma (e.g., due to concussion), and (f) issues concerning PTSD malingering. Throughout this article we offer recommendations for psychological and other medical-legal practice in relation to the evaluation of PTSD claims.
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