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Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: Results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions
Open accessAbstract
The present study used data from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,653) to examine lifetime Axis I psychiatric comorbidity of posttraumatic stress disorder (PTSD) in a nationally representative sample of U.S. adults. Lifetime prevalences ± standard errors of PTSD and partial PTSD were 6.4% ± 0.18 and 6.6% ± 0.18, respectively. Rates of PTSD and partial PTSD were higher among women (8.6% ± 0.26 and 8.6% ± 0.26) than men (4.1% ± 0.19 and 4.5% ± 0.21). Respondents with both PTSD and partial PTSD most commonly reported unexpected death of someone close, serious illness or injury to someone close, and sexual assault as their worst stressful experiences. PTSD and partial PTSD were associated with elevated lifetime rates of mood, anxiety, and substance use disorders, and suicide attempts. Respondents with partial PTSD generally had intermediate odds of comorbid Axis I disorders and psychosocial impairment relative to trauma controls and full PTSD.
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“Clinic-wide screening yielded 52 (50.4% positive rate) potentially eligible women, which is consistent with previous literature regarding rate of PTSD/SUD comorbidity [27].”
From Written exposure therapy for treatment of perinatal PTSD among women with comorbid PTSD and SUD: A pilot study examining feasibility, acceptability, and preliminary effectiveness (2023) · cites this paper as [27]
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“odds of having a mood, anxiety and/or substance use disorder [3].”
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BackgroundInfluentialSelf-citationReddy, S., Dick, A. M., Gerber, M. R., & Mitchell, K. S. (2014) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2014.0014 · Cited by 83
“46 The current study examined the effect of the intervention on alcohol and drug use in women with PTSD.”
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BackgroundTrauma, psychiatric disorders, and treatment history among pregnant African American women
Powers, A., Woods-Jaeger, B., Stevens, J. S., Bradley, B., Patel, M. B., Joyner, A., Smith, A. K., Jamieson, D. J., Kaslow, N., & Michopoulos, V. (2020) · Psychological Trauma: Theory, Research, Practice, and Policy · doi:10.1037/tra0000507 · Cited by 73
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“(Blanco, Xu, Brady, Perez-Fuentes, Okuda, & Wang, 2013; Bowe & Rosenheck, 2015; Kaier, Possemato, Lantinga, Maisto, & Ouimette, 2014; Pietrzak et al., 2011).”
Crowdsourcing Trauma: Psychopathology in a Trauma‐Exposed Sample Recruited via Mechanical Turk
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“Estimates from NESARC also suggest that over 46% of those with drug or alcohol use disorders have met full diagnostic criteria for PTSD during their lifetimes.(16) The rates of co-occurrence vary somewhat based on the drug of abuse, with higher rates of co-occurring ADs among those with drug use disorders, and higher…”
BackgroundPilot randomized controlled trial of exercise training for older veterans with PTSD
Hall, K. S. M., Morey, M. C., Bosworth, H. B., Beckham, J. C., Pebole, M. M., Sloane, R. J., & Pieper, C. F. (2019) · Journal of Behavioral Medicine · doi:10.1007/s10865-019-00073-w · Cited by 81
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MethodResultInfluentialTreatment-refractory posttraumatic stress disorder (TRPTSD): a review and framework for the future
Koek, R. J., Schwartz, H. N., Scully, S., Langevin, J., Spangler, S. L., Korotinsky, A., Jou, K., & Leuchter, A. F. (2016) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2016.01.015 · Cited by 74
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Mahoney, A., Karatzias, T., & Hutton, P. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.09.059 · Cited by 81
Substance Use Disorders and Anxiety: A Treatment Challenge for Social Workers
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Impact of a child’s cancer disease on parents’ everyday life: a longitudinal study from Sweden
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“(Pietrzak et al., 2011).”
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Self-citationHigh burden of subthreshold DSM ‐5 post‐traumatic stress disorder in U.S. military veterans
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“Therefore, the results of the studies conducted by Breslau, Pietrzak, and their respective research teams (Breslau, 2009; Pietrzak et al., 2011) were not replicated.”
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“79) and validity of these diagnoses have been reported elsewhere (Grant et al., 2003, 2004a, 2004b, 2004c; Pietrzak et al., 2011; Pulay et al., 2010; Ruan et al., 2008; Stinson et al., 2005).”
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“Existing evidence suggests that even though a substantial proportion of cases recover within a few months, at least one-third of cases persist for many years (Kessler et al. 1995; Breslau et al. 1998; Pietrzak et al. 2011; Chapman et al. 2012), and that chronic PTSD can lead to secondary disorders (Perkonigg et al.”
BackgroundInfluentialThe effects of exercise on transdiagnostic treatment targets: A meta-analytic review
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“In addition, due to the high rates of comorbidity of PTSD and alcohol use disorders (AUDs), especially among veterans (Pietrzak et al., 2011; Scherrer et al., 2008), interventions targeting both PTSD and AUDs are of primary interest.”
BackgroundWalsh, K., Elliott, J. C., Shmulewitz, D., Aharonovich, E., Strous, R. D., Frisch, A., Weizman, A., Spivak, B., Grant, B. F., & Hasin, D. S. (2013) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2013.11.016 · Cited by 56
“, endorsed at least 1 symptom from each of Criteria B, C, and D, and symptoms lasted at least 1 month following the traumatic event) [43].”
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Comorbid PTSD and Social Anxiety Disorder
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“functional difficulties, reduced quality of life, and adverse physical health outcomes.(4)”
BackgroundTranscranial magnetic stimulation for post-traumatic stress disorder
Petrosino, N. J., Cosmo, C. S. A., Berlow, Y. A., Zandvakili, A., Wout‐Frank, M. V. ‘., & Philip, N. S. (2021) · Therapeutic Advances in Psychopharmacology · doi:10.1177/20451253211049921 · Cited by 55
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Roberts, A. L., Liu, J., Lawn, R. B., Jha, S. C., Sumner, J. A., Kang, J. H., Rimm, E. B., Grodstein, F., Kubzansky, L. D., Chibnik, L. B., et al. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.17698 · Cited by 55
Dissociative subtype of DSM-5 posttraumatic stress disorder in U.S. veterans
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Self-citationPTSD symptoms as a consequence of breast cancer diagnosis: clinical implications
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Is Amazon’s Mechanical Turk (MTurk) a comparable recruitment source for trauma studies?
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“Available evidence indicates that women, as compared with men, have a greater risk of PTSD (Kessler et al. 1995; Breslau et al. 1997; Tolin and Foa 2006; Pietrzak et al. 2011).”
BackgroundInfluentialAlcohol, cannabis, and other drug use: Engagement and outcome in PTSD treatment
Bedard-Gilligan, M., Garcia, N., Zoellner, L. A., & Feeny, N. C. (2018) · Psychology of Addictive Behaviors · doi:10.1037/adb0000355 · Cited by 48
Árias, F., Szerman, N., Vega, P., Mesías, B., Basurte-Villamor, I., Morant, C., Mangado, E. O., Poyo, F., & Vich, F. D. A. B. (2013) · Adicciones · doi:10.20882/adicciones.59 · Cited by 49
Vicarious Trauma and Vicarious Posttraumatic Growth among Substance Abuse Treatment Providers
Cosden, M., Sanford, A., Koch, L. M., & Lepore, C. E. (2016) · Substance Abuse · doi:10.1080/08897077.2016.1181695 · Cited by 50
Loflin, M., Earleywine, M., & Bonn‐Miller, M. O. (2017) · Addictive Behaviors · doi:10.1016/j.addbeh.2017.01.008 · Cited by 48
Complex PTSD among treatment-seeking veterans with PTSD
Letica-Crepulja, M., Stevanović, A., Protuđer, M., Grahovac-Juretić, T., Rebić, J., & Frančišković, T. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2020.1716593 · Cited by 42
Boals, A., Contractor, A. A., & Blumenthal, H. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102235 · Cited by 47
Olff, M., Hein, I. M., Amstadter, A. B., Armour, C., Birkeland, M. S., Bui, É., Cloître, M., Ehlers, A., Ford, J. D., Greene, T., et al. (2025) · European Journal of Psychotraumatology · doi:10.1080/20008066.2025.2458406 · Cited by 68
“The prevalence of PTSD among those aged 60 and older ranges from 1.9% to 9.5% (Fox et al., 2020; Pietrzak et al., 2011).”
InfluentialTsai, J., Schick, V., Hernandez, B., & Pietrzak, R. H. (2020) · Depression and Anxiety · doi:10.1002/da.23098 · Cited by 47
Self-citationPatterns of comorbidity associated with ICD-11 PTSD among older adults in the United States
Fox, R. J., Hyland, P., Power, J. M., & Coogan, A. N. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113171 · Cited by 49
Gupta, S., & Guleria, R. S. (2022) · Cells · doi:10.3390/cells11132034 · Cited by 49
“A significant increase of PTSD is observed in socially challenged people, young people, and first responders to trauma [16] and is associated with mood, anxiety and substance related issues [17].”
BackgroundHien, D. A., Papini, S., Saavedra, L. M., Bauer, A. G., Ruglass, L. M., Ebrahimi, C. T., Fitzpatrick, S., López‐Castro, T., Norman, S. B., Killeen, T. K., et al. (2023) · Psychological Bulletin · doi:10.1037/bul0000409 · Cited by 46
Trauma exposure and Axis I psychopathology: A cotwin control analysis in Norwegian young adults.
Brown, R. C., Berenz, E. C., Aggen, S. H., Gardner, C. O., Knudsen, G. P., Reichborn-Kjennerud, T., Kendler, K. S., & Amstadter, A. B. (2014) · Psychological Trauma: Theory, Research, Practice, and Policy · doi:10.1037/a0034326 · Cited by 45
“Third, studies have found that higher magnitude of trauma, as indicated by directly-experienced TE (Amstadter et al., 2009; Pietrzak et al., 2011), assaultive TE (Breslau et al., 1991), life-threat or injury (Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993), or history of multiple traumas…”
BackgroundResultInfluentialPosttraumatic stress disorder in opioid agonist therapy: A review.
Ecker, A. H., & Hundt, N. E. (2017) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000312 · Cited by 48
Brodnik, Z. D., Black, E. M., Clark, M. J., Kornsey, K. N., Snyder, N. W., & España, R. A. (2017) · Neuropharmacology · doi:10.1016/j.neuropharm.2017.07.032 · Cited by 45
“…stress disorder (PTSD) and substance use disorder are highly co-morbid psychiatric conditions (Jacobsen et al., 2001; Kessler et al., 1995; Pietrzak et al., 2011), with PTSD onset generally occurring prior to the development of substance use disorders (Jacobsen et al., 2001).”
BackgroundPosttraumatic stress disorder and neurocognition: A bidirectional relationship?
Jacob, S. N., Dodge, C. P., & Vasterling, J. J. (2019) · Clinical Psychology Review · doi:10.1016/j.cpr.2019.101747 · Cited by 50
One-year clinical outcomes following theta burst stimulation for post-traumatic stress disorder
Petrosino, N. J., Wout‐Frank, M. V. ‘., Aiken, E., Swearingen, H. R., Barredo, J., Zandvakili, A., & Philip, N. S. (2019) · Neuropsychopharmacology · doi:10.1038/s41386-019-0584-4 · Cited by 46
Ma, K., Wang, X., Feng, S., Xia, X., Zhang, H., Rahaman, A., Dong, Z., Lu, Y., Li, X., Zhou, X., et al. (2020) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2020.110810 · Cited by 45
Hien, D. A., López‐Castro, T., Fitzpatrick, S., Ruglass, L. M., Fertuck, E. A., & Melara, R. D. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.05.022 · Cited by 46
Self-disgust as a potential mechanism underlying the association between PTSD and suicide risk.
Brake, C., Rojas, S., Badour, C. L., Dutton, C., & Feldner, M. (2017) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2017.01.003 · Cited by 47
Postpartum Depressive Symptomatology: Results from a Two‐Stage US National Survey
Beck, C. T., Gable, R. K., Sakala, C., & Declercq, E. R. (2011) · Journal of Midwifery & Women s Health · doi:10.1111/j.1542-2011.2011.00090.x · Cited by 44
Do Benzodiazepines Reduce the Effectiveness of Exposure Therapy for Posttraumatic Stress Disorder?
Rosen, C. S., Greenbaum, M. A., Schnurr, P. P., Holmes, T. H., Brennan, P. L., & Friedman, M. J. (2013) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.13m08592 · Cited by 44
“Substance misuse 38 and prescribing of opiates for pain 39 are both common in the PTSD patient population.”
Nichter, B., Haller, M. M., Norman, S. B., & Pietrzak, R. H. (2019) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2019.11.008 · Cited by 45
Self-citationThe Multivariate Effect of Ketamine on PTSD: Systematic Review and Meta-Analysis
Du, R., Han, R., Niu, K., Xu, J., Zhao, Z., Lu, G., & Shang, Y. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.813103 · Cited by 51
Morris, V. L., Huffman, L. G., Naish, K. R., Holshausen, K., Oshri, A., McKinnon, M. C., & Amlung, M. T. (2020) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000588 · Cited by 44
Trauma and Posttraumatic Stress Disorder
(2018) · Cambridge University Press eBooks · doi:10.1017/9781107445130 · Cited by 45
Reckless Self‐Destructive Behavior and PTSD in Veterans: The Mediating Role of New Adverse Events
Lusk, J., Sadeh, N., Wolf, E. J., & Miller, M. W. (2017) · Journal of Traumatic Stress · doi:10.1002/jts.22182 · Cited by 43
The relationship between DSM‐5 PTSD symptom clusters and alcohol misuse among military veterans
Walton, J. L., Raines, A. M., Cuccurullo, L. J., Vidaurri, D. N., Hurlocker, M. C., & Franklin, C. L. (2017) · American Journal on Addictions · doi:10.1111/ajad.12658 · Cited by 43
Kang, B., Xu, H., & McConnell, E. S. (2018) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5055 · Cited by 46
The Comorbidity of Post-traumatic Stress Disorder (PTSD) and Substance Use Disorders
Brady, K. T., McCauley, J. L., & Back, S. E. (2020) · Springer eBooks · doi:10.1007/978-3-030-36391-8_93 · Cited by 42
Schnurr, P. P., Chard, K. M., Ruzek, J. I., Chow, B. K., Shih, M., Resick, P. A., Foa, E. B., Marx, B. P., Huang, G. D., & Lü, Y. (2014) · Contemporary Clinical Trials · doi:10.1016/j.cct.2014.11.017 · Cited by 44
“Without adequate treatment, PTSD can become chronic [6], lasting even into old age [2,7,8].”
Background
Metadata
- Authors
- Pietrzak, R. H., Goldstein, R. B., Southwick, S. M., & Grant, B. F.
- Affiliations
- Yale University (US)
- National Institutes of Health (US)
- Corresponding author
- Pietrzak, Robert H.
- Venue
- Journal of Anxiety Disorders
- Publisher
- Elsevier BV
- Published
- 2011-04
- Volume
- 25
- Issue
- 3
- Pages
- 456-465
- ISSN
- 0887-6185 (ISSN-L)
- PMC
- PMC3051041
- OpenAlex
- W1969551391
- Cited by
- 963
- References
- 87
- Citations by year
- 2026: 32 · 2025: 55 · 2024: 69 · 2023: 69 · 2022: 88 · 2021: 79 · 2020: 102 · 2019: 84 · 2018: 75 · 2017: 70 · 2016: 64 · 2015: 56 · 2014: 51 · 2013: 40 · 2012: 18
- FWCI
- 24.53
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Anxiety Disorders (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (NIAAA)
- National Institute on Drug Abuse (NIDA)
- Intramural Program of the National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism
- National Center for Posttraumatic Stress Disorder
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- post-traumatic stress disorder, PTSD prevalence, psychiatric comorbidity, Axis I disorders, mood disorders, anxiety disorders, substance use disorders, suicide attempts, sex differences, trauma exposure, sexual assault, unexpected death, psychosocial impairment, NESARC
- MeSH terms
- Adult, Female, Health Surveys, Humans, Life Change Events, Male, Middle Aged, Psychiatric Status Rating Scales, Sex Factors, Stress Disorders, Post-Traumatic, United States, Comorbidity, Prevalence, Mood Disorders, Substance-Related Disorders
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