The Development of Trauma-Related Symptoms in Veterans of Operation Desert Storm

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Southwick, S. M., Morgan, A., Nagy, L. M., Bremner, D., Nicolaou, A. L., Johnson, D. R., Rosenheck, R., Charney, D. S. (1993). Trauma-related symptoms in veterans of operation desert storm: a preliminary report. The American Journal of Psychiatry, 150, 1524-1528.

Southwick, S. M., Morgan III, C. A., Darnell, A., Bremner, D., Nicolaou, A. L., Nagy, L.., Charney, D. S. (1995). Traumarelated symptoms in veterans of operation desert storm: a 2-year follow-up. The American Journal of Psychiatry, 152, 1150-1155.

Posttraumatic stress disorder (PTSD) is experienced by somewhere between 7% to 12% of the general population (Beckham, Davidson & March, 2003; Seedat & Stein, 2001) and typically develops following exposure to a situation or event that is, or is perceived to be, threatening to the safety or physical integrity of one's self or others. As presented in the current Diagnostic and Statistical Manual of Mental Disorders [4th ed., text revision; DSM-IV-TR; APA, 2000], PTSD symptoms are grouped into three clusters: re-experiencing of the event (e.g., recurrent and intrusive thoughts, distressing dreams), avoidance and emotional numbing (e.g., avoidance of reminders of the traumatic event, restricted range of affect), and hyper-arousal (e.g., sleep difficulties, exaggerated startle response). For symptoms to satisfy criteria for a diagnosis of PTSD, a person must be exposed to a traumatic event with actual or perceived threat and they must (a) experience intense fear or helplessness; (b) have at least one re-experiencing symptom, at least three avoidance and numbing symptoms, and at least two hyper-arousal symptoms; (c) must be bothered by these symptoms for one month or more; and (d) must experience significant distress or impairment in social, occupational, or other functioning. The types of trauma that people experience are wide ranging. Examples include physical assault, sexual assault, combat, tragic death, terrorism, motor vehicle accidents, and natural disasters (Norris, 1992).

Southwick, Morgan, Nagy, Brenmner, Nicolaou, Johnson, Rosenheck, and Charney (1993) recognized that PTSD is a particularly relevant topic for those in the military. The authors report that other studies have found prevalence rates ranging from 2% (in veterans of the Vietnam theater of operations 20 years later) to 50% (in former POW's of WWII). While PTSD is a concern for those exposed to combat and other traumatic experiences related to being in the military, little is known about the natural course of PTSD symptomology.

Southwick et al. (1993) conducted one of the first studies to take a prospective look at the natural development of trauma related symptoms. In a follow-up study Southwick, Morgan, Darnell, Bremner, Nicolaou, Nagy, and Charney (1995) extended their findings with a two-year re-evaluation of the same participants. Southwick et al. (1993) recruited 84 National Guard reservists one month and six months after returning from the Persian Gulf area. Southwick and colleagues (1995) examined the responses of 62 of those same reservists two years after they had returned from Operation Desert Storm.

Participants were assessed for PTSD symptoms using the Mississippi Scale for Combat-Related Post-Traumatic Stress Disorder, the Combat Exposure Scale, a Desert Storm trauma questionnaire, and an unstandardized scale based on DSM-III-R criteria. The later PTSD symptom scale was created by the authors specifically for the purpose of this study. Participants rated all 17 symptoms in the DSM-III-R on a scale of 0 (slight) to 4 (extreme). The Mississippi PTSD scale is a self-report inventory that consists of 35 items derived from DSM-III criteria and associated features. The Combat Exposure Scale is a subjective scale that quantifies wartime stressors with ratings ranging from 1 (light exposure) to 5 (heavy exposure). The Desert Storm trauma questionnaire was composed of 19 items dealing with stressors that somewhat overlapped with the Combat Exposure Scale, but also included specific items that were frequently experienced by Desert Storm personnel. …