Research Note: Is Severe Trauma Needed to Produce PTSD Symptoms?

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/

Brief Research Notes

Michael Atkinson, Adam Guetz and Lawrence Wein write in the September 2009 issue of Management Science that the high tempo of deployments to the Middle East by U.S. troops makes it difficult for the VA to plan for veterans' care in the future. Delayed onset in many of our military makes it hard to predict when they will seek help and it what numbers. The authors use a mathematical model with deployment data and PTSD data from Iraq to predict a roughly 35% rate of PTSD in Iraqi veterans. They recommend that the VA "...needs to urgently ramp up its mental health resource capacity." Nothing was mentioned about the conflict heating up in Afghanistan. Another topic of interest is recent research on the relationship of diastolic blood pressure and cognitive impairment. Previous findings have shown a link between chronic stress and elevated blood pressure. Also, brain studies have found linkage between chronic stress and shrinkage of the hippocampus (a brain area involved in memory). Researchers at the University of Alabama in Birmingham have found that for every 10-point increase in diastolic blood pressure there is a 7% increased likelihood of cognitive impairment. Let's see. If my diastolic pressure should be 70, but is 100 then my potential for decreased concentration and memory increases by (3 X 7 =) 21%. Ye gads! Maybe I will take by blood pressure pills after all....

Bad News and Good News....

The bad news is that the Institute of Medicine has found a stronger association between the Agent Orange exposure of Vietnam veterans and two diseases. Ischemic heart disease and Parkinson's Disease are more closely correlated with Agent Orange (dioxin) exposure than we realized. The US Department of Veterans Affairs (VA) has not yet been granted authority to service connect the two disorders for veterans. Service connection means that veterans are allowed to file a claim after the fact to have a present illness recognized as having occurred in service and thus allow it to be treated in VA medical facilities. For example, if a soldier is shot in the knee that would be in his or her military medical records and entitle the veteran to life long treatment for the residuals of the injury (and death benefits to survivors if it kills you). However, certain service related illnesses are only recognized later in life and are hard to document if they occur after a person is out of the military. Agent Orange has already been linked to many disorders which had been service connected by act of Congress. So, what's the Good News? The IOM is also studying "Persian Gulf Syndrome" from the 1990-91 Gulf War so we know somebody out there cares. More information is available at the VA web site (http://www.publichealth.va.gov/exposures/agentorange/index.asp ).

Bad PR for VA....

In a March 20th e-mail to staff of her PTSD program at the Olin E. Teague VA psychologist Dr. Norma J. Perez noted that "Given that we are having more and more compensation seeking veterans, I'd like to suggest that you refrain from giving a diagnosis of PTSD straightout. Consider a diagnosis of adjustment disorder NOS, R/O PTSD. Additionally, we really don't have time to do the extensive testing that should be done to determine PTSD." This has caused a stir in the blogosphere among veterans, service organizations, Congress and the general public.

A general belief has been expressed that this indicates a generally negative mindset among VA staff toward veterans with Post Traumatic Stress Disorder (PTSD). I think that there are other ways to interpret the quote. One of those might be a concern that there are not enough resources to adequately diagnose and treat veterans and that incorrectly diagnosing a vet's problem would be a bad idea. My belief is that there need to be many more resources devoted to one of the two signature wounds (along with traumatic brain injuries) of war in the sandbox. What say you?

Never Ending War

The title of "Traumatized Psychologist" for this blog is intended as a psychological "hook" and is in no way an attempt to diminish the suffering that people experience in war. I have had my share of stresses and so have most people. It is when the stress is a catastrophic trauma that we as human beings are likely to go off track. With the war in the Middle East seeming to be turning into a Never Ending or 100 Years War that more and more folks are beginning to become concerned about the effects of the war on our husbands, wives, children, parents and country. I will attempt in these blogs to address some of the things I learned in Vietnam, as a graduate student and professor, and as a professional helper who has been privileged to help our wounded warriors in my own small way. Please feel free to respond to any of my posts. I am not a guru or expert and definitely do not have all the answers......