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Temporal relationships were examined among four PTSD symptom clusters (reexperiencing, avoidance, emotional numbing, and hyperarousal) with particular attention to the influence of hyperarousal. Multilevel cross\u2010lagged random coefficients autoregression for intensive time series data analyses were used to model symptom fluctuation decades after combat experiences. As anticipated, hyperarousal predicted subsequent fluctuations in the 3 other PTSD symptom clusters (reexperiencing, avoidance, emotional numbing) at subsequent 2\u2010week intervals (<jats:italic>r<\/jats:italic>s = .45, .36, and .40, respectively). Additionally, emotional numbing influenced later reexperiencing and avoidance, and reexperiencing influenced later hyperarousal (<jats:italic>r<\/jats:italic>s = .44, .40, and .34, respectively). These findings underscore the important influence of hyperarousal. Furthermore, results indicate a bidirectional relationship between hyperarousal and reexperiencing as well as a possible chaining of symptoms (hyperarousal \u2192 emotional numbing \u2192 reexperiencing \u2192 hyperarousal) and establish potential internal, intrapersonal mechanisms for the maintenance of persistent PTSD symptoms. Results suggested that clinical interventions targeting hyperarousal and emotional numbing symptoms may hold promise for PTSD of long duration.<\/jats:p>","DOI":"10.1002\/jts.22039","type":"journal-article","created":{"date-parts":[[2015,9,14]],"date-time":"2015-09-14T22:04:33Z","timestamp":1442268273000},"page":"410-417","source":"Crossref","is-referenced-by-count":47,"title":["Temporal Associations Among Chronic PTSD Symptoms in U.S. Combat Veterans"],"prefix":"10.1002","volume":"28","author":[{"given":"Susan","family":"Doron\u2010LaMarca","sequence":"first","affiliation":[{"name":"Behavioral Science Division National Center for PTSD VA Boston Healthcare System and Boston University School of Medicine  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara L.","family":"Niles","sequence":"additional","affiliation":[{"name":"Behavioral Science Division National Center for PTSD VA Boston Healthcare System and Boston University School of Medicine  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel W.","family":"King","sequence":"additional","affiliation":[{"name":"National Center for PTSD VA Boston Healthcare System Department of Psychology Boston University and Department of Psychiatry Boston University School of Medicine  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynda A.","family":"King","sequence":"additional","affiliation":[{"name":"National Center for PTSD VA Boston Healthcare System Department of Psychology Boston University and Department of Psychiatry Boston University School of Medicine  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anica","family":"Pless\u00a0Kaiser","sequence":"additional","affiliation":[{"name":"Behavioral Science Division National Center for PTSD VA Boston Healthcare System and Boston University School of Medicine  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Lyons","sequence":"additional","affiliation":[{"name":"Department of Psychological and Brain Sciences Boston University  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,9,14]]},"reference":[{"key":"e_1_2_5_2_1","unstructured":"Abt Associates. 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