Does Combat Trauma Cause a Majority of PTSD Symptoms in Combat Veterans?
To the Editor: Gilbertson et al concluded that "the majority of psychiatric symptoms reported by combat veterans with PTSD [posttraumatic stress disorder] would not have been present were it not for their exposure to traumatic events."1(p1324) This conclusion was based on a comparison between combat-exposed Vietnam veterans and identical male twins who were not exposed to combat trauma. I question whether the results truly support the conclusion that the majority of symptoms would not have been present, as an important factor contributing to reported psychopathology in veterans is compensation status.2-4 The authors seemed to have dismissed this possibility by noting that "[W]e cannot rule out the possibility that increased SCL-90-R scores to some degree represent compensation-seeking or general symptom overreporting in the PTSD group. The literature on this, however, has been inconclusive."1(p1328)
Would it not have been possible, and desirable, to have included compensation status among the variables included in the analysis, perhaps to further clarify the relationship between compensation status and psychopathology? Had this been done, the conclusion that the majority of symptoms would not have been present absent exposure to traumatic events would have been better supported. Perhaps the authors have since performed such an analysis and can shed light on this.
References
1. Gilbertson MW, McFarlane AC, Weathers FW, et al; Harvard/VA PTSD Twin Study Investigators. Is trauma a causal agent of psychopathologic symptoms in posttraumatic stress disorder? findings from identical twins discordant for combat exposure. J Clin Psychiatry. 2010;71(10):1324-1330. PubMed doi:10.4088/JCP.10m06121blu
2. Frueh BC, Gold PB, de Arellano MA. Symptom overreporting in combat veterans evaluated for PTSD: differentiation on the basis of compensation seeking status. J Pers Assess. 1997;68(2):369-384. PubMed doi:10.1207/s15327752jpa6802_8
3. Gold PB, Frueh BC. Compensation-seeking and extreme exaggeration of psychopathology among combat veterans evaluated for posttraumatic stress disorder. J Nerv Ment Dis. 1999;187(11):680-684. PubMed doi:10.1097/00005053-199911000-00005
4. Frueh BC, Elhai JD, Gold PB, et al. Disability compensation seeking among veterans evaluated for posttraumatic stress disorder. Psychiatr Serv. 2003;54(1):84-91. PubMed doi:10.1176/appi.ps.54.1.84
Author affiliation: Department of Medical Ethics, Mercer University School of Medicine, Macon, Georgia. Potential conflicts of interest: None reported. Funding/support: None reported.
doi:10.4088/JCP.11lr06851
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