Heterogeneity in the course of posttraumatic stress disorder: Trajectories of symptomatology

Abstract

Unconditional and conditional trajectories of posttraumatic stress disorder (PTSD) symptomatology were examined using a sample of U.S. soldiers deployed on a NATO-led peacekeeping mission to Kosovo. Data were collected at 4 time points, ranging from the weeks leading up to deployment to 9-months post deployment. Latent class growth analysis revealed 4 unique symptom trajectories: resilience, recovery, delayed, and unrealized anxiety. Variables identified as significant predictors of trajectory class included previous traumatic events, combat exposure, peacekeeping daily hassles, depression, alcohol use, aggressive behavior, stress reactivity, and military rank. Results from this study add to the literature detailing the variability in PTSD course, as well as to the literature pertaining to predictors of PTSD onset and course.

Resilience and Other Reactions to Military Deployment: The Complex Task of Identifying Distinct Adjustment Trajectories

“…For example, Bonanno and colleagues 2 found that 83% of American military personnel deployed to Iraq and Afghanistan showed low levels of posttraumatic stress symptoms both before and up to 5 years after their deployment. Similarly, Dickstein and colleagues, 3 in a longitudinal study of American peacekeepers in Kosovo, found that over 80% showed minimal PTSD symptoms before their deployment and no increase in distress after it.…”

“…In spite of the surprising nature of this pattern, a number of previous studies have identified it as well, although it has drawn little attention in the literature. For example, Dickstein et al 3 found that 9% of American peacekeepers showed a sharp reduction in PTSD symptoms after being deployed. Similarly, Bonanno et al 2 found that 8% of soldiers showed improvement after deployment.…”

Posttraumatic Stress Disorder

“…The delayed onset trajectory, which was identified in a number of these studies (i.e., Dickstein et al, 2010;Norris et al, 2009;Orcutt et al, 2004;Schnurr et al, 2003), has been the cause of some controversy. Specifically, there is some debate within the literature about the validity of this trajectory (e.g., Spitzer, First, & Wakefield, 2007).…”

Beyond Categorical Classifications: The Importance of Identifying Posttrauma Symptom Trajectories and Associated Negative Outcomes

“…With the addition of these recent findings by Madsen and colleagues, 3 as well as other seminal works (eg, Andersen et al, 10 Berntsen et al, 11 Dickstein et al, 12 Ruscio et al 8 ), sufficient evidence now exists to encourage widespread reconceptualization of PTSD from a dose response to a specific stressor to an adjustment to multiple stressors over the lifespan. Interestingly, we, the authors of this commentary, have previously made a similar argument in regard to understanding the range of outcomes following mild traumatic brain injury, 21 the other signature condition 22 of the conflicts in Iraq and Afghanistan.…”

“…7 In fact, studies examining the latent structure of PTSS using taxometric analyses have demonstrated that the underlying latent structure of posttraumatic stress is more consistent with a dimensional rather than a categorical model. 5,8,9 Since then, Andersen and colleagues 10 as well as others (eg, Berntsen et al, 11 Dickstein et al 12 ) have examined the latent structure of PTSS responses using different approaches. Specifically, these prospective studies applied a set of analytic techniques (eg, latent class analysis, growth mixture modeling) to identify empirically validated symptom profiles that, once again, challenged the assumption that responses to potentially traumatic events develop in a fairly homogenous pattern across individuals.…”