Ochberg Fellowship Program
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:
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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