Sixty head injured patients participated in this research, an evaluation of the validity of the DSM-III/III-R criteria to diagnose cases of Post Traumatic Stress Disorder among the head injured. Data were collected from a battery of tests, including a self-report checklist of symptoms, the Diagnostic Interview Schedule, Life Events Inventory, Novaco Anger Inventory, MMPI, WAIS-R, and the Halstead-Reitan Battery, at three times within the first year of recovery. Results indicated that concordance rates between DSM-III/III-R criteria and alternative criteria were low, while concordance rates between alternative sets of criteria were acceptable. Assessment of the convergent validity of PTSD criteria with external measures of distress and impairment indicated that the largest multivariate group separation and highest discrimination rates were achieved for alternative PTSD criteria. Individuals who met DSM-III criteria at the initial assessment appeared less distressed and more healthy than corresponding non-PTSD groups; this pattern was less obvious at follow-up. In contrast, those who met alternative criteria for PTSD at all assessments appeared more distressed and impaired than corresponding non-PTSD groups at all assessments. Of the external predictor variables, anger or irritability had the highest association with PTSD, regardless of how diagnosed. The PTSD and non-PTSD groups could not be discriminated on the basis of medical/neurological variables even though all subjects had some evidence of impairment; thus, all sets of PTSD criteria had discriminant validity when compared to brain damage. The PTSD groups formed on the basis of "post-concussional" symptoms were generally less seriously injured than either corresponding non-PTSD groups or PTSD groups formed from DSM-III/III-R criteria. This finding makes questionable DSM-III/III-R's dismissal of such symptoms as Organic Mental Disorder. The implications of this research for DSM-IV are that PTSD criteria may need to be less restrictive by (a) including somatic symptoms and those symptoms used in operational definitions of Post-Concussional Syndrome; (b) removing the requirement that both intrusion and avoidance-numbness must be present for a diagnosis; (c) recognizing that global symptoms of maladjustment that occur or re-occur after a trauma may indicate PTSD and not comorbidity; and (d) recognizing that the presence of intrusion and/or avoidance-numbness may indicate an adaptive response to the trauma and not a disorder, especially in the absence of associated distress or impairment. (Abstract shortened by UMI.)
| Identifer | oai:union.ndltd.org:uottawa.ca/oai:ruor.uottawa.ca:10393/7519 |
| Date | January 1991 |
| Creators | Gough, Doreen C. |
| Publisher | University of Ottawa (Canada) |
| Source Sets | Université d’Ottawa |
| Detected Language | English |
| Type | Thesis |
| Format | 537 p. |
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