Debate reawakened: premorbid factors for soldiers with refractory posttraumatic stress disorder.

Soldiers with severe Posttraumatic Stress Disorder who did not respond favourably to the front echelon treatment units, were treated in a rear echelon treatment centre, named Combat Fitness Retraining Unit, an alternative to psychiatric hospitalization. The soldiers were given individual clinical interviews; their combat potential scores were measured to tap premorbid factors which may have contributed to the development of symptoms. Analysis indicated that (1) in the clinical interview subjects showed clear interpersonal, school, family, and army adjustment problems prior to the trauma, (2) soldiers with Posttraumatic Stress Disorder treated in the rear unit tended to come from the lower end of the military combat potential level. Ramifications of these findings were carefully elucidated.