Faculty Bibliography

In this study we tested for a protective effect of secure attachment representations in the development of posttraumatic stress disorder (PTSD). In a design with a control group, we replicated and extended a recent study that found no underrepresentation of secure attachment representations in veterans with PTSD (Nye, Katzman, Bell, Kilpatrick, Brainard, & Haaland, 2008). Furthermore, we examined the association of the Adult Attachment Interview (AAI) classification of unresolved loss or trauma and PTSD symptomatology. The Adult Attachment Interview and the Clinician Administered PTSD Scale (CAPS) were administered with 31 veterans with PTSD and 29 trauma-exposed veterans without PTSD of similar age and country of deployment. Patient and control groups did not differ in the prevalence of secure attachment representations, neither did unresolved and not unresolved subjects differ in prevalence of secure attachment representations. Unresolved state of mind with respect to deployment related trauma was found to correlate strongly with total CAPS score. This study shows no protective effect of secure attachment representations in the development of PTSD. AAI unresolved state of mind with respect to deployment related trauma and PTSD correlate strongly, due to the common core phenomenon of lack of integration.

Severe fatigue and co-morbid depressive symptoms are frequently reported by recently deployed military personnel. Stress can induce lasting changes in the negative feedback regulation of the hypothalamic-pituitary-adrenal axis (HPA-axis) and the regulation of the immune system by cortisol. Since these actions of cortisol are modulated via glucocorticoid receptors (GR), we investigated the effect of deployment and of deployment-related fatigue on glucocorticoid binding to peripheral blood mononuclear cells (PBMCs) in a prospective design. Psychological assessments and blood sample collection took place before and one and six months after deployment. Participants were selected from a larger group and assigned to three groups based on their level of fatigue and depressive symptoms six months after deployment. We compared fatigued participants without depressive symptoms (n=21), fatigued participants with depressive symptoms (n=14) and non-fatigued participants without depressive symptoms (n=21). Fatigued participants with depressive symptoms at six months after deployment had higher glucocorticoid binding to PMBCs than the other two groups at all three time points. Notably, this difference was already present before deployment. There was no effect of deployment on glucocorticoid binding to PBMCs. The observed differences in glucocorticoid binding were not related to pre-existing group differences in psychological symptoms. No group differences were observed in the composition of the PBMC population and plasma cortisol levels. These results indicate that high glucocorticoid binding to PBMCs might represent a vulnerability factor for the development of severe fatigue with depressive symptoms after a sustained period of stress, such as deployment.

Most available research on MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) scores in combat veterans suffering from posttraumatic stress disorder (PTSD) has focused on Vietnam veterans. No data are available from peacekeepers suffering from PTSD. The aim of this study was to investigate the relationship between PTSD and the MMPI-2 in a sample of 120 treatment seeking peacekeeping veterans. Results show that relative to a non-PTSD reference group, veterans who screened positive for PTSD scored higher on Scales F, 2 (D), 4 (Pd), 6 (Pa), 7 (Pt), 8 (Sc), and 0 (Si) of the MMPI-2. Scales 2 (D), 7 (Pt), and 8 (Sc) were highest in the mean PTSD profile but no 2- or 3-point code type could be defined. Moderate correlations were found between a self-report measure for PTSD symptoms and scores on MMPI-2 clinical scales 1 (Hs), 2 (D), 6 (Pa), 7 (Pt), and 8 (Sc). The MMPI-2 proved to be useful in assessing the broad range of symptoms typically present in trauma populations as well as the severity of posttraumatic morbidity.

To account for individual differences in vulnerability for stress-related disorders, studies have examined the relationship between hypothalamic-pituitary-adrenal (HPA) axis functioning and personality. The present study examined the relationship between the free fraction of cortisol in saliva after awakening and personality as measured with Cloninger's Temperament and Character Inventory [Cloninger, C.R., Przybeck, T.R., Svrakic, D.M., Wetzel, R.D., 1994. The Temperament and Character Inventory (TCI): A Guide to its Development and Use. Washington University, Center for Psychobiology of Personality, St. Louis, MO] in 107 healthy male soldiers. Harm avoidance explained 9% of variance in cortisol levels after awakening (AUCG), and harm avoidance and self-directedness predicted 10% of variance in mean cortisol increase. The cortisol awakening response (CAR) was lower in participants with low scores on harm avoidance, and mean cortisol increase after awakening was higher in soldiers high on self-directedness and harm avoidance. These results show that the CAR is related to personality and that it can be used to examine individual differences in HPA (re)activity.

BACKGROUND: Several studies have investigated volumetric brain changes in patients with posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). Both groups exhibit volume reductions of the hippocampus and amygdala. Our aim was to investigate the influence of comorbid PTSD on hippocampus and amygdala volumes in patients with BPD. METHODS: We compared 2 groups of unmedicated female patients with BPD (10 with and 15 without comorbid PTSD) and 25 healthy female controls. We used T(1)- and T(2)-weighted magnetic resonance images for manual tracing and 3-dimensional reconstruction of the hippocampus and amygdala. RESULTS: Hippocampus volumes of patients with BPD and PTSD were smaller than those of healthy controls. However, there was no significant difference between patients with BPD but without PTSD and controls. Impulsiveness was positively correlated with hippocampus volumes in patients with BPD. LIMITATIONS: Our study did not allow for disentangling the effects of PTSD and traumatization. Another limitation was the relatively small sample size. CONCLUSION: Our findings highlight the importance of classifying subgroups of patients with BPD. Comorbid PTSD may be related to volumetric alterations in brain regions that are of central importance to our understanding of borderline psychopathology.

Although posttraumatic stress disorder (PTSD) is associated with chronic pain, preliminary evidence suggests reduced experimental pain sensitivity in this disorder. The questions addressed in the present study were whether pain perception would also be reduced in PTSD patients who are not suffering from chronic pain symptoms, and whether a reduction in pain sensitivity would also be present in combat veterans who did not develop PTSD. For this, we determined thermal detection and pain thresholds in 10 male combat-related PTSD patients, 10 combat control subjects (no PTSD) and 10 healthy controls without combat experience. All subjects were pain free. First, we measured thermal sensory thresholds with ramped heat and cold stimuli using the method of limits. Ramped thermal sensory stimulation revealed no deficits for the detection of (non-noxious) f2.1thermal stimuli between groups. In contrast, heat and cold pain thresholds in both combat groups (PTSD and combat controls) were significantly increased compared to healthy controls. However, these stimuli could not distinguish between the two groups due to ceiling effects. When using longer-lasting heat stimulation at different temperatures (30s duration; method of fixed stimuli), we found significantly lower frequency of pain reports in PTSD patients compared with both combat and healthy controls, as well as significantly lower pain ratings. Our results suggest an association of PTSD with reduced pain sensitivity, which could be related to PTSD-related (neuro-)psychological alterations or to a pre-existing risk factor for the disorder.

BACKGROUND: Several studies have reported deficits in both immediate and delayed recall of verbal memory in patients with posttraumatic stress disorder (PTSD). However, most of these studies had several methodological disadvantages. None of these studies assessed parameters related to social or occupational functioning. METHODS: Fifty Dutch veterans of UN peacekeeping missions (25 with PTSD and 25 without PTSD) were assessed with a comprehensive neuropsychological test battery consisting of four subtests of the Wechsler Adult Intelligence Scale-III, California Verbal-Learning Test, and the Rey Auditory Verbal-Learning Test. Veterans with PTSD were free of medication and substance abuse. RESULTS: Veterans with PTSD had similar total intelligence quotient scores compared to controls, but displayed deficits of figural and logical memory. Veterans with PTSD also performed significantly lower on measures of learning and immediate and delayed verbal memory. Memory performance accurately predicted current social and occupational functioning. CONCLUSIONS: Deficits of memory performance were displayed in a sample of medication- and substance abuse-free veterans with PTSD. Deficits in memory performance were not related to intelligence quotient, length of trauma exposure, or time since trauma exposure. This study showed that cognitive performance accurately predicted current social and occupational functioning in veterans with PTSD.