Anxiety sensitivity and depression: Mechanisms for understanding somatic complaints in veterans with posttraumatic stress disorder

Journal of Traumatic Stress, Vol. 19, No. 4, August 2006, pp. 471–479 ( C© 2006)

Anxiety Sensitivity and Depression: Mechanismsfor Understanding Somatic Complaints in VeteransWith Posttraumatic Stress Disorder

Matthew JakupcakSeattle Division, Puget Sound Health Care System, Seattle, WA and Department of Psychiatryand Behavioral Sciences, University of Washington School of Medicine, Seattle, WA

Travis OsborneEvidence-Based Treatment Centers of Seattle, Seattle, WA and Department of RehabilitationMedicine, University of Washington School of Medicine, Seattle, WA

Scott Michael and Jessica CookSeattle Division, Puget Sound Health Care System, Seattle, WA and Department of Psychiatryand Behavioral Sciences, University of Washington School of Medicine, Seattle, WA

Peg AlbrizioSeattle Division, Puget Sound Health Care System, Seattle, WA

Miles McFallSeattle Division, Puget Sound Health Care System, Seattle, WA and Department of Psychiatryand Behavioral Sciences, University of Washington School of Medicine, Seattle, WA

A study was conducted among 45 male veterans seeking inpatient treatment for posttraumatic stressdisorder (PTSD) to test whether the relationship between PTSD and somatic complaints was accountedfor by depression and anxiety sensitivity. Posttraumatic stress disorder symptom severity, depressionsymptom severity, and anxiety sensitivity were each positively and significantly related to veterans’self-reported severity of somatic complaints. Results of hierarchical regression analyses indicated thatanxiety sensitivity and depression severity account for the relationship between PTSD and veterans’somatic complaints, suggesting PTSD influences somatic complaints by virtue of underlying symptomsof depression and anxiety sensitivity.

A line of research has emerged with regard to the re-

lationship between PTSD and somatic complaints (e.g.,

Beckham et al., 1998; Shalev, Bleich, & Ursano, 1990).

Among people with both PTSD and somatic symp-

toms (i.e., physical pain, cardiovascular, neurological, gas-

trointestinal, and audiological difficulties), pain symptoms

are the most commonly reported complaint (McFarlane,

Atchison, Rafolowicz, & Papay, 1994; Shalev et al., 1990;

Correspondence concerning this article should be addressed to: Matthew Jakupcak, VAPSHCS Psychiatry, 1660 S. Columbian Way, Seattle, WA 98108. E-mail:[email protected].

C© 2006 International Society for Traumatic Stress Studies. This article is a US Government work and, as such, is in the public domain in the United States of America. Published onlinein Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/jts.20145

White & Faustman, 1989). White and Faustman (1989)

examined the medical records of male veterans seeking in-

patient treatment for PTSD and found that 42% of the

sample had evidence of multiple medical problems, with

25% of the veterans suffering from musculoskeletal or pain

problems. However, there is evidence that self-reports of

pain are higher in individuals with PTSD compared to in-

dividuals without PTSD, even in the absence of objective

471

472 Jakupcak et al.

assessments of physical injury (Asmundson & Norton,

1995; McFarlane et al., 1994; Shalev et al., 1990), per-

haps indicating that somatization may be more common

among people with PTSD (see also, Engel, 2004).

Beckham and colleagues (1997) investigated rates of

chronic pain and somatization in veterans seeking outpa-

tient PTSD treatment using self-reports of PTSD symptom

severity, depression, pain, pain-related disability, and mea-

sures of somatization. The authors report over 80% of the

sample suffered chronic pain symptoms, with 49% of the

sample reporting pain in at least three areas. Furthermore,

PTSD symptom severity was positively and strongly asso-

ciated with self-reported pain levels, pain-related disabil-

ity, and somatization whereas veterans’ depressive symp-

toms were only significantly related to overall percentage

of bodily pain. The evidence of high rates of pain in the

sample prompted Beckham et al. (1997) to conclude that

“. . .veterans with PTSD may experience actual physical

symptoms, but how interpretation of physical symptoms,

chronic pain, and PTSD relate will require further empir-

ical investigation” (p. 385).

A number of psychological mechanisms have been pro-

posed to explain the relationships that PTSD has with

somatic complaints such as pain (see Asmundson, Coons,

Taylor, & Katz, 2002; Sharpe & Harvey, 2001). In gen-

eral, theoretical models acknowledge the co-occurrence and

potentially interactive relationships of physical–medical

mechanisms (e.g., musculoskeletal damage incurred during

psychological trauma events) and cognitive mechanisms,

such as fear and avoidance styles of coping, depressive at-

tributions, and catastrophic interpretations of bodily sen-

sations (Otis, Keane, & Kerns, 2003). Two potential psy-

chological mechanisms that may explain the relationship

between PTSD and somatic complaints have gained in-

creasing empirical support: comorbid depression and anx-

iety sensitivity.

D E P R E S S I O N A N D S O M A T I C C O M P L A I N T S

Depression is often accompanied by somatic com-

plaints (Kroenke, 2003; Simon, VonKorff, Piccinelli,

Fullerton, & Ormel, 1999); there is a well-established as-

sociation between depression and reports of chronic pain

(Fishbain, Cutler, Rosomoff, & Rosomoff, 1997; Romano

& Turner, 1985). Several psychological theories have been

proposed to explain the relationship between depression

and somatic complaints. Physical symptoms may be an

early indicator of later problems with mood (Terre, Poston,

Foreyt, & St. Jeor, 2003). More specifically, the onset of

somatic complaints, such as pain symptoms, may interfere

with access to positive reinforcers (i.e., enjoyable activities),

lead to increased feelings of helplessness, and activate neg-

ative cognitive schemas or distortions (e.g., catastrophiz-

ing) that contribute to depression (Banks & Kerns, 1996;

Campbell, Clauw, & Keefe, 2003; Pincus & Williams,

1999). Alternatively, depressed persons may misinterpret

typical physical sensations as being indicative of an under-

lying illness (Miranda, Meyerson, Marx, & Tucker, 2002).

In both civilian and veteran populations, depression is

highly comorbid with PTSD (Kessler, Sonnega, Bromet,

Hughes, & Nelson, 1995; Orsillo et al., 1996). As such,

the association between PTSD and pain and somatic

complaints may be spurious in nature and better ex-

plained by the presence of comorbid depression. There

is evidence that, among civilians, PTSD is related to so-

matic complaints by virtue of comorbid depressive symp-

toms (Miranda et al., 2002; Roy-Byrne, Smith, Goldberg,

Afari, & Buchwald, 2004). Yet, studies of veterans seek-

ing mental health services indicate that PTSD symp-

tom severity is related to the severity ratings of somatic

complaints, whereas depression severity is not (Beckham

et al., 1997, 1998). Even if depression partly accounts for

the association between PTSD and somatic complaints,

PTSD may be related to somatic complaints via other

mechanisms.

A N X I E T Y S E N S I T I V I T Y A N D S O M A T I CC O M P L A I N T S

Sometimes referred to as a “fear of fear,” anxiety sensitivity

describes an individual’s hypersensitivity and catastrophic

reaction to physical signs of autonomic arousal associated

with anxiety (Taylor, 1999). Anxiety sensitivity has been

Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.

Somatic Complaints in Veterans With PTSD 473

implicated in the etiology of anxiety disorders, such as ago-

raphobia and panic disorder (see Taylor, 1999), and found

to predict patterns of emotional-avoidance and vigilance

to interoceptive bodily sensations (Zvolensky & Forsyth,

2002). Researchers have observed high levels of anxiety sen-

sitivity in persons with PTSD (Taylor, Koch, & McNally,

1992) and there is evidence that anxiety sensitivity predicts

the onset and maintenance of PTSD symptoms (Fedoroff,

Taylor, Asmundson, & Koch, 2000; Keogh, Ayers, &

Francis, 2002). Furthermore, anxiety sensitivity has been

found to positively predict severity ratings of chronic pain

symptoms (Asmundson & Norton, 1995; Asmundson

& Taylor, 1996), perhaps because increased awareness

of autonomic arousal exacerbates the awareness or ex-

perience of somatic symptoms (Norton & Asmundson,

2003).

S T U D Y O B J E C T I V E S

The current study utilized an existing data set to examine

depression and anxiety sensitivity as psychological mech-

anisms that might account for the relationship between

PTSD and somatic complaints. It was hypothesized that

PTSD would emerge as a proxy risk variable, predicting

somatic complaints by virtue of its association with symp-

toms of depression and anxiety sensitivity. A proxy risk

factor model describes relationships in which one variable

(i.e., the proxy risk factor) is found to be highly associ-

ated with an outcome through its relationship to one or

more variables strongly associated with that outcome (see

Kraemer, Stice, Kazdin, Offord, & Kupfer, 2001).

M E T H O D

Participants

Participants were recruited from the population of pa-

tients admitted to the inpatient PTSD Evaluation and

Brief Treatment Unit at the VA Puget Sound Health

Care System in Seattle, Washington. All participants were

given a diagnosis of PTSD based on the Diagnostic and

Statistical Manual of Mental Disorders, Fourth Edition

(DSM-IV; American Psychiatric Association, 1994) cri-

teria generated from information gathered in standard

psychiatric interviews conducted during admission to the

unit. Fifty-three men consented to participate in a study

described as examining fear and avoidance behaviors associ-

ated with PTSD. Nine participants who were approached

for the study declined to participate. Eight participants

were excluded from the current analyses due to missing

data. Of the remaining 45 participants, 39 were White

(86.7%), two were African American (4.4%), and one

was Latino (2.4%); three participants did not report their

race. The mean age of the sample was 55.4 years (SD =5.3).

A medical chart review was conducted to determine if

the rates of chronic pain in this sample were comparable to

those previously found in veterans seeking PTSD treatment

(i.e., Beckham et al., 1997; White & Faustman, 1989).

Chronic pain was defined as the presence of nonacute,

nontransient pain lasting at least 3 months (see Interna-

tional Association for the Study of Pain, 1986). Participants

were identified as having chronic pain based (a) a previ-

ous diagnosis–treatment of chronic pain syndromes (e.g.,

a diagnosis of degenerative disc disease or a documented

narcotic plan for ongoing treatment of chronic pain); or

(b) pain symptoms assessed during medical examinations

conducted by psychiatric nurses, physician assistants, or

psychiatrists on the inpatient PTSD treatment team. This

review of medical records indicated that 37(70%) of the

veterans enrolled in the study had evidence of chronic

pain.

Procedure

Participants were asked to complete a questionnaire packet

including measures of fear and avoidance symptoms spe-

cific to the domains of physical–somatic functioning and

emotional functioning. Additionally, participants were

asked for permission to access pertinent psychiatric and

medication information that they provided upon admis-

sion to the inpatient PTSD unit, including medical pro-

fessionals’ intake examinations and diagnoses.


474 Jakupcak et al.

Measures

Anxiety sensitivity. Anxiety sensitivity was assessed using

the Bodily Sensations Questionnaire (BSQ; Chambless,

Caputo, Bright, & Gallagher, 1984). The BSQ is an 18-

item self-report measure of the fear of physical sensations

associated with autonomic arousal and anxiety. Respon-

dents rate the degree of fear they experience in response to

symptoms associated with anxiety (e.g., heart palpitations,

feeling short of breath, and sweating) on a 5-point scale

(1 = not frightened or worried by this sensation; 5 = extremely

frightened by this sensation). The BSQ has demonstrated

strong psychometric properties (Chambless et al., 1984)

and there is strong support for the construct validity of

the scale (Berg, Shapiro, Chambless, & Aherns, 1998;

Chambless et al., 1984).

PTSD symptom severity. The Mississippi Scale for

Combat-Related PTSD (M-PTSD; Keane, Caddell, &

Taylor, 1988) is a commonly used self-report measure that

assesses PTSD symptom severity. The scale is comprised of

35 items assessing PTSD symptoms and experiences asso-

ciated with trauma exposure (e.g., feelings of guilt/shame).

Respondents are asked to endorse the degree to which they

experience each of the symptoms described on a 5-point

Likert-type scale (1 = not at all true, 5 = extremely true).

Item ratings are summed to provide a continuous measure

of PTSD symptom severity. The measure has demonstrated

good psychometric properties and there is strong evidence

for the scale’s ability to assess PTSD symptoms accurately

in veterans (Keane et al., 1988; McFall, Smith, Roszell,

Tarver, & Malas, 1990).

Depression and somatic complaint symptoms. The Pa-

tient History Questionnaire (PHQ; Spitzer, Kroenke, &

Williams, 1999) is a self-report measure based on the

clinician-administered Primary Care Evaluation of Mental

Disorders (PRIME-MD; Spitzer et al., 1994). The PHQ

assesses a variety of psychiatric symptoms, including symp-

toms of depression, anxiety, and eating disorders, as well

as somatic complaints and current or recent alcohol abuse.

Prior research suggests that the PHQ has good psycho-

metric properties and is an effective screening measure for

common psychiatric conditions such as depression (e.g.,

Kumar, Kim, Krefetz, & Steer, 2001; Spitzer et al., 1999).

The 9-item depression subscale of the PHQ was used to

assess depressive symptom severity. The subscale asks indi-

viduals, “Over the last 2 weeks, how often have you been

bothered by any of the following problems?” Participants

then indicate how often they experienced each of the nine

DSM-IV symptoms for a major depressive episode during

the past 2 weeks (not at all, several days, more than half the

days, nearly every day). Scores were summed to provide a

continuous measure of depression symptom severity, with

higher scores indicating more severe depressive symptoms.

The 13-item somatic subscale of the PHQ was used

to assess somatic complaint symptoms. The subscale asks

participants, “During the last 4 weeks, how much have

you been bothered by any of the following problems?” The

subscale assesses somatic complaints, including stomach

and back pain, pain in the legs, arms, or joints, menstrual

cramps,1 pain during sex, headaches, gut-pain (constipa-

tion, nausea, gas, and indigestion), chest pain, dizziness,

fainting spells, racing heart, and shortness of breath. Re-

sponses were assigned numerical values (0 = not bothered

at all, 1 = bothered a little, and 2 = bothered a lot) and the

scores were summed to provide a continuous measure of

somatic complaint symptoms, with higher scores indicat-

ing more severe and greater number of complaints (see

Kroenke, Spitzer, & Williams, 2002).

R E S U L T S

Analytic Plan

Hierarchical multiple regression analyses tested (a) whether

PTSD (proxy risk factor) predicted somatic complaints,

and (b) whether the relationship between PTSD and so-

matic complaints was explained by anxiety sensitivity or

depression symptom severity. Although strategies used to

test a proxy risk factor model are consistent with those

1 This item was not included in the total score somatic complaint score, asthe sample was entirely comprised of men.



used to test mediation, unlike tests of mediation, a proxy

risk factor model does not require the establishment of

the order of onset for each factor (Kraemer et al., 2001).

Based on the criteria of proxy risk factor models (Kraemer

et al., 2001), we predicted that (a) PTSD symptom severity

would positively predict the severity of veterans’ somatic

complaints; (b) PTSD symptom severity would positively

predict both anxiety sensitivity and depression symptom

severity; and (c) when separately entered into the same

model with PTSD symptom severity, depression and anx-

iety sensitivity would each predict somatic complaints and

the relationship between PTSD symptom severity and so-

matic complaints would no longer be significant.

Preliminary Analyses

Preliminary analyses of all self-report variables suggested

normal distributions without violations of linearity or ho-

moscedasticity. Table 1 displays the frequency of the so-

matic complaints on the PHQ endorsed by participants.

The most frequently endorsed somatic complaints (i.e.,

symptoms that respondents rated as being “bothered a lot”

by) were pain in the arms, legs, or joints (66.7%) and back

pain (55.5%).

Table 1. Frequency of Somatic Complaints-PHQ Somatic Subscale(N = 45)

Bothered Bothered Not Bothereda Lot a Little at All

Complaint n % n % n %

Stomach pain 3 6.7 21 46.7 20 44.4Back pain 25 55.5 14 31.1 6 13.3Pain in your arms, legs, or joints 30 66.7 10 22.2 4 8.9Pain during intercourse 7 15.6 5 11.1 29 64.5Headaches 10 22.2 24 53.3 10 22.2Chest pain 7 15.6 17 37.8 21 46.7Dizziness 1 2.2 28 62.2 16 35.6Fainting spells 2 4.4 5 11.1 38 84.4Feeling your heart pound/race 7 15.6 21 46.7 17 37.8Shortness of breath 6 13.3 27 60 12 26.7Constipation/loose bowels/diarrhea 15 33.3 13 28.9 17 37.8Nausea/gas/indigestion 11 24.4 23 51.1 10 22.2

Note. PHQ = Patient History Questionnaire.

Descriptive statistics and the results of correlation anal-

yses are presented in Table 2. Posttraumatic stress disorder

symptom severity was positively and significantly corre-

lated with anxiety sensitivity, depression symptom severity,

and somatic pain symptoms. Depression symptom severity

and anxiety sensitivity were positively and significantly cor-

related with the severity of somatic complaints. Age was

significantly correlated with depression severity and was

statistically controlled in all subsequent regression mod-

els. Although the majority of the correlations between

the primary study variables was significant, the magni-

tude of these correlations did not suggest multicollinearity

(see parameters for multicollinearity; Tabachnick & Fidell,

1996).

Hierarchical Regression Analyses

Hierarchical regression analysis was used to test the first

criterion of the proxy risk factor model. After control-

ling for age, PTSD symptom severity positively predicted

somatic complaint severity, β= .40, R2�change = .15,

F (2, 41) = 3.45, p < .05. The veterans reporting greater

PTSD symptom severity tended to endorse higher levels of

somatic complaints.


476 Jakupcak et al.

Table 2. Descriptive Statistics and Pearson Correlations Among Variables (N = 45)

Variable M SD 1 2 3 4 5

1. Age 55.42 5.32 −.27 −.32∗ .03 .142. PTSD 143.37 23.76 .40∗∗ .41∗∗ .34∗

3. Depression 25.96 6.06 .24 .37∗∗

4. Anxiety sensitivity 52.39 12.89 .51∗∗

5. Somatic complaints 20.00 3.60

Note. PTSD = Posttraumatic stress disorder.∗ p < .05. ∗∗ p < .01.

Next, hierarchical regression was used to examine

whether the relationship between the proposed proxy risk

factor (PTSD symptom severity) and somatic complaint

severity was explained by depression symptom severity.

The second criterion for the proxy risk factor model was

met; after controlling for age, PTSD symptom severity pos-

itively and significantly predicted the severity of depressive

symptoms, �R2 change = .17, F (2, 41) = 5.49, p < .05.

To test the final criterion of the proposed proxy risk factor

model, hierarchical regression examined whether depres-

sion predicted somatic complaints when placed onto the

same regression step as PTSD symptom severity. As shown

in Table 3, depression symptom severity, β = .40, p < .05,

and not PTSD symptom severity, β = .26, ns, accounted

for a significant portion of variance in somatic complaints

when placed on the same regression step. Veterans who

endorsed higher levels of depression tended to report ele-

vated somatic complaints, and this relationship explained

Table 3. Results of Hierarchical RegressionPredicting Somatic Complaints (N = 45)

Variable B SE B β

Step 1a

Age 0.08 0.11 .14Step 2b

Age 0.23 0.10 .36PTSD 0.04 0.02 .26Depression 0.24 0.10 .40∗

Note. PTSD = Posttraumatic stress disorder.aStep 1 R2�= .02, F (1,43) = .67, ns. bStep 2 R2� = .26,F (2,41) = 6.27, p < .01.∗ p < .05.

the relationship between PTSD symptom severity (proxy

risk factor) and somatic complaint severity.

Next, hierarchical regression was used to examine

whether anxiety sensitivity influenced the relationship be-

tween the proposed proxy risk factor (PTSD symptom

severity) and somatic complaint severity. The second cri-

terion for the proxy risk factor model was met; PTSD

severity significantly and positively predicted anxiety sen-

sitivity, R2�change = .19, F (1, 41) = 9.56, p < .01. A

subsequent hierarchical regression analysis was used to ex-

amine whether anxiety sensitivity predicted somatic com-

plaints when placed onto the same regression step as PTSD

severity. As shown in Table 4, anxiety sensitivity, β = .43,

p < .01, and not PTSD symptom severity, β = .19, ns,

accounted for a significant portion of the variance in

somatic complaints when placed on the same regression

step. Individuals endorsing higher anxiety sensitivity were

more likely to report elevated somatic complaints, and this

Table 4. Results of Hierarchical RegressionPredicting Somatic Complaints (N = 45)

Variable B SE B β

Step 1a

Age 0.08 0.11 .14Step 2b

Age 0.12 0.10 .19PTSD 0.03 0.03 .19Anxiety sensitivity 0.12 0.05 .43∗

Note. PTSD = Posttraumatic stress disorder.aStep 1 R2�= .02, F (1, 43) = .63, p = .43. bStep 2R2�= .29, F (2,41) = 6.81, p < .01.∗ p < .05.



relationship explained the association between PTSD

symptom severity and somatic complaints.

D I S C U S S I O N

The review of veterans’ medical records indicated that

the majority of the veterans in this sample suffered from

chronic pain. These rates of chronic pain were higher than

those previously found among veterans seeking inpatient

PTSD treatment (White & Faustman, 1989) and compa-

rable to rates reported by Beckham et al. (1997). Consis-

tent with previous findings (Shalev et al., 1990; White &

Faustman, 1989), pain symptoms were found to be the

most common type of somatic complaint.

Posttraumatic stress disorder symptom severity was pos-

itively and significantly related to veterans’ somatic com-

plaints. In addition, PTSD symptom severity significantly

and positively predicted both depression symptom sever-

ity and anxiety sensitivity. Yet when depression symptom

severity and anxiety sensitivity were entered into separate

regression analyses, PTSD symptom severity no longer ac-

counted for a significant portion of the variance associated

with somatic complaints. This would suggest that, among

veterans with PTSD, the relationship between PTSD sever-

ity and somatic complaints can be accounted for by co-

morbid depression and anxiety sensitivity. As noted pre-

viously, the relationship between depression and somatic

complaints is well established (e.g., Romano & Turner,

1985), and there is evidence that depression may account

for the relationship between PTSD and somatic complaints

in civilians (Miranda et al., 2002). The current findings in-

dicate this is also the case for veterans with PTSD and that,

in addition to depression, anxiety sensitivity may be an

important factor for understanding the nature of somatic

complaints in persons with PTSD.

Perhaps anxiety sensitivity and the attention to signs

of physiological arousal exacerbate awareness and the

experience of pain symptoms for persons with PTSD

(Asmundson et al., 2002). As previously noted, anxiety

sensitivity is associated with an increased awareness of in-

teroceptive bodily sensations (Zvolensky & Forsyth, 2002),

potentially increasing one’s awareness of somatic symptoms

that might be present. In this sample, medical records in-

dicated that 70% of the veterans suffered from chronic

pain. Repeatedly scanning the body for signs of anxiety

might lead these veterans to have an increased awareness of

their pain symptoms. Another potential explanation lies in

the interpretation of pain signals. Pain sensations may be

perceived to indicate that one’s health is worsening, which

could trigger anxiety and increased vigilance for signs of

potential danger in the body.

This was a preliminary study that utilized an exis-

tent data set. As such, a number of limitations suggest

a need for caution in interpreting the results. The sam-

ple was homogenous (White male veterans, mostly of

the Vietnam era) and drawn from an inpatient psychi-

atric setting, so the findings may not generalize to fe-

male, outpatient, or civilian populations of persons with

PTSD, or to populations more diverse in race or ethnicity.

Although staff members of a PTSD-specialty unit diag-

nosed participants, measurements of PTSD and depression

symptom severity were based on self-report instruments,

rather than clinician-administered structured interviews

(e.g., Clinician-Administered PTSD Scale [Blake et al.,

1990]). Thus, the assessment of these factors may be sub-

ject to self-report biases. Because the sample was comprised

of veterans who met diagnosis for PTSD, the range of

PTSD symptom severity was restricted at the lower end.

Restriction in the range of PTSD symptom severity and

limited statistical power associated with a small sample size

may have obscured a PTSD specific effect. In addition,

because the study is a cross-sectional design and temporal

precedence cannot be established, we cannot infer causality

from these relationships.

Nonetheless, the results of this study suggest that anx-

iety sensitivity and depression may represent psychologi-

cal mechanisms that account for the relationship between

PTSD and somatic complaints. In addition to addressing

depression, therapies that target anxiety sensitivity asso-

ciated with PTSD (see Taylor, 2003) might be particu-

larly useful for veterans with PTSD and comorbid somatic

complaints. Further research is needed to replicate these

findings in larger samples and more diverse populations

of persons with PTSD. Future studies should use designs


478 Jakupcak et al.

that include comprehensive assessment measures of PTSD,

depressive disorders, onset of physical pain, and current

functional impairment.

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Anxiety sensitivity and depression: Mechanisms for understanding somatic complaints in veterans with posttraumatic stress disorder