Delayed and immediate onset posttraumatic stress disorder

I. Differential clinical characteristics
  • Z. Solomon
  • M. Mikulincer
  • M. Waysman
  • D. H. Marlowe


Delayed PTSD has been the focus of numerous clinical reports. Systematic investigations of this phenomenon are practically nonexistent, however. Utilizing a unique psychiatric register developed by the Israel Defense Forces in the 1982 Lebanon War, this study compared the clinical picture of three groups of veterans: 1. PTSD casualties who sought help at least six months after their exposure to combat; 2. PTSD casualties who sought help during the Lebanon War; and 3. soldiers who emerged from the 1982 war without any diagnosable psychiatric disorder (controls). Significant differences were found in the clinical picture of the study groups. Both treated groups, the delayed and the immediate onset PTSD casualties, showed significantly more trauma-related intrusion and avoidance responses, more severe psychiatric symptomatology, more problems in social fuctioning, and lower perceived self efficacy in combat than non-PTSD controls. However, the psychological and social adjustment of the PTSD veterans whose treatment was delayed was found to be significantly better than that of the immediate onset PTSD veterans. Implications of these findings and recommendations for further research into the significance of time of onset are discussed.


Public Health Psychiatric Disorder Clinical Picture Stress Disorder Posttraumatic Stress 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders 3rd edn, (DSM-III-R). American Psychiatric Association, WashingtonGoogle Scholar
  2. Anderson R, Aday L (1978) Access to medical care in the U.S.: reality and potential. Med Care 16: 533–546Google Scholar
  3. Archibald HC, Tuddenham RD (1965) Persistent stress reaction after combat. Arch Gen Psychiatry 12: 474–481Google Scholar
  4. Bandura A (1982) Self-efficacy mechanism in human agency. Am Psychol 37: 122–147Google Scholar
  5. Boulanger G (1985) Post-traumatic stress disorder: an old problem with a new name. In: Sonnenberg SM, Blank AS, Talbott TA (eds) The trauma of war: stress and recovery in vietnam veterans. American Psychiatr Press, WashingtonGoogle Scholar
  6. Bourne PG (1970) Men, stress and Vietnam. Little Brown, BostonGoogle Scholar
  7. Chodoff PC (1963) Late effects of the concentration camp syndrome. Arch Gen Psychiatry 8: 323–342Google Scholar
  8. Christenson RM, Walker JI, Ross DR, et al. (1981) Reactivation of traumatic conflicts. Am J Psychiatry 138: 984–985Google Scholar
  9. Derogatis LR (1977) The SCL-90 Manual F: scoring, administration, and procedures for the SCL-90. Baltimore, Johns Hopkins University, School of Medicine. Clinical Psychometrics Unit, BaltimoreGoogle Scholar
  10. Derogatis L, Clearly P (1977) A confirmation of the dimensional structure of the SDL-90: a study in construct validity. J Clin Psychol 33: 981–989Google Scholar
  11. Derogatis L, Rickels K, Rock A (1976) SCL-90 and the MMPI: a step in the validity of a new self-report scale. Br J Psychiatry 128: 280–289Google Scholar
  12. Dyke C van, Zilberg NJ, McKinnion JA (1985) Posttraumatic stress disorder: a thirty-year delay in a World War II veteran. Am J Psychiatry 142: 1070–1073Google Scholar
  13. Figley CR (1978a) Delayed stress response syndrome: family therapy implications. J Marriage Fam Counseling 4: 53–60Google Scholar
  14. Figley CR (1978b) Symptoms of delayed combat stress among a college sample of Vietnam veterans. Military Med 143: 107–110Google Scholar
  15. Hannay D (1979) A Study of Community Health. Routledge & Kegan Paul, LondonGoogle Scholar
  16. Hendin H, Pollinger-Haas A (1984) Wounds of war: a psychological aftermath of combat in Vietnam. Basic Books, New YorkGoogle Scholar
  17. Horowitz MJ, Solomon GF (1975) A prediction of delayed stress response syndromes in Vietnam veterans. J Soc Issues 31: 67–80Google Scholar
  18. Horowitz MJ, Wilner N, Alvarez W (1979) Impact of event scale: a measure of subjective stress. Psychosom Med 41: 209–218Google Scholar
  19. Kulka RA, Schlenger WE, Fairbank JA, Hough RL, Jordan BK, Marmar CR, Weiss DS (1988) Executive summary: contractual report of findings from the National Vietnam Veterans Readjustment Study. Research Triangle Institute, North CarolinaGoogle Scholar
  20. Laufer RS, Gallops MS, Frey-Wouters E (1984) War stress and postwar trauma. J Health Soc Behav 25: 65–85Google Scholar
  21. Lindemann E (1944) Symptomatology and management of acute grief. Am J Psychiatry 101: 141–148Google Scholar
  22. McMichael HJ, Hetzel BS (1974) Patterns of help seeking for mental illnees among Australian University students: an epidemiological study. Soc Sci Med 8: 197–206Google Scholar
  23. Putten T van, Emory WH (1973) Traumatic neuroses in Vietnam returnees: a forgotten diagnosis? Arch Gen Psychiatry 29: 695–698Google Scholar
  24. Schwarzwald J, Solomon Z, Weisenberg M, Mikulincer M (1987) Validation of the Impact of Event Scale for psychological sequelae of combat. J Consult Clin Psychol 55: 251–256Google Scholar
  25. Solomon Z (1989a) PTSD and social functioning: a three year prospective study. Soc Psychiatr Psychiatr Epidemiol 24: 127–133Google Scholar
  26. Solomon Z (1989b) A three year prospective study of post traumatic stress disorder in Israeli combat veterans. J Traum Stress 2: 59–73Google Scholar
  27. Solomon Z (1989c) Untreated combat-related PTSD—why some Israeli veterans do not seek help. Isr J Psychiatry Relat Sci 26: 111–123Google Scholar
  28. Solomon Z, Weisenberg M, Schwarzwald J, Mikulincer M (1988) CSR and PTSD as determinants of perceived self-efficacy in battle. J Soc Clin Psychol 6: 356–370Google Scholar
  29. Solomon Z, Kotler M, Shalev A, Lin R (1989) Delaved onset PTSD among Israeli veterans of the 1982 Lebanon War. Psychiatry 52: 428–436Google Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • Z. Solomon
    • 1
    • 2
  • M. Mikulincer
    • 1
    • 3
  • M. Waysman
    • 1
  • D. H. Marlowe
    • 4
  1. 1.Department of Mental Health, Medical Corps Research BranchIsrael Defense ForcesIsrael
  2. 2.Department of Social WorkTel Aviv UniversityTel Aviv
  3. 3.Department of PsychologyBar Ilan UniversityRamat Gan
  4. 4.Department of Military PsychiatryWalter Reed Army Institute of ResearchWashington D.C.USA

Personalised recommendations