The Associations Between Physical and Psychological Symptoms and Traumatic Military Deployment Exposures

Abstract

Current paradigms regarding the effects of traumatic exposures on military personnel do not consider physical symptoms unrelated to injury or illness as independent outcomes of trauma exposure, characteristically dealing with these symptoms as comorbidities of psychological disorders. Our objective was to ascertain the proportions of deployed military personnel who experienced predominantly physical symptoms, predominantly psychological symptoms, and comorbidity of the two and to examine the association between traumatic deployment exposures (TDEs) and these symptomatic profiles. Data were taken from a cross-sectional study of Australian Defence Force personnel who were deployed to the Middle East during 2001-2009 (N = 14,032). Four groups were created based on distributional splits of physical and psychological symptom scales: low-symptom, psychological, physical, and comorbid. Multinomial logistic regression models assessed the probability of symptom group membership, compared with low-symptom, as predicted by self-reported TDEs. Group proportions were: low-symptom, 78.3%; physical, 5.0%; psychological, 9.3%; and comorbid, 7.5%. TDEs were significant predictors of all symptom profiles. For subjective, objective, and human death and degradation exposures, respectively, the largest relative risk ratios (RRRs) were for the comorbid profile, RRRs = 1.47, 1.19, 1.48; followed by the physical profile, RRRs = 1.27, 1.15, 1.40; and the psychological profile, RRRs = 1.22, 1.07, 1.22. Almost half of participants with physical symptoms did not have comorbid psychological symptoms, suggesting that physical symptoms can occur as a discrete outcome trauma exposure. The similar dose-response association between TDEs and the physical and psychological profiles suggests trauma is similarly associated with both outcomes.

The sense of self in the aftermath of trauma: lessons from the default mode network in posttraumatic stress disorder

“…Cognitively, individuals who have experienced trauma are often tormented by thoughts that reflect intensely negative core beliefs about themselves, which can include, ‘I will never be able to feel normal emotions again,’ ‘I feel like an object, not like a person,’ ‘I do not know myself anymore,’ or, ‘I have permanently changed for the worse’ (Cox, Resnick, & Kilpatrick, 2014 ; Foa, Tolin, Ehlers, Clark, & Orsillo, 1999 ). Somatically, recent research points increasingly towards the notion that trauma can leave a lasting physical representation, where lower back pain, general muscle aches and pains, flatulence/burping, or feeling as though your bowel movement has not finished have been identified as somatic disturbances that significantly perturb the sense of self (Graham, Searle, Van Hooff, Lawrence-Wood, & McFarlane, 2019 ). Here, Graham et al ( 2019 ) found that two thirds of cases of military-related posttraumatic stress disorder (PTSD) are missed when a PTSD checklist for the Diagnostic and Statistical Manual (DSM-5; APA, 2013 ) (i.e.…”

Longitudinal Relationship Between Posttraumatic Stress Symptoms and Physical Symptoms in Military Veterans

“…Participants were asked to indicate the severity of symptoms over the past month on a 4-point scale selecting never, mild, moderate, or severe. Each symptom was further dichotomized as "no" ("never") or "yes" ("mild", "moderate," or "severe"), as per previous military studies (40)(41)(42). We assigned physical distress caseness as endorsing 16 or more physical symptoms.…”

Traumatic experiences in Lebanon: PTSD, associated identity and interoception

“…Moreover, studies on PTSD in Lebanon are limited to few studies with small samples pertaining to specific groups (not the general population). While previous literature has widely documented the relations between trauma characteristics (number and type of trauma) and the incidence and symptomology of PTSD (Jakob et al, 2017;Janoff-Bulman, 1989;Graham et al, 2019), studies recently has been moving from studying the effects of trauma characteristics on PTSD towards investigating how trauma is assimilated in one's identity (trauma centrality) and its effects on PTSD (Bernard et al, 2015;Brensten & Rubin, 2006, 2007Robinaugh & McNally, 2011). Bernard et al (2015) also documented that trauma centrality has a wider influence on PTSD than the mere characteristics of the traumatic event.…”

“…The exposure to a potentially traumatic event such as sexual assault, car accident, combat and so serves as the gatekeeper for the diagnosis and is presumed to be the root cause of the symptoms. Accordingly, research has focused primarily on studies that showed association between trauma characteristics (number of traumas and type of trauma) and the incidence and symptomology of PTSD (Jakob et al, 2017;Janoff-Bulman, 1989;Graham et al, 2019). Studies have indicated that a higher number of traumatic experiences is more likely to lead to severe PTSD symptoms, with interpersonal traumata, such as sexual abuse, being particularly predictive (Jakob et al, 2017;Janoff--Bulman, 1989;Graham et al, 2019;Lancaster et al, 2009).…”

“…Cognitively, negative core beliefs about oneself such as "I feel like an object", "I will never be able to feel normal again", "I don't know myself", or even "I am damaged beyond repair", are commonly experienced (Cox et al, 2014, pp 302). Somatically, traumatic experiences through physical representations such as general fatigue, lower back pain, muscle ache, palpitation and increased perspiration are common manifestations of traumatic experiences (Graham et al, 2019). In addition, trauma survivors often report somatically based alterations in relation to self-experience such as feeling disembodiment reported like "I feel dead inside", "I feel as if I am outside my body", "I feel like my body does not belong to me" or "I feel like there is no boundary around my body" (Frewen & Lanius, 2015, pp 27).…”