PTSD

CBT & POST TRAUMATIC STRESS DISORDER WITH ANXIETY DISORDER

CBT & POST TRAUMATIC STRESS DISORDER WITH ANXIETY DISORDER

Introduction

The specific type of psychopathology that develops over the lifetime of an individual is thought to be associated with both the nature of events experienced (e.g. whether life threat has been experienced) and the personal predispositions of that individual based on their family history of particular types of psychopathology (Dohrenwend, 2000). Early studies of posttraumatic stress disorder ( PTSD) emphasized the importance of trauma exposure as the major etiologic variable in PTSD. However, since only a proportion of trauma exposed persons develop PTSD ( Kessler; Breslau and Perkonigg), it has also been of interest to examine other contributors to this disorder, including familial risk factors ( Yehuda and Yehuda).

In fact, the idea that familial psychiatric history may contribute to posttraumatic symptoms predates the current conceptualization of the diagnosis of PTSD. Among the earliest published findings of war veterans were observations of a greater family history of psychopathology in those who developed posttraumatic symptoms compared with those who did not. In 1918, Wolfsohn demonstrated that 74 of 100 patients with war neuroses reported a family history of psychoneurosis compared to none of 100 matched subjects (Wolfsohn, 1918). Others found similar associations in World War I and World War II veterans and their families ( Oppenheimer; Robey; Swan; Cohen; Curran and Speed), and in civilians exposed to disaster ( McFarlane, 1988). Although these early studies are noteworthy for their careful consideration of the nature of the event and consequent symptoms experienced by the individual, neither the nature of familial mental illness nor a direct relationship to PTSD versus other potential co-occurring disorders in subjects was elucidated.

More recent studies have confirmed that respondents with PTSD are typically three times more likely than trauma survivors without PTSD to report anxiety, depression, psychosis, and antisocial behavior in family members (Davidson; Davidson; Davidson; True; Watson; Reich and Yehuda). In a sample that compared familial psychopathology in rape victims with PTSD, rape victims without PTSD, depressed patients, anxiety disorder patients, and healthy controls, PTSD was associated with the presence of major depressive disorder in first-degree relatives ( Davidson et al., 1998). However, this finding may have been related to the presence of comorbid depression in the rape victims with PTSD ( Davidson et al., 1998).

Although a family history of psychopathology, particularly depression, is clearly present in a substantial number of persons who develop PTSD, there are almost no studies that have specifically examined the relationship between PTSD in subjects and PTSD in parents. In part, this may be due to the fact that prior to 1980 mental health workers did not make the diagnosis of PTSD. As such, it would be difficult for subjects who have been diagnosed with PTSD within the last two decades to be aware of the presence of this disorder in parents, unless exposure to extreme trauma had been a notable presence in their parents' lives. Indeed, it is likely that parents who did seek mental ...