| Despite that war-related posttraumatic stress disorder is known to persist for years in many afflicted individuals, few studies have examined the changes in symptoms that occur over the disorder's course. A review of relevant publications found evidence for a variety of trajectories of symptom change including gradual diminution of symptoms over time, persistence of or increases in symptoms over time, and intermittent exacerbations of symptoms punctuated by temporary symptomatic abatements. Theoretical models also suggest the disorder may have a varied course. In this dissertation, the continuous course of war-related PTSD was examined retrospectively in 84 Vietnam veterans by analyzing graphs of symptom change over more than a decade. The goals of this study were to classify and describe different disorder course profiles; to investigate the relationship between course profile and other PTSD outcomes; and to examine the relationships between PTSD course profiles and pre-war, war-zone, and post-war risk factors for PTSD. Results: Three subtypes of PTSD course were identified and these were significantly associated with PTSD outcomes. No associations were found between pre-war risk factors and PTSD course profile. Course profile was significantly associated with one exposure variable--- receipt of a purple heart-- and trends were identified with other, though not all, exposure variables. Course profile was also related to co-morbid psychiatric disorders beginning during or after the war, and self-reported use of mental health services. Lastly, course profile was found to moderate the relationship between combat severity and persistence of PTSD between one and two decades after military service. Implications and areas for further research are discussed. |
