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From the Deployment Health Clinical Center (C.C.E., X.L., B.D.M., R.F.M.), Walter Reed Army Medical Center, Washington, DC; and the Department of Psychiatry (C.C.E., X.L., R.U.), Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Address reprint requests to: Dr. Engel, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814. Email: cengel{at}pobox.com
OBJECTIVES: Studies of the relationship of posttraumatic stress disorder (PTSD) to physical symptoms in war veterans consistently show a positive relationship. However, traumatic experiences causing PTSD may correlate with other war exposures and medical illnesses potentially accounting for those symptoms.
METHODS: We analyzed data obtained from 21,244 Gulf War veterans seeking care for war-related health concerns to assess the relationship of PTSD to physical symptoms independent of environmental exposure reports and medical illness. At assessment, veterans provided demographic information and checklists of 15 common physical symptoms and 20 wartime environmental exposures. Up to seven ICD-9 provider diagnoses were ranked in order of estimated clinical significance. The relationship of provider-diagnosed PTSD to various physical symptoms and to the total symptom count was then determined in bivariate and multivariate analyses.
RESULTS: Veterans diagnosed with PTSD endorsed an average of 6.7 (SD = 3.9) physical symptoms, those with a non-PTSD psychological condition endorsed 5.3 (3.5), those with medical illness endorsed 4.3 (3.4), and a group diagnosed as "healthy" endorsed 1.2 (2.2). For every symptom, the proportion of veterans reporting the symptom was highest in those with PTSD, second highest in those with any psychological condition, third highest in those with any medical illness, and lowest in those labeled as healthy. The PTSD–symptom count relationship was independent of demographic characteristics, veteran-reported environmental exposures, and comorbid medical conditions, even when symptoms overlapping with those of PTSD were excluded.
CONCLUSIONS: PTSD diminishes the general health perceptions of care-seeking Gulf War veterans. Clinicians should carefully consider PTSD when evaluating Gulf War veterans with vague, multiple, or medically unexplained physical symptoms.
Key Words: unexplained physical symptoms • posttraumatic stress disorder, • Gulf War veterans • Comprehensive Clinical Evaluation Program • multivariate analysis, • war-related illnesses.
Abbreviations: CCEP = Comprehensive Clinical Evaluation Program; ICD-9 = International Classification of Diseases, ninth revision; PTSD = posttraumatic stress disorder.
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