Am J Psychiatry 1992; 149:1568-1574
Copyright © 1992 by American Psychiatric Association
Phenomenology and course of psychiatric disorders associated with combat-related posttraumatic stress disorder
TA Mellman, CA Randolph, O Brawman-Mintzer, LP Flores and FJ Milanes
Miami Veterans Administration Medical Center, FL 33125.
OBJECTIVE: Studies indicate that chronic combat-related posttraumatic
stress disorder (PTSD) is frequently associated with other psychiatric
disorders. Questions regarding the nature and interrelationships of these
conditions require clarification. The purpose of this study was to address
primary and secondary illness relationships by focusing on the specific
phenomenology and course of illness onset of PTSD comorbidity. METHOD: In
order to minimize confounding factors, only outpatients without recent
substance use disorders were included. Sixty subjects who had been exposed
to severe combat stress including veterans of Vietnam and veterans of World
War II or Korea, 15 of whom were former prisoners of war, received
structured assessments over serial evaluations. RESULTS: PTSD was the most
prevalent lifetime disorder followed by major depression, panic disorder,
generalized anxiety disorder, and phobic disorder or symptoms.
Endogenous-appearing features overlapping other clinical populations were
common; however, some specific symptom patterns also were suggestive of
traumatic influence. Unlike generalized anxiety disorder and past substance
use, the mean onset of phobias, major depression, and panic disorder,
respectively, occurred later than PTSD. CONCLUSIONS: These observations
suggest that persistent conditions related to PTSD progress toward symptoms
that are increasingly autonomous in their pattern of occurrence.
