Long-term risk for mental health symptoms in Dutch ISAF veterans: the role of perceived social support.

BACKGROUND: Military personnel deployed to combat and peacekeeping missions are exposed to high rates of traumatic events. Accumulating evidence suggests an important association between deployment and the development of other mental health symptoms beyond post-traumatic stress disorder. METHODS: This study examined the prevalence of agoraphobia, anxiety, depression, and hostility symptoms in a cohort of Dutch ISAF veterans (N = 978) from pre-deployment up to 10 years after homecoming. The interaction of potential moderating factors with the change in mental health symptoms relative to pre-deployment was investigated at each time point. RESULTS: The probable prevalence of agoraphobia, anxiety, depression, and hostility symptoms significantly increased over time to respectively 6.5, 2.7, 3.5, and 6.2% at 10 years after deployment. Except for hostility symptoms, the probable prevalence at 10 years after deployment was the highest compared to all previous follow-up assessments. Importantly, less perceived social support after returning from deployment was found as a risk factor for all different mental health symptoms. Unit support was not associated with the development of mental health problems. CONCLUSIONS: This study suggests a probable broad and long-term impact of deployment on the mental health of military service members. Due to the lack of a non-deployed control group, causal effects of deployment could not be demonstrated. Continued effort should nevertheless be made in the diagnosis and treatment of a wide range of mental health symptoms, even a decade after deployment. The findings also underscore the importance of social support after homecoming and its potential for the prevention of long-term mental health problems.

Long-term development of post-traumatic stress symptoms and associated risk factors in military service members deployed to Afghanistan: Results from the PRISMO 10-year follow-up.

BACKGROUND: Symptoms of post-traumatic stress disorder (PTSD) can manifest several years after trauma exposure, and may impact everyday life even longer. Military deployment can put soldiers at increased risk for developing PTSD symptoms. Longitudinal evaluations of PTSD symptoms in deployed military personnel are essential for mapping the long-term psychological burden of recent operations on our service members, and may improve current practice in veterans' mental health care. METHODS: The current study examined PTSD symptoms and associated risk factors in a cohort of Dutch Afghanistan veterans 10 years after homecoming. Participants (N = 963) were assessed seven times from predeployment up to 10 years after deployment. Growth mixture modeling was used to identify distinct trajectories of PTSD symptom development. RESULTS: The probable PTSD prevalence at 10 years after deployment was 8%. Previously identified risk factors like younger age, lower rank, more deployment stressors, and less social support were still relevant 10 years after deployment. Four trajectories of PTSD symptom development were identified: resilient (85%), improved (6%), severely elevated-recovering (2%), and delayed onset (7%). Only the delayed onset group reported increasing symptom levels between 5 and 10 years postdeployment, even though 77% reported seeking help. CONCLUSIONS: This study provides insights into the long-term burden of deployment on the psychological health of military service members. It identifies a group of veterans with further increasing PTSD symptoms that does not seem to improve from currently available mental health support, and underlines the urgent need for developing and implementing alternative treatment opportunities for this group.

Associations between the development of PTSD symptoms and longitudinal changes in the DNA methylome of deployed military servicemen: A comparison with polygenic risk scores.

Objective: Military servicemen deployed to war zones are at increased risk of developing posttraumatic stress disorder (PTSD) and successful adaptation to stress is important. Epigenetic alterations in response to trauma have been identified as mechanism of adaptation and may therefore predict deployment-related PTSD symptoms. To date, human studies of epigenetic marks for traumatic stress have been largely constrained by short-term analyses of one or two time points. Method: This study in a prospective Dutch military cohort (N â€‹= â€‹125) examined longitudinal changes of DNA methylation profiles before, as well as one and six months after deployment-related combat exposure in relation to the development of PTSD symptoms over a period of up to five years after deployment. We investigated the predictive value of specific methylation changes for immediate and delayed-onset PTSD symptoms and recovery. This epigenetic prediction was compared to polygenic risk score predictions obtained from the currently available largest genome-wide association study of PTSD. Results: A total of fourteen genomic regions were identified in which PTSD symptom levels were associated with methylation changes over time (pre-deployment, one, and six months post-deployment). Of these regions, four were significant determinants of longitudinal development of PTSD symptoms. In addition, we observed that, together with risk level during deployment (operating inside or outside the military base) and physical childhood trauma, post-deployment decreases in methylation at a genomic region in EP300/miRNA1281 was associated with a delayed onset of PTSD compared to a resilient profile. Polygenic risk, in contrast, was related to PTSD onset within six months after deployment but was not associated with long term outcomes. Conclusion: The present study suggests predictive utility of changes in DNA methylation for the subsequent development of PTSD symptoms and showed that the currently available measure of polygenic risk is primarily related to non-delayed disease onset.

Cohort profile: the Prospective Research In Stress-Related Military Operations (PRISMO) study in the Dutch Armed Forces.

PURPOSE: The Prospective Research in Stress-Related Military Operations (PRISMO) study was initiated to gain a better understanding of the long-term impact of military deployment on mental health, and to map the different biological and psychological factors that contribute to the development of stress-related mental health symptoms. PARTICIPANTS: The PRISMO cohort consists of a convenience sample of Dutch military personnel deployed to Afghanistan between 2005 and 2008. Baseline data collection resulted in the recruitment of 1032 military men and women. Combat troops as well as non-combat support troops were recruited to increase the representativeness of the sample to the population as a whole. FINDINGS TO DATE: The prevalence of various mental health symptoms increases after deployment in PRISMO cohort members, but symptom progression over time appears to be specific for various mental health symptoms. For post-traumatic stress disorder, we found a short-term symptom increase within 6 months after deployment (8.2%), and a long-term symptom increase at 5 years after deployment (12.9%). Several biological vulnerability factors associated with the development of stress-related conditions after deployment were identified, including predeployment glucocorticoid receptor sensitivity and predeployment testosterone level. Thus far, 34 publications have resulted from the cohort. FUTURE PLANS: Various analyses are planned that will include the prevalence of mental health symptoms at 10 years postdeployment, as well as trajectory analyses that capture the longitudinal development of symptoms. Furthermore, we will use a machine learning approach to develop predictive and network models for several mental health symptoms, incorporating biological, psychological and social factors.

Role of Sexuality in Body Integrity Identity Disorder (BIID): A Cross-Sectional Internet-Based Survey Study.

BACKGROUND: Body integrity identity disorder (BIID)-a strong desire for amputation or paralysis-is often accompanied by feelings and cognitions of sexual arousal, although this sexual component has been largely neglected in the recent literature. AIM: To examine the presence of BIID-related sexual arousal in subjects with BIID and explore clinical and demographic variables of subjects with BIID who do and do not possess this sexual arousal. METHODS: Eighty individuals with BIID responded to an internet-based survey we created. For all subjects, restoring identity was the primary motivation for preferred body modification. We collected data about respondents' demographic, clinical, and sexual characteristics. Based on responses to questions about BIID-specific sexual desires, subjects were assigned to the group with BIID-related sexual feelings (S-BIID; n = 57) or the group without such feelings (NS-BIID; n = 23). OUTCOMES: Differences in clinical, demographic, and sexual characteristics between S-BIID and NS-BIID groups. RESULTS: Of the respondents, 71.3% endorsed S-BIID. Subjects with S-BIID were significantly more often men, religious, and of a homosexual identity compared with the NS-BIID group. Subjects with S-BIID also significantly more often reported a change in localization and/or intensity of their BIID feelings over time. Furthermore, 66.7% of subjects with S-BIID reported S-BIID as an additional motivation for body modification. Seven of the 57 subjects with S-BIID achieved their preferred body modification through (self)-amputation, whereas none of the subjects with NS-BIID did. CLINICAL IMPLICATIONS: BIID is a heterogeneous disorder in which subjects who self-reported comorbid sexual arousal more often resorted to (self-induced) amputation. STRENGTHS AND LIMITATIONS: This study contains the largest BIID cohort presented in the literature and is the first to genuinely research sexuality in BIID. The first limitation is the lack of face-to-face interviews with the subjects, so no clinical diagnoses could be made. Moreover, there is an ascertainment bias because subjects were collected through the internet and in English, which excluded those who spoke other languages or subjects without an internet connection. CONCLUSION: The present study provides preliminary evidence for a subpopulation or distinct group of individuals with BIID based on the presence of S-BIID. Blom RM, van der Wal SJ, Vulink NC, Denys D. Role of Sexuality in Body Integrity Identity Disorder (BIID): A Cross-Sectional Internet-Based Survey Study. J Sex Med 2017;14:1028-1035.

Autism in Action: Reduced Bodily Connectedness during Social Interactions?

Autism is a lifelong disorder, defined by deficits in social interactions and flexibility. To date, diagnostic markers for autism primarily include limitations in social behavior and cognition. However, such tests have often shown to be inadequate for individuals with autism who are either more cognitively able or intellectually disabled. The assessment of the social limitations of autism would benefit from new tests that capture the dynamics of social initiative and reciprocity in interaction processes, and that are not dependent on intellectual or verbal skills. New entry points for the development of such assessments may be found in 'bodily connectedness', the attunement of bodily movement between two individuals. In typical development, bodily connectedness is related to psychological connectedness, including social skills and relation quality. Limitations in bodily connectedness could be a central mechanism underlying the social impairment in autism. While bodily connectedness can be minutely assessed with advanced techniques, our understanding of these skills in autism is limited. This Perspective provides examples of how the potential relation between bodily connectedness and specific characteristics of autism can be examined using methods from the coordination dynamics approach. Uncovering this relation is particularly important for developing sensitive tools to assess the tendency to initiate social interactions and the dynamics of mutual adjustments during social interactions, as current assessments are not suited to grasp ongoing dynamics and reciprocity in behavior. The outcomes of such research may yield valuable openings for the development of diagnostic markers for autism that can be applied across the lifespan.

The Desire for Amputation or Paralyzation: Evidence for Structural Brain Anomalies in Body Integrity Identity Disorder (BIID).

BACKGROUND: Body Integrity Identity Disorder (BIID) is a condition in which individuals perceive a mismatch between their internal body scheme and physical body shape, resulting in an absolute desire to be either amputated or paralyzed. The condition is hypothesized to be of congenital nature, but evidence for a neuro-anatomical basis is sparse. METHODS: We collected T1-weighted structural magnetic resonance imaging scans on a 3T scanner in eight individuals with BIID and 24 matched healthy controls, and analyzed the data using voxel-based morphometry. RESULTS: The results showed reduced grey matter volume in the left dorsal and ventral premotor cortices and larger grey matter volume in the cerebellum (lobule VIIa) in individuals with BIID compared to controls. CONCLUSION: The premotor cortex and cerebellum are thought to be crucial for the experience of body-ownership and the integration of multisensory information. Our results suggest that BIID is associated with structural brain anomalies and might result from a dysfunction in the integration of multisensory information, leading to the feeling of disunity between the mental and physical body shape.

Body integrity identity disorder crosses culture: case reports in the Japanese and Chinese literature.

Body integrity identity disorder (BIID) is a condition in which people do not perceive a part of their body as their own, which results in a strong desire for amputation or paralyzation. The disorder is likely to be congenital due to its very early onset. The English literature describes only Western patients with BIID, suggesting that the disorder might be merely prevalent in the West. To scrutinize this assumption, and to extend our knowledge of the etiology of BIID, it is important to trace cases with BIID in non-Western populations. Our objective was to review Chinese and Japanese literature on BIID to learn about its presence in populations with a different genetic background. A systematic literature search was performed in databases containing Japanese and Chinese research, published in the respective languages. Five Japanese articles of BIID were identified which described two cases of BIID, whereas in the Chinese databases only BIID-related conditions were found. This article reports some preliminary evidence that BIID is also present in non-Western countries. However, making general statements about the biological background of the disorder is hampered by the extremely low number of cases found. This low number possibly resulted from the extreme secrecy associated with the disorder, perhaps even more so in Asian countries.