More broadly, research that psychologist George A. Bonanno of Columbia University and his colleagues reviewed in 2011 suggests that only about 5 to 10 percent of people typically develop PTSD after experiencing traumatic life events. And although the rates rise when stressors are severe or prolonged, they hardly ever exceed 30 percent. The rare exceptions may occur with repeated trauma. In another 2011 study psychologist Stevan Hobfoll of Rush Medical College and his colleagues reported that of 763 Palestinians living in areas rife with political violence, more than 70 percent exhibited moderate PTSD symptoms and about 26 percent had severe symptoms.
The finding that PTSD is not an inevitable sequela to trauma has spurred investigators to pursue factors that forecast relative immunity to the condition. Across studies, higher income and education, strong social ties and male gender tend to confer heightened resilience, although these predictors are far from perfect. People who usually experience very little anxiety, guilt, anger, alienation and other unpleasant emotions—that is, who have low “negative emotionality”—are also less likely to suffer from PTSD following trauma. Thus, in ways that researchers do not yet understand, individual characteristics must combine with trauma to produce this illness.
Emotional Triggers
Not only is trauma insufficient to trigger PTSD symptoms, it is also not necessary. Although by definition clinicians cannot diagnose PTSD in the absence of trauma, recent work suggests that the disorder’s telltale symptom pattern can emerge from stressors that do not involve bodily peril. In 2008 psychologist Gerald M. Rosen of the University of Washington and one of us (Lilienfeld) reviewed data demonstrating that significant PTSD symptoms can follow emotional upheavals resulting from divorce, significant employment difficulties or loss of a close friendship. In a 2005 study of 454 undergraduates, psychologist Sari Gold of Temple University and her colleagues revealed that students who had experienced nontraumatic stressors, such as serious illness in a loved one, divorce of their parents, relationship problems or imprisonment of someone close to them, reported even higher rates of PTSD symptoms than did students who had lived through bona fide trauma. Taken together, these findings call into question the long-standing belief that these symptoms are tied only to physical threat.
In light of these and other data, some authors have suggested that the PTSD diagnosis be extended to include anxiety reactions to events that are stressful but not terrifying. Yet such a change could lead to what Harvard University psychologist Richard J. McNally calls “criterion creep”—expanding the boundaries of the diagnosis beyond recognition. This and other controversies aside, recent results raise the possibility that PTSD is a less distinctive affliction than originally thought and that its symptoms may arise in response to a plethora of intense stressors that are part and parcel of the human condition.
This article was published in print as "When Coping Fails."
This article was originally published with the title Stress.
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11 Comments
Add CommentDoes Post-Traumatic Stress Disorder Require Trauma?
Reply | Report Abuse | Link to thisDoes a traffic accident require motor vehicles?
Trick question, right?
Reply | Report Abuse | Link to thisDid someone really ask this question? I mean really-or is it a long typo?Hey-othere than that, cant come up with better comments than the first two.
Reply | Report Abuse | Link to thisIs losing a loved one a "physical" trauma to you?? I'm not a doctor but know it hurts more than hitting my thumb with a hammer. A lot more.
Reply | Report Abuse | Link to thisTrauma implies "blood", but "stress" implies psychological issues. Therefore, is "Traumatic Stress" an oxymoron??
Can you be afraid of being blown up without being blown up first?? Can you be traumatized by seeing trauma??
It sounds to me like someone is afraid that somebody else might be "faking it". OK, some people do that. I say we err on the compassionate side, with our Vets anyway.
However, if the person is a Democrat, I say we tell them, "Welcome to the real world, take an aspirin, and get on with your life."
Traumatic disorder require Trauma.Particularly Trauma of childhood is very dreadful.It afflicted and tormented with unbearable fear ,pain and not curable.Joseph LeDoux did excellent research in his the emotional brain on PSTD.There are many variates in childhood trauma.Recent research in neuroscience particularly "Mirror neutrons and empathy" has also terrible effect on PSTD..I am suffering from mirror neutrons and empathy form last 76 years and I gone through anguish guilt feeling horribly.As I study the life of Dostoevsky, Hitler I found out both were victims of mirror neutrons.I wrote both of them a essays and experts appreciated.
Reply | Report Abuse | Link to thisThe basic problem here is, what is the definition of "trauma"? As much as science has uncovered that everything that goes on in the human psyche has an underlying neurobiological component, there still exists this false dichotomy of "physical" threat, disease, or injury and those of the "mental" realm.
Reply | Report Abuse | Link to thisPersonally, I believe that the heightened incidence of PTSD symptoms in individuals for whom there is no evidence of an "actual," meaning physical, threat, is due precisely to the unseen nature of what they perceive as threatening. The ability to hide, bury, ignore, and become numb to emotions is hallowed in our society; therefore, without a physical scar, sufferers of psychological trauma are often belittled (or are afraid that they will be belittled). Absent a clear way to acknowledge the pain, they don't heal, or the healing is extremely difficult and slow, fraught with neuroses and behavioral problems along the way.
Not sure what's "new" here. Complex PTSD (C-PTSD), proposed for inclusion in the DSM-V, was described in 1992 by trauma expert Judith Herman in her classic "Trauma & Recovery". The notion, in a nutshell, is that various life stressors and events can collectively lead to PTSD-like symptoms and conditions, which may be remediated via treatments used for conventional PTSD, notably EMDR.
Reply | Report Abuse | Link to thisYitzchak Samet, MA, LMHC
Of topics not mentioned are those who suffer from earthquake related PTSD and these days there's far more of them post Haiti (2010) and Japan (2011), though others around the world suffer from anxiety in fear The Big One won't be to far afield from today's noted earthquake reports.
Reply | Report Abuse | Link to thisYet, what of persons who experience horrendous events in hospitals? They may not seek counseling, (thus being under the radar), though I think it difficult not to believe when experiencing a life threatening illness and painful treatments it won't leave an indelible mark on ones life.
However, for many it's still seen as a weakness to live in fear about something that happened long ago that doesn't quite go away and with that age old thought that everyone who seeks counseling is crazy I think your study numbers may be on the low side.
i live in a black mouth that with their hussle habits can robber and fighting that no one can help or protect us from them, not trauma but just the police let them fight and robbering us. They really not educated, terorist and komunist. You cant say i am trauma with what your journal write here, the situations take in charge.
Reply | Report Abuse | Link to thisVery interesting article, Thanks! The definition of "trauma" seems a bit arbitrary. Seeing a loved one die slowly from cancer is not traumatic but seeing a loved one killed suddenly in an accident or crime is traumatic...not sure about that.
Reply | Report Abuse | Link to thisAnother thing to consider is the age of the sufferer. An independent adult who loses (to death, imprisonment or abandonment) a loved one may be very sad, but it's less likely that they will feel that their life is threatened than a child, who may be very dependent upon the loved one for food, safety, etc.
What's yours?
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