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Update on Post Traumatic Stress Disorder
Forensic mental health experts are increasingly required to assess emotional damages, particularly Post Traumatic Stress Disorder claimed by plaintiffs as well as defendants in a variety of non-criminal and criminal matters. The goal of this update is to provide a brief overview of the currently accepted seven factors that are associated with Post Traumatic Stress Disorder as antecedents, precipitants or collateral events. Some of these components actually reflect symptoms of the disorder itself. This update is not meant as a comprehensive review of the diagnosis and treatment of Post Traumatic Stress Disorder. Interested readers are referred to Solomon, et al. for a review of Post Traumatic Stress Disorder treatments (Journal of the American Medical Association, 1992, Vol. 268, 633-638), Blanchard, et al. for a discussion of psychophysiology in Post Traumatic Stress Disorder (Journal of Consulting and Clinical Psychology, 1996, Vol. 64, 742-751) and Cooperstein for a brief overview of the condition (The Forensic Examiner, September, 1999).
At least seven factors are associated and influence the risk to develop course and response to treatment for Post Traumatic Stress Disorder. These include:
- Pre-existing Trauma. Researchers have demonstrated that individuals with a history of psychological trauma tend to be more sensitive or at risk to experience a more severe traumatic reaction to a second or third trauma.
- Environmental Factors. Factors related to the individual’s immediate social environment, nature and personal experience of the trauma and the individual’s immediate response to the trauma have been found to contribute significantly to the long-term stability of the disorder.
- Recent Life Events. Recognized life stressors such as geographic move, new job or family problems have been found to contribute to risk for developing and maintaining Post Traumatic Stress Disorder.
- Qualities of Personality. Limited research suggests that certain personality styles place individuals at greater risk to experience a stressful event as more traumatizing. In particular, individuals whose personality is characterized by a high degree of emotional reactivity to every day life.
- Pre-existing Personality Disorders. Between 5% to 15% of the population carries a quality of personality that has been defined as a disorder. That is, this quality of personality not only places individuals at risk who have a maladaptive response to stress but also to experience a dysfunction set of responses in a pervasive pattern of interpersonal stress. For example, individuals with a dependent personality disorder likely have a life time history of over relying on others. In the face of a trauma, those individuals might be expected to become even more dependent and dysfunctional.
- World View. The extent to which the world view of an individual experiencing Post Traumatic Stress Disorder has been altered appears to be a predictor in the course of the condition. That is, individuals whose view of the world either before or after trauma shifts to more tenuous, less predictable perceptions is likely to experience a more severe course of Post Traumatic Stress Disorder. Often, these individuals experience a heightened sense of vulnerability across multiple, everyday life situations.
- The Existence and Development of Co-Occurring Psychiatric and Psychological Problems. It has been recognized that individuals with histories of problems such as depression, for example, appear at much greater risk to develop more severe depression in the face of a Post Traumatic Stress Disorder. Further, a small group of individuals developing Post Traumatic Stress Disorder over a period of time instead of improving appear to worsen, developing full syndrome Major Depression and Generalized Anxiety. The risk for this course is increased in individuals experiencing chronic pain as secondary to their trauma.
Increasingly, neuropsychologists and other forensic experts are able to relay on the growing body of research examining risks for, severity and course as well as response to treatment of Post Traumatic Stress Disorder. Post Traumatic Stress Disorder as a condition that was once considered of low occurrence and developing only in the face of chronic stress over long term (e.g., Vietnam veterans) is now recognized as a phenomena that can occur as the result of a single, life threatening event. Even in the latter case this single experience can, in the face of other risk factors, cause a severely disabling and at times unfortunately chronic stress condition. On a positive ending note, researchers are increasingly demonstrating that the condition of Post Traumatic Stress Disorder with careful diagnosis and the combination of psychotherapy, family and environmental support, as well as medication when needed, can be treated effectively.