Why Do PTSD Rates Vary Depending On Trauma?

[Roerich]

So what happens to the percentages if say, you had experienced a violent assault and seen someone killed? Or had been a veteran and been in a natural disaster, etc? Like I'm just curious from a statistical standpoint. Do you add the 2 percentages together to come up with an average rate? Hope my question makes sense.

Hi,

I found this data from one study, reference article listed at the end of my post.

TABLE 3. Relation Between Number of Traumas and Risk of PTSD
for Male and Female Chemically Dependent Adolescents

Number of Experienced Traumas
PTSD N %

One Trauma

Total group (N=110) 36 32.7%
Males (N=89) 24 27.0
Females (N=21) 12 57.1

Two
Total group (N=76) 34 44.7%
Males (N=49) 15 30.6
Females (N=27) 19 70.4

Three

Total group (N=36) 23 63.9%
Males (N=24) 15 62.5
Females (N=12) 8 66.7

From this table of data we can see that one traumatic event resulted in a PTSD rate of 32.7%, two traumas increased the rate to 44.7%, and three traumatic events raised it even more to 63.9%.

The table is taken from this study.

Prevalence and Risk Factors for Posttraumatic Stress Disorder
Among Chemically Dependent Adolescents

Eva Y. Deykin, Dr.P.H., and Stephen L. Buka, Sc.D.


Roerich

 

[Roerich]

Dr Roerich,

Thank you for the above information. It is very much appreciated.

D (wildcritter)

D,

You're welcome. I very much appreciate the discussion here as well. Asking questions and discussing expands our point of view and adds to our fund of knowledge.

Roerich

 

[Roerich]

I think I have a clue what you are asking Evie and have wondered the same... Also does it build up until boom? I was involved with Hurricane Rita (I was lucky while seeing my neighbors home leveled), more than a few different assaults and types of, and even self inflicted trauma. I wondered is it possible not to develope PTSD from one thing but would the build up just send you to a breaking point where it all just collapses or are you being even further damaged? Or can it go both ways?

Veiled,

Great question! The DSM-IV criteria for PTSD requires the person's response involves the feelings of fear, horror or helplessness.

"Severity of the trauma, in terms of its intensity, frequency, and duration, is one of the most important determinants of a stressor’s potential to induce subsequent PTSD. Clinical observation and research show a “dose-response” relationship between degree of stress and the likelihood, chronicity, and severity of PTSD symptoms. Specific characteristics of the traumatic stressors are important, such as degree of violence involved and whether
sexual victimization occurred. Listed below are aspects of traumatic stress that are important to consider when assessing for Criterion A:

• Qualities of intensity, frequency and duration of stressor severity
• Unpredictability and uncontrollability of the stressor
• Presence of life threat
• Bodily injury
• Tragic loss of a significant other
• Involvement with brutality or the grotesque
• Degree of violence involved, particularly violence of a criminal nature
• Sexual victimization

"Qualifying stressors must induce an intense emotional response. According to DSM-IV, a qualifying stressor must not only be threatening, but it must also induce a response involving intense fear, helplessness, or horror. This requirement is not without controversy, as there are no guidelines for determining how “intense” the response needs to be in order to satisfy the
stressor criterion. Moreover, 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. For assessment purposes, if an intense emotional reaction
occurs directly related to the traumatic experience, but is delayed by days or even weeks, the emotional reaction criterion can still be met. In these cases, it is necessary to determine whether the individual engaged in dissociation or numbing during or immediately following the traumatic event."

Reference: PTSD Basics

Fear, Helplessness, and Horror in Posttraumatic Stress Disorder: Investigating DSM-IV Criterion A2 in Victims of Violent Crime

Journal Journal of Traumatic Stress
Publisher Springer Netherlands
ISSN 0894-9867 (Print) 1573-6598 (Online)
Subject Behavioral Science
Issue Volume 13, Number 3 / July, 2000
DOI 10.1023/A:1007741526169
Pages 499-509
SpringerLink Date Monday, November 01, 2004

Chris R. Brewin1, Bernice Andrews2 and Suzanna Rose2
(1) Subdepartment of Clinical Health Psychology, University College London, Gower Street, London, WC1E 6BT, England
(2) Department of Psychology, Royal Holloway, University of London, England

Abstract A DSM-IV diagnosis of posttraumatic stress disorder (PTSD) required for the first time that individuals must report experiencing intense fear, helplessness, or horror at the time of the trauma. In a longitudinal study of 138 victims of violent crime, we investigated whether reports of intense trauma-related emotions characterized individuals who, after 6 months, met criteria for PTSD according to the DSM-III-R. We found that intense levels of all 3 emotions strongly predicted later PTSD. However, a small number of those who later met DSM-III-R or ICD criteria for PTSD did not report intense emotions at the time of the trauma. They did, however, report high levels of either anger with others or shame.

PTSD - crime - fear - helplessness - horror

When emotional buttons are pushed in our lives ( fear, horror, or helplessness), what threshold is needed in order to develop PTSD? As noted above, there are no guidelines to determine how "intense" the response needs to be in order to satisfy the stressor criterion. If the amount of stress is subthreshold and does not produce PTSD a month after the stressful event, does it reside in the neurochemical circuitry of the brain like a brain receptor in flux, either down-regulated or up-regulated ( like a thermostat for temperature control, but here it is emotional control).

Perhaps a person did not develop PTSD from intense helplessness, fear, or horror in early life, but now being in combat, may if the remaining criteria are met?

Would treatment for PTSD involve the here and now with cognitive behavioral or exposure therapy, and ignore earlier emotional buttons involving fear, horror, or helplessness? Can the logical brain truly process emotional injury when that emotional trauma is beyond the capacity of the logical brain to process those feelings? Sometimes the logical brain disconnects from the emotional loads, that is dissociates, and in severe psychological injury can lose touch with reality in acute psychosis or psychotic depression, with a depletion of neurotransmitters and result in catatonia, physical paralysis due to severe depression.

There are many questions and few answers. But if we can share and discuss our thoughts and viewpoints we are closer to finding those answers we seek.

Roerich

 

[batgirl]

Thanks for those explanations. It's interesting and it makes a lot more sense to me now!

 

[cookie]

interesting. i am very curious (ok, nosey) by nature, it seems like the more you understand, the more questions you have,lol. thanks for the research and explanations.
cathy

 

[Deleted member 93]

OK, my thoughts. To try and answer my own question and by info provided. You can indeed disassociate enough to bury and not readily be able to say what you felt at the time. I think things can even be pushed for years and be functioning even if not well. Hence the molesting and fires. Little recall and mother telling of some things and confirming others. Like I did not know why I smelled smoke so she told me he tried to set me on fire and set the home on fire over and over. Did I have symptoms when the older brother was around? No clue as I can barely remember a thing of him. What I do can make me sick at times. I assume it was so overwhelming I did detach from myself enough that it isn't even a memory anymore except a few flashes. My mind found a way to protect me.

I really think you can become accustomed to shoving it down when it is expected of you. While I may have showed signs in the classic sense about (forced abortion after changing mind)5 years,(rape) 6 years, (assault)12 years,(kidnapping, rape and intended homicide) and 13 years ago I was able to suck it up again and try to move on again (never really stopped to think about symptoms after assults). Strange thing. I did NOT have the symptoms when I had been beaten badly in another incident, phone lines unplugged from outdoors... Though it was very scary the police were wonderful that time, hauled him off, and I had a great support system. Eventually for me I just had hit a breaking point at over a year and a half ago. The day I "broke for real" without being able to deny it I had stress that day but by no means anything to cause PTSD, it was just a bad day. But it seemed that day was enough to have my world come crashing in and recently I saw it was a trigger date. Enter the dope... But shortly after that we in the area I lived we did as much as we could for for Katrina victims. Then we ourselves got nailed with Rita right after. But I had some sense and seeing a Cat 5 heading our way I said screw this and left, I was able to beat most of the traffic and used "back roads" not hi ways so I did not see the traffic except on news and the damage I saw was after the storm passed. Having the break down right before these storms I think it helped the ball get rolling out of hand. I was not able to suck it up within a month or so. Before I could always stuff it down after a month average. I think the month had a reason. I had to suck it up some how some way. Bills had to be paid once a month so I would have to scramble to get my bills paid and not get things shut off or kicked out.

So I guess I cannot say when the switch just flipped into the "it won't go away" out of control PTSD realm because of detaching myself. But obviously I was just balancing. Because when the symptoms came worse than they had ever been nothing happened to warrant it. So where can you say one thing is normal PTS and you can move on? Do those people really move on? How can you know for sure? It appeared I did on the surface. But now I had to go back and try to work through every one of these things and they demanded to be.

I think you can build up until you blow. I think some people can function with this but if not addressed and turned inside out you end up in the shape I am now. Though now is 10 times better than a year and a half ago as I learn how much I can handle a day and try to work on triggers in managable amounts. But impossible to say where or what my break point was.

I am reading this and not sure it made sense, but that seems to be the maze of my mind.

Just my personal experience in the name of science.

 

[Jim]

For political prisoners and prisoners of war, rates can range from 30% to more than 70%. For torture victims, rates can be as high as 90%.

Very interesting. My father served in Korea, was in a prison camp for close to 2 years. I'm more than certain he was tortured. He's been deceased for many years, but the last little while I have been wondering about him having PTSD as well. If the rates you mention are correct and really as high as 90%, I think that answers my question.

Jim.

 

[Roerich]

A linear rise of stress with increasing number of traumatic events

Njau, JW. Post-traumatic stress disorder among the heads of households of ethnic clashes survivors in the Rift Valley Province, Kenya: a comparative study. Thesis. University of Nairobi: 2005.

Neuner F. Schauer M. Karunakara U, et al. Psychological trauma and evidence for enhanced vulnerability for posttraumatic stress disorder through previous trauma among West Nile refugees. BMC Psychiatry. 2004;4:34.

Referenced in:

War and mental disorders in Africa

The most commonly encountered mental disorders were found to be post-traumatic stress disorder (PTSD) at 39.9%, depression at 52%, anxiety at 60% and somatization disorder at 72.2%. The prevalence of suicidal behaviour was recorded as 22.7% and that of alcohol abuse as 18.2%.

Njau found, in this highly traumatized population, a prevalence rate of 80.2% of PTSD amongst the heads of households. Neuner et al studied a random sample of 3,339 refugees in the west Nile region, including Ugandans and Sudanese, and found that 31.6% of the male and 40.1% of the female respondents fulfilled the criteria for a DSM-IV PTSD diagnosis. He also found a near linear rise of psychological strain with the increasing number of traumatic events, ranging from a 23% prevalence of PTSD in those who reported three or fewer pre-defined traumatizing experiences to a 100% prevalence in those who reported 28 or more traumatic events.

 

[Roerich]

What Is Psychological Trauma?

What Is Psychological Trauma?

By Esther Giller

Psychological effects are likely to be most severe if the trauma is:

1. Human caused
2. Repeated
3. Unpredictable
4. Multifaceted
5. Sadistic
6. Undergone in childhood
7. And perpetrated by a caregiver

 

[Deleted member 93]

OK, just in a nosey mood... What if all the above? Just since it was put out there...

 

[Roerich]

Abusive Head Trauma: The Relationship of Perpetrators to Their Victims
Suzanne P. Starling MD1, James R. Holden MS2, and Carole Jenny MD, MBA1

1 Department of Pediatrics, School of Medicine, University of Colorado Health Sciences Center, Denver, Colorado
2 Department of Biology, University of Northern Colorado, Greeley, CO

Objective. Abusive head trauma is the most common cause of morbidity and mortality in physically abused infants. Effective prevention requires the identification of potential perpetrators. No study has specifically addressed the relationship of the perpetrators of abusive head trauma ("shaken baby syndrome") to their victims. The objectives of this study were to identify the abusers and their relationship to victims in these cases.

Methods. We reviewed the medical charts of 151 infants who suffered abusive head trauma to determine the perpetrator of the abuse. Caretakers were classified by level of certainty: confession to the crime, legal actions taken, or strong suspicion by the staff. The relationship of abusers to victims was analyzed.

Results. Male victims accounted for 60.3% of the cases. Twenty-three percent of the children died, although death rates for boys and girls did not vary significantly. Male perpetrators outnumbered females 2.2:1, with fathers, step-fathers, and mothers' boyfriends committing over 60% of the crimes. Fathers accounted for 37% of the abusers, followed by boyfriends at 20.5%. Female baby-sitters, at 17.3%, were a large, previously unrecognized group of perpetrators. Mothers were responsible for only 12.6% of our cases. All but one of the confessed abusers were with the child at the time of onset of symptoms.

Conclusions. Our data suggest male caretakers are at greater risk to abuse infants. Baby-sitters are a concerning risk group, because they represent a significant proportion of abusers, and they more easily escape prosecution. In addition, no prevention efforts have been directed at baby-sitters. These statistics could help change the focus of efforts to prevent abusive head trauma.

 

[Roerich]

PERPETRATOR-VICTIM RELATIONSHIP: LONG-TERM EFFECTS OF SEXUAL ABUSE FOR MEN AND WOMEN

Author: A. Ketring Leslie L. Feinauer, Scott

Source: American Journal of Family Therapy, Volume 27, Number 2, April - June 1999, pp. 109-120(12)

Publisher: Routledge, part of the Taylor & Francis Group



Abstract:
This study investigated the emotional and familial relationships of 465 victims and perpetrators of childhood sexual abuse. Four hundred nineteen women and 56 men who were victims of childhood sexual abuse completed the Trauma Symptom Checklist-33 (TSC-33; J. Briere & M. Runtz, 1989) and a severity of sexual abuse scale. In addition, the abuse survivors answered questions about their emotional relationships with the offender prior to the abuse. The data were analyzed with analysis of variance. The dependent variable was the adjustment to the trauma, as measured by the TSC-33. The independent variables were perpetrator identity, gender, level of abuse, and emotional feelings exhibited toward the perpetrator prior to being sexually abused. The most pervasive symptoms were found among participants who were abused by a father figure and women who were very severely abused. Contrary to theoretical expectations, there were no statistically significant differences based on gender.

Document Type: Research article

DOI: 10.1080/019261899262005