Knowledge, myths and unanswered questions
Reprinted from "Trauma and Victimization" issue of Visions Journal, 2007, 3 (3), pp. 4-5
This special issue of Visions on trauma and victimization discusses trauma and its results in a variety of contexts (e.g., sexual abuse, car accidents, the workplace, the military and emergency workers). These articles, however, barely scratch the surface of our current knowledge of trauma and its relationship to people’s mental and physical health.
Authors have described the consequences of trauma for centuries. It is now common knowledge that people exposed to assaults, military combat, natural disasters and car accidents are at risk for lingering emotional distress. However, the characteristics of trauma that lead to distress and the relative contribution of the trauma versus people’s pre-existing personalities are still matters of debate among academics.
Early research focused on the effects of large-scale military trauma (e.g., American Civil War, Vietnam War) or of large-scale disasters (e.g., floods, fires). Early diagnostic systems created a myth that severe psychological distress could result only from extraordinary traumas that are not part of most people’s lives. This myth has largely been discredited by modern research.1
Similarly, early writings suggested that everyone exposed to such traumas would develop mental health problems. Extensive research has shown that many people are initially very distressed following trauma, but that only a small number of people develop long-standing mental health problems. For example, childhood sexual abuse is widely considered the most powerful traumatic stressor commonly studied. It is clear, however, that for the vast majority of childhood sexual abuse survivors, the event itself is associated with little psychological distress in adulthood.2 In short, the psychological distress associated with traumatic stress passes relatively quickly for most people. This does not trivialize the distress suffered by chronic sufferers, but illustrates that some individuals respond to trauma with greater resiliency than do others. We are still learning which factors provide resiliency or vulnerability following trauma. Such research is especially important for developing more effective treatments.
What makes a trauma traumatic? There is substantial debate about the definition of trauma, with some scientists arguing for a limited spectrum of life-threatening experiences and others arguing that many different life events (e.g., sexual harassment, marital infidelity) are potentially traumatic. Any event that is able to induce an immediate state of severe fear, helplessness or horror can be a traumatic stressor. Types of trauma more likely to result in post-traumatic stress disorder (PTSD) include physical assault, car accidents and life-threatening illnesses (e.g., cancer).
The best predictors of PTSD are the person’s emotional responses at the time of the trauma (e.g., extreme fear, panic, shock). The next best predictor is previous history of anxiety or depression. The third predictor is stress following the trauma (e.g., financial problems, low social support, chronic pain). Objective physical characteristics of the trauma (e.g., damage to vehicles) typically finish a distant fourth in predicting who develops PTSD.
PTSD is not the only mental health problem that can follow trauma. Fifty per cent of individuals suffering from PTSD also suffer from depression, and as many as one-third of PTSD sufferers also suffer from another anxiety disorder (e.g., panic disorder, generalized anxiety disorder). Alcohol and drug abuse also occur frequently in PTSD sufferers. Finally, recent research shows that trauma, PTSD and depression change personal health perceptions, physical health and use of medical care. That is to say, psychological trauma can make us physically sick.
Trauma not only causes many different mental health problems, but it can also be a consequence of such problems. For example, alcohol intoxication is perhaps the best predictor of being a victim of sexual assault. This has obvious implications for preventing trauma, leading to research on rape prevention.
We sometimes learn that what we commonly do in clinical practice has little beneﬁt. Sympathy for trauma survivors and misguided good intentions has sometimes led to ill-considered treatments. Although there are effective treatments for both acutely and chronically distressed trauma survivors (see page 23), other interventions, such as single-session debrieﬁng given shortly after the trauma incident, have failed to demonstrate any beneﬁt to patients (see page 7). I usually urge clinicians to focus less on the speciﬁc type of trauma and more on the immediate emotional experience of the trauma survivor.
In summary, trauma is a very large area of research and clinical practice. Over the past 25 years we have learned a great deal about the consequences of trauma, about better and worse methods of coping with trauma and about effective treatments. However, much remains to be learned about vulnerability factors (see page 6), the prevention of trauma, early intervention for distressed trauma survivors, and effective treatments for chronic PTSD.
About the authorDr. Koch holds adjunct appointments at the University of British Columbia and at Simon Fraser University. He co-authored Psychological Injuries: Forensic Assessment, Treatment, and Law, published in 2005 by Oxford University Press. Dr. Koch practices and publishes extensively with respect to the consequences of trauma. Visit his website at www.drwilliamkoch.com.
- Norris, F.H. (1992). Epidemiology of trauma: Frequency and impact of different potentially traumatic events on different demographic groups. Journal of Consulting and Clinical Psychology, 60, 409-418.
- Rind, B., Tromovitch, P. & Bauserman, R. (1998). Meta-analytic examination of assumed properties of child sexual abuse using college samples. Psychological Bulletin, 124(1), 22-53.