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PTSD of Comorbidity

PTSD of Comorbidity
Another key component of the epidemiology of PTSD is its pattern of occurrence with other psychiatric and physical conditions, or comorbidities. Both general population studies and studies of individuals exposed to particular traumas indicate that the experience of other psychiatric disorders is common among individuals with PTSD. For example, in the St. Louis ECA study, almost 80% of persons with PTSD had a previous or concurrent psychiatric disorder, compared to about onethird of persons with no posttraumatic symptoms. Similarly, in Breslau et al.’s urban young adult sample, 83% of participants with lifetime PTSD had at least one other lifetime psychiatric disorder. In interpreting these and other findings addressing the psychiatric comorbidity of PTSD, however, it is worth noting that such results may in part be an artifact that reflects similarities in the diagnostic criteria for PTSD and other anxiety or depressive disorders. Further, as suggested by Acierno et al. in reviewing research on crime-related PTSD, ‘‘large relative risk estimates may be a function of exposure to traumatic events, rather than PTSD per se’’ and thus may indicate of the potentially broad-reaching effects of traumatic life experiences. In the NCS, the most extensive study of psychiatric comorbidities conducted to date, lifetime comorbidity between PTSD and the other DSM-IIIR disorders was 88% for men and 79% for women.
In contrast, 46% of women and 55% of men with disorders other than PTSD had lifetime histories of another psychiatric disorder. The disorders most prevalent among men with lifetime histories of PTSD were alcohol abuse or dependence (51.9%), major depression (47.9%), conduct disorder (43.3%), and drug abuse or dependence (34.5%). The disorders most prevalent among women with lifetime PTSD were major depression (48.5%), simple phobia (29.0%), social phobia (28.4%), and alcohol abuse/dependence (27.9%). In Breslau et al.’s young adult sample, the two most prevalent disorders among individuals with lifetime PTSD were major depression (36.6%) and alcohol abuse or dependence (31.2%). Note, however, that comorbidity rates in both of these studies refer to lifetime disorder rather than current disorder and therefore do not necessarily imply the simultaneous occurrence of PTSD with other psychiatric disorders. High rates of psychiatric comorbidity have been also found in studies of PTSD among individuals who experienced specific types of trauma. In the NVVRS, Kulka et al. found that virtually all Vietnam veterans with PTSD had met the criteria for one or more other psychiatric disorders at some time during their lives (three-quarters if alcohol disorders are excluded). Moreover, half of the veterans with PTSD met criteria for another current psychiatric disorder. In men with PTSD, the most frequent diagnostic comorbid disorders were alcohol abuse or dependence (75% lifetime, 20% current), generalized anxiety disorder (44% lifetime, 20% current), and major depression (20% lifetime, 16% current). Among women veterans with PTSD, the most frequent disorders were major depression (42% lifetime, 23% current), generalized anxiety disorder (38% lifetime, 20% current), and dysthymic disorder (33% lifetime). Consistent with these findings for women military veterans, a study of criminal victimization among women community residents also found that women with current PTSD were more likely than women without PTSD to meet criteria for the following disorders: major depression (32% vs. 4%), obsessive-compulsive disorder (27% vs. 3%), agoraphobia (18% vs. 1%), and social phobia (18% vs. 4%). Epidemiologic studies also examined the temporal order of PTSD in relation to other psychiatric disorders that are highly comorbid with PTSD. In the NCS, the absence of a PTSD assessment for all traumas experienced precluded an unequivocal determination of how often comorbid PTSD was a primary disorder (in the sense of having an earlier onset than other psychiatric disorders). By placing upper and lower bounds on this figure, however, Kessler et al. estimated that PTSD was primary with respect to all other disorders between 29% and 51% of the time among men and between 41% and 58% of the time among women. In a community sample of 801 women, PTSD was associated with an increased risk for first-episode onset of major depression and alcohol abuse or dependence (but not any anxiety disorder). Exposure to a potentially traumatic event also was associated with an increased risk of alcohol abuse or dependence in this sample. In Breslau et al.’s sample of young adults, PTSD was associated with an increased risk of subsequent drug abuse or dependence, whereas exposure to a potential trauma in the absence of PTSD did not increase risk for drug use disorders.
In addition to studies of psychiatric comorbidity, there is a growing body of research on the physical health comorbidities and life adjustment problems associated with PTSD. Correlates of PTSD identified in the empirical literature include more somatic complaints, poorer health status, increased use of health services, and higher rates of cardiovascular symptoms, neurological symptoms, gastrointestinal symptoms, and other physical symptoms of known and unknown etiology. Research also has shown a greater frequency of adverse health practices (e.g., smoking, alcohol use) among persons with PTSD. Although the impact of PTSD on functioning has not been wellstudied, a few studies found evidence of impaired functioning (e.g., more physical limitations, a greater likelihood of not being employed) among individuals with PTSD.

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