Dr. French's comments also were of interest. In several different veteran populations we too have found confusion, shame, isolation, and guilt to be major concerns for combat veterans with PTSD. However, we do not agree that PTSD arises in response to these concerns "rather than" in response to trauma, pain, and abuse. Further, we do not believe that memories of a traumatic incident are immaterial to the development of PTSD. Instead, we agree with Roemer et al. who note that a simple dose-response model of the relationship between trauma experiences and symptoms is insufficient. It appears that multiple factors, including degree of traumatic exposure, are related to level of PTSD symptoms.