Duration of Exposure and the Dose-Response Model of PTSD

University of Washington Medical School, Department of Psychiatry and Behavioral Sciences, Box 356560, Seattle,WA 98195-0650, USA.
Journal of Interpersonal Violence (Impact Factor: 1.64). 03/2009; 25(1):63-74. DOI: 10.1177/0886260508329131
Source: PubMed


A dose-response model underlies posttraumatic stress disorder (PTSD) and posits a relationship between event magnitude and clinical outcome. The present study examines whether one index of event magnitude--duration of exposure--contributes to risk of PTSD among female victims of sexual assault. Findings support a small but significant contribution of event duration to clinical status in the immediate aftermath of trauma but not at 3-month follow-up. The opposite pattern is obtained for subjective appraisals of threat. These findings add to a growing literature that suggests that a simple application of the dose-response model to objective event characteristics may be insufficient to explain the risk of PTSD.

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Available from: Debra Kaysen
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    • "Many investigators (Groleau et al., 2013; Kaysen et al., 2010; Martin et al., 2013; Ozer et al., 2008) point out that peritraumatic reactions, including the meaning attached to the sexualized assault, are highly predictive of later difficulties and may modify the impact of other variables such as the number of trauma exposures. For example, for victims of sexualized assault, subjective appraisal of threat is more significant in predicting risk of PTSD than the duration of the assault (Kaysen et al., 2010). The centrality of a traumatic event, i.e. the extent to which the event becomes part of the person's sense of identity or life story, and level of threat to core beliefs, i.e. the extent to which the event violates basic assumptions about the world, both predict both posttraumatic distress and posttraumatic growth (Groleau et al., 2013). "
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    ABSTRACT: Though childhood sexualized assault (CSA) in- creases risk for varied psychological difficulties, no single condition, syndrome, or set of difficulties is reliably associated with such experiences. CSA likely disrupts or impairs normal development in complex ways that depend on the risk and resilience factors present before, during, and after CSA. CSA characteristics that increase risk for later difficulties include young age, trauma inflicted by another person, number of occurrences, violence or intrusiveness, betrayal of trust, ad- verse peri-traumatic reactions, negative reactions from others following disclosure, and a context of previous sexualized assault or maltreatment. Resilience increases with positive self-esteem, better intellectual functioning, good self-control, positive social support, and early therapeutic intervention. CSA is associated with impaired psychological development, mental health disorders, behavioural and relationship difficulties, physical health problems, reduced intellectual function, lower educational achievement, lower occupational attainment, and reduced lifetime income. Any particular difficulty may be problematic in its own right and may also contribute to other difficulties in the interlocking domains of individual abilities and attributes, relationships, and significant life activities. In individual forensic assessment cases, general evidence on CSA risk/resilience and impacts can be used in combination with the lifespan developmental analysis (Barnes & Josefowitz, Psychological Injury and Law, 2014),
    Full-text · Article · Mar 2014 · Psychological Injury and Law
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    • "For example, the unexpected death of a close friend or relative was endorsed by 75% of our sample; life-threatening illness was endorsed by 54% of our sample; and exposure to a natural disaster was endorsed by 79% of our Bay Area sample, many of whom may have been exposed to the 1989 Bay Area earthquake. We also did not collect information on either age at trauma exposure, number of exposures to each specific type of trauma or severity of traumatic events, each of which is likely to play an important role in the relationship between trauma exposure and inflammation (Danese et al., 2007; Kaysen et al., 2010). "
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    ABSTRACT: Exposure to traumatic psychological stress increases risk for disease events and mortality in patients with cardiovascular disease (CVD). While the biological mechanisms of these effects are not known, inflammation may play a key role as it is both elevated by psychological stress and involved in the development and progression of CVD. In a prospective study of patients with stable CVD (n=979), we examined if higher lifetime trauma exposure was associated with elevated levels of inflammation at baseline and at five-year follow-up, and with greater increases in inflammation over time. Inflammation was indexed by a composite score incorporating the inflammatory markers interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and resistin. In follow-up analyses, we adjusted for sociodemographic factors, psychiatric disorders and health behaviors that were significantly associated with trauma exposure. Higher trauma exposure was associated with elevated inflammation at baseline (β=.09, p=.01) and at five-year follow-up (β=.09, p=.03). While levels of inflammation increased from baseline to follow-up in the sample, there was no significant association between trauma exposure and rate of change in inflammation. Findings were robust to adjustments for sociodemographic factors and psychiatric disorders, but health behaviors appeared to contribute to the association between trauma and inflammation at follow-up. This is the first large-scale demonstration of an association between lifetime trauma exposure and inflammation. High lifetime exposure to traumatic stress may contribute to an accelerated rate of CVD progression through elevated inflammation.
    Full-text · Article · Feb 2012 · Brain Behavior and Immunity
    • "Cumulative trauma burden, intense adversities, and polyvictimization across life span have been found to contribute to significant unique variance in mental health outcomes beyond that accounted for by the combination of all aggregate trauma and victimization types (e.g., Kira et al., 2008a; Richmond, Elliott, Pierce, Aspelmeier, & Alexander, 2009). The dose-dependent response model has proved to be insufficient in explaining the risk for PTSD symptoms in such CT situations (e.g., Kaysan et al., 2010). "
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    ABSTRACT: We investigated the relationship between trauma type, posttraumatic stress disorder (PTSD), and intelligence quotient (IQ) utilizing a development-based taxonomy of trauma in a sample of 390 African-American adolescents and Iraqi refugee adolescents. Utilizing structural equation modeling, we compared different “good-fitting” models that describe the specific relationships between different trauma types, PTSD cluster symptoms (i.e., re-experiencing, arousal, avoidance, and emotional numbness/dissociation), and IQ factors (i.e., perceptual reasoning, verbal comprehension, working memory, and processing speed). Our findings support the hypothesis that different trauma types have different influences, some positive and some negative. Whereas abandonment and personal identity trauma (e.g., sexual abuse) have direct negative effects, secondary trauma (e.g., parents' involvement in war or combat) has a positive effect on IQ. Collective identity trauma (e.g., oppression) did not have either negative or positive effects on IQ. The PTSD components re-experiencing and arousal generally mediated some of the negative effects of traumas on IQ; avoidance and emotional detachment/dissociation generally mediated positive effects. In conclusion, trauma type differentially impacts IQ. However, cumulative trauma dynamics have total negative significant effects on all of the four IQ components: perceptual reasoning, working memory, processing speed, and verbal comprehension. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
    No preview · Article · Dec 2011 · Psychological Trauma Theory Research Practice and Policy
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