The Many Faces of Posttraumatic Stress Disorder

Chronic posttraumatic stress disorder (PTSD) may occur secondary to combat, terrorism, civilian assaults including physical and sexual abuse, or other traumatic experiences. This month’s special report includes a series of articles that address contemporaneous topics of interest to practicing clinicians. The focus in this series is the link between PTSD and sleep disturbances, traumatic brain injury, dissociation, and the prevalence of violence among minority populations. In many respects we live in troubled times and a better understanding of these issues is vital to the initial approach to patients. It was a pleasure reading these articles, and I hope that you will find them useful as well.

Neylan provides a synopsis of sleep disturbances associated with PTSD. Insomnia and sleep disturbances such as nightmares occur frequently in patients with PTSD. Disturbed sleep is associated with a wide range of adverse conditions, including fatigue, cognitive impairment, mood disturbance, and reduced quality of life, as well as increased frequency of accidents, aggression, and use of alcohol. The article also provides a concise overview of psychotherapeutic and pharmacological treatment strategies.

The assessment of traumatic brain injury (TBI) in the context of PTSD is reviewed by Granacher. This is a topic of critical interest to clinicians who treat veterans of the Afghanistan and Iraq conflicts, as well as other populations. The authors address the epidemiology of this comorbidity, potential mechanisms, and other neuropsychiatric syndromes associated with TBI, and they review practical aspects for the assessment of PTSD associated with TBI. They suggest 3 approaches to treatment-including psychopharmacological therapy for cognitive deficits associated with TBI and pharmacotherapy and psychotherapy for PTSD symptoms.

Hopper and Lanius discuss dissociative states that result from PTSD. They report that dissociative responses to psychological trauma predict the development of chronic PTSD. These findings have important implications for treatment, including the need to assess patients with PTSD for dissociative symptoms and to treat dissociative symptoms before using exposure-based approaches.

The increased prevalence of violence and suicide among historically disadvantaged peoples-racial/ethnic and sexual orientation minorities and women-is reviewed by McLeod-Bryant and associates. They discuss the complex history and makeup of each group, which produce unique patterns of violence, and include suggestions for psychiatrists who treat disadvantaged patients.

We hope that the articles in this special report will aid the practicing clinician as well as clinical researchers to better understand PTSD assessment and treatment approaches. This understanding may, in turn, lead to better ongoing treatment of PTSD and patient outcomes.