Relationship of physical symptoms to posttraumatic stress disorder among veterans seeking care for Gulf War-related health concerns

Objectivess: Studies of the relationship of posttraumatic stress disorder ( PTSD) to physical symptoms in war veterans consistently show a positive rel ationship. However, traumatic experiences causing PTSD may correlate with o ther war exposures and medical illnesses potentially accounting for those s ymptoms. Methods: We analyzed data obtained from 21,244 Gulf War veterans s eeking care for war-related health concerns to assess the relationship of P TSD to physical symptoms independent of environmental exposure reports and medical illness. At assessment, veterans provided demographic information a nd checklists of 15 common physical symptoms and 20 wartime environmental e xposures. Up to seven ICD-9 provider diagnoses were ranked in order of esti mated clinical significance. The relationship of provider-diagnosed PTSD to various physical symptoms and to the total symptom count was then determin ed 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 il lness 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 w as highest in those with PTSD, second highest in those with any psychologic al condition, third highest in those with any medical illness, and lowest i n those labeled as healthy. The PTSD-symptom count relationship was indepen dent of demographic characteristics, veteran-reported environmental exposur es, and comorbid medical conditions, even when symptoms overlapping with th ose 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 me dically unexplained physical symptoms.