Trauma-Related Pain, Reexperiencing Symptoms, and Treatment of Posttraumatic Stress Disorder: A Longitudinal Study of Veterans.

Research has demonstrated a strong positive association between posttraumatic stress disorder (PTSD) symptoms and physical pain. However, few studies have explored the impact of pain problems on the symptoms and treatment of PTSD, and results remain inconsistent. This longitudinal study examined whether trauma-related and trauma-unrelated pain differentially and uniquely predicted reexperiencing symptoms. We also examined whether levels of reexperiencing symptoms mediated the relationship between pain intensity and posttreatment symptoms of avoidance, numbing, and hyperarousal (ANH). Analyses were conducted using archival data from 99 treatment-seeking veterans who reported the etiology and intensity of their pain and severity of PTSD symptoms pre- and posttreatment. Among veterans with trauma-related pain, pain intensity (a) uniquely corresponded to greater posttreatment reexperiencing symptoms (b = 1.09), and (b) was indirectly predictive of ANH symptoms via the reexperiencing symptoms (b = 1.93). However, veterans with trauma-unrelated pain evidenced no associations between pain intensity and reexperiencing (b = 0.04) or ANH symptoms (b = 0.06). We thus found that trauma-related pain was indirectly related to poor PTSD treatment outcomes via reexperiencing symptoms. These findings offer additional insight into factors that may influence PTSD treatment outcomes for pain-suffering trauma survivors.

The impact of panic disorder on interoception and dyspnea reports in chronic obstructive pulmonary disease.

The prevalence of panic disorder (PD) in patients with chronic obstructive pulmonary disease (COPD) is significantly higher than that in the general population. Comorbid anxiety disorders in COPD are associated with a number of worse outcomes, however little is known about the mechanisms by which PD affects patients with COPD. We hypothesized that patients with COPD and PD would have greater dyspnea severity, but not greater somatosensory sensitivity, to dyspneic stimuli. We studied 10 patients with COPD and PD, 9 patients with COPD without PD, and 9 healthy, matched controls. Participants were administered the Anxiety Sensitivity Index-3. We tested interoceptive sensitivity using a respiratory load detection protocol and dyspnea ratings in response to inspiratory resistive loads. Participants with COPD and PD had higher anxiety sensitivity scores and reported greater dyspnea in response to resistive loads. However no group differences were found in resistive load detection threshold. Anxiety sensitivity scores accounted for a significant amount of the variance in the group difference in dyspnea ratings. Patients with COPD and PD do not show heightened interoceptive sensitivity, but report greater dyspnea to inspiratory resistive loads. Emotional responses to dyspneic sensations may account for higher dyspnea ratings in patients with PD and COPD.

The factor structure of the Narcissistic Personality Inventory.

In the first study, we administered the 40-item Narcissistic Personality Inventory (NPI; Raskin & Terry, 1988) to 843 female and 843 male college students, most of whom were Euro-American, to comprehensively assess the NPI factor structure using confirmatory factor analysis. Initial exploratory common factor analyses (N = 724) revealed a 2-factor model (Leadership/Authority and Exhibitionism/Entitlement). Subsequently, we used confirmatory factor analysis in a separate sample (N = 724) to evaluate the Emmons (1987) 4-factor model, the Raskin and Terry (1988) 7-factor model, the Kubarych, Deary, and Austin (2004) 2- and 3-factor models, and our 2-factor model. Finally, we assessed construct validity by correlating the scale scores with the Five-factor model of personality in an independent sample (N = 238). The 2-factor models for the NPI we obtained in this study and by Kubarych et al. (2004) appeared to be the most parsimonious models, with both a good fit to the data and satisfactory internal consistency values; so they are recommended for use. However, additional NPI research is needed to rescale, modify, or omit several NPI items and develop gender-equivalent items.