Relationships between anxiety, hostility, startle, and guilt in Vietnam veterans suffering from PTSD: a path analytic study

Hesson, Jacqueline Barbara (1996) Relationships between anxiety, hostility, startle, and guilt in Vietnam veterans suffering from PTSD: a path analytic study. Masters thesis, Memorial University of Newfoundland.

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Abstract

Anxiety, hostility, guilt, and an exaggerated startle response are common symptoms experienced by Vietnam veterans with posttraumatic stress disorder (PTSD). In the present study, several theory based path models of possible causal relationships among these symptoms and exposure to trauma (combat) were developed and assessed in two samples of Vietnam veterans with PTSD. A total of 39 Vietnam combat veterans with PTSD and 34 Vietnam combat veterans without PTSD took part in the study. All subjects completed the State-Trait Anxiety Inventory (STAI), the Buss-Durkee Hostility Inventory, and either the Legacies Combat Scale-Revised or the Combat Exposure Scale (CES). Auditory startle data was also available for 15 of the veterans with PTSD and 10 of the veterans without PTSD. Assessment of an initial model indicated that intensity of combat exposure per se is not predictive of PTSD symptomatology. Given that the latest edition of the Diagnostic and Statistical Manual states that an individual's perception of an event as traumatic is equally as important as the objective severity of the trauma, the initial model was modified to include a trauma factor that represented those aspects of combat that accounted for the variability in PTSD diagnosis. The good overall fit indices and significant paths obtained when the modified model was applied to a test sample of veterans replicated when the model was applied to a second data sample. Alternative models of the relationships among the relevant variables, with literature based rationale, were constructed and assessed in the two data samples. These alternative models differed from the initial model in terms of the relationships predicted between trauma, state anxiety, and trait anxiety. Of the four alternative models tested, two were found to fit the two data samples as well as the hypothesized model. Overall, the results of the study suggest that the increased levels of hostility seen in veterans with PTSD may be due to increases in anxiety that result from exposure to trauma. Increases in hostility then lead to increased guilt. In addition, the models tested supported the idea that the exaggerated startle response observed in many individuals with PTSD is the result of elevated levels of state anxiety. Implications of each of the models for therapy are discussed.

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