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The Roles of Combat Exposure, Personal Vulnerability, and Involvement in Harm to Civilians or Prisoners in War-Related Post-Traumatic Stress Disorder

This chapter examines the central assumption in the DSM-III, DSM-III-R, and DSM-IV that potentially traumatic stressors are more important than personal vulnerability in causing PTSD. This chapter tests this assumption with data from a rigorously diagnosed male subsample (n = 260) from the NVVRS. It concludes that, of the three risk factors, only combat exposure proved necessary for disorder onset. Although none of the three risk factors proved sufficient, estimated onset reached 97% for veterans high on all three, with harm to civilians or prisoners showing the largest independent contribution. Severity of combat exposure proved more important than pre-war vulnerability in onset; pre-war vulnerability was as least as important in long-term persistence. Implications for the primacy of the stressor assumption are discussed.