ABSTRACT
OBJECTIVE: The current classification of posttraumatic stress disorder in acute, chronic and delayed-onset types is incomplete and of limited usefulness. The present paper explores the possibilities of a clinically-based typology that would reflect both the patients' syndromic presentation and modern research findings. METHOD: Review of current clinical and research literature, with a critical examination of proposed typologies, parameters utilised, applicability and relevance; elaboration of theoretical and practical bases of a clinical typology of posttraumatic stress disorder. RESULTS: None of the existing posttraumatic stress disorder typologies presents a clinically comprehensive scope. A typology supported by literature findings and clinical observations is proposed. The six clinical types are depressive, dissociative, somatomorphic, psychotomorphic, organomorphic and 'neurotic-like'. Substance abuse and personality disorder-like variants remain as areas of investigation. CONCLUSIONS: The proposed typology, while accepting the nuclear manifestations of posttraumatic stress disorder, highlights prominent coexisting symptoms that define the clinical appearance of different patients. The typological approach in posttraumatic stress disorder does not carry the ambiguities of comorbidity, and facilitates a more specific and appropriate management of the cases.
Subject(s)
Stress Disorders, Post-Traumatic/classification , HumansABSTRACT
While there are many studies of comorbidity in combat veterans with posttraumatic stress disorder (PTSD), studies of PTSD from other sources of trauma (e.g., disasters, crimes, and civil violence) are just beginning to emerge. This is the first formal review comparing patterns of comorbidity in PTSD from different sources of trauma. Specific attention is given to the relative frequencies of substance abuse, depression, generalized anxiety, phobic, panic, somatization, psychotic, and personality disorders. The findings reveal that although similarities exist, the comorbidity profiles differ according to the type of trauma experienced and the population studied. Additionally, the evidence suggests that the associated psychiatric disorders are not truly comorbid, but are interwoven with the PTSD.
Subject(s)
Stress Disorders, Post-Traumatic/epidemiology , Wounds and Injuries/psychology , Adult , Comorbidity , Crime/psychology , Depressive Disorder/epidemiology , Depressive Disorder/psychology , Disasters , Female , Humans , Male , Middle Aged , Panic Disorder/epidemiology , Panic Disorder/psychology , Personality Disorders/epidemiology , Personality Disorders/psychology , Phobic Disorders/epidemiology , Phobic Disorders/psychology , Psychotic Disorders/epidemiology , Psychotic Disorders/psychology , Somatoform Disorders/epidemiology , Somatoform Disorders/psychology , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/psychology , Substance-Related Disorders/epidemiology , Substance-Related Disorders/psychology , Violence/psychologyABSTRACT
Psychiatric evaluations of nonincarcerated adult male victims of same-sex rape have been reported infrequently in the literature. In their work with a population of military men, the authors reviewed the psychiatric evaluations of 13 such victims, ages 18 to 31, over a 2-year period. Most of the men reported mood disturbances (e.g., fear, depression, anger), somatic disturbances (e.g., in sleep, appetite, digestion), and difficulties in peer relationships following the assault, and almost half of these victims reported that they had experienced subsequent sexual problems.
