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Symptom Patterns Related to Traumatic Exposure Among Female Inmates With and Without a Diagnosis of Posttraumatic Stress Disorder

Dr. Warren is Professor of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA; Dr. Loper is Professor of Psychology, Curry School of Clinical and School Psychology, University of Virginia, Charlottesville, VA; and Dr. Komarovskaya is Postdoctoral Fellow in Forensic Psychology, Bellevue Hospital, New York City, NY. This research was funded by Grant 98-DE-VX-0027 from the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice, to the University of Virginia. Points of view expressed in this article are those of the authors and do not necessarily represent the official position or policy of the U.S. Department of Justice. Address correspondence to: Janet I. Warren, DSW, Institute of Law, Psychiatry and Public Policy, P.O. Box 800660, UVA Health Systems, Charlottesville, VA 22908-0660. E-mail: jiw{at}virginia.edu

Our study examines the trauma-related experiences of 203 female prison inmates, most of whom had experienced chronic trauma throughout their lives but among whom only 51 percent met diagnostic criteria for PTSD. We used the two groups to study differences in trauma exposure and pre-existent psychopathology as they related to the emergence of full diagnostic criteria for PTSD. We also used the entire sample to explore the factor structure and endorsement frequencies of each symptom category as it related to trauma exposure. Our analyses indicated that the PTSD group differed from the non-PTSD group in the number of life traumas each group had experienced and the pre-existence of borderline personality disorder. Five symptoms accurately differentiated the two groups, with an 86 percent correct classification: recurrent thoughts, amnesia, loss of interest, difficulty concentrating, and a heightened startle response. An exploratory factor analysis further suggested two primary factors: intrusion and arousal. We apply our findings to the naturalistic versus interactional debate surrounding the disorder and reflect on the endorsement frequencies as they might inform our understanding of malingering as it occurs in legal and forensic settings.

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