Progress and controversy in the study of posttraumatic stress disorder.

Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, Massachusetts 02138, USA.
Annual Review of Psychology (Impact Factor: 20.53). 02/2003; 54:229-52. DOI: 10.1146/annurev.psych.54.101601.145112
Source: PubMed

ABSTRACT Research on posttraumatic stress disorder (PTSD) has been notable for controversy as well as progress. This article concerns the evidence bearing on the most contentious issues in the field of traumatic stress: broadening of the definition of trauma, problems with the dose-response model of PTSD, distortion in the recollection of trauma, concerns about "phony combat vets," psychologically toxic guilt as a traumatic stressor, risk factors for PTSD, possible brain-damaging effects of stress hormones, recovered memories of childhood sexual abuse, and the politics of trauma.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The validity of applying the construct of post-traumatic stress disorder (PTSD) across cultures has been the subject of contention. Although PTSD symptoms have been identified across multiple cultures, questions remain whether the constellation represents a coherent construct with an interpretable factor structure across diverse populations, especially those naïve to western notions of mental disorder. An important additional question is whether a constellation of Complex-PTSD (C-PTSD) can be identified and if so, whether there are distinctions between that disorder and core PTSD in patterns of antecedent traumatic events. Our study amongst West Papuan refugees in Papua New Guinea (PNG) aimed to examine the factorial structure of PTSD based on the DSM-IV, DSM-5, ICD-10 and ICD-11 definitions, and C-PTSD according to proposed ICD-11 criteria. We also investigated domains of traumatic events (TEs) and broader psychosocial effects of conflict (sense of safety and injustice) associated with the factorial structures identified. Culturally adapted measures were applied to assess exposure to conflict-related traumatic events (TEs), refugees' sense of safety and justice, and symptoms of PTSD and C-PTSD amongst 230 West Papuan refugees residing in Port Morseby, PNG. Confirmatory factor analysis (CFA) supported a unitary construct of both ICD-10 and ICD-11 PTSD, comprising the conventional symptom subdomains of intrusion, avoidance, and hyperarousal. In contrast, CFA did not identify a unitary construct underlying C-PTSD. The interaction of witnessing murders and sense of injustice was associated with both the intrusion and avoidance domains of PTSD, but not with the unique symptom clusters characterizing C-PTSD. Our findings support the ICD PTSD construct and its three-factor structure in this transcultural refugee population. Traumatic experiences of witnessing murder associated with a sense of injustice were specifically related to the intrusion and avoidance domains of PTSD. The unitary nature of C-PTSD across cultures remains in question.
    BMC Psychiatry 05/2015; 15(1):111. DOI:10.1186/s12888-015-0480-3 · 2.24 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Maltreatment in childhood is associated with a significantly increased likelihood of psychiatric disorder that endures across the life span. If disorders emerge they tend to be more severe and less responsive to treatment. We introduce the concept of latent vulnerability as a way of conceptualizing the nature of this psychiatric risk. We argue that vulnerability to mental health problems can be understood as changes in a suite of neurocognitive systems that reflect adaptation or altered calibration to early neglectful or maltreating environments. Altered threat processing is presented as one exemplar candidate system. Heightened neurocognitive vigilance to threat is argued to reflect a calibration to an early at-risk environment that becomes maladaptive (and instantiates vulnerability) in the longer term. Other neurocognitive domains, including reward and memory processing, represent equally promising candidates for indexing latent vulnerability and warrant future enquiry. We suggest that the operationalization of latent vulnerability has the potential to guide a preventative psychiatry approach. Intervention currently occurs at two stages when maltreatment is confirmed: first, by addressing issues of risk; and second, by providing clinical intervention if a child meets criteria for psychiatric disorder. We argue that indexing latent vulnerability represents a third intervention opportunity, with the potential to target an indicated prevention approach for the most vulnerable children, offsetting risk trajectories before psychiatric disorders emerge.
    Development and Psychopathology 05/2015; 27(02):493-505. DOI:10.1017/S0954579415000115 · 4.89 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The study examined posttraumatic growth, resilience and PTSD among a random sample of 426 (mean age: 35 years; 51.6% females) Congolese refugees resident at Nakivale camp, using a cross-sectional survey. Interviews were conducted using the Posttraumatic Growth Inventory, Connor-Davidson Resilience Scale, and Posttraumatic Diagnostic Survey. Prevalence of PTSD was 61.7%, with 58.6% female reporting PTSD. Female gender, low education level, and trauma load were significant predictors of PTSD. The regression model accounted for 12.2 percent of the variance in PTSD. Resilience, posttraumatic growth, number of displacements and trauma load were significant predictors accounting for 6.1 percent of the variance in PTSD symptom severity. There were no significant differences in the resilience and posttraumatic growth of refugees with and without PTSD. The high prevalence of PTSD is partly explained by risk factors including trauma load. Our findings also point to the protective role of resilience and posttraumatic growth among refugees.
    Procedia - Social and Behavioral Sciences 07/2013; 82. DOI:10.1016/j.sbspro.2013.06.238


Available from