Post-Traumatic Stress Disorder: Symptom Profiles in Men and Women

Ben Green

Disclosures

Curr Med Res Opin. 2003;19(3) 

In This Article

Discussion

Roszell et al. performed a comparable study of 116 military veterans.[4] Using DSM-III-R criteria the majority of symptoms attained a greater than 50% frequency except flashbacks, psychogenic amnesia, and sense of foreshortened future. This would appear to concur with the present study's mainly civilian sample, except for the sense of a foreshortened future, which attained a 78% frequency in this study.

Symptom profiles of male and female sufferers of PTSD were compared in this study. Men were significantly more likely than women to suffer with irritability and to use alcohol to excess. This has important implications for physical health and for professionals who analyse offending behaviour or provide forensic reports. This finding echoes work by Zlotnick et al. who found that men with PTSD in general psychiatric practice were more likely to meet criteria for a substance use disorder and for antisocial personality disorder.[5] Zlotnick et al.'s other finding that women with PTSD were likely to quote sexual trauma as a cause and to have a higher frequency of re-experiencing type symptoms were not replicated in this sample. (However, as noted, women were more likely to complain of childhood abuse.) Zlotnick et al. concluded that, as in this study, men and women had fairly comparable clinical symptom profiles.

There was otherwise a broad similarity in the relative frequency of symptoms amongst males and females. This broad similarity in symptom profiles between males and females also seems to occur in military cases of PTSD.[6] This finding is not universal and some authors have found differences between male and female presentations, particularly with regard to dissociative-type symptoms, which in Fullerton et al.'s study, women appeared to be more susceptible.[7] Maes et al. found that women were more likely to have re-experiencing symptoms and arousal symptoms.[8] Maes' study, however, included fewer than 40 people with PTSD. Its findings are not replicated in the current study, which has a larger number of subjects with PTSD.

A case could be made for retaining the association between the diagnosis and the most prevalent symptoms and perhaps dropping some of the less-frequently experienced symptoms — such as difficulty recalling detail (18%) and restricted affect (31%). A case could also be made for including some frequently occurring apparent symptoms (e.g. low mood and reduced libido) and often overlooked symptoms in the diagnostic guidelines (such as mood lability). Many would argue for two discrete diagnoses — PTSD which accounts for such problems as anxiety at reminder cues, nightmares, and depression, which accounts for problems such as low mood and reduced libido. The latter argument is made by those in favour of the concept of co-morbidity.

Co-morbidity with PTSD has been recognised in earlier studies, prompting others to contemplate whether PTSD is a discrete diagnostic entity. Up to 50% of PTSD patients have co-morbid diagnoses.[9] Some authors have even questioned whether PTSD exists at all.[10] Roszell et al. and others found that mood disorders, psychoactive substance abuse disorders and anxiety disorders commonly co-existed with PTSD in military veterans.[4,11] This study found similarly increased use of cigarettes and alcohol and very high rates of lowered mood in a civilian population with PTSD.

The argument is in some ways a philosophical one, but the single origin of the symptoms can be ascribed to the trauma itself, and one may argue that it makes more sense to link a trauma to a single disorder or syndrome than to two separate disorders. This would widen the concept of PTSD to include affective disorder. Leaving the philosophical argument aside, it is clear that PTSD may have considerably more to tell us clinically about the genesis of depression than psychiatrists have generally inferred to date.

The frequency of previous acute stress disorder was high (87%), lending some further credence to the predictive value of this factor for later PTSD.[12] Other authors have found that acute stress disorder predicted 83% of the PTSD group.[13] Koren et al. also found a good predictive value for symptoms within the first week being associated with PTSD at 1 year.[14]

Limitations of this study include the use of a possibly biased sample in that these were people primarily referred for clinical and medico-legal assessments. Blaszczynski et al. have condemned this methodology, preferring non-selected research samples.[15] The preferred methodology would involve a prospective follow-up of a large and complete set of trauma survivors or a sizeable and representatively-drawn population sample. If the incidence of PTSD is only 5% in, say, motor vehicle accident (MVA) survivors, then to find 100 cases of PTSD would require a costly psychiatric and psychological follow-up over several years of at least 2000 or more survivors. This is possible, but would require national or international collaborative funding. Until this is funding is available, such studies as this one still have merit and real-world or heuristic validity, and may help sharpen the hypotheses for larger studies.

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