Dr. Jordan Robinson and Dr. Christine Larson recently conducted research to try to answer this interesting question. Current formulations require the presence of a trauma that is life threatening and involves fear, helplessness or horror. Following having such a trauma or witnessing it folks may begin to re-experience that trauma in a variety of ways (e.g., intrustive thoughts, flashbacks); may avoid whatever triggers the re-experiencing (e.g., crowds, loud noises) and have overly active autonomic nervous system reactions (e.g, insomina, startle responses). People who meet that criteria are diagnosed with post traumatic stress disorder (PTSD).
The problem is that some folks have the intrusive experiences, avoidance and arousal symptoms without a clear cut horrific traumatic experience. For them the triggers seem to be more gradual, long term, and less immediately life threatening. Drs. Robinson and Larson at the University of Wisconsin-Milwaukee gathered 64 adults who had a clear traumatic incident happen to them in the past year (Trauma Only Group); 149 who had stressful experiences during the past year, but not severe trauma (Stress Only); and 149 who had both a trauma and stressful conditions (Both). The "traumatic" events included incidents such as life threatening accidents, physical and sexual assaults. Those in the "stressful" category included relational stress, legal problems, expected loss by death of a loved one. The volunteers in the study took tests such as the Post Traumatic Checklist-Civilian version (PCL-C) and the Life Events Survey.
Surprisingly, there were no statistically significant differences in the total symptom scores on the PCL-C between the Trauma Only and the Stress Only groups. There was a significant difference between the Stress Only and the Both Stress and Trauma Group (the Both group score was higher). The symptoms of PTSD were analyzed among the 3 groups using the Re-experiencing cluster of symtoms, Avoidance cluster, and Arousal cluster. No significant differences were found between the Stress Only and Trauma Only groups on either Re-experiencing, Avoidance or Arousal clusters. This suggests that both groups seem to have similar levels of stress response symptoms regardless of having an acute, sudden onset life threatening trauma or a more gradual, less intense but continuing stressor. Those exposed to both stress and trauma tended to have more problems than the other two groups.
The implications for those in the mental health field are enormous. Folks exposed to chronic life stressors may develop symptom clusters closely resembling PTSD. In other words, the individual under constant stress financially, personally, and occupationally by a hurricane or oil spill off their coast might be at risk for mental health problems much as a soldier in combat would be. The bad news is that we may be in for a wave of significant mental health problems among the citizens of the Gulf of Mexico states in the aftermath of the BP oil spill. The good news is that we know some ways to help folks cope with it.
Interested readers are encouraged to read the article by Drs. Robinson and Larson titled "Are Traumatic Events Necessary to Elicit Symptoms of Posttraumatic Stress?" in the June 2010 issue of Psychological Trauma: Theory, Research, Practice and Policy, Volume 2, Number 2, pages 71-76. For tips on coping strategies see the most recent post on the Mindful Helper at http://mindfulhelper.blogspot.com/
