Evidence of “accelerated aging”
Campbell and Banas (1999) were among the first researchers who believed that the occurrence of aging conditions in mid-life among people with physical disability was “accelerated aging.” Some researchers characterize the relationship between aging and SCI as “accelerated aging” of organ systems, although the relationship between the two is complex and inconclusive (DeVivo et al., 1992; Frontera & Mollett, 2017; Jorgensen et al., 2016).
Most of the evidence of “accelerated aging" is based on clinical observations of secondary complications or functional decline. Rodakowski et al. (2014) base their thesis of “accelerated aging” or “premature aging” on the evidence of increased frequency of secondary health complications and the risk of re-hospitalization. DeVivo and colleagues (1992) also comment on the role of age of onset, claiming that persons older than 61 years are likely to develop some kind of serious secondary' condition immediately after the lesion and that the age of onset could have an effect on re-hospitalization and on other long-term consequences. However, Chen and colleagues (2016) claim that these increased complications are related to external and behavioral reasons such as slipping, tripping, and falls that account for about 60% of secondary conditions.
Persons with post-traumatic stress disor der (PTSD): comorbidity and aging
Posttraumatic stress disorder is a serious mental illness characterized by symptoms of avoidance and nervous system arousal after experiencing or witnessing a traumatic event. Although PTSD was once considered a type of anxiety disorder, it is categorized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a trauma and stress-related disorder. The criteria for PTSD involve exposure to one or more traumatic events that may include direct exposure, witnessing in person, indirect exposure, or repeated extreme indirect exposure to death, actual or threatened serious injury or actual or threatened sexual violence. The symptoms of PTSD are clustered into four categories: (a) intrusion symptoms; (b) avoidance symptoms; (c) negative alterations in cogtrition and mood; and (d) alterations in arousal and reactivity.
Persons who are diagnosed with PTSD have significant comorbidity conditions. According to Kessler et al. (1995), about 80-90% of individuals with PTSD have one or more comorbid conditions, and two-thirds have two or more additional diagnoses. The most frequent comorbid diagnosis is major depression, followed by anxiety disorders, substance use disorders, borderline personality disorder, and psychotic disorders. This population tends to be diagnosed as
Aging with disability 45 suicidal, dissociative, or possessing distorted and negative trauma-related cognitions, persistent negative trauma-related emotions, and poor social functioning (van Mimien et al., 2015).
Researchers offer possible explanations for the complex relationship between PTSD and mental disorders. Mueser et al. (2002) hypothesize that PTSD mediates the effects between traumatization and the course of severe mental illness both directly (through specific PTSD) or indirectly. Lockwood and Forbes (2014) review the association between the two and believe that PTSD and comorbid conditions share similar etiologies or vulnerabilities. The relationship can be reciprocal, suggesting that PTSD may influence comorbid conditions and vice versa, as in the case of the relationship between PTSD and either substance abuse or major depression. There is a need for additional research to unravel the mechanisms that predict comorbidity or severity.
The core comorbidities of PTSD and mental disorders are listed here:
PTSD and major depression is the most known comorbidity and is interrogated in a large meta-analysis study showing that 52% of individuals with PTSD have suffered major depression (Rytwinski et al., 2013).
Personality disorders - comorbidity with trauma cases is common and reported in clinical studies (Dunn et al., 2004). However, the range is very' wide, ranging between 39% and 79%. However, a meta-analysis of 125 clinical and non-clinical studies (Friborg et al., 2013) demonstrates that the prevalence is lower (35%) for those who have at least one personality disorder. The most common type was paranoid (26%) followed by avoidant (23%) and borderline (22%).
Psychosis is a less common morbidity with PTSD and was estimated to be 12.4% in the meta-analysis study (Achim et al., 2009). Suicidality is more common among PTSD patients than in the general public. Panagioti, Gooding, and Tamer (2012), who studied a sample of 91 persons who have had either PTSD or experienced a serious traumatic event in the past, found that about one-third had suicidal thoughts in the previous year. Those with PTSD were significantly more likely to report lifetime suicidal behavior and suicidal behavior in the previous year compared to the trauma comparable group.
Dissociation is quite common among PTSD patients. Some dissociative symptoms, such as flashbacks, numbing, and psychogenic amnesia, are included in the PTSD DSM diagnostic criteria and are, as such, considered part of the diagnosis of PTSD. On the other hand, derealization, depersonalization, and cunent reduction in awareness are diagnosed separately from the PTSD diagnosis. Wolf, Lumiey et al. (2012) found that 12% of the veteran sample reported elevated symptoms of derealization and depersonalization. However, there are studies that found a wider range of 15% to 30% (Wolf, Miller et al., 2012).
Negative cognitions and emotions are prevalent among PTSD patients. Miller et al. (2013) found that 35% reported negative beliefs, 34% reportedguilt or shame, and 30% reported anger or aggression symptoms in the previous month in their national sample. They claimed that these numbers are lower than those known before.
