Post-traumatic stress disorder in victims of civilian trauma and criminal violence

G C Davis, N Breslau
Psychiatric Clinics of North America 1994, 17 (2): 289-99
Many individuals in the community suffer from PTSD and other stress reactions. Physicians, however, tend to diagnose post-traumatic symptoms as anxiety or depressive disorders rather than PTSD. Contacting and engaging patients after a disaster can be quite difficult. The chronic PTSD patient has been described as elusive and difficult to detect within the health care system. In one study, the time interval from trauma to psychiatric consultation was well over 3 years. A history of PTSD is often obscured by comorbid disorders or adjustment difficulties, such as depression, aggressive behavior, and drug and alcohol abuse. PTSD is a common problem, particularly in populations that are at high risk for exposure to traumatic events, such as the homeless, drug abusers, and those of specific professions. Although research on treatment of PTSD has revealed only modest benefits, early detection and intervention are important and might prevent poor adjustment and a chronic outcome. Clinicians should routinely inquire about history of unpleasant events and distasteful and unspeakable experiences, both recent and lifetime. Studies of various traumatic events consistently demonstrated that the presence of significant symptoms between 6 weeks to 6 months after exposure predicts chronic PTSD. Although early intervention might lead to the prevention of PTSD or its chronic course, there have been no randomized or controlled studies to support this hypothesis. Research on PTSD in victims of civilian trauma has only recently begun. Rape is the most extensively studied civilian trauma. Most studies reported that PTSD following rape is common. Further, characteristics of the rape event, such as rape by a stranger, use of physical force, display of weapons, and victim injury, are associated with a greater likelihood of PTSD, and symptoms at 3 months after the rape are predictive of a chronic course. Interest in the consequences of MVAs has increased dramatically, perhaps owing to the frequency of such accidents and the large number of PTSD damage claims. There is a great need to understand work environments better and the special risks associated with dangerous occupations, such as police, firefighters, rescue workers, and body handlers. Clinicians commonly attribute symptoms to a particular stressor, usually the most recent stressor or the stressor that represents the content of the symptoms. For example, nightmares about a recent auto accident and avoidance of expressways are interpreted as evidence that a recent auto accident is the cause of PTSD symptoms.(ABSTRACT TRUNCATED AT 400 WORDS)

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