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Traumatic stress, as defined in this module, is the pressure, force or strain
on the human mind and body from a specific event of major dimension that shocks,
stuns and horrifies. The witnessing of and learning about traumatic stressors
experienced by others can also be traumatizing. Common examples include witnessing
or learning about the sudden death of a loved one or observing the serious
injury or unnatural death of another person.
Often the victim who directly experiences traumatic stress fears for his
or her life or feels imminently threatened with serious injury. Some severely
traumatized individuals may dissociate during a stressor or have a blunted
response, due to defensive avoidance and numbing. Often, the intense emotional
response to the stressor may not occur until considerable time has elapsed
after the incident has terminated.
Up to 90 percent of the general population in the United States is exposed
to a traumatic stressor at some time (Breslau, Kessler, Chilcoat, Schultz,
Davis, & Andreski, 1998). Common types of trauma include road traffic accidents,
man-made or natural disasters, wartime combat, interpersonal violence (e.g.,
child abuse, sexual assault, domestic violence, other criminal violence),
life-threatening medical conditions, and sudden unexpected death of a close
relative or friend.
The percentage of those exposed to traumatic stressors who
then develop posttraumatic stress disorder (PTSD) can vary depending on the
nature of the trauma. At the time of a traumatic event, many people feel overwhelmed
with fear, others feel numb or disconnected. Most trauma survivors will be
upset for several weeks following an event, but recover to a variable degree
without treatment. The percentage of trauma victims that will continue to
have problems and develop posttraumatic stress disorder (PTSD) will depend
on many factors, including the severity of trauma exposure. In one major epidemiological
study of American civilians aged 15-54 (National Comorbidity Survey, Kessler
et al., 1995) lifetime prevalence rates of PTSD following specific types of
trauma were:
| TRAUMA |
MEN |
WOMEN |
| Combat |
38 % |
- |
| Rape |
65 % |
46 % |
| Life-threatening Accident |
6 % |
9 % |
| Physical Attack |
2 % |
21 % |
| Witnessing Death or Injury |
6 % |
8 % |
| Natural Disaster |
4 % |
5 % |
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About 1 in 12 adults experiences PTSD at some time during their lifetime
(women 10.4%; men = 5%; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995).
Women are twice as likely as men to develop PTSD following exposure to traumatic
events.
Although a key dimension of traumatic stress research is its
effect on an individual's psychological health, there is an important underlying
physiological dimension to traumatic stress. The physiological dimensions
of traumatic stress are discussed at the end of Part 2.
CASE IN POINT:
Tragedy in a Houston Suburb
In June 2001, a 36-year-old woman was taken into custody after telling
police that she had drowned her five children in a bathtub. Responding officers
found her five children dead in her home, the youngest child only six months
old. The woman's husband spoke on camera in front of their home not long
after the discovery of the bodies and appeared to some observers to be calm
and articulate, although not emotionless. He explained to the media about
his wife's history of depression and that despite what she did he still
loved her and wanted to help her.
Sometimes when we see people talking about a profoundly tragic event soon
after it happens we expect them to display certain emotions — perhaps
hysteria, hostility, an inability to speak coherently. When people do not
respond the way we expect them to (or the way we think we would respond
under the same circumstances), we may make all kinds of faulty assumptions
about that person's sincerity or degree of grief and pain. The fact is,
people respond to personal tragedy in their own way. Trauma experts warn
us not to assume a person is "taking it well" just because he or she does
not appear to be affected by a tragic event. That person could be in shock,
in a stage of emotional anesthesia, or displaying a number of other emotional
states that camouflage the degree of trauma that he or she is actually experiencing.
This period of withdrawal or muted emotions may be helping the person to
survive the unthinkable horror that has just occurred. One should never
assume that psychological damage is minimal or non-existent simply by a
person's outward display of emotion (or lack thereof).
It is important to keep in mind that discussing a traumatic event soon after
exposure may have a detrimental effect on some traumatized individuals. Preliminary
research in this area suggests that those individuals with heightened arousal
immediately following or shortly after a trauma, may be more likely to develop
long-term posttraumatic stress disorder (PTSD) (Shalev, 2001; Bryant, 2000).
Therefore, overriding an individuals need for distance, avoidance of reminders
of the trauma, and dissociation in the immediate phase of a trauma, may be
detrimental to some individuals, particularly those with heightened arousal.
A key dimension of traumatic stress research is its effect
on an individual's psychological health, which will be highlighted in the
next section.
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