The PTSD interview: rationale, description, reliability, and concurrent validity of a DSM-III-based technique.

This paper describes the PTSD Interview (PTSD-I). It was developed to meet four specifications: (a) close correspondence to DSM-III standards; (b) binary present/absent and continuous severity/frequency outputs on each symptom and the entire syndrome; (c) administrable by trained subprofessionals; and (d) substantial reliability and validity. It was written to meet the first three criteria. It demonstrated very high internal consistency (alpha = .92) and test-retest reliability (Total score r = .95; diagnostic agreement = 87%). It correlated strongly with parallel DIS criteria (Total score vs. DIS diagnosis rbis = .94, sensitivity = .89, specificity = .94, overall hit rate = .92, and kappa = .84). Earlier studies revealed correlations with a military stress scale and Keane et al.'s MMPI PTSD subscale. It is apparently the only PTSD instrument that meets all of the above criteria.

A factor analysis of the DSM-III post-traumatic stress disorder criteria.

The authors factor analyzed DSM-III-based post-traumatic stress disorder symptom ratings made on 131 Vietnam-veteran PTSD patients. Five factors--termed Intrusive Thoughts and Their Effects, Increased Arousal, Impoverished Relationships, Guilt, and Cognitive Interference--emerged. The factor structure gave more support to Laufer, Brett and Gallops' conceptualization of PTSD than to the Horowitz, DSM-III, or DSM-III-R systems. It also generated suggestions for future editions of the diagnostic manual.

What does the Keane et al. PTSD scale for the MMPI measure?

The correlations of the Keane, Malloy, and Fairbank (1984) MMPI PTSD scale with DSM-III-based post-traumatic stress disorder symptom, section, and factor score ratings, and with combat history, were studied to determine what aspects of the disturbance it measures (N = 61). The scale's correlations with the various symptom criteria were both substantial and strikingly consistent. However, its relationships with trauma history measures were modest and frequently nonsignificant. The data suggest that the scale is a moderately strong measure of the various PTSD symptoms, but is related only weakly to trauma history.

A factor analysis of Ellis' irrational beliefs.

In an effort to identify, organize, and operationally define the philosophies that underlie Albert Ellis' self-defeating beliefs, the authors factored an 11-item irrational-values self-report instrument given to 190 psychiatric patients. Four factors emerged and were named to reflect the contents of their items--"I need to control a dangerous world," "Self-assertion is painful," "I need affirmation," and "I lack control over my fate."

The contributions of self-defeating philosophies, perceived helplessness, and repression to anxiety among psychiatric patients.

Four of the most influential psychological explanations for the development of anxiety attribute it to (1) repressed awareness of undesirable emotions; (2) the emergence of unacceptable feelings from the unconscious; (3) adherence to irrational, self-defeating philosophies; and (4) perceived helplessness/lack of control over one's affairs. To test these theories, the authors administered the Trait Anxiety, Denial, Irrational Beliefs, and Locus of Control scales to 190 psychiatric inpatients. Appropriate zero-order, attenuation-corrected, multiple, and partial correlations were run. Denial was correlated negatively with Trait Anxiety; this is consistent with the view that awareness of unpleasant emotions generates anxiety, but does not support the claim that it is the result of repression. The correlations of Trait Anxiety with the Irrational Beliefs scale were substantial. However, its relationships with Locus of Control were limited and nonsignificant after the effects of the Denial and Irrational Beliefs scales were removed statistically. The findings lend support to the positions that anxiety results from self-defeating philosophies and/or the emergence of unpleasant thoughts about oneself, but give only modest support to the "perceived helplessness" hypothesis and seem to contradict the "excessive repression" explanation.

Childhood stress disorder behaviors in veterans who do and do not develop posttraumatic stress disorder.

The purpose of this study was to test a variation of the stress-evaporation theory, which maintains that posttraumatic stress disorder (PTSD) symptoms are simply exacerbations of behaviors present before the trauma. Retrospective childhood self-ratings were made by 63 PTSD patients, 53 psychiatric controls, and 28 normals on 13 PTSD-like symptoms. The results did not support the hypothesis, and they give more support to the residual-stress model than to the stress-evaporation theory.

Differences between posttraumatic stress disorder patients with delayed and undelayed onsets.

In an effort to determine whether they differ from one another in important ways, the authors compared posttraumatic stress disorder (PTSD) victims who reported delayed onsets with those who claimed undelayed onsets of PTSD symptom self-ratings, MMPI clinical and validity scale scores, stress histories, and repression measures. The number and the sizes of the differences did not exceed chance expectations and did not support the establishment of separate delayed- and undelayed-onset PTSD categories in the diagnostic manual, nor did they support the hypotheses that the delay, when it appears, is attributable to the magnitude of the trauma, the severity of the symptoms, repression, or a limited stress history.

Perceptual distraction in schizophrenia.

The purpose of this project was to determine whether a distractibility deficit at the stimulus-identification level could be identified in schizophrenics after distractor and non-distractor conditions had been matched for difficulty (N = 110). Process schizophrenics, reactive schizophrenics, and psychiatric controls were asked to identify tachistoscopically presented stimuli shown with and without distractors. The distractor and non-distractor tasks were matched for difficulty beforehand by manipulating presentation intervals. The schizophrenics did not show more deficit under the distractor conditions than did the nonschizophrenic patients. Moreover, compared to psychiatric controls, the schizophrenics' performances were no more deficient under distractor conditions than under non-distractor conditions, even before the tasks were matched for difficulty. These findings suggest that perceptual distractibility at the stimulus identification level is no more pronounced in schizophrenics than in nonschizophrenics, especially after difficulty is controlled.

The relationships of post-traumatic stress disorder to adolescent illegal activities, drinking, and employment.

The authors compared the self-reported incidences of adolescent legal problems, drinking, employment, and church attendance in psychiatric patients (N = 116) with and without post-traumatic stress disorder (PTSD) and normals (N = 28). The differences did not exceed chance expectations. The data raise doubts about the validity of the theory that PTSD is at least partially a result of pre-traumatic personality maladjustment.

The comparative validities of six MMPI repression scales.

The validities of six MMPI repression scales were compared using each of the other five and an independent measure as criteria (N = 190). The data gave little support to the Eichman, Welsh, and Haan Repression scales as operational definitions of this construct. The results for the Little-Fisher Denial, Byrne et al. R-S, and Haan Denial scales showed more promise.

Performance asymptotes in schizophrenia: a further test of the Broen-Storms theory.

Broen and Storms have developed a theory that attributes schizophrenic cognitive deficit to the combination of high drive levels and low response strength ceiling. The authors tested four hypotheses drawn from the theory in a multiple-choice paired associates learning study (N = 90). The hypotheses were that schizophrenics would demonstrate faster acquisition of reinforced (dominant) responses, lower peak performances, and greater declines in post-peak performance than would two comparison groups. They also hypothesized that all three groups would manifest declines in number of dominant responses after peak performance levels were reached. None of the hypotheses was supported. These results, and the majority of the earlier research on the Broen-Storms hypothesis, cast doubt on the utility of the theory.

A cross-validation of the Keane and Penk MMPI scales as measures of post-traumatic stress disorder.

The scores of DSM-III-diagnosed post-traumatic stress disorder (PTSD) patients (N = 116), psychiatric patients who did not meet the criteria, and normals (N = 19) on the Keane, Malloy, and Fairbank (1984) PTSD and Penk Combat scales for the MMPI were compared. The Keane scale discriminated PTSD-positive patients from normals at a substantial level of accuracy (omega 2 = .23; mean hit rate = 80.5%) and PTSD-positive from PTSD-negative patients at a more modest level (omega 2 = .09; mean hit rate = 64%). The scores of the PTSD-positive and PTSD-negative patients were considerably lower than those of Keane et al.'s (1984) samples, which suggests that local norms may be needed to facilitate their interpretation. The Penk Combat Intensity scale, which was correlated highly with the Keane scale, differentiated the PTSD-positive patients from both the normals and the PTSD-negative patients, but with less differentiating power (omega 2'S = .07 and .08). The Penk Combat Exposure scale did not separate the groups.