312 CHAPTER 7
- the person’s response involved intense fear, helplessness, or horror. Note: In
children, this may be expressed instead by disorganized or agitated behavior.”
(American Psychiatric Association, 2000)
This defi nition has two components—the traumatic event itself, and the per-
son’s response to it. Let’s examine both components.
Traumatic events are beyond the normal stressful events we all
regularly encounter. Examples of traumatic events range from large-
scale catastrophes with multiple victims (such as disasters and wars)
to unintended acts or situations involving fewer people (such as mo-
tor vehicle accidents and life-threatening illnesses) to events that
involve intentional and personal violence, such as rape and assault
(Briere, 2004). Table 7.16 lists examples of various types of trau-
matic events. Traumatic events are relatively common: up to 30%
of people will experience some type of disaster in their lifetime,
and 25% have experienced a serious car accident (Briere & Elliott,
2000). Note that according to the DSM-IV-TR defi nition, emotional
abuse is not a traumatic event, because it does not involve actual or
threatened physical injury or death.
Several factors can affect whether a stress disorder will develop
following a traumatic event:- The kind of trauma. Trauma involving violence—particularly intended personal
violence—is more likely to lead to a stress disorder than are natural disasters (Breslau
et al., 1998; Briere & Elliott, 2000; Copeland et al., 2007; Dikel, Engdahl, &
Eberly, 2005; Resnick et al., 1993). - The severity of the traumatic event, its duration, and its proximity(American Psy-
chiatric Association, 2000). Depending on the specifi cs of the traumatic event,
those physically closer to it—nearer to the primary area struck by a tornado, for
example—are more likely to develop a stress disorder (Blanchard et al., 2004;
Middleton, Willmer, & Simmons, 2002), as are those who have experienced mul-
tiple traumatic events (Copeland et al., 2007). For instance, Vietnam veterans
were more likely to develop PTSD if they had been wounded or if they spent more
time in combat (Gallers et al., 1988; King et al., 1999). The same is true of veter-
ans returning from Iraq and Afghanistan: Soldiers who were involved in combat
were up to three times more likely to develop PTSD than soldiers who were not
exposed to combat (Levin, 2007; Smith et al., 2008).
The types of traumatic events identifi ed in Table 7.16 can lead to stress disor-
ders, in part, because they challenge the basic assumptions that most people have
about the world. These assumptions can be categorized into four types (Everly &
Lating, 2004):1.The belief in a fair and just world, where people get what they deserve and
deserve what they get. When an individual who believes himself or herself to
be a good person experiences a traumatic event, the person’s basic beliefs about
justice and fairness are called into question.2.The belief that it is possible to trust others and be safe. Particularly when trau-
matic events are perpetrated by a known and previously liked or loved person,
the victim often feels doubly betrayed or abandoned, thinking, “If I loved this
person and he was able to hurt me this much, how can I trust my judgment
about people?” (Janoff-Bulman, 1995).3.The belief that it is possible to be effective in the world. When a traumatic event
occurs, people often feel that they should have done something to prevent the
event or at least somehow lessen its intensity (“If only I had.. .”). Thus, trau-
matic events challenge people’s beliefs in their ability to protect themselves and
others. People may develop a sense of learned helplessness (see Chapter 6)This is the wreckage of one of the trains blasted
by a bomb in the Attocha railway station in
Madrid in March 2004; more than 130 people
were killed. During times of political unrest, vio-
lence, or terrorism, rates of stress disorders are
likely to increase.Johannes Simon/AFP Live/Newscom