Comprehensive Psychiatry
Volume 51, Issue 3 , Pages 236-242 , May 2010

Prospective study of externalizing and internalizing subtypes of posttraumatic stress disorder and their relationship to mortality among Vietnam veterans

  • Amanda M. Flood

      Affiliations

    • Durham Veterans Affairs Medical Center, Durham, NC, USA
    • ,
  • Stephen H. Boyle

      Affiliations

    • Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
    • ,
  • Patrick S. Calhoun

      Affiliations

    • Durham Veterans Affairs Medical Center, Durham, NC, USA
    • Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
    • VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
    • ,
  • Michelle F. Dennis

      Affiliations

    • Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
    • ,
  • John C. Barefoot

      Affiliations

    • Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
    • ,
  • Scott D. Moore

      Affiliations

    • Durham Veterans Affairs Medical Center, Durham, NC, USA
    • Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
    • VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
    • ,
  • Jean C. Beckham

      Affiliations

    • Durham Veterans Affairs Medical Center, Durham, NC, USA
    • Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
    • VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
    • Corresponding Author InformationCorresponding author. Durham VAMC, 116B, Durham, NC 27705, USA. Tel.: +1 919 286 0411x7973.

References 

  1. Achenbach TM, Edelbrook CS. The classification of child psychopathology: a review and analysis of empirical efforts. Psychol Bull. 1978;85:1275–1301
  2. Krueger RF, McGue M, Iacono WG. The higher-order structure of common DSM mental disorders: internalization, externalization, and their connections to personality. Pers Individ Differences. 2001;30:1245–1259
  3. Krueger RF, Caspi A, Moffitt TE, Silva PA. The structure and stability of common mental disorders (DSM-III-R): a longitudinal-epidemiological study. J Abnorm Psychol. 1998;107:216–227
  4. Schwartz CE, Snidman N, Kagan J. Early childhood temperament as a determinant of externalizing behavior in adolescence. Dev Psychopathol. 1996;8:527–537
  5. Clark LA, Watson D, Mineka S. Temperament, personality, and the mood and anxiety disorders. J Abnorm Psychol. 1994;103:103–116
  6. Miller MW, Greif JL, Smith AA. Multidimensional Personality Questionnaire profiles of veterans with traumatic combat exposure: externalizing and internalizing subtypes. Psychol Assess. 2003;15:205–215
  7. Miller MW, Kaloupek DG, Dillon AL, Keane TM. Externalizing and internalizing subtypes of combat-related PTSD: a replication and extension using the PSY-5 scales. J Abnorm Psychol. 2004;113:636–645
  8. Iacono WG, Malone SM, McGue M. Substance use disorders, externalizing psychopathology, and P300 event-related potential amplitude. Int J Psychophysiol. 2003;48:147–178
  9. Kirz JL, Drescher KD, Klein JL, Gusman FD, Schwartz MF. MMPI-2 assessment of differential posttraumatic stress disorder patterns in combat veterans and sexual assault victims. J Interpers Violence. 2001;16
  10. Tellegen A, Walker N. Exploring personality through test construction: development of the Multidimensional Personality Questionnaire. In:  Briggs SR,  Cheek JM editor. Personality measures: development and evaluation. Greenwich (Conn): JAI Press; 1994;p. 133–161
  11. Butcher JN, Dahlstrom WG, Graham JR, Tellegen AM, Kaemmer B. Minnesota Multiphasic Personality Inventory-2 (MMPI-2): manual for administration and scoring. Minneapolis (Minn): University of Minnesota Press; 1989;
  12. Harkness AG, McNulty JL, Ben-Porath YS, Graham JR. MMPI-2 Personality Psychopathology Five (PSY-5) Scales. Minneapolis: University of Minnesota Press; 2002;
  13. Miller MW, Resick PA. Internalizing and externalizing subtypes in female sexual assault survivors: implications for the understanding of complex PTSD. Behav Ther. 2007;38:58–71
  14. Armenian HK, Melkonian AK, Hovanesian AP. Long term mortality and morbidity related to degree of damage following the 1998 earthquake in Armenia. Am J Epidemiol. 1998;148:1077–1084
  15. Boscarino JA. Association between posttraumatic stress disorder and physical illness: results and implications from clinical and epidemiologic studies. Ann N Y Acad Sci. 2004;1032:141–153
  16. Schnurr PP, Green BL. Trauma and health: physical health consequences of exposure to extreme stress. Washington, DC: American Psychological Association; 2004;
  17. Schnurr PP, Green BL. Understanding relationships among trauma, post-traumatic stress disorder, and health outcomes. Adv Mind Body Med. 2004;20:18–29
  18. Boscarino JA. A prospective study of PTSD and early-age heart disease mortality among Vietnam veterans: implications for surveillance and prevention. Pyschosom Med. 2008;70:668–676
  19. Boscarino JA. External-cause mortality after psychologic trauma: the effects of stress exposure and predisposition. Compr Psychiatry. 2006;47:503–514
  20. Boscarino JA. Posttraumatic stress disorder and mortality among U.S. Army veterans 30 years after military service. Ann Epidemiol. 2006;16:248–256
  21. Centers For Disease Control and Prevention . Health status of Vietnam veterans. JAMA. 1988;259:2701–2719
  22. Centers For Disease Control and Prevention . Vol IV: Psychological and neuropsychological evaluation. In Health status of Vietnam veterans. Atlanta (Ga.): Center for Environmental Health and Injury Control; 1989;
  23. Centers For Disease control and Prevention Vietnam Experience Study . Postservice mortality among Vietnam veterans. JAMA. 1989;257:790–795
  24. Greene RL. The MMPI2: an interpretive manual. 2nd ed.. Needham Heights, (Mass): Allyn & Bacon; 2000;
  25. Beckham JC. Smoking and anxiety in combat veterans with chronic posttraumatic stress disorder: a review. J Psychoactive Drugs. 1999;31:103–110
  26. Spitzer RL, Williams JBW, Gibbon M, First MB. Structured Clinical Interview for DSM-III-R. Washington, DC: American Psychiatric Press, Inc; 1990;
  27. Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, et al. The development of a clinician-administered posttraumatic stress disorder scale. J Trauma Stress. 1995;8:75–80
  28. Weathers FS, Ruscio AM, Keane TM. Psychometric properties of nine scoring rules for the Clinician-Administered Posttraumatic Stress Disorder Scale. Psychol Assess. 1999;11:124–133
  29. Robins LN, Helzer JE, Cottler LB. The diagnostic interview schedule training manual, version III-A. St. Louis (Mo): Veterans Administration; 1987;
  30. Robins LN, Helzer JE. The half life of a structured interview: the NIMH Diagnostic Interview Schedule (DIS). Int J Methods Psychiatr Res. 1994;4:95–102
  31. Hathaway SR, McKinley JC. MMPI manual. New York: Psychological Corporation; 1951;
  32. Harkness AG, McNulty JL, Ben-Porath YS. The Personality Psychopathology Five (PSY-5): constructs and MMPI-2 Scales. Psychol Assess. 1995;7:104–114
  33. World Health Organization . International Statistical Classification of Diseases and Related Health Problems, 10th revision. 2nd ed.. WHO: Geneva; 2004;
  34. Boscarino JA. Diseases among men 20 years after exposure to severe stress: implications for clinical research and medical care. Psychosom Med. 1997;59:605–614
  35. Beckham JC, Calhoun PS, Glenn DM, Barefoot JC. Posttraumatic stress disorder, hostility, and health in women: a review of current research. Ann Behav Med. 2002;24:219–228
  36. Beckham JC, Moore SD, Reynolds V. Interpersonal hostility and violence in Vietnam combat veterans with chronic posttraumatic stress disorder: a review of theoretical models and empirical evidence. Aggression Violent Behav. 2000;5:451–466

PII: S0010-440X(09)00094-7

doi: 10.1016/j.comppsych.2009.08.002

Comprehensive Psychiatry
Volume 51, Issue 3 , Pages 236-242 , May 2010

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