Over half of the population is exposed to at least one lifetime traumatic event, yet relatively few of those exposed have lasting psychiatric sequelae. As psychiatrists, we attend to the needs of those who suffer. In this Special Report, the authors point out that psychiatrists’ clinical practice and trauma research focus more often on disease states and less often on enhancing resiliency factors. They present an approach for identifying trauma exposure within a brief psychiatric evaluation and discuss proposed DSM-5 criteria for developmental trauma disorder in youths.
Carl C. Bell, MD, describes the problem of extreme stressors that confront individuals who live in violent neighborhoods. He interweaves a case history of an African American patient with trauma underlying her diverse psychiatric chief complaints. He discusses protective and healing factors, such as communities with collective efficacy, and ways that clinicians can help patients develop a sense of mastery over traumatic experiences.
Patricia Watson, PhD, and Yuvall Neria, PhD, identify constructs of resilience and specific resilience factors related to stress resistance and posttraumatic growth. They suggest psychosocial interventions to promote resilience and emotional growth, drawing from developmental, trauma, and disaster research. The authors further identify biological markers related to resilience and stress responses and touch on current studies of neurochemical systems that may yield pharmacological treatments for PTSD and depression.
Trauma may be experienced throughout life and in many different contexts. Mass shootings and bombings, wars, and natural and man-made disasters all affect large numbers of people and command international media attention. However, much trauma is experienced privately—childhood maltreatment, sexual and physical assault, witnessing violence and death, surviving a life-threatening accident or illness, or suddenly losing a loved one. When problems develop, caregivers need to be sensitive to the pain of exposing raw memories as they explore health and mental health issues associated with extreme stress.
Mental health correlates of trauma include PTSD and other anxiety disorders, mood disorders, and substance use disorders; comorbidity is the rule. Sorting out PTSD symptoms from those of other anxiety, mood, and somatoform disorders is often challenging. Although the type of disaster is not necessarily related to PTSD, North and colleagues1 found that certain demographic factors do predict PTSD, as do a mental health history and being the victim of or a witness to trauma.
Some populations may warrant extra attention by clinicians after trauma exposure. In its consideration of the elderly—who were among the groups at high risk for morbidity after Hurricane Katrina—the American Association of Geriatric Psychiatry noted that the absence of family and other support may be the single most critical factor for adverse outcomes.2 PTSD may be underreported in some older adults as a result of alexithymia. Clinicians should always explore life trauma in the elderly. Because of their emotional salience, traumatic events may be remembered quite well, even in persons with cognitive impairment.
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