ORIGINAL ARTICLES Symptom Patterns Associated With Chronic PTSD in Male Veterans New Findings From the National Vietnam Veterans Readjustment Study Randall D. Marshall, MD,*† J. Blake Turner, PhD,‡ Roberto Lewis-Fernandez, MD,*† Karestan Koenan, PhD,§ Yuval Neria, PhD,* and Bruce P. Dohrenwend, PhD† Abstract: A subsample of 255 male Vietnam veterans from the National Vietnam Veterans Readjustment Study received in-depth psychiatric diagnostic interviews. This paper focuses on the 88 veterans with a war-related onset of PTSD. Among these veterans, the avoidance cluster, especially its symptoms of numbing, was most strongly associated with chronic PTSD; less strongly but also significantly associated was the hyperarousal cluster. Further anal- yses show that these associations are not artifacts of the relationship of symptom patterns to prewar demographic factors (race/ethnicity, socioeconomic status, age at entry into Vietnam), comorbidity, treatment and compensation seeking, or probable severity of war- related trauma. We conclude that certain symptom profiles may predict enduring pathological responses to trauma and therefore provide targets for intervention efforts. Key Words: PTSD, Vietnam, chronicity, NVVRS, avoidance. (J Nerv Ment Dis 2006;194: 275–278) S ymptomatic reactions after severe trauma are common (Rothbaum et al., 1992). Chronic PTSD is less common and is strongly associated with multiple indicators of severe impairment (Davidson et al., 1991; Marshall et al., 2001; McFarlane et al., 1994; Riggs et al., 1998). If a high-risk symptom profile could be identified, such knowledge would help guide both etiologic and intervention research. Given that acute symptomatic reactions after severe trauma are extremely common (Rothbaum et al., 1992), research on predictors of illness has focused on chronic PTSD as the outcome most strongly associated with multiple indicators of severe impairment (Davidson et al., 1991; Marshall et al., 2001; McFarlane et al., 1994; Riggs et al., 1998). If a high-risk acute symptom profile could be identified, such knowledge could help guide both etiologic and intervention research. The PTSD diagnosis is a disjunctive category, meaning that only one out of any 4 re-experiencing symptoms (crite- rion B), 3 out of 7 avoidance symptoms (criterion C), and 2 out of 6 hyperarousal symptoms (criterion D) were required to receive the diagnosis in DSM-III-R. Thus, there can be considerable variation in actual symptom presentation within the diagnosis itself, allowing for the possibility that some symptoms or symptom clusters are more strongly associated with chronicity than others. Moreover, the presence of clin- ically significant comorbidity in most PTSD patients (Kessler et al., 1995) raises the possibility that associated problems or disorders, which vary considerably across individuals with PTSD, may be predictors of chronicity rather than PTSD symptoms per se. The National Vietnam Veterans Readjustment Study database provides a unique opportunity to examine symptoms associated with highly chronic PTSD (i.e., 11–12 years after the end of the war). A subsample of veterans in the study received in-depth psychiatric assessments that included dis- order history. In this paper, we use these histories to examine the association of the three main symptom clusters (re- experiencing, avoidance, and arousal) to the persistence of PTSD. We also examine the role of certain prewar demo- graphic factors, comorbid psychiatric disorders, receiving treatment, seeking and receiving VA compensation, and se- verity of war-zone trauma. METHODS Respondents The sample consists of 255 male Vietnam veterans from majority white, African American, and Latino back- grounds. These individuals were drawn from the pool of *Department of Psychiatry, Columbia University, New York, New York; †New York State Psychiatric Institute, New York, New York; ‡Depart- ment of Socio-Medical Sciences, Mailman School of Public Health, Columbia University, New York, New York; §Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York. Supported by NIMH grants MH01412 (Dr. Marshall) and MH59309 (Dr. Dohrenwend) and an NRSA Postdoctoral training grant in psychiatric epidemiology, MH13043 (Dr. Koenan). Send reprint requests to Randall D. Marshall, MD, Director of Trauma Studies, Anxiety Disorders Clinic (Unit 69), New York State Psychiatric Institute 1051 Riverside Drive, New York, NY 10032. Copyright © 2006 by Lippincott Williams & Wilkins ISSN: 0022-3018/06/19404-0275 DOI: 10.1097/01.nmd.0000207363.25750.56 The Journal of Nervous and Mental Disease • Volume 194, Number 4, April 2006 275