DM: When I give workshops, I review four classes of factors that I think distinguish those who develop PTSD from those who do not. The four general headings have to do with characteristics of the trauma itself. There is a good deal of research that highlights the nature of the objective features of the traumatic event including its intensity, its durability, and people's proximity to the event. Another important aspect of these stimulus characteristics is not only the objective features but also the subjective features. There are a number of studies that highlight that the meaning the event has may play more of a role than the actual stimulus characteristics. That is, does the individual feel that by their actions or lack of actions, that they may have inadvertently contributed to the traumatic experience? This can play an important role in determining who develops PTSD. For example, if the individual feels blameworthy and guilty about the nature of their role in the traumatic event, this would clearly increase the likelihood of people developing PTSD. So, one whole class of events involvesstimulus characteristics. The second class of events areresponse characteristics. We know that the nature of the response that individuals have in reaction to the traumatic event is critical in determining who goes on to develop PTSD. There are three features that turn out to be important. One is how the person responded at the time of the traumatic event. What has notably been characterized as the acute stress reaction. Does the person show anxiety, dissociation and the like? This may play an important role in influencing the nature of the reactions they encounter and the support that they may receive.
Another element that becomes important is the recognition that the reactions of traumatized individuals change over the course of time. It is not only important to recognize that clients have symptoms, but when they have these symptoms is critical. For example, a common referral problem is intrusive ideation. Research by Baum and others indicates that if intrusive ideation occurs down the road, well after the event, it increases the likelihood of PTSD. Also, is there comorbidity? That is when the individual not only experiences what is considered classical PTSD, but what is known as complex PTSD. Are there comorbid responses such as anxiety, depression, suicidal ideation, and what is often overlooked, anger responses? Also, as I noted, are there guilt reactions? This clearly complicates the nature of the situation and increases the likelihood of developing PTSD.
TwootherfactorsplayanimportantroleindeterminingwhodevelopsPTSD.Thereisagooddealofresearchtoimplicatetheroleofpremorbidfeatures;thatisthenatureofpriorexposuretovictimizationincreasestheriskofdevelopingPTSD.Whetheronelooksattheresearchoncombat,oronbeingavictimofcrime,ormanyothertraumaticevents,youfindthatpriorexposurebothfortheindividualandtheirfamilyorcommunity,canputindividualsathighrisk.ThereareanumberofotherpremorbidfeaturesintermsofsocializationpatternsandthelikethatmayalsopredisposeindividualstodevelopPTSD.Forexample,intergenerationalvictimizationbecomesimportant.Somerecentfindingshighlightthatwhenchildrenarevictimized,iftheirparentshavehadahistoryofvictimization,itincreasesthelikelihoodofthechildrendevelopingPTSD.Thelastandperhapsthemostoverlookedfactoristhenatureoftherecoveryenvironment.Itisnotonlywhatthepersonexperiencedandhowtheyreactedbothatthetimeordowntheroad,orwhetherthiswasthefirsttimethattheyweretraumatizedornot
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