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A High Risk Twin Study of Combat-Related PTSD Comorbidity

Published online by Cambridge University Press:  21 February 2012

Karestan C. Koenen*
Affiliation:
Women's Health Sciences Division, National Center for PTSD,VA Boston Healthcare System, Boston, MA, USA; Department of Child and Adolescent Psychiatry, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA. Karestan.Koenen@bmc.org
Michael J. Lyons
Affiliation:
Department of Psychology, Boston University, Boston, MA, USA; Harvard Institute of Psychiatric Epidemiology and Genetics, Brockton, MA, USA; Harvard Medical School Department of Psychiatry at Massachusetts, Mental Health Center, Boston, MA, USA.
Jack Goldberg
Affiliation:
Seattle VA ERIC/Vietnam Era Twin Registry, Seattle,Washington, USA; University of Washington, Department of Epidemiology, Seattle,Washington, USA.
John Simpson
Affiliation:
Harvard Institute of Psychiatric Epidemiology and Genetics, Brockton, MA, USA; VA Boston Healthcare System, Brockton, Massachusetts, USA.
Wesley M. Williams
Affiliation:
Harvard Institute of Psychiatric Epidemiology and Genetics, Brockton, MA, USA.
Rosemary Toomey
Affiliation:
Harvard Institute of Psychiatric Epidemiology and Genetics, Brockton, MA, USA; Harvard Medical School Department of Psychiatry at Massachusetts, Mental Health Center, Boston, MA, USA.
Seth A. Eisen
Affiliation:
St. Louis Veterans Affairs Medical Center, Research and Medical Services, St. Louis,MO, USA; Washington University, Department of Internal Medicine, Division of General Medical Sciences, St.Louis,MO, USA.
William R. True
Affiliation:
St. Louis Veterans Affairs Medical Center, Research and Medical Services, St. Louis,MO, USA; St. Louis University Medical Center, School of Public Health, St. Louis,MO, USA.
Marylene Cloitr
Affiliation:
NYU Child Study Center, USA.
Jessica Wolfe
Affiliation:
Women's Health Sciences Division, National Center for PTSD,VA Boston Healthcare System, Boston, MA, USA.
Ming T. Tsuang
Affiliation:
Harvard Institute of Psychiatric Epidemiology and Genetics, Brockton, MA, USA; Harvard Medical School Department of Psychiatry at Massachusetts, Mental Health Center, Boston, MA, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
*
*Address for correspondence: Karestan C. Koenen, Women's Health Sciences Division (116B-3), National Center for PTSD, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130 USA.

Abstract

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Combat-related posttraumatic stress disorder (PTSD) is highly comorbid with other mental disorders. However, the nature of the relationship between PTSD and other mental disorders remains unclear. A discordant high-risk twin design was used on data from a sub-sample of the male-male twin pair members of the Vietnam Era Twin Registry to examine whether patterns of comorbidity are consistent with a psychopathological response to combat exposure or reflect familial vulnerability to psychopathology. Mental disorders were assessed via the Mental Health Diagnostic Interview Schedule Version III — Revised. Discordant monozygotic within-pair comparisons revealed that PTSD probands had higher symptom counts and diagnostic prevalences of mood and anxiety disorders than their non-combat exposed co-twins. Monozygotic co-twins of PTSD probands had significantly more mood disorder symptoms than monozygotic co-twins of combat controls or dizygotic co-twins of veterans with PTSD. These findings suggest that a) major depression, generalized anxiety disorder and panic disorder are part of a post-combat response syndrome; b) a shared familial vulnerability also contributes to the association between PTSD and major depression, PTSD and dysthymia, and c) this shared vulnerability is mediated by genetic factors.

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