The Impact of Psychiatric Comorbidity on the Clinical Manifestations and Severity of Posttraumatic Stress Disorder

Background: PTSD in combatants is characterized by high comorbidity with mental disorders of the organic, affective, anxiety and personality spectrums. It is relevant to study the influence of comorbidity on the clinical picture and severity of PTSD manifestations.

The Aim of study: to analyze the structure and severity of clinical and psychopathological characteristics of PTSD taking into account comorbidity and to establish relationships with the intensity of subjective experience of a traumatic event.

Patients and Methods: the study included male participants of the Special military operation (n = 52) aged 22 to 55 years (mean age 38.2 ± 8.9 years), who independently sought and underwent inpatient treatment for PTSD comorbid with other mental disorders (ICD-10 criteria). The diagnosis of PTSD was additionally verified by the international neuropsychiatric interview M.I.N.I. for PTSD. The severity of clinical manifestations of PTSD and the intensity of the impact of the traumatic event were assessed using the Mississippi PTSD Scale and the Traumatic Event Impact Rating Scale (TEIRS).

Results: a predominance of other anxiety disorders, adjustment disorders (n = 24; 46.2%) and organic mental disorders (n = 12; 23.1%) was revealed in the structure of mental disorders comorbid with PTSD. The conducted factor analysis of PTSD symptoms made it possible to identify four groups of factors reflecting: (1) intrusive manifestations with pronounced anxiety, recurrence of experience and avoidance of the traumatic event; (2) negative emotional self-perception; (3) inability to experience positive emotions; (4) sleep disorders with hyperarousal. A statistically significant highest intensity of the impact of a traumatic event on the personality profile of combatants and the severity of PTSD manifestations was established in cases of comorbidity with anxiety, affective and personality disorders (p = 0.00001). Comorbidity with organic mental disorders is characterized by a lower severity of clinical manifestations of PTSD and a lower intensity of the impact of a traumatic event on the personality profile (p = 0.00001).

Conclusion: the identified features associated with the impact of comorbid mental disorders on the clinical picture of PTSD should be analyzed in the context of the relationship with the severity and intensity of the impact of traumatic events on the personality profile, and should also be taken into account when developing treatment and rehabilitation programs and dynamically assessing the effectiveness of therapy.

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