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: 21.81). 02/2003; 54(1):229-52. DOI: 10.1146/annurev.psych.54.101601.145112
Source: PubMed


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.

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    • "Based on this research, definitions of PTSD (reviewed below) have evolved over time: many have advocated for a more inclusive definition of trauma (e.g., Avina and O'Donohue, 2002;Butts, 2002) that encompasses both extreme events that are traditionally viewed as traumatic (e.g., combat, interpersonal violence) and events that are traditionally viewed as stressful life events (e.g., sexual harassment, divorce, chronic illness, racial discrimination; seeRosen & Lillienfeld, 2008for a review). Others have advocated for a more restrictive definition (McNally, 2003;Rosen, 2004), and/or for completely eliminating the need to objectively define a traumatic event (Brewin, Lanius, Novac, Schnyder, & Galea, 2009). To some extent, this is a question of deciding on the purpose of the criterion: whether to capture all events that may precipitate PTSD, thus capturing more individuals who may be eligible for PTSD-related treatment or services, or whether to be more restrictive so as to capture only those with the most severe cases (Kilpatrick, Resnick, & Acierno, 2009). "
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    ABSTRACT: Experts have long debated how to define the PTSD traumatic stressor criterion. Prior research demonstrates that PTSD symptoms (PTSS) sometimes stem from events that do not meet the DSM requirements for Criterion A (e.g., divorce, bereavement, illness). This meta-analysis of 22 studies examined whether PTSS differ for DSM-congruent criterion A1 traumatic events vs. DSM-incongruent events. The overall effect was significant, albeit small, suggesting that PTSS were greater for individuals who experienced a DSM-congruent event; heterogeneity analyses also indicated further exploration. Two significant moderators emerged: assessment of both A1 and A2 (vs. A1 alone) yielded a significant effect for higher PTSS following traumas vs. stressors. Likewise, self-report assessment of life threat (Criterion A1)—vs. rater or a priori assessment of A1—yielded a significant effect for higher PTSS following traumas. Our results indicate that higher levels of PTSS develop following traumas, and highlight important methodological moderators that may affect this relationship.
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    • "As the trauma literature has matured, many research groups have noted that trauma is not easily defined by a specific event, such as an earthquake, fire, or assault (Berger et al., 2012; Kilpatrick et al., 2013). Similarly, several research groups have criticized the definition based on distress alone (Rosen, 2004; McNally, 2003), arguing that those responding with Posttraumatic Stress Disorder (PTSD) like symptoms to a minor event are a separate group and should not be considered " traumatized. " A strong theme in trauma definition work in recent years has been the role of meaning, going back to Freud's definition of trauma as being in excess of the ego's ability to cope. "
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    ABSTRACT: Information Deprivation Trauma (IDT; Schild & Dalenberg, 2012b) is a concept that has not been adequately addressed in the trauma literature. IDT is a concept requiring a negative emotional response (e.g., fear, helplessness, horror) consequent to (a) a lack of understanding of the extent/magnitude/consequences/probability of a current or impending meaningful event and (b) an inability to access information about this event that would reasonably allow a person to prepare, appropriately respond, and/or self-protect. Arguments are presented that information deprivation itself may constitute a trauma, in addition to and apart from the possibility that information deprivation may enhance vulnerability to traumatization. Clinical examples are provided and the Information Deprivation Trauma Interview (IDTI) is introduced for use in clinical and research settings.
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    • "cesses that produce sensory details that are not well integrated conceptually (e.g., Brewin, Dalgleish, & Joseph, 1996; Ehlers & Clark, 2000; Horowitz, 1976; for reviews from various perspectives , see Brewin & Holmes, 2003; Dalgleish, 2004; McNally, 2003a, b; Porter & Birt, 2001; and Shobe & Kihlstrom, 1997). According to an alternative view, incoherence can be understood in terms of cognitive and affective processes that have been developed to account for memory in general. "
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    ABSTRACT: We examined the coherence of trauma memories in a trauma-exposed community sample of 30 adults with and 30 without posttraumatic stress disorder. The groups had similar categories of traumas and were matched on multiple factors that could affect the coherence of memories. We compared the transcribed oral trauma memories of participants with their most important and most positive memories. A comprehensive set of 28 measures of coherence including 3 ratings by the participants, 7 ratings by outside raters, and 18 computer-scored measures, provided a variety of approaches to defining and measuring coherence. A multivariate analysis of variance indicated differences in coherence among the trauma, important, and positive memories, but not between the diagnostic groups or their interaction with these memory types. Most differences were small in magnitude; in some cases, the trauma memories were more, rather than less, coherent than the control memories. Where differences existed, the results agreed with the existing literature, suggesting that factors other than the incoherence of trauma memories are most likely to be central to the maintenance of posttraumatic stress disorder and thus its treatment. (PsycINFO Database Record
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