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Am J Psychiatry 1993; 150:620-624
Copyright © 1993 by American Psychiatric Association
Psychophysiologic assessment of traumatic imagery in Israeli civilian patients with posttraumatic stress disorder
AY Shalev, SP Orr and RK Pitman
Center for Traumatic Stress, Hadassah University Hospital, Jerusalem, Israel.
OBJECTIVE: This study used a script-driven imagery technique, previously
used with combat veterans, to assess physiologic responses of Israeli
survivors of noncombat traumas. METHOD: Each subject had experienced an
event meeting DSM-III-R criterion A for posttraumatic stress disorder
(PTSD). The subjects were classified on the basis of the full DSM-III-R
criteria into a current PTSD group (N = 13) and a non-PTSD group (N = 13).
Thirty-second scripts describing each subject's personal traumatic event,
as well as other events, were prepared. The scripts incorporated subjective
visceral and muscular responses reported to have accompanied each
experience. In the laboratory, the scripts were read one at a time to the
subject, who was instructed to imagine each event portrayed as vividly as
possible, while heart rate, skin conductance, and left lateral frontalis
electromyogram levels were measured. RESULTS: Multivariate analysis of
variance revealed that the physiologic responses of the PTSD subjects
during imagery of their personal traumatic experiences were significantly
greater than those of the non-PTSD subjects. This difference was not
explained by age, gender, or rated severity of the traumatic event. A
physiologic discriminant function derived from previously studied Vietnam
veterans correctly classified nine of the 13 PTSD subjects (sensitivity =
69%) and 10 of the 13 non-PTSD subjects (specificity = 77%). CONCLUSIONS:
These results replicate previous findings of heightened physiologic
responses during personal combat imagery in male American war veterans and
extend them to a group of male and female Israeli civilian victims of
trauma, supporting the robustness of physiologic responding during personal
traumatic imagery as a measure of PTSD.
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