Article

The stressor criterion in DSM-IV Posttraumatic Stress Disorder: An empirical investigation

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Abstract

The DSM-IV two-part definition of posttraumatic stress disorder (PTSD) widened the variety of stressors (A1) and added a subjective component (A2). The effects of the revised stressor criterion on estimates of exposure and PTSD in a community sample are evaluated. A representative sample of 2181 persons in southeast Michigan were interviewed about lifetime history of traumatic events and PTSD. The evaluation of the revised two-part definition is based on a randomly selected sample of events that represents the total pool of traumatic events experienced in the community. The enlarged definition of stressors in A1 increased the total number of events that can be used to diagnose PTSD by 59%. The majority of A1 events (76.6%) involved the emotional response in A2. Females were more likely than males to endorse A2 (adjusted odds ratio = 2.66; 95% confidence interval 1.92, 3.71). Of all PTSD cases resulting from the representative sample of events, 38% were attributable to the expansion of qualifying events in A1. The identification of exposures that lead to PTSD were not improved materially by A2 however, events that did not involve A2 rarely resulted in PTSD. Compared to previous definitions, the wider variety of stressors in A1 markedly increased the number of events experienced in the community that can be used to diagnose PTSD. Furthermore, A2 might be useful as a separate criterion, an acute response necessary for the emergence of PTSD, and might serve as an early screen for identifying a subset of recently exposed persons at virtually no risk for PTSD. The utility of A2 as a screen must be tested prospectively.

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... Acute: if duration of symptoms is less than three months Chronic: if duration of symptoms is three months or more With delay onset: if onset of symptoms at least six months after the stressor More recent research has started to look at the limitations of trauma definition of DSM-IV. Gold et al. (2005) criterion is an established predictor of PTSD (Breslau & Kessler, 2001), there is also theoretical and empirical support for the importance of A2 criterion. ...
... Overall, 95 participants (50.7%) met the criterion A for PTSD. In the DSM-IV (APA, 2000), the definition of a traumatic event consists of two components: (1) Exposure to a catastrophic event (the A1 criterion); and (2) Although A1 criterion is an established predictor of PTSD (Breslau & Kessler, 2001), there is also theoretical and empirical support for the importance of A2 criterion. In a recent study, Boals and Schuettler (2009) Ortman (2009) defined the experience of offended partners as helplessness in her recent book named "Transcending post-infidelity stress disorder". ...
... DSM-IV"de (APA, 2000) travmatik bir olayın iki komponenti tanımlanmıĢtır: (1) katastrofik bir olaya maruz kalma (A1 kriteri); ve (2) Maruz kalma nedeniyle duygusal sıkıntı (A2 kriteri). A1 kriteri TSSB"nin belirleyicisi olduğu belirtilmesine karĢın(Breslau & Kessler, 2001), teorik ve ampirik destek daha çok A2 kriterinin önemi üzerinedir. Son zamanlardaki araĢtırmalar, DSM-IV travma tanımının sınırlılıklarını tartıĢmaya baĢlamıĢlardır. ...
Thesis
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Extramarital infidelity (EMI) occurs with high frequency and produces penetrating consequences for individuals and couples. EMI has been studied as an interpersonal trauma in the couples’ life. The aims of the present study are to examine the traumatic effects of EMI on the offended partners as well as to find out the predictors (coping strategies, conservation of resources, and forgiveness stages) of the severity of PTSD. The participants of the study consisted of 189 married women who had continued their marriage after discovery of partners’ EMI. EMI was defined with one item measure with the six-point continuum starting from “entirely sexual” to “entirely emotional” involvement. The instruments of the: Post-Traumatic Stress Disorder Symptom Scale-Self Report (PSS-SR), Ways of Coping Inventory (WCI), The Conservation of Resources Evaluation (COR-E), and Forgiveness Inventory (FI: its reliability and validity study was completed for the present study). Descriptive statistics, Pearson correlation coefficients, a one-way between subjects multivariate analysis of covariance (MANCOVA), and hierarchical multiple regression analyses were conducted as statistical methods. Although EMI is a traumatic event that was not consist with the DSM-IV, the results of the present study revealed that 34.4% of participants completed the whole DSM-IV criteria for PTSD. More specifically, the rates of participants who met the criteria were: 50.7% A (stressor), 97.9% B (intrusive recollection), 85.2% C (avoidant/numbing), 91.0% D (hyper-arousal), 93.1% E (duration), 85.7% F (functional significance). In addition, results of the present study showed: Coping; problem-focused group had lower PTSD than emotion-focused coping groups, Resource; a resource loss group had higher PTSD than resource gain group, and Forgiveness; stage I-impact group showed the highest PTSD whereas the stage III-recovery group showed the lowest PTSD. Furthermore, the final model of regression analyses revealed the predictors of PTSD total symptom severity as emotion-focused coping, problem-focused coping, resource gain, and stage I-impact, and these variables explained 46 % of the total variance. The results were discussed in accordance with the relevant literature.
... Subsequently, DSM IV and DSM IV-TR ushered in a more inclusive definition of trauma (including varied events such as car accidents, natural disasters, or learning about the death of a loved one) that resulted in a marked expansion in trauma-related diagnoses [2,6]. Contemporary theory conceptualizes trauma and responses to it as occurring along a continuum [2,6]. ...
... Subsequently, DSM IV and DSM IV-TR ushered in a more inclusive definition of trauma (including varied events such as car accidents, natural disasters, or learning about the death of a loved one) that resulted in a marked expansion in trauma-related diagnoses [2,6]. Contemporary theory conceptualizes trauma and responses to it as occurring along a continuum [2,6]. It is clear that not all persons exposed to even highly traumatic events will go on to develop PTSD [7]; nonetheless, the experience of that trauma can still have a lasting impact on that individual. ...
Chapter
This chapter will provide critical background on interpersonal trauma, how it became conceptualized as a harmful exposure and public health issue, and a discussion of the landmark Adverse Childhood Experiences, which illustrates the impact on health of early traumatic exposures. Next, we include a brief overview of the proposed pathways and mechanisms through which trauma results in poor health and health disparities. Interpersonal trauma may result in posttraumatic stress disorder which is a known mediator of adverse health effects. Next, the definitions, nature and prevalence of some common examples of interpersonal trauma are reviewed; these include childhood maltreatment, intimate partner violence, sexual assault, community violence, human trafficking, and historical trauma. This chapter identifies the ubiquitous nature of traumatic experiences and lays the ground work for clinicians and healthcare systems to better understand the need for trauma-informed care and the role it can play in promoting health and healing for individuals and communities.
... Our finding that both witnessed and non-witnessed overdose can precipitate changes in drug use behaviors that increase risk of overdose is consistent with prior research that direct and indirect exposure to a traumatic event can lead to PTSD symptoms ( Breslau & Kessler, 2001 ;May & Wisco, 2016 ;Weathers & Keane, 2007 ), and has important implications for network-based overdose prevention interventions. Earlier research has documented that witnessing a greater number of overdoses is associated with greater overdose risk ( Bohnert et al., 2012 ;Havens et al., 2011 ;Man et al., 2002 ). ...
... However, we also found that indirect exposure to overdose (i.e., learning about an overdose without directly witnessing the event) was followed by increased engagement in drug use practices that increased risk of overdose for some participants, particularly when the individual who overdosed was someone emotionally close to the participant. Previous research has documented that learning about the accidental or violent death of a loved one, such as a close friend or family member, can result in PTSD ( Breslau & Kessler, 2001 ;May & Wisco, 2016 ;Weathers & Keane, 2007 ). While the probability of developing PTSD from indirect exposure is lower than that from direct exposure ( May & Wisco, 2016 ), our finding that indirect exposure to overdose can precipitate negative emotional affect and increased drug use for some individuals is supported by this previous research. ...
Article
Background Scant research has examined the influence of overdoses occurring in social networks (i.e., knowing someone who has overdosed) on individual overdose risk. We sought to characterize drug use behaviors of individuals following the overdose of someone in their social network. Methods We conducted semi-structured interviews with 25 people who use drugs and knew someone who overdosed in the prior 90 days. All interviews were conducted in person in Rhode Island from July to October 2021. Data were stratified by drug use behaviors following the overdose of a network member (i.e., risk behaviors, protective behaviors, no change; selected a priori) and analyzed using a thematic analysis variation to identify salient themes. Results We identified variation in the effect of knowing someone who overdosed on subsequent drug use behaviors and emotional affect. Several participants described increasing their drug use or using more types of drugs than usual to manage feelings of bereavement and trauma, and a subset of these participants described increased drug use with suicidal intention and increased suicidal ideations following the overdose event. Other participants described reducing their drug use and engaging in protective behaviors in response to heightened perceived overdose risk, protection motivation (i.e., increased motivation to protect oneself), and concern for others. Additionally, some participants reported no change in drug use behaviors, and these participants described already engaging in harm reduction practices, feeling desensitized due to frequent or repeated exposure to overdose, and ambivalence about living. Conclusions Findings suggest a need for enhanced investment in network-based overdose prevention interventions, as well as more robust integration of bereavement support and mental health services in settings that serve people who use drugs. The findings also suggest a need for future research to identify mediators of the effect of overdose occurring in social networks on individual overdose risk.
... Subsequently, DSM IV and DSM IV-TR ushered in a more inclusive definition of trauma (including varied events such as car accidents, natural disasters, or learning about the death of a loved one) that resulted in a marked expansion in trauma-related diagnoses [2,6]. Contemporary theory conceptualizes trauma and responses to it as occurring along a continuum [2,6]. ...
... Subsequently, DSM IV and DSM IV-TR ushered in a more inclusive definition of trauma (including varied events such as car accidents, natural disasters, or learning about the death of a loved one) that resulted in a marked expansion in trauma-related diagnoses [2,6]. Contemporary theory conceptualizes trauma and responses to it as occurring along a continuum [2,6]. It is clear that not all persons exposed to even highly traumatic events will go on to develop PTSD [7]; nonetheless, the experience of that trauma can still have a lasting impact on that individual. ...
... Post-traumatic stress disorder (PTSD) is a debilitating disorder that occurs after being exposed to one or multiple traumatic events. Clinical studies have highlighted that only a minority of trauma-exposed individuals develop PTSD (Kessler et al., 1995;Chilcoat and Breslau, 1998;Breslau and Kessler, 2001). Like humans, laboratory mice (Lebow et al., 2012;Sillivan et al., 2017) and rats (Elharrar et al., 2013;Toledano and Gisquet-Verrier, 2014) also display a great heterogeneity in their response to trauma exposure, with some animals developing PTSD-like (or stress) behaviors, while others displaying less symptoms or remaining symptom-free. ...
Article
Post-traumatic stress disorder (PTSD) is triggered by exposure to traumatic events, but not everyone who experiences trauma develops this disorder. Like humans, PTSD-like symptoms develop in some laboratory rodents (susceptible individuals), while others express less or no symptoms (resilient individuals). Here, considering (i) the putative causal role of fear conditioning in PTSD development and (ii) the involvement of the medial prefrontal cortex (mPFC) in the regulation of conditioned fear response, we tested whether trauma-associated changes in the mPFC may discriminate stress-resilient from stress-susceptible mice. From data on avoidance behavior (as a major symptom), we found that trauma-exposed mice displayed a bimodal distribution in their step-through latency, with low avoider (stress-resilient) individuals and high avoider (stress-susceptible) individuals. Dendrites of Golgi–Cox-stained neurons were analyzed in two parts of the mPFC: the prelimbic (PrL) and infralimbic (IL) areas. In the resilient phenotype, the total number of dendrites decreased in the PrL and increased in the IL; however, it decreased only in the IL in the susceptible phenotype compared to controls. These findings demonstrate that the type of post-trauma morphological changes in the mPFC is associated with susceptibility or resilience to trauma related symptoms
... First, women were more likely to experience emotional responses such as fear, helplessness, or horror, than men. 16 Of 49 articles on disaster studies, 46 (96%) found that women experienced more stress after a disaster than men. 17 Similar gender differences in posttraumatic stress disorder (PTSD) were observed in a previous study of the GEJE, 18 suggesting a possible mechanism in this study. ...
Article
Objectives Experience of a major disaster can potentially impact on tobacco consumption. Our objective was to explore the determinants of increasing tobacco consumption after the Great East Japan Earthquake (GEJE). Methods We conducted a cross-sectional study using data from the Miyagi Prefectural Health Survey 2014: a total of 2632 people were randomly selected from residents aged ≥20 years in Miyagi, Japan. Of 2443 respondents (response rate = 92.8%), 551 current smokers (411 men) were included in the analysis. Odds ratios (OR) and 95% confidence interval (CI) for increasing tobacco consumption were calculated using multivariable logistic regression models including variables of age, sex, disaster-related job status change, education status, self-rated health, and age at smoking initiation. Results After adjustments for all variables, significantly higher ORs for increasing tobacco consumption after the GEJE were observed in women (OR = 1.87; 95% CI = 1.10–3.15), 20–39 years old (OR = 5.18; 95% CI = 2.28–11.75), 40–59 years old (OR = 3.97; 95% CI = 1.76–8.94) and respondents who had lost their jobs (OR = 3.42; 95% CI = 1.06–11.05) than the counterpart categories. Conclusions This study found 3 determinants of increasing tobacco consumption after a major disaster: being a woman, being of working age, and experiencing disaster-related job loss.
... Exposure to trauma can lead to debilitating conditions such as post-traumatic stress disorder (PTSD). Most people in the general US population (90%) experience at least one traumatic event in their lifetime, and a substantial portion (9-12%) develop PTSD after trauma (1). However, PTSD is not the only potential deleterious outcome of experiencing trauma. ...
Article
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Exposure to trauma can lead to debilitating health conditions that are not effectively addressed by the current standard treatments, which include medication and psychotherapy. Mind-body practices such as yoga have demonstrated therapeutic efficacy in treating effects of traumatic stress but have primarily focused only on symptoms of post-traumatic stress disorder (PTSD) and on yoga programs that emphasize the physical exercise and postural aspects of yoga practice. The current study addresses additional measures of health and well-being that are relevant in trauma recovery, evaluating the impact of an 8-week individual yoga therapy intervention on symptoms related to cognition, emotion, relationships, pain, and physical health in fifteen adults with various traumatic stress histories. The yoga protocol used here does not focus on physical exercise or postures but on the relationship between the teacher and student and on empowering the student's agency over their own body and encouraging self-focus. We find support for the therapeutic efficacy of this type of yoga intervention for treating traumatized individuals, with significant improvements in five domains of functioning (cognitive, psychological, emotional, rel-ational, and physical). We conclude these benefits result from a combination of building a trusting, supportive relationship with the yoga teacher and from the practice itself in facilitating a mind-body connection that promotes trauma resilience and recovery.
... Trigger warnings may raise awareness of the struggles of trauma survivors but may also lead people to believe that trauma invariably undermines survivors' ability to cope with everyday stressors. In fact, most people who experience trauma are resilient, with acute posttraumatic symptoms markedly dissipating over time (Breslau & Kessler, 2001). ...
... In subsequent versions of the DSM, however, the committees found ''usual human experience'' difficult to define and rather asserted that trauma was possible if someone ''experienced, witnessed, or [were] confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others'' such that ''the person's response involved intense fear, helplessness or horror'' (Rosen, 2004, p. 3). As this broadened the diagnosis to those who witnessed the traumatic event of another person, studies found it increased the rate of exposure significantly across contexts (Breslau & Kessler, 2001;Schuster et al., 2001) and raised the concern that this diagnostic criterion was too broad (Rosen, 2004). More recently, the DSM-5 narrowed the qualifying traumatic event such that the expected death of a family member or close friend due to natural causes was no longer included-reducing the number of individuals who met the diagnostic criteria (Kilpatrick et al., 2013). ...
Article
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The symptomatology for Post-Traumatic Stress Disorder (PTSD) narrowly focuses on particular diagnostic frames and a single triggering event. Such narrow definitions of trauma and recovery have been heavily critiqued by anthropologists and cultural psychiatrists for overlooking cultural complexity as well as the effects of multiple and overlapping events that may cause someone to become “traumatized” and thereby affect recovery. This article investigates how subjective reporting of traumatic experience in life history narratives relates to depressive and PTSD symptomatology, cultural idioms, and repeated traumatic experiences among low-income Mexican immigrant women in Chicago. We interviewed 121 Mexican immigrant women and collected life history narratives and psychiatric scales for depression and PTSD. Most women spoke of the detrimental effects of repeated traumatic experiences, reported depressive (49%) and PTSD (38%) symptoms, and described these experiences through cultural idioms. These data complicate the PTSD diagnosis as a discrete entity that occurs in relation to a single acute event. Most importantly, these findings reveal the importance of cumulative trauma and cultural idioms for the recognition of suffering and the limitation of diagnostic categories for identifying the needs of those who experience multiple social and psychological stressors.
... To measure traumatic experiences, the QPLC uses an adapted version of the survey of lifetime traumatic events originally developed by Breslau and Kessler (2001), including the extensions to measure the direct effect of traumatic experiences on people who lived in war-torn countries developed by Shmotkin and Litwin (2009). The survey asks respondents to recall if they have experienced any of 10 events that cover wartime injury or death, terrorism and experiences 3 The Leben-in-Deutschland test is given to individuals who seek either permanent residence or naturalization in Germany by the responsible authority and is made up of 33 questions. ...
... Though traumatic experiences are usually rare occasions for any individual, the experience of at least one such event in one's lifetime is not uncommon. Depending on exact criteria and country, estimates of the share of the general adult population who have experienced at least one traumatic event in their lifetime range from 29% in Bulgaria ( Benjet et al., 2016) and 40% in Chile (Pérez Benítez et al., 2009) to 85% in Ukraine ( Benjet et al., 2016) and 70-90% in the US ( Breslau & Kessler, 2001;Elliott, 1997;Kilpatrick et al., 2013). Based on the World Mental Health survey, Benjet et al. (2016) reported that a global average of 70% of adults have experienced a traumatic event and 30% four or more events. ...
Thesis
Background: For many who experience them, repeated traumatic events lead to chronic posttraumatic stress symptoms (PTSS). Forms of trauma-focused cognitive-behavioral therapy are able to treat PTSS among adults as well as children and adolescents. However, not all those suffering from PTSS benefit from such treatment. Availability and utilization of treatment are also significant problems both globally and in Finland. For further developing, better targeting, and effective implementation of treatments, it would be important to understand the underlying mechanisms of change by which they are able to reduce PTSS. Theories of posttraumatic stress disorder suggest two psychological mechanisms of change in particular to be key to treating PTSS: improvements in overly negative posttraumatic cognitions and the integration, contextualization, or normalization of traumatic memories. This dissertation examined the role of changes in negative posttraumatic cognitions and traumatic memories in two interventions aimed at children and adolescents traumatized by war or violence and evaluated the overall level of evidence available for different mechanisms of change in the treatment of PTSS. Additionally, with a randomized controlled trial, we studied the feasibility, acceptability, and effectiveness of narrative exposure therapy in the treatment of multiply traumatized children and adolescents within the Finnish healthcare system. Method: The empirical research in this dissertation is based on two sets of data. The first data set, collected from Gaza, Palestine, concerned 482 school-aged children randomized to take part in either a four-week group intervention, Teaching Recovery Techniques, or a waitlist. Using self-report measures, we collected information on the children’s experiences of war trauma, mental health, and posttraumatic cognitions before the intervention, during it, after it, and as follow-up six months later. The second data set concerned 50 children and adolescents 9–17 years of age living in Finland, who entered treatment at different healthcare units due to significant PTSS because of exposure to war or violence in the family. Half were randomized to receive narrative exposure therapy, while the rest received treatment as usual. Using mainly self-report measures, we collected information on their mental health, posttraumatic cognitions, and traumatic memories before and after treatment. In addition, the dissertation contains a systematic review collecting all available empirical evidence from randomized, controlled trials on the role of different mechanisms of change in psychological treatment of PTSS. Results: The Teaching Recovery Techniques group intervention was not able to change the posttraumatic cognitions of Gazan children significantly. Such changes did not act as its mechanism of change. This may also explain its limited effects on PTSS. High levels of PTSS and depressive symptoms predicted particularly severe, stable posttraumatic cognitions. Clinicians were able to implement narrative exposure therapy successfully in the treatment of multiply traumatized children and adolescents at different units within the Finnish healthcare system. Narrative exposure therapy was at least as effective in treating PTSS as treatment as usual. Some results suggested it was slightly more effective. Positive changes in posttraumatic cognitions and traumatic memories were both associated with amelioration of PTSS. However, we found no evidence of such changes acting as mechanisms of change specific to narrative exposure therapy. We found no evidence of overall significant changes in posttraumatic cognitions during treatment. Overall changes in traumatic memories were relatively small. The systematic review found evidence for the importance of changes in negative posttraumatic cognitions in several forms of treatment. Negative cognitions related to the self may be especially relevant. As of yet, there is next to no empirical evidence on changes in traumatic memories as a mechanism of change. Some preliminary findings suggest mindfulness-based interventions can reduce PTSS by increasing levels of dispositional mindfulness. The evidence for other specific mechanisms of change is still very limited and mixed. Conclusions: Exposure-based treatment is suitable for treatment of multiply traumatized children and adolescents within the Finnish healthcare system and does reduce PTSS. Changing the negative posttraumatic cognitions of children and adolescents traumatized by war and violence may be especially challenging. Still, it is a probable pathway to treating PTSS among them, as well. The effectiveness of group psychosocial interventions in reducing PTSS may be limited by their inability to affect posttraumatic cognitions. Changes in traumatic memories may be linked to recovery from PTSS, but evidence for such a link is still very limited.
... Symptoms include trauma-related intrusions, avoidance, negative mood and cognitions, and hyperarousal (American Psychiatric Association, 2013). Though trauma exposure is common (Breslau and Kessler, 2001), relatively few trauma-exposed individuals subsequently develop PTSD (Kessler et al., 2005), though risk varies by trauma type (Frans et al., 2005). This observation indicates vulnerability factors that predispose individuals to PTSD following trauma exposure, such as a genetic vulnerability that may be "unmasked" by acute stress. ...
Article
Posttraumatic stress disorder (PTSD) and insomnia are comorbid clinical conditions that are thought to result from genetic and environmental effects. Though studies have established the heritability of these disorders independently, no study to date has examined the genetic contributions to the relation between insomnia and PTSD symptoms (PTSS). The present study assessed this gap in the literature using a behavioral genetics approach to symptom dimensions. The sample consisted of 242 twin pairs who endorsed lifetime trauma exposure. Insomnia symptoms were assessed with the Women's Health Initiative Survey, and intrusion and avoidance PTSS were assessed with the Impact of Events Scale. Structural equation modeling was then employed to test the relative contributions of genetic, shared environmental, and nonshared environmental components to the relations between insomnia symptoms and intrusions and avoidance. Results indicated a significant association between insomnia symptoms and intrusions (r = 0.33, p < 0.01) and insomnia symptoms and avoidance (r = 0.20, p < 0.01), and 36-44% of phenotypic variance was accounted for by genetic contributions. These findings highlight a significant role for genetic factors in the mechanisms underlying the comorbidity between insomnia and PTSS. The implications for current etiological models of PTSD and insomnia are discussed.
... Interestingly, and due largely to the expanded definition of "trauma" (with the number of qualifying "traumatic events" increasing by 59% in the DSM-IV (Breslau & Kessler, 2001), the number of combinations of ways in which an individual could clinically meet the criteria for PTSD expanded from 135 (DSM-III) to 10,500 (DSM-IV). Not surprisingly, some took issue with this "bracket creep" phenomenon: ...
Article
The Department of Veterans Affairs (VA) faces a plethora of challenges as it daily encounters and treats veterans. With a great prevalence of co-occurring diagnoses, veterans’ needs today are significant and arguably more complex than ever before (Clark, Bair, Buckenmaier, Gironda & Walker, 2007; Phillips et al., 2016). The following two papers seek to build a justification for reconsidering how post-traumatic stress disorder (PTSD) is treated given the illness’ prevalence and the efficacy of current treatments. The first paper reviews the literature and includes: a chronology of the PTSD diagnosis; an examination of current treatments offered by the VA and consideration of their effectiveness; a discussion of current and alternative treatments offered for PTSD; and an exploration of therapeutic horticulture as a healing modality for veterans coping with PTSD. After reviewing the historical and theoretical foundation for this research, the second paper details a mixed method study designed to better understand the depth and breadth of therapeutic horticulture programs that have been operationalized at VA facilities. Using survey and interviews of VA personnel, the author elicited information about VA therapeutic horticulture programs and was able to deduce themes related to the genesis of programs, details of programs’ operationalization and facilitation, and the impact on veterans. The author concludes the study with recommendations for those VA facilities considering implementing a therapeutic horticulture program along with an appeal that the VA begins to more earnestly consider the increasing body of evidence concerning the efficacy of therapeutic horticulture.
... The term complex trauma is also used to describe the unique symptoms and sequelae that occur as a result of exposure to this type of trauma (Kliethermes et al. 2014). The often intentional and interpersonal nature of the trauma is recognized as contributing to the complexity of subsequent traumatic stress responses (Breslau & Kessler, 2001). Poly-victimization in childhood (Finkelhor et al. 2009) and re-victimization in adulthood (Widom et al. 2008) are common exposure patterns in complex trauma. ...
Article
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Translation and application of current complex trauma knowledge for high-risk groups such as the homeless is needed. Existing research in this area has been limited by lack of a cohesive theoretical framework that captures the dynamic and heterogeneous nature of complex trauma within the context of ecological vulnerability (e.g. homelessness). This paper aims to address these gaps by proposing an integrated resources perspective framework situating Layne and colleagues’ (Layne et al. 2009, 2010) concept of ‘risk factor caravans’ as central focus. We demonstrate how the ‘risk factor caravan’ representation captures current theoretical and clinical insights into the pervasive and enduring consequences of complex trauma exposure. Personal resources are highlighted as key for understanding resource loss and gain in the current context. Longitudinal person-centered approaches as integral methodological considerations for future application of this proposed framework are examined. Implications for reducing barriers to access of available support services are discussed.
... Department of Veterans Affairs 2015). Other studies report that about 5% of those exposed to a trauma develop clinically relevant PTSD (Breslau & Kessler 2001, Kessler et al. 1995. The lifetime prevalence of PTSD in the US general population is an estimated 7% One candidate gene that has been studied is Neuropeptide Y (NPY). ...
Article
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Background: Individuals who are exposed to traumatic events are at an increased risk of developing posttraumatic stress disorder (PTSD), a condition during which an individual's ability to function is impaired by emotional responses to memories of those events. The gene coding for neuropeptide Y (NPY) and the gene coding for brain-derived neurotrophic factor (BDNF) are among the number of candidate gene variants that have been identified as potential contributors to PTSD. The aim of this study was to investigate the association between NPY and BDNF and PTSD in individuals who experienced war-related trauma in the South Eastern Europe (SEE) conflicts (1991-1999). Subjects and methods: This study included participants with current and remitted PTSD and healthy volunteers (N=719, 232 females, 487 males), who were recruited between 2013 and 2015 within the framework of the South Eastern Europe (SEE) - PTSD Study. Psychometric methods comprised the Mini International Neuropsychiatric Interview (M.I.N.I.), the Clinician Administered PTSD Scale (CAPS), and the Brief Symptom Inventory (BSI). DNA was isolated from whole blood and genotyped for NPY rs5574 via PCR - RFLP and NPY rs16147 and BDNF rs6265 using the KASP assay. Results: Tests for deviation from Hardy-Weinberg equilibrium showed no significant results. Analyses at the categorical level yielded no associations between the affected individuals and all three SNPs when compared to controls. Within lifetime PTSD patients, the major alleles of both NPY variants showed a nominally significant association with higher CAPS scores (p=0.007 and p=0.02, respectively). Also, the major allele of rs5574C>T was associated with higher BSI scores with a nominal significance among current PTSD patients (p=0.047). The results did not withstand a Bonferroni adjustment (α=0.002). Conclusion: Nominally significant associations between NPY polymorphisms and PTSD susceptibility were found that did not withstand Bonferroni correction.
... The ID:p0090 impact of trauma exposure is cumulative in nature (Brewin, Andrews, & Valentine, 2000), with rates of mental health disorders among emergency service personnel increasing with age and each additional critical incident (Harvey et al., 2016). Evidence has shown that multiple previous trauma was a stronger predictor of the development of PTSD than a single previous trauma (Breslau & Kessler, 2001). The cumulative effects of prior traumas (i.e., first responders exposed to ongoing traumatic stress) may be associated with more severe emotional responses to the next trauma (Berninger et al., 2010). ...
Article
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This randomized controlled trial aimed to evaluate the effectiveness of the Eye Movement Desensitization and Reprocessing Protocol for Recent Critical Incidents and Ongoing Traumatic Stress (EMDR-PRECI) in reducing posttraumatic stress disorder (PTSD), anxiety, and depression symptoms related to the work of first responders on active duty. Participants were randomly assigned to two 60-minute individual treatment sessions ( N = 30) or to a no-treatment control condition ( N = 30). They completed pre-, post-, and follow-up measurements using the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders , fifth edition ( DSM-5 ) (PCL-5) and the Hospital Anxiety and Depression Scale (HADS). Data analysis by repeated measures analysis of variance (ANOVA) showed clear effects of the EMDR-PRECI in reducing PTSD work-related symptoms in the treatment group with symptom reduction maintained at 90-day follow-up with a large effect size ( d = 3.99), while participants continued to experience direct exposure to potentially traumatic work-related events during the follow-up period. Data analysis by repeated measures ANOVA revealed a significant interaction between time and group, F (2,116) = 153.83, p < .001, η P² = .726 for PTSD, and for anxiety F (1,58) = 37.40, p < .005, ηP2 = .090, but not for depression. A t-test showed a clear decrease for depression symptoms for the treatment group with statistically significant results. The study results suggest that the EMDR-PRECI could be an efficient and effective way to address first responders' work-related PTSD, anxiety and depression symptoms. Future research is recommended to replicate these results and to investigate if symptom improvement also results in the reduction of physical health symptoms and early retirement for PTSD-related reasons among first responders.
... Posttraumatic stress disorder (PTSD) is a disabling mental health condition that can develop after exposure to trauma, characterised by symptoms such as mood changes, intrusive memories, hyperarousal, and avoidance behaviour. Epidemiological studies estimate that about 75% of the population will experience at least one traumatic event during their lifetime (Breslau and Kessler, 2001), yet only a subset of individuals go on to develop PTSD. Several risk factors have been identified for the development of PTSD, which include socioeconomic and sociodemographic factors such as education level, employment, and marital status, in addition to a family history of psychiatric disorders and childhood trauma (Breslau, 1999;Breslau and Davis, 1992;Brewin et al., 2000). ...
Article
In this study we investigated genome-wide sperm DNA methylation patterns in trauma-exposed Vietnam veterans. At the genome-wide level, we identified 3 CpG sites associated with PTSD in sperm including two in-tergenic and one CpG within the CCDC88C gene. Of those associated with PTSD in sperm at a nominal level, 1868 CpGs were also associated with PTSD in peripheral blood (5.6% overlap) including the RORA, CRHR1 and DOCK2 genes that have been previously implicated in PTSD. A total of 10 CpG sites were significantly associated with a reported history of a diagnosed mental health condition in children and reached genome-wide significance. CpGs associated with a history of a reported mental health condition in children were also enriched (90% of tested genes) for genes previously reported to be resistant to demethylation, making them strong candidates for transgenerational inheritance. In conclusion, our findings identify a unique sperm-specific DNA methylation pattern that is associated with PTSD.
... Studies in line with this study like David F.Tolin et al, Lioyd et al, Xuetaly et al and Tebble N J et al (29,30,31,38) . A study of Andersen, Maksud et al (41) , Newell et al (42) Breslau and Kessler et al (33) suggested that gender can affect the patient vulnerability to develop (PTSD). Despite of the small size of females in some studies, researchers suggested that females are more prone to develop psychological disorders and this may be due to the biological variations between males and females, like hormones and genes (44) . ...
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Background: Human face is a vital component of every one's personality, and plays an important role in emotion and social communication. Undiagnosed psychological problems can potentially complicate physical recovery after trauma, and cause significant trauma co morbidity. This research studied the psychological factors (anxiety and depression) after maxillofacial trauma and correlates these factors with the demographic data. Methodology: A descriptive cross sectional study for trauma patients attended at Khartoum teaching dental hospital (KTDH) during the period from 15/12/2017 to 15/9/2018. The study was achieved using the HADS questionnaire. Results: Of 81 trauma patients attended at (KTDH), 79% of them were males, mean age of the sample (31.7±12.4 SD) years, median was 30 years. 60% of the samples were singles, 68% were employed, Different educational levels were observed, and 8.6% of the patients had anxiety while 13.6% reported with depression. Conclusion: The study concluded that psychological problems (anxiety and depression) are frequent following maxillofacial trauma, and require early diagnosis and management so as to promote physical recovery and reduce the trauma co morbidity.
... Lastly, our current data add to a growing body of evidence showing that stress affects the male and female brain differently (Bangasser and Wicks 2017;Farrell et al. 2015), an area of research with clear clinical implications. Because stress-related mental illnesses differ in both prevalence and symptomatology in men and women (Breslau and Kessler 2001), a better understanding of the situational and neurobiological factors that determine long-term outcomes in both sexes will be critical to progress in improving therapeutic and interventional strategies. ...
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Actual or perceived behavioral control during a traumatic event can promote resilience against future adversity, but the long-term cellular and circuit mechanisms by which this protection is conferred have not been identified. Clinical outcomes following trauma exposure differ in men and women, and, therefore, it is especially important in preclinical research to dissect these processes in both males and females. In male adult rats, an experience with behavioral control over tail shock (“escapable stress”, ES) has been shown to block the neurochemical and behavioral outcomes produced by later uncontrollable tail shock (“inescapable stress”, IS), a phenomenon termed “behavioral immunization”. Here, we determined whether behavioral immunization is present in females. Unlike males, the stress-buffering effects of behavioral control were absent in female rats. We next examined the effects of ES and IS on spine morphology of dorsal raphe nucleus (DRN)–projecting prelimbic (PL) neurons, a circuit critical to the immunizing effects of ES in males. In males, IS elicited broad, non-specific alterations in PL spine size, while ES elicited PL–DRN circuit-specific spine changes. In contrast, females exhibited broad, non-specific spine enlargement after ES but only minor alterations after IS. These data provide evidence for a circuit-specific mechanism of structural plasticity that could underlie sexual divergence in the protective effects of behavioral control.
... Additionally, while we acknowledge differential impacts of direct vs. indirect trauma exposure on psychopathology (Kim et al., 2009), other trauma characteristics beyond type/count such as age of exposure (Dunn, Nishimi, Powers, & Bradley, 2017) and trauma appraisal (Kucharska, 2017) may have additional variance in explaining relations of PTE type clusters to psychopathology. Lastly, we acknowledge concerns regarding the definition and measurement of PTSD DSM-5 Criterion A. Criterion A has been controversial since its inception (Breslau & Kessler, 2001;Kilpatrick, Resnick, & Acierno, 2009), resulting in several revisions across DSM versions. For DSM-5, significant revisions including the removal of the subjective component to the definition of trauma and broadening the definition of trauma to include PTEs experienced as part of one's job (American Psychiatric Association, 2013;Brewin, Lanius, Novac, Schnyder, & Galea, 2009). ...
Article
Experiences of potentially traumatic events (PTE), commonly assessed with the Life Events Checklist for DSM-5 (LEC-5), can be both varied in pattern and type. An understanding of LEC-assessed PTE type clusters and their relation to psychopathology can enhance research feasibility (e.g., address low base rates for certain PTE types), research communication/comparisons via the use of common terminology, and nuanced trauma assessments/treatments. To this point, the current study examined (1) clusters of PTE types assessed by the LEC-5; and (2) differential relations of these PTE type clusters to mental health correlates (i.e., posttraumatic stress disorder [PTSD] severity, depression severity, emotion dysregulation, reckless and self-destructive behaviors [RSDBs]). A trauma-exposed community sample of 408 participants was recruited via Amazon's Mechanical Turk (M age = 35.90 years; 56.50% female). Network analyses indicated three PTE type clusters: Accidental/Injury Traumas (LEC-5 items 1, 2, 3, 4, 12), Victimization Traumas (LEC-5 items 6, 8, 9), and Predominant Death Threat Traumas (LEC-5 items 5, 7, 10, 11, 13-16). Multiple regression analyses indicated that the Victimization Trauma Cluster significantly predicted PTSD severity (β = .23, p <.001), depression severity (β = .20, p =.001), and negative emotion dysregulation (β = .22, p <.001); and the Predominant Death Threat Trauma Cluster significantly predicted engagement in RSDBs (β = 31, p <.001) and positive emotion dysregulation (β = .26, p <.001), accounting for the influence of other PTE Clusters. Results support three PTE type classifications assessed by the LEC-5, with important clinical and research implications.
... A range of non-Criterion A events have been reported to trigger the development of PTSD symptoms [Rosen & Lilienfeld, 2008;Scott & Stradling, 1994]. Such as, learning of the sudden unexpected death of a close relative or friend [Breslau & Kessler, 2001], or cumulative and prolonged stress from bullying or harassment [Nielsen, Tangen, Idsoe, Matthiesen, & MogerØy, 2015;Pathe & Mullen, 1997]. Furthermore, it has been posited that PTSD symptoms may be more easily triggered by lower intensity non-Criterion A traumas in individuals with heightened stress reactivity [Brewin et al., 2009] or altered perceptual experiences such as psychosis, other delusional states, and ASD [Brewin, Rumball, & Happé, 2019]. ...
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Research to date suggests that individuals with autistic spectrum disorder (ASD) may be at increased risk of developing post‐traumatic stress disorder (PTSD) following exposure to traumatic life events. It has been posited that characteristics of ASD may affect perceptions of trauma, with a wider range of life events acting as possible catalysts for PTSD development. This study set out to explore the nature of “trauma” for adults with ASD and the rates of self‐reported PTSD symptomatology following DSM‐5 and non‐DSM‐5 traumas—the latter being defined as those that would not meet the standard DSM‐5 PTSD trauma Criterion A. Fifty‐nine adults with ASD who reported exposure to traumatic events took part in the study, which involved completing a series of online questionnaires. Thirty‐three individuals reported experiencing a “DSM‐5” traumatic event (i.e., an event meeting DSM‐5 PTSD Criterion A) and 35 reported a “non‐DSM‐5” traumautic event. Trauma‐exposed ASD adults were found to be at increased risk of PTSD development, compared to previous general population statistics, with PTSD symptom scores crossing thresholds suggestive of probable PTSD diagnosis for more than 40% of ASD individuals following DSM‐5 or non‐DSM‐5 traumas. A broader range of life events appear to be experienced as traumatic and may act as a catalyst for PTSD development in adults with ASD. Assessment of trauma and PTSD symptomatology should consider possible non‐DSM‐5 traumas in this population, and PTSD diagnosis and treatment should not be withheld simply due to the atypicality of the experienced traumatic event. Lay Summary This study explored the experience of trauma and rates of probable post‐traumatic stress disorder (PTSD) in adults with autistic spectrum disorder (ASD). We asked 59 autistic adults to complete online questionnaires about their experiences of stressful or traumatic events and related mental health difficulties. Autistic adults experienced a wide range of life events as traumatic, with over 40% showing probable PTSD within the last month and over 60% reporting probable PTSD at some point in their lifetime. Many of the life events experienced as traumas would not be recognized in some current diagnostic systems, raising concerns that autistic people may not receive the help they need for likely PTSD.
... The DSM-5 (APA, 2013) revision of Criterion A again significantly modified the definition of trauma by eliminating the ambiguous expression "threat to physical health" from Criterion A1 and the emotional component of Criterion A2. The choice to eliminate the subjective, emotional component of Criterion A relies on conflicting evidence about its ability to improve the diagnostic accuracy of PTSD (Bedard-Gilligan & Zoellner, 2008;Breslau & Kessler, 2001;Karam et al., 2010). Further, the elimination of Criterion A2 and the shift of PTSD syndrome from the anxiety disorders chapter into the new trauma and stressor-related disorders chapter also reflect a change in the theoretical conceptualization of the disorder. ...
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The aim of this article is to introduce the reader to how control-mastery theory (CMT; Gazzillo, 2016; Silberschatz, 2005; Weiss, 1993), an integrative relational cognitive-dynamic theory of mental functioning, psychopathology, and psychotherapeutic process, understands traumas, their consequences, and their mastery. In the first part of this article, we will present an overview of the debate about the definition of trauma within the different editions of the Diagnostic and Statistical Manual of Mental Disorders. Then, we will focus on the concept of complex traumas and on their consequences on mental health. Finally, we will discuss how CMT conceptualizes traumas and their pathological consequences. We will stress in particular how, according to CMT, in order for a painful experience to become a trauma, its victim has to come to believe that s/he caused it in the attempt to pursue a healthy and adaptive goal. In order to master traumas and disprove the pathogenic beliefs developed from them, people attempt to reexperience situations similar to the traumatic ones in safer conditions while giving them happier endings.
... PTSD is conceptualized and categorized as a trauma-related disorder. It is a conditional diagnosis specifically requiring the experience of trauma as defined in criterion A [2,[31][32][33][34][35][36]. If the traumatic event is interpreted to be causal of the disorder, then the criteria for this diagnosis represent an exception to the general agnostic and atheoretical approach to diagnosis in the American Psychiatric Association's diagnostic system that avoids the invocation of a potential etiology as part of the criteria [33,37,38]. ...
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The coronavirus disease of 2019 (COVID-19) pandemic rapidly spread around the world, resulting in massive medical morbidity and mortality and substantial mental health consequences. Post-traumatic stress disorder (PTSD) is an important psychiatric disorder associated with disasters, and many published scientific articles have reported post-traumatic stress syndromes in populations studied for COVID-19 mental health outcomes. American diagnostic criteria for PTSD have evolved across editions of the manual, and the current definition excludes naturally occurring medical illness (such as viral illness) as a qualifying trauma, ruling out this viral pandemic as the basis for a diagnosis of PTSD. This article provides an in-depth nosological consideration of the diagnosis of PTSD and critically examines three essential elements (trauma, exposure, and symptomatic response) of this diagnosis, specifically applying these concepts to the mental health outcomes of the COVID-19 pandemic. The current criteria for PTSD are unsatisfying for guiding the response to mental health consequences associated with this pandemic, and suggestions are made for addressing the conceptual diagnostic problems and designing research to resolve diagnostic uncertainties empirically. Options might be to revise the diagnostic criteria or consider categorization of COVID-19-related psychiatric syndromes as non-traumatic stressor-related syndromes or other psychiatric disorders.
... Serious post-migration living difficulties, including residential instability, were related to PTSD. Serious post-migration living difficulties have a re-traumatizing effect on vulnerable individuals with limited capacity to handle resettlement stress due to their previous traumatic history [56]. Policies enhancing the social protection of immigrants in a host country would be a powerful instrument to reduce the number of traumatic events, of post-migration living difficulties, and consequent post-traumatic stress disorder. ...
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Migrant women are disproportionately more likely to experience traumatic events in their country of origin, during migration and after arriving in the host country. Homeless women are more likely to be exposed to multiple victimizations in childhood (emotional or physical maltreatment) and in adulthood (sexual abuse, street victimization). This study’s objective was to describe the factors associated with the likelihood of post-traumatic stress disorder (PTSD) among homeless migrant mothers in the Paris region. Face-to-face interviews were conducted by bilingual psychologists and interviewers in a representative sample of homeless families in the Paris region. PTSD was ascertained using the Mini International Neuropsychiatric Interview (MINI) (n = 691 mothers). We studied PTSD in mothers using weighted Poisson regression. Homeless migrant mothers had high levels of PTSD (18.9%) in the 12 months preceding the study. In multivariate analysis, PTSD was associated with departure from the country of origin because of violence (PR = 1.45 95% CI 1.03; 2.04), depression in the preceding 12 months (PR = 1.82 95% CI 1.20; 2.76), and residential instability (PR = 1.93 95% CI 1.27; 2.93). Homeless migrant mothers have high levels of traumatic events and PTSD. Improvements in screening for depression and PTSD and access to appropriate medical care are essential for this vulnerable group.
... Estimates of trauma exposure across the lifespan range from about 73.7% to 89.6% (Breslau and Kessler, 2001;Frans et al., 2005;Mills et al., 2011), and trauma has been implicated in several psychiatric conditions including mood, personality, eating, and posttraumatic stress disorders (PTSD; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995;Mauritz et al., 2013;Meltzer-Brody et al., 2011). A handful of studies have begun to consider the impact of trauma exposure on the onset and severity of obsessive-compulsive disorder (OCD; e.g., Fontenelle et al., 2012;Imthon et al., 2020;Morina et al., 2016;Pinciotti et al., 2021). ...
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A growing body of research has highlighted connections between obsessive-compulsive disorder (OCD) symptoms and traumatic and stressful life events. However, findings regarding the impact of traumatic and stressful events on posttraumatic stress symptoms are mixed, with some studies suggesting that the perception of an event as traumatic—regardless of the strict definition of trauma—may be most predictive of outcomes. Despite this, research has yet to ask individuals with OCD, themselves, why they believe their OCD developed; instead, findings linking trauma exposure and OCD are largely causally extrapolated. The current study examined the perceptions of OCD etiology in 45 individuals with OCD enrolled in residential treatment and qualitative responses were coded as traumatic, stressful, or other (i.e., non-event) etiologies. Nearly half of the sample (44.4%) believed their OCD developed following an identifiable event, six of whom identified a distinguishable traumatic event (13.3% overall). Individuals with perceived traumatic etiologies consistently endorsed engagement in more obsessions and compulsions, particularly in the past, and implicated themes of symmetry/exactness, repeating, checking, scrupulosity, pathological doubt, and hoarding. Findings suggest that events that occur pre-OCD onset may be likely to be perceived as the catalyst for OCD and may ultimately impact the theme and severity of symptoms in intuitive ways.
... The experience of trauma, especially early in life, has been linked to the eventual development of a broad range of psychopathology (Dixon, Howie, & Starling, 2005;Kauer-Sant'Anna et al., 2007). Perhaps unsurprisingly, an estimated 80% of clients in community mental health clinics have experienced a traumatic event at some point in their lives (Breslau & Kessler, 2001;Shi, 2013). Understanding how people experience, process, and recover from trauma is of paramount importance to global mental health. ...
Article
Introduction: Previous research demonstrates that perceived authenticity is positively associated with psychological health and security in the face of threats. The current research extends this work by testing whether perceived authenticity promotes recovery from the negative mental health consequences of collective trauma (e.g., a natural disaster). Methods: We recruited a sample of undergraduates (N = 570), many of whom reported direct or indirect exposure to Hurricane Harvey, to complete surveys at two time points. We assessed exposure to the disaster, acute stress, post-traumatic stress, coping, and authenticity twice, once approximately 1 month after Hurricane Harvey (Time 1) and again approximately 9 weeks after Hurricane Harvey (Time 2). Results: We employed multilevel modelling to explore whether authenticity would aid in recovery from collective trauma. Results showed that perceived authentic living at Time 1 predicted a variety of indicators of stress related to the hurricane at Time 2. Specifically, those participants who reported low authentic living at Time 1 reported greater levels of stress at Time 2, compared to individuals who reported higher levels of authentic living. Importantly, these effects remained even when controlling for known predictors of stress (e.g., levels of stress at Time 1 and coping strategies). Discussion: Findings provide preliminary insight into authenticity as a part of a likely larger network of interrelated psychosocial qualities that have the potential to help one navigate recovery from trauma.
... A large number of studies indicate that it is common among humans to be exposed to traumatic events at some point during their lives. [1][2][3][4] Findings of research showed that among the general population, a large number of people seem to be exposed to at least one traumatic event, with a prevalence ranging between 28% and 90%. [5][6][7][8][9][10][11][12] There are different ways of responding to traumatic experiences as it can be identified in two ways. ...
Article
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Introduction Post-traumatic stress disorder (PTSD) is a debilitating mental disorder that develops after being exposed to a traumatic event. PTSD is common among adults who have experienced physical/sexual childhood abuse. Several psychological and pharmacological interventions are used for treating PTSD in this particular group, and it is important to identify what interventions, whether alone or in combination with other treatments, are more effective compared with others. Therefore, this review aims to provide synthesis of evidence on the effectiveness of different interventions used for treating PTSD following childhood abuse. Methods and analysis Electronic search will be conducted using different databases such as PubMed, EMBASE, PsycINFO to identify randomised controlled trials (RCTs) used for assessing interventions for PTSD following childhood abuse. Data on treatment effectiveness for PTSD with childhood abuse and other variables will be extracted from each paper and reported as appropriate. Extracted effect-size estimates will be combined using Bayesian network meta-analysis (NMA). Risk of bias will be assessed through the Cochrane Collaboration tool for RCTs tool. NMA assumptions (heterogeneity, transitivity, inconsistency) will be assessed and reported. Meta-regression and subgroup analyses will be performed to explore and explain possible sources of heterogeneity. Ethics and dissemination This research is based on literature review and does not require the approval of ethical board as it does not involve dealing with humans or animals. Findings of this review will be published in a peer-reviewed journal. PROSPERO registration number CRD42020207409.
... All-encompassing definitions have been made more difficult due to stressors containing varying dimensions such as magnitude, frequency, complexity, duration, predictability, and controllability. Magnitude of stressors also encompass several meanings such as threat of harm, life threat, interpersonal loss, and property destruction [28]. Overt exposure to traumatic events is common on the NICU. ...
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Parents of neonates represent an integral area of potential clinical focus for practice consideration in NICU care. Fostering parents’ music as a unique forum, pre-emptive to the music they use for bonding with their infant, or for/with them exclusively, when their infants are not referred, can open many doors of critical relevance. Assessing the impact that early birth may have, and recognizing the experience of trauma that may potentially linger, can infringe upon valuable NICU time for parents and their infants. To address stress, and the potential of trauma, along with its definition and possible impact warrants knowledge of its symptomatology. In this article, stress will be defined, and the potential for acute stress and post traumatic stress disorder will be exemplified prior to addressing the potential parameters for music therapy involvement. Music psychotherapy for referred parents, with focused relevance to the ways in which impending fragility can be addressed with a holding environment of musical nurturance may provide meaningful moments of secured support. These moments, in turn, may likely serve as a safe space for the emergence of music connection with their infants. Our multi-disciplinary team will reflect upon experiences of collaborative practice with families who have experienced trauma related to premature birth. A case vignette highlighting the focal features of music psychotherapy with two parents and a video excerpt exemplifying their experience utilizing song of kin will follow. Keywords: NICU MT, neonatology, song of kin, music medicine, infant stimulation, trauma
... Events that are not an immediate threat to life or physical injury, regardless of the circumstance (i.e., divorce, cancer diagnosis, etc.) do not qualify for a PTSD diagnosis (APA, 2013). Finkelhor et al. (2005) have established the prevalence of trauma; other researchers suggest that the majority of persons will experience some form of a traumatic event in their lifetime (Breslau & Kessler, 2001;Copeland et al., 2007;McLaughlin et al., 2013). While the expectation for individual trauma is present, the variability of whether or not a person manifests a mental health disorder is quite large (APA, 2017). ...
Research
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The study of posttraumatic stress disorder (PTSD) and its effects on an individual is relatively robust; however, the research is scant from an organizational, performance, and leadership perspective. Based on the prevalence of PTSD, expanding the research into understanding the relationships of PTSD symptom severity toward perceived organizational support (POS), trauma-exposed employee work performance, and whether or not Authentic Leadership (AL) strengthens those relationships has come into view. Using the snowball technique and Amazon’s Mechanical Turk (MTurk), the study found that as PTSD symptom severity was reduced, trauma-exposed employee work performance increased. Further, as PTSD symptom severity decreased, POS increased; moreover, as POS increased, trauma-exposed employee work performance also improved. Finally, AL did not prove to affect the relationships between PTSD symptom severity and trauma-exposed employee work performance, nor was it a significant interaction between PTSD symptom severity toward POS. Based on the findings, this study is an essential first step in bridging the understanding of PTSD with organizational support, performance, and leadership research.
... Prior research has identified gender differences in posttrauma psychological responses. For instance, studies have found women and girls are more likely than men and boys to endorse peri-traumatic DSM-IV-TR PTSD Criterion A2 (i.e., exposure is accompanied by intense fear, helplessness, or horror; Breslau & Kessler, 2001;Tolin & Foa, 2006) and peri-traumatic dissociation (Bryant & Harvey, 2003;Dyb et al., 2008). This is notable given that psychological peri-traumatic reactions and peri-traumatic dissociation have been found to be predictive of and strongly associated with PTSD to a greater extent than the objective characteristics of the traumatic event (Ozer et al., 2003;Trickey et al., 2012). ...
Article
Objective: Gender differences in the development and severity of PTSD have long been observed, but much less is known about gender differences within the context of trauma-focused treatment. This study investigated gender differences in the PTSD symptoms of polytraumatized youth during Trauma-focused Cognitive Behavioral Therapy (TF-CBT). Method: The sample included child welfare-involved youth ages 7-18 (N = 138) who experienced a mean of 4.78 types of trauma and received TF-CBT at a trauma treatment clinic. Mixed ANOVA analyses assessed gender differences in PTSD symptoms from baseline to termination of treatment. PTSD symptoms were then mapped according to the phase of treatment, and factorial ANOVAs examined gender differences during isolated phases of TF-CBT. Potential interactions with sexual violence history were considered. Results: Significant reductions in overall PTSD, intrusive, avoidance and arousal symptoms were found from baseline to termination of TF-CBT for the entire sample, although females reported higher symptom levels across all PTSD symptom domains. Significant gender differences were also revealed during some, but not all, phases of treatment, with variations among PTSD symptom domains noted. Conclusions: Findings suggest TF-CBT is effective in reducing PTSD in youth with poly-trauma exposure, irrespective of gender. Gender differences in symptom severity were revealed, however, and indicate the need to attend to gender within the context of treatment. Findings also suggest the use of measurement-based care, and specifically attending to symptom fluctuation in PTSD symptom domains during treatment, can help inform clinical decision making and individualize treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... The number of exposures to adversities has been reported as an essential risk factor for PTSD development, an effect called building block [45,46]. Adolescents might be at peak age for trauma exposure from16-20 years of age [47], possibly due to less supervision and parents' social support. Current models on PTSD etiology describe symptoms severities mainly as a linear function of cumulative adverse childhood experiences [48]. ...
Article
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Background The frequency of trauma and different types of violence exposure in urban areas and their effects on the mental health of adolescents in developing countries are poorly investigated. Most information about traumatized young people comes from war scenarios or disasters. This study aimed to determine the prevalence of PTSD in trauma-exposed students in a low-resource city of the state of Rio de Janeiro, Brazil. The effects of sociodemographic and individual and family factors in the development of PTSD were also investigated. Methods Through multi-stage cluster sampling, 862 adolescents (Mage = 15 years old, 65% female) from public and private schools in the city of São Gonçalo were selected for the study. Self-rating structured questionnaires were applied to assess sociodemographic profile, exposure to physical and psychological violence (family, school, community), sexual abuse, social support, social functional impairment, resilience, and posttraumatic stress disorder. The data were grouped in blocks regarding sociodemographic, individual, family, and community variables. For statistical analysis, chi-square, Fisher’s exact test, and logistic regression were performed. Results The PTSD prevalence was 7.8% among adolescents. Boys were exposed to significantly higher number of events of community violence, while girls to family violence. The adjusted odds ratio (OR) for PTSD were statistically significant for age (OR, 1.45, [95% CI, 1.043–2.007]), social functional impairment (OR, 4.82, [95% CI, 1.77–13.10]), severe maternal physical violence (OR, 2.79, [95% CI, 0.79–9.93]), psychological violence by significant people (OR, 3.96, [95% CI, 1.89–8.31]) and a high number of episodes of community violence (OR, 3.52, [95% CI, 1.47–8.40). Conclusions There was a high prevalence of PTSD within this population associated with exposure to violence. Not only physical, but also psychological violence contributed to PTSD. The results also raise awareness to the differences in life trajectories between boys and girls regarding violence. These differences need to be better understood in order to enable the development of effective preventative interventions. Treating and preventing mental health disorders presents a challenge for countries, especially those with a lower degree of social and economic development and high community violence.
... As events classified as traumatic became less extraordinary and less directly experienced, trauma became increasingly normalized and ubiquitous. According to one 2001 study, 89.6% of Americans were trauma survivors under the prevailing diagnostic definition(Breslau and Kessler 2001). ...
Article
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Over the past century the concept of trauma has substantially broadened its meanings in academic and public discourse. We document four directions in which this semantic expansion has occurred: from somatic to psychic, extraordinary to ordinary, direct to indirect, and individual to collective. We analyse these expansions as instances of ‘concept creep’, the progressive inflation of harm-related concepts, and present evidence for the rising cultural salience and semantic enlargement of trauma in recent decades. Expansive concepts of trauma may have mixed blessings for personal and collective identity.
Chapter
Posttraumatic stress disorder (PTSD) can develop following exposure to severe, often life-threatening stressors (e.g., combat, rape, and natural disasters). Although many survivors experience intrusive thoughts, nightmares, difficulty sleeping, and other symptoms in the immediate wake of trauma, PTSD is only diagnosable when symptoms persist longer than 1 month and produce clinically significant distress or impairment in everyday life. This article covers description of the four clusters of symptoms constitutive of PTSD, the historical evolution of the diagnosis, consideration of what distinguishes traumatic from other stressors, sex ratio, epidemiology, course of the disorder, risk factors for PTSD, comorbidity, cognitive research, biological research, and treatments for PTSD.
Article
The Life Events Checklist (LEC), a measure of exposure to potentially traumatic events, was developed at the National Center for Posttraumatic Stress Disorder (PTSD) concurrently with the Clinician Administered PTSD Scale (CAPS) to facilitate the diagnosis of PTSD. Although the CAPS is recognized as the gold standard in PTSD symptom assessment, the psychometric soundness of the LEC has never been formally evaluated. The studies reported here describe the performance of the LEC in two samples: college undergraduates and combat veterans. The LEC exhibited adequate temporal stability, good convergence with an established measure of trauma history—the Traumatic Life Events Questionnaire (TLEQ)— and was comparable to the TLEQ in associations with variables known to be correlated with traumatic exposure in a sample of undergraduates. In a clinical sample of combat veterans, the LEC was significantly correlated, in the predicted directions, with measures of psychological distress and was strongly associated with PTSD symptoms.
Thesis
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Over the past decade, cyber-sexual assault (also known as "nonconsensual pornography" or "revenge porn") has gained the attention of legal experts, the media, and most recently, the counseling profession. Whereas this nonconsensual sharing of sexually explicit images online, through social medial, or other forms of technology has been demonstrated to have significant impacts on victims, researchers have focused heavily upon the legality of these actions (i.e. should there be consequences for posting nude/semi-nude photos of non-consenting adults to the internet), but there has been a lack of attention to the mental health consequences of cyber-sexual assault on victims. The purpose of this study was to provide empirical support to how the psychological aftermath of cyber-sexual assault mirrors that of sexual assault and thus should be taken as seriously as sexual assault (clinically and legally). This study was conducted to investigate the direction and strength of relationships among latent variables associated with trauma symptomology (i.e., emotional dysregulation, trauma guilt, post-traumatic stress disorder, and depression) in a sample of survivors of cyber-sexual assault. This investigation specifically tested whether modeling latent variables emotional dysregulation as measured by the Brief Version of the Difficulties in Emotion Regulation Scale [DERS-16] (Bjureberg et al., 2015) or trauma guilt as measured by the Trauma-Related Guilt Inventory [TRGI] (Kubany et al., 1996) as the independent variable, where the remaining latent variables of post-traumatic stress disorder as measured by the Impact of Events Scale Revised [IES-R] (Weiss & Marmar, 1996) and depression as measured by the Center for Epidemiologic Studies Depression Scale Revised [CESD-R] (Eaton et al., 2004) were modeled as dependent variables, was a good fit for data collected from cyber-sexual assault survivors. Furthermore, the secondary analysis investigated whether modeling the latent variables of emotional dysregulation and trauma guilt as mediating variables on the direction and strength of relationship on the dependent variables of post-traumatic stress disorder and depression was a good fit for data collected from cyber-sexual assault survivors. To test the hypotheses that cyber-sexual assault survivors would show increased trauma symptomology similar to physical sexual assault survivors a structural equation model was developed. The results of the structural equation model (SEM) analyses identified trauma guilt contributed to 14% of the variance of emotional dysregulation; which then served to mediate the outcome variables most significantly. In fact, Emotional Dysregulation contributed to 67% of the variance in the levels of PTSD symptomology, and 44% of the variance in the levels of Depression.
Chapter
Traumatic events experienced throughout the different stages of childhood and adolescence are frequent circumstances with a detrimental impact on the physical and psychological health of the individual. A growing body of evidence shows the trauma-related effects on the hypothalamic-pituitary-adrenal axis, the sympathetic nervous system, the serotonin system, the immune system, and the brain development, structure, and connectivity. Interestingly a relation was found between early-life stress and bipolar disorder: the patients who were exposed to childhood trauma showed a worsened course of the disorder with poor clinical and psychopathological factors. According to the kindling hypothesis, early environmental stressors interact with the genetic susceptibility through epigenetic mechanisms, making the subject more vulnerable to milder stressors and lowering the threshold for the occurrence of subsequent mood episodes. Understanding these processes is crucial to the discovery of new targets of treatment to reduce or, possibly, reverts the effect of early-life stress on bipolar disorder.
Article
Objective: We aimed to assess whether peritraumatic threat experienced during a period of armed conflict predicted subsequent depression symptoms. Method: Ninety-six Israeli civilians provided real-time reports of exposure to rocket warning sirens and subjective sense of threat, twice daily for 30 days, during the 2014 Israel-Gaza conflict. Depression symptoms were reported 2 months after the conflict. Mixed-effects models were used to estimate peritraumatic threat levels and peritraumatic threat reactivity (within-person elevations in threat following siren exposure). These were then assessed as predictors of depression symptoms at 2 months in an adjusted regression model. Results: Individual peritraumatic threat level, but not peritraumatic threat reactivity, was a significant predictor of 2 months depression symptoms, even after controlling for baseline depression symptoms. Conclusions: The findings imply that in situations of ongoing exposure, screening for perceived levels of peritraumatic threat might be useful in identifying those at risk for developing subsequent depression symptoms.
Article
Objectives The aim of this study is to assess prevalence of major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) in students of Keyano College 18 months after a wildfire and to determine the predictors of likely MDD, GAD, and PTSD in the respondents. Methods A quantitative cross-sectional survey was used to collect data through self-administered, paper-based questionnaires to determine likely MDD, GAD, and PTSD using the PHQ 9, GAD-7, and the PTSD Checklist for DSM 5, Part 3, respectively. Data were analyzed with SPSS version 20 (IBM Corp, Armonk, NY) using univariate analysis with chi-square tests. Results Eighteen months after the wildfire, the 1-month prevalence rates for MDD, GAD, and PTSD among the college students were 23.4%, 18.7%, and 11.0%, respectively. There were statistically significant associations between multiple sociodemographic variables and the likelihood respondents presented with MDD, GAD, and PTSD 18 months after the wildfire. There were also associations between the likely MDD, GAD, and PTSD and abuse/dependence on alcohol and substances in respondents at 18 months. Conclusion Our study has established prevalence rates for MDD, GAD, and PTDS among college students 18 months after the Fort McMurray wildfires. Further studies are needed to explore the impact of college-based mental health interventions on the long-term mental health effects of the wildfires.
Chapter
This chapter reviews the psycho-social aspects of trauma and related disorders. A wealth of information has accumulated over the decades of research on the trauma and related disorders. However, some aspects of trauma are still debatable globally such as definition of trauma, diversity in expression and response across individuals and cultures. Exposure to trauma can lead to troubling memories, psycho-physical arousal and avoidance of the event, has been a central theme in literature. Until researchers have realized the complexity of trauma transcends the relatively narrow definition of trauma. Cultural diversity in trauma and related disorders have brought into notice the multi-dimensional nature of trauma which is the focus of this chapter.
Article
Individual differences in fear learning are a crucial prerequisite for the translational value of the fear-conditioning model. In a representative sample (N=936), we used latent class growth models to detect individual differences in associative fear learning. For a series of subsequent test phases varying in ambiguity (i.e., acquisition, extinction, generalization, reinstatement, and re-extinction), conditioned responding was assessed on three response domains (i.e., subjective distress, startle responding, and skin conductance). We also associated fear learning across the different test phases and response domains with selected personality traits related to risk and resilience for anxiety, namely Harm Avoidance, Stress Reaction, and Wellbeing (MPQ; Tellegen & Waller, 2008). Heterogeneity in fear learning was evident, with fit indices suggesting subgroups for each outcome measure. Identified subgroups showed adaptive, maladaptive, or limited-responding patterns. For subjective distress, fear and safety learning was more maladaptive in the subgroups high on Harm Avoidance, while more adaptive learning was observed in subgroups with medium Harm Avoidance and the limited-or non-responders were lowest in Harm Avoidance. Distress subgroups did not differ in Stress Reaction or Wellbeing. Startle and SCR subgroups did not differ on selected personality traits. The heterogeneity in fear-learning patterns resembled risk and resilient anxiety development observed in real life, which supports the associative fear-learning paradigm as a useful translational model for pathological fear development.
Article
Threat responses are often shaped by social information, such as observation of aversive outcomes for others. Yet, the neurochemistry regulating observational learning of threats is largely unknown. Here, we examined the impact of the GABAergic and noradrenergic system, which are central in regulating threat learning from first-hand experiences, on observational threat learning in humans. To this end, 61 participants received either 1 mg Lorazepam (enhancing GABAergic signalling N = 18), 20 mg Yohimbine (enhancing Noradrenergic transmission, N = 16), Placebo (double blind and randomized control for Lorazepam and Yohimbine, N = 12) or no treatment (N = 15) prior to observational threat conditioning. Participants acquired conditioned threat responses by observation of another individual who is presented with a conditioned stimulus (CS) and an aversive unconditioned stimulus (US). Participants' threat responses were tested by direct exposure to the CSs immediately after learning, as well as two days later (drug free). Our results indicate decreased fear ratings to socially acquired CSs by enhanced GABAergic transmission as compared to the control group (placebo and no treatment) during the immediate test. We could not provide evidence for noradrenergic modulation of socially acquired threat responses. Further, we found no differences in psychophysiological responses (Skin conductance responses) or long-term persistence of conditioned responses. Our results provide initial evidence for an impact of the GABAergic system on social acquisition of threats.
Article
Posttraumatic Stress Disorder (PTSD) is susceptible to feigning and it can be challenging to differentiate between genuine and feigned cases. Past studies have shown that in genuine cases the symptom profiles varies as a function of trauma type; but it is less clear if this variation occurs for feigned PTSD. Sixty participants were randomly assigned to one of two experimental conditions. In both conditions the participants were coached about PTSD, and then they were instructed to feign PTSD, as if for financial gain. The trigger event in the conditions was manipulated in a vignette and this was depicted as a sexual assault (SA) or a motor vehicle collision (MVC). The effects were measured via standardized measures for PTSD symptoms (PCL-5) and profile invalidity (Structured Inventory of Malingered Symptomology [SIMS]). The PCL-5 scores of the participants were indicative of PTSD. There were no statistically significant group differences on either measure at the overall or subscale level. Unlike the pattern for genuine PTSD, the symptom profile for simulated PTSD did not differ by trauma type. If understanding of these profiles can be further developed, it may assist clinicians when evaluating feigned PTSD.
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The article presents a brief review of the concept of complex psychological trauma transformations over thirty years, which occurred since the moment when the term Complex Post-traumatic Stress Disorder (C-PTSD) was proposed as a clinical syndrome of multiple psychological traumatization to its official recognition as a diagnostic construct. The article analyzes the dynamics of ideas about the causes and the nature of psychological trauma manifestations under the influence of extreme stress factors, which is reflected in the current nomenclatures of mental and somatic disorders. A comparative analysis of the specific characteristics of various types of psychological traumas that intersect with the term complex PTSD in the conceptual field of trauma psychology is presented. The basic characteristics of complex psychological trauma that distinguish it from similar terms are defined, and the ways of further research in this direction are outlined.
Article
Identifying the optimal factor structure of posttraumatic stress disorder (PTSD) has recently been reinvigorated in literature due to the substantial changes to its diagnostic criteria in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Currently, six models of PTSD are supported in literature, but there is no consensus on the best-fitting factor structure. Additionally, the extant literature examining the relationship between PTSD symptom-grouping and AS in the latent level has been scarce. The present study’s objectives are two-fold: first, we aimed to identify the best-fitted model of PTSD by comparing the six empirically-supported models, and; second, we examined the relationship between the best-fitting model with anxiety sensitivity (AS). Utilizing a sample of 476 combat-exposed soldiers, the results suggest that both the anhedonia and hybrid models provide the best fit to the data, with the anhedonia model achieving slightly better fit indices. Further, the examination on the influence of AS to PTSD reveal that while there is a pattern of decreasing factor loadings and factor correlations when accounting for AS, the changes are not significant to alter the PTSD symptom-structure. Based on these results, our findings suggest further investigation on the possible mediating or moderating mechanisms by which AS may influence PTSD.
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The Routledge International Handbook of Global Therapeutic Cultures explores central lines of enquiry and seminal scholarship on therapeutic cultures, popular psychology, and the happiness industry. Bringing together studies of therapeutic cultures from sociology, anthropology, psychology, education, politics, law, history, social work, cultural studies, development studies, and American Indian studies, it adopts a consciously global focus, combining studies of the psychologisation of social life from across the world. Thematically organised, it offers historical accounts of the growing prominence of therapeutic discourses and practices in everyday life, before moving to consider the construction of self-identity in the context of the diffusion of therapeutic discourses in connection with the global spread of capitalism. With attention to the ways in which emotional language has brought new problematisations of the dichotomy between the normal and the pathological, as well as significant transformations of key institutions, such as work, family, education, and religion, it examines emergent trends in therapeutic culture and explores the manner in which the advent of new therapeutic technologies, the political interest in happiness, and the radical privatisation and financialisation of social life converge to remake self-identities and modes of everyday experience. Finally, the volume features the work of scholars who have foregrounded the historical and contemporary implication of psychotherapeutic practices in processes of globalisation and colonial and postcolonial modes of social organisation. Presenting agenda-setting research to encourage interdisciplinary and international dialogue and foster the development of a distinctive new field of social research, The Routledge International Handbook of Global Therapeutic Cultures will appeal to scholars across the social sciences with interests in the advance of therapeutic discourses and practices in an increasingly psychologised society.
Thesis
p>Traumatic spinal cord injury (SCI), resulting from tearing or severing of the spinal cord, has far reaching consequences both psychologically and physiologically that are often catastrophic to the individual. The individual, and his or her family, have to learn to adapt and adjust to circumstances that have changed drastically. The initial traumatic event that caused the injury can result in the onset of post traumatic stress disorder (PTSD), adding a further complicating factor to the adjustment process. The development of this disorder poses a significant problem for the SCI population, particularly in terms of rehabilitation, adjustment and long-term management of the injury. The literature review explores the history of theories of psychological adjustment to SCI and the relationship between SCI and PTSD. The literature review explores what makes some people with SCI more psychologically vulnerable to PTSD than others. Knowledge of such vulnerability factors would help establish criteria by which to aid the identification of those at risk of developing PTSD and the development of treatment protocols. The empirical paper investigates the presence of PTSD symptoms and potential predictors of PTSD within this population. High levels of PTSD symptoms were found. The study also found negative cognitive appraisals of self and neuroticism to be associated with the symptoms of PTSD for those with SCI.</p
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Unexpected extreme sudden traumatic stressor may cause post-traumatic stress disorder (PTSD). Important traumatic events include war, violent personal assault (e.g., sexual assault, and physical attack), being taken hostage or kidnapped, confinement as a prisoner of war, torture, terrorist attack, severe car accidents, and natural disasters. In childhood age sexual abuse or witnessing serious injuries or unexpected death of a beloved one are among important traumatic events.PTSD can be categorized into two types of acute and chronic PTSD: if symptoms persist for less than three months, it is termed "acute PTSD," otherwise, it is called "chronic PTSD." 60.7% of men and 51.2% of women would experience at least one potentially traumatic event in their lifetime. The lifetime prevalence of PTSD is significantly higher in women than men. Lifetime prevalence of PTSD varies from 0.3% in China to 6.1% in New Zealand. The prevalence of PTSD in crime victims are between 19% and 75%; rates as high as 80% have been reported following rape. The prevalence of PTSD among direct victims of disasters was reported to be 30%-40%; the rate in rescue workers was 10%-20%. The prevalence of PTSD among police, fire, and emergency service workers ranged from 6%-32%. An overall prevalence rate of 4% for the general population, the rate in rescue/recovery occupations ranged from 5% to 32%, with the highest rate reported in search and rescue personnel (25%), firefighters (21%), and workers with no prior training for facing disaster. War is one of the most intense stressors known to man. Armed forces have a higher prevalence of depression, anxiety disorders, alcohol abuse and PTSD. High-risk children who have been abused or experienced natural disasters may have an even higher prevalence of PTSD than adults.Female gender, previous psychiatric problem, intensity and nature of exposure to the traumatic event, and lack of social support are known risk factors for work-related PTSD. Working with severely ill patients, journalists and their families, and audiences who witness serious trauma and war at higher risk of PTSD.The intensity of trauma, pre-trauma demographic variables, neuroticism and temperament traits are the best predictors of the severity of PTSD symptoms. About 84% of those suffering from PTSD may have comorbid conditions including alcohol or drug abuse; feeling shame, despair and hopeless; physical symptoms; employment problems; divorce; and violence which make life harder. PTSD may contribute to the development of many other disorders such as anxiety disorders, major depressive disorder, substance abuse/dependency disorders, alcohol abuse/dependence, conduct disorder, and mania. It causes serious problems, thus its early diagnosis and appropriate treatment are of paramount importance.
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SYNOPSIS Post-traumatic stress disorder (PTSD) was studied in the Piedmont region of North Carolina. Among 2985 subjects, the lifetime and six month prevalence figures for PTSD were 1·30 and 0·44 % respectively. In comparison to non-PTSD subjects, those with PTSD had significantly greater job instability, family history of psychiatric illness, parental poverty, child abuse, and separation or divorce of parents prior to age 10. PTSD was associated with greater psychiatric co-morbidity and attempted suicide, increased frequency of bronchial asthma, hypertension, peptic ulcer and with impaired social support. Differences were noted between chronic and acute PTSD on a number of measures, with chronic PTSD being accompanied by more frequent social phobia, reduced social support and greater avoidance symptoms.
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Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated life-time prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode. Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey. The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years. Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.
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The nature of traumatic memories is currently the subject of intense scientific investigation. While some researchers have described traumatic memory as fixed and indelible, others have found it to be malleable and subject to substantial alteration. The current study is a prospective investigation of memory for serious combat-related traumatic events in veterans of Operation Desert Storm. Fifty-nine National Guard reservists from two separate units completed a 19-item trauma questionnaire about their combat experiences 1 month and 2 years after their return from the Gulf War. Responses were compared for consistency between the two time points and correlated with level of symptoms of posttraumatic stress disorder (PTSD). There were many instances of inconsistent recall for events that were objective and highly traumatic in nature. Eighty-eight percent of subjects changed their responses on at least one of the 19 items, while 61% changed two or more items. There was a significant positive correlation between score on the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder at 2 years and the number of responses on the trauma questionnaire changed from no at 1 month to yes at 2 years. These findings do not support the position that traumatic memories are fixed or indelible. Further, the data suggest that as PTSD symptoms increase, so does amplification of memory for traumatic events. This study raises questions about the accuracy of recall for traumatic events, as well as about the well-established but retrospectively determined relationship between level of exposure to trauma and degree of PTSD symptoms.
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The present study examined the comparability of data obtained by telephone and face-to-face interviews for diagnosing axis I and II disorders. Sixty young adults from the community were interviewed face-to-face and over the telephone regarding axis I disorders; another 60 subjects were interviewed twice regarding axis II disorders. The order of interviews was counterbalanced, and subjects with a history of disorder were oversampled. Agreement between telephone and face-to-face interviews was contrasted with interrater values, which were obtained by having a second interviewer rate a recording of the original interview. Interrater reliability was excellent. Agreement between telephone and face-to-face assessment was excellent for anxiety disorders and very good for major depressive disorder and alcohol and substance use disorders; agreement was problematic, however, for adjustment disorder with depressed mood. Strong support was shown for the validity of the axis II telephone assessment format. Small but consistent trends were noted for lower rates of psychopathology reported in the second interview. This is the first study in which telephone and face-to-face assessments of axis I and II psychopathology were conducted with the same subjects assigned to conditions in a counterbalanced manner. The present findings provide qualified justification for the use of telephone interviews to collect axis I and II data. The apparent concerns do not appear sufficient to override the economic and logistic advantages of telephone interviewing.
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The study estimates the relative importance of specific types of traumas experienced in the community in terms of their prevalence and risk of leading to posttraumatic stress disorder (PTSD). A representative sample of 2181 persons in the Detroit area aged 18 to 45 years were interviewed by telephone to assess the lifetime history of traumatic events and PTSD, according to DSM-IV. Posttraumatic stress disorder was assessed with respect to a randomly selected trauma from the list of traumas reported by each respondent, using a modified version of the Diagnostic Interview Schedule, Version IV, and the World Health Organization Composite International Diagnostic Interview. The conditional risk of PTSD following exposure to trauma was 9.2%. The highest risk of PTSD was associated with assaultive violence (20.9%). The trauma most often reported as the precipitating event among persons with PTSD (31% of all PTSD cases) was sudden unexpected death of a loved one, an event experienced by 60% of the sample, and with a moderate risk of PTSD (14.3%). Women were at higher risk of PTSD than men, controlling for type of trauma. The risk of PTSD associated with a representative sample of traumas is less than previously estimated. Previous studies have overestimated the conditional risk of PTSD by focusing on the worst events the respondents had ever experienced. Although recent research has focused on combat, rape, and other assaultive violence as causes of PTSD, sudden unexpected death of a loved one is a far more important cause of PTSD in the community, accounting for nearly one third of PTSD cases.
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With the exception of a few reports of higher rates of childhood trauma in Vietnam veterans with posttraumatic stress disorder (PTSD), little is known about the influence of previous exposure to trauma on the PTSD effects of subsequent trauma. The authors examine interrelated questions about the effects of previous exposure to trauma. A representative sample of 2,181 individuals in southeast Michigan were interviewed by telephone to record lifetime history of traumatic events specified in DSM-IV as potentially leading to PTSD. PTSD was assessed with respect to a randomly selected index trauma from the list of events reported by each respondent. History of any previous exposure to traumatic events was associated with a greater risk of PTSD from the index trauma. Multiple previous events had a stronger effect than a single previous event. The effect of previous assaultive violence persisted over time with little change. When they examined several features of the previous exposure to trauma, the authors found that subjects who experienced multiple events involving assaultive violence in childhood were more likely to experience PTSD from trauma in adulthood. Furthermore, previous events involving assaultive violence--single or multiple, in childhood or later on--were associated with a higher risk of PTSD in adulthood. Previous exposure to trauma signals a greater risk of PTSD from subsequent trauma. Although these results are consistent with a sensitization hypothesis, like the results from previous research on PTSD, they do not address the mechanism of increased responsivity to trauma. Long-term observational studies can further elucidate these observations.
Article
Because only a proportion of persons exposed to traumatic events develop posttraumatic stress disorder (PTSD), it has become important to elucidate the factors that increase the risk for the development of PTSD following trauma exposure as well as the factors that might serve to protect individuals from developing this condition. Putative risk factors for PTSD may describe the index traumatic event or characteristics of persons who experience those events. Recent data have implicated biological and familial risk factors for PTSD. For example, our recent studies have demonstrated an increased prevalence of PTSD in the adult children of Holocaust survivors, even though these children, as a group, do not report a greater exposure to life-threatening (Diagnostic and Statistical Manual of Mental Disorders [DSM-IV] Criterion A) events. These studies are reviewed. It is difficult to know to what extent the increased vulnerability to PTSD in family members of trauma survivors is related to biological or genetic phenomena as opposed to experiential ones. because of the large degree of shared environment in families. In particular, at-risk family members, such as children, may be more vulnerable to PTSD as a result of witnessing the extreme suffering of a parent with chronic PTSD rather than because of inherited genes. But even if the diathesis for PTSD were somehow "biologically transmitted" to children of trauma survivors, the diathesis is still a consequence of the traumatic stress in the parent. Thus, even the most biological of explanations for vulnerability must at some point deal with the fact that a traumatic event has occurred.
Article
Posttraumatic stress disorder (PTSD) was established in 1980, when it was incorporated in the DSM-III. The PTSD definition brackets a distinct set of stressors-traumatic events-from other stressful experiences and links it causally with a specific response, the PTSD syndrome. Explicit diagnostic criteria in DSM-III made it feasible to conduct large-scale epidemiological surveys on PTSD and other psychiatric disorders, using structured diagnostic interviews administered by nonclinicians. Epidemiologic research has been expanded from Vietnam veterans, who were the center of DSM-III PTSD study, to civilian populations and postwar regions worldwide. This chapter summarizes information on the prevalence estimates of PTSD in U.S. veterans of the Vietnam War, soldiers returning from deployment in Iraq and Afghanistan, and civilian populations. It outlines research findings on the course of PTSD, risk factors, comorbidity with other psychiatric disorders, and the risk for other posttrauma disoders. It concludes with recommendations for future research.
Article
To ascertain the prevalence of posttraumatic stress disorder (PTSD) and risk factors associated with it, we studied a random sample of 1007 young adults from a large health maintenance organization in the Detroit, Mich, area. The lifetime prevalence of exposure to traumatic events was 39.1%. The rate of PTSD in those who were exposed was 23.6%, yielding a lifetime prevalence in the sample of 9.2%. Persons with PTSD were at increased risk for other psychiatric disorders; PTSD had stronger associations with anxiety and affective disorders than with substance abuse or dependence. Risk factors for exposure to traumatic events included low education, male sex, early conduct problems, extraversion, and family history of psychiatric disorder or substance problems. Risk factors for PTSD following exposure included early separation from parents, neuroticism, preexisting anxiety or depression, and family history of anxiety. Life-style differences associated with differential exposure to situations that have a high risk for traumatic events and personal predispositions to the PTSD effects of traumatic events might be responsible for a substantial part of PTSD in this population.
Article
Background: Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated lifetime prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode.Methods: Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey.Results: The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years.Conclusions: Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.
Article
Epidemiologic studies of post-traumatic stress disorder (PTSD) have used the PTSD module of the NIMH Diagnostic Interview (DIS) in its various editions and modifications. Although the diagnoses of numerous disorders made by the DIS or the WHO – Composite International Diagnostic Interview (CIDI), which is modelled on the DIS, have been compared to clinical diagnoses, little is known about the performance of these instruments in diagnosing PTSD. In this study, we examine the test–retest reliability of a modified version of the PTSD section of the DIS-IV and the CIDI 2.1 and compare it with an independently conducted clinical interview in the 1996 Detroit Area Survey of Trauma, an epidemio-logical study of a representative sample of 2181 persons. A blind readministration of the structured interview was conducted by a lay interviewer 12–18 months after the initial interview, on 32 respondents classified as PTSD cases in the initial interview and on 23 non-cases who reported exposure to trauma. The clinical reappraisal was conducted blindly by two psychiatric social workers, using the Clinician Administered PTSD Scale for DSM-IV (CAPS-DX). The data were weighted to adjust for the oversampling of cases and the differential probabilities of selection of traumatic events across respondents with different numbers of events. The test–retest consistency of the structured interview was a kappa of 0.62 and an odds ratio of 42.5. The comparison of the structured interview with the clinical reappraisal showed agreement in 81% of the assessed sample. Positive predicted value was 0.75, negative predictive value was 0.97, and the odds ratio was 94.8 (all weighted values). Discrepant cases were mostly ‘false positives’ and, of these, the majority were subthreshold cases missing only one symptom in the CAPS-DX. Copyright © 1998 Whurr Publishers Ltd.
Article
The frequency and impact of 10 potentially traumatic events were examined in a sample of 1,000 adults. Drawn from four southeastern cities, the sample was half Black, half White, half male, half female, and evenly divided among younger, middle-aged, and older adults. Over their lifetimes, 69% of the sample experienced at least one of the events, as did 21% in the past year alone. The 10 events varied in importance, with tragic death occurring most often, sexual assault yielding the highest rate of posttraumatic stress disorder (PTSD), and motor vehicle crash presenting the most adverse combination of frequency and impact. Numerous differences were observed in the epidemiology of these events across demographic groups. Lifetime exposure was higher among Whites and men than among Blacks and women; past-year exposure was highest among younger adults. When impact was analyzed as a continuous variable (perceived stress), Black men appeared to be most vulnerable to the effects of events, but young people showed the highest rates of PTSD.
Article
To ascertain the prevalence of posttraumatic stress disorder (PTSD) and risk factors associated with it, we studied a random sample of 1007 young adults from a large health maintenance organization in the Detroit, Mich, area. The lifetime prevalence of exposure to traumatic events was 39.1%. The rate of PTSD in those who were exposed was 23.6%, yielding a lifetime prevalence in the sample of 9.2%. Persons with PTSD were at increased risk for other psychiatric disorders; PTSD had stronger associations with anxiety and affective disorders than with substance abuse or dependence. Risk factors for exposure to traumatic events included low education, male sex, early conduct problems, extraversion, and family history of psychiatric disorder or substance problems. Risk factors for PTSD following exposure included early separation from parents, neuroticism, preexisting anxiety or depression, and family history of anxiety. Life-style differences associated with differential exposure to situations that have a high risk for traumatic events and personal predispositions to the PTSD effects of traumatic events might be responsible for a substantial part of PTSD in this population.
Article
To increase the feasibility of identifying persons with depressive disorders in a large-scale health policy study, we tested the concordance between face-to-face and telephone-administered versions of the depression section of the NIMH Diagnostic Interview Schedule (DIS). This section was administered over the telephone to 230 English-speaking participants of the Los Angeles site of the NIMH Epidemiologic Catchment Area Program (ECA) after their completion of a face-to-face interview (Wave II) with the full DIS. Time lag between interviews was 3 months, on the average. Persons with depressive symptoms were oversampled. Using the face-to-face version as the criterion measure, the sensitivity, specificity, and positive predictive value of the telephone version for identifying the presence or absence of any lifetime unipolar depressive disorder were 71, 89, and 63 percent, respectively; the kappa statistic was 0.57, and agreement was unbiased. The comparable figures for concordance between two face-to-face interviews administered one year apart to the same subjects were 54, 89, and 60 percent and 0.45 (kappa), respectively. Thus, disagreement was due primarily to test-retest unreliability of the DIS rather than the method of administration.
Article
There have been numerous studies of post-traumatic stress disorder in trauma victims, war veterans, and residents of communities exposed to disaster. Epidemiologic studies of this syndrome in the general population are rare but add an important perspective to our understanding of it. We report findings on the epidemiology of post-traumatic stress disorder in 2493 participants examined as part of a nationwide general-population survey of psychiatric disorders. The prevalence of a history of post-traumatic stress disorder was 1 percent in the total population, about 3.5 percent in civilians exposed to physical attack and in Vietnam veterans who were not wounded, and 20 percent in veterans wounded in Vietnam. Post-traumatic stress disorder was associated with a variety of other adult psychiatric disorders. Behavioral problems before the age of 15 predicted adult exposure to physical attack and (among Vietnam veterans) to combat, as well as the development of post-traumatic stress disorder among those so exposed. Although some symptoms of post-traumatic stress disorder, such as hyperalertness and sleep disturbances, occurred commonly in the general population, the full syndrome as defined by the Diagnostic and Statistical Manual of Mental Disorders, third edition, was common only among veterans wounded in Vietnam.
Article
Recently, the use of telephone sampling methods in epidemiology has been sharply increasing. Properly applied, these methods provide powerful tools. Improperly applied, they may produce invalid results. This review covers many points to which the investigator should be alert. An underlying theme is that bias in studies that use telephone sampling can potentially spring from many sources and should be avoided wherever feasible. In epidemiology, there are two main uses of telephone sampling--in general surveys (cross-sectional studies) and in case-control studies. For the former, the principles differ little from those for general surveys in other fields. For the latter, most of the same principles apply, but case-control studies also have their own unique aspects. In this review, several topics receive detailed treatment. Valid combinations of area code and prefix can be found through careful processing of a file that is available commercially. Three options that can be used singly or in any combination provide broadened adaptability for the Mitofsky-Waksberg method of random digit dialing. Bias can be thwarted by certain steps in the interviewing and by weighting. For population-based and then center-based case-control studies, a scheme that samples controls from household censuses and avoids usual problems is offered.
Article
The risk for first-onset major depression, anxiety, and substance use disorders associated with prior posttraumatic stress disorder (PTSD) was estimated in a sample of women. The National Institute of Mental Health Diagnostic Interview Schedule, revised according to DSM-III-R, was used to measure lifetime psychiatric disorders in a stratified random sample of 801 mothers of children, who participated in a study of cognitive and psychiatric outcomes by level of birth weight. Cox proportional hazards models with time-dependent covariates were used to calculate the hazards ratios of first onset of other disorders following PTSD. The lifetime prevalence of traumatic events was 40% and of PTSD, 13.8%. Posttraumatic stress disorder signaled increased risks for first-onset major depression (hazards ratio, 2.1) and alcohol use disorder (hazards ratio, 3.0). The risk for major depression following PTSD was of the same magnitude as the risk for major depression following other anxiety disorders. Women with preexisting anxiety and PTSD had significantly increased risk for first-onset major depression. Additional analysis showed that preexisting major depression increased women's vulnerability to the PTSD-inducing effects of traumatic events and risk for exposure to traumatic events. Posttraumatic stress disorder influences the risk for first-onset major depression and alcohol use disorder. The causal explanation of these temporally secondary disorders is unclear and might involve the effect of PTSD or underlying vulnerabilities exposed by the traumatic experience.
Article
DSM-IV added an emotional response component to the definition of Criterion A for PTSD. The present study investigated the relationship between retrospective reports of emotional responses (fear, helplessness, and horror) and disrupted emotional responses ("numbing") at the time of a potentially traumatizing event and reports of PTSD symptomatology among undergraduate participants. We found that, of the DSM-IV criteria, only helplessness was significantly correlated with post-traumatic symptomatology. Reports of peritraumatic emotional numbing uniquely predicted subsequent PTSD symptomatology beyond coincident emotional responses, suggesting that further research is needed to explore the various dimensions of peritraumatic emotional response relevant to the development of PTSD.
Article
We examine potential sources of the sex differences in post-traumatic stress disorder (PTSD) in the community. Data were obtained from a representative sample of 2181 persons aged 18-45 years in the Detroit primary metropolitan statistical area, which is a six-county area containing more than four million residents. A random digit dialling method was used to select the sample and a computer-assisted telephone interview was used to obtain the data. DSM-IV PTSD was assessed with respect to a randomly selected trauma from the list of qualifying traumas reported by each respondent. The lifetime prevalence of exposure and the mean number of traumas were lower in females than males. The overall conditional risk of PTSD (i.e. the probability of PTSD among those exposed to a trauma) was approximately twofold higher in females than males, adjusting for the sex difference in the distribution of trauma types. The sex difference was due primarily to females' greater risk following assaultive violence. The sex difference in the avoidance and numbing symptom group following assaultive violence exceeded the sex differences in other symptom groups. Future research should focus on sex differences in the response to assaultive violence, including potential explanations for females' greater probability to experience avoidance and numbing.
Article
A DSM-IV diagnosis of posttraumatic stress disorder (PTSD) required for the first time that individuals must report experiencing intense fear, helplessness, or horror at the time of the trauma. In a longitudinal study of 138 victims of violent crime, we investigated whether reports of intense trauma-related emotions characterized individuals who, after 6 months, met criteria for PTSD according to the DSM-III-R. We found that intense levels of all 3 emotions strongly predicted later PTSD. However, a small number of those who later met DSM-III-R or ICD criteria for PTSD did not report intense emotions at the time of the trauma. They did, however, report high levels of either anger with others or shame.
Epidemiology of trauma and posttraumatic stress disorder In: Yehuda R, editor. Psychol Trauma Old-ham JM, Riba MB, editors
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Breslau N (1998b): Epidemiology of trauma and posttraumatic stress disorder. In: Yehuda R, editor. Psychol Trauma Old-ham JM, Riba MB, editors. Review of Psychiatry, Vol 17. Washington, DC: American Psychiatric Press:1–29
Henry Ford Health System, Department of Psychiatry
  • Address
  • Naomi Requests
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Address reprint requests to Naomi Breslau, Ph.D., Henry Ford Health System, Department of Psychiatry, One Ford Place, 3A, Detroit MI 48202-3450.
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March JS (1993): What constitutes a stressor: the " Criterion A " issue. In: Davidson JRT, Foa EB, editors. Posttraumatic Stress Disorder, DSM-IV and Beyond. Washington, DC: Psychiatric Press Inc. Norris FH (1992): Epidemiology of trauma: frequency and impact of different potentially traumatic events on different demographic groups. J Consult Clin Psychol 60:409 – 418.
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Survey Sampling Inc (1996): Random Digit Telephone Sampling Methodology. Fairfield, CT: Survey Sampling Inc. US Bureau of Census (1990): Census of Population and Housing, 1990 (United States): Public Use Microdata Sample: 1% Sample. Washington, DC: US Dept. of Commerce, Bureau of the Census.
Posttraumatic stress disorder field trial: evaluation of the PTSD construct -criteria A through E
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  • T A Widiger
  • A J Frances
  • H A Pincus
  • R Ross
  • M B First
  • W Davis
  • M Kline
Kilpatrick DG, Resnick HS, Freedy JR, Pelcovitz D, Resick P, Roth S, van der Kolk B (1998) Posttraumatic stress disorder field trial: evaluation of the PTSD construct -criteria A through E. In: Widiger TA, Frances AJ, Pincus HA, Ross R, First MB, Davis W, Kline M, editors. DSM-IV Sourcebook,Vol 4. Washington, DC: American Psychiatric Association.
Composite International Diagnostic Interview (CIDI, Version 2.1)
World Health Organization (1997): Composite International Diagnostic Interview (CIDI, Version 2.1). Geneva, Switzerland: World Health Organization.
Previous exposure to trauma and PTSD-effects of subsequent trauma
  • Breslau
Vulnerability to assaultive violence
  • Breslau
Post-traumatic stress disorder assessment with a structured interview
  • Breslau
Trauma and posttraumatic stress disorder in the community
  • Breslau
Posttraumatic stress disorder field trial
  • Kilpatrick