Physical ills follow trauma response.

Combat veterans suffering from post-traumatic stress disorder (PTSD) grapple with a mental legacy that includes recurrent nightmares, intense distress when reminded of upsetting incidents, feelings of detachment from others, and fragmented concentration. A new study indicates that these veterans also face an increased likelihood of contracting a wide variety of physical diseases up to 20 years after surviving combat.

Vietnam veterans who developed PTSD after experiencing heavy combat exhibit much higher rates of circulatory, digestive, musculoskeletal, nervous system, respiratory, and infectious diseases following military service than do their comrades who had little exposure to combat and no subsequent PTSD, a researcher reports in the November-December Psychomatic Medicine.

The physiological repercussions of PTSD may cause a litany of illnesses in ways that are as yet unclear, says Joseph A. Boscarino, an epidemiologist and psychologist at Catholic Health Initiatives-Southeast Region, a hospital in Louisville, Ky.

Boscarino analyzed the medical histories of 332 male Vietnam vets who developed PTSD after exposure to heavy combat and 1,067 of their nonafflicted counterparts. He statistically controlled for many factors that can affect either trauma responses or physical illness, including intelligence, race, region of birth, enlistment status, marital status, medical history, education, income, cigarette smoking, and alcohol and illicit drug abuse.

The chronic vigilance and emotional turmoil associated with PTSD may sharply raise or lower secretions of stress hormones and alter the functioning of a number of bodily systems, Boscarino theorizes.

A genetic predisposition to PTSD may also influence susceptibility to physical disease, he notes (SN: 5/18/96, p. 310). Moreover, it's possible that Vietnam combat vets had greater exposure to toxic chemicals and infectious diseases during the war than did noncombat vets.

A different pattern of health consequences may characterize women who develop PTSD as a result of rape or other traumatic experiences, Boscarino adds.

Much previous research has indicated that physical health suffers after exposure to a severely traumatic event, but most of the work did not distinguish between people who did or did not exhibit PTSD symptoms, says psychologist Paula P. Schnurr of the National Center for PTSD In White River Junction, Vt. "Boscarino's study is one of the rare ones to suggest that an excess of physical health problems occurs specifically among PTSD victims," she remarks.

The disorder probably sets in motion a variety of still poorly understood biological changes, according to Schnurr. She suspects that PTSD contributes substantially to the spectrum of health problems that has been linked to trauma.