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Anxiety Disorders 313

and become depressed (Abramson, Metalsky, & Alloy, 1989; Bandura, 1997).

In addition, when a person experiences the same traumatic event as others but

suffers less physical harm or loss of property, the victim may develop survivor

guilt, feeling guilty about faring better than others did.

4.The sense that life has purpose and meaning. Many people believe that life—

their own lives or human existence in general—has a purpose. This belief may

be spiritual or religious. Traumatic events can challenge these beliefs, lead-

ing victims to feel that their existence is pointless and meaningless (Everly &

Lating, 2004).

Although certain types of traumatic events are more likely than others to lead

to stress disorders, individuals differ in how they perceive the same traumatic event

and how they respond to it. These differences will be based, in part, on previous

experience with related events, appraisal of the stressors, and coping style. Thus, we

need to consider the second component of the DSM-IV-TR defi nition of a traumatic

event: a response of intense fear, helplessness, or horror. Unfortunately, DSM-IV-TR

does not offer guidance on the degree of fear, helplessness or horror that qualifi es,

and given the horrifi c nature of a traumatic event, most people would respond with

at least one of these emotions (Briere, 2004).

The stress disorders are two of only a small number of disorders in DSM-IV-TR

for which the criteria explicitly include a causal factor—in this case, a traumatic

event. However, experiencing a traumatic event is a necessary but not suffi cient fac-

tor leading to a stress disorder (Everly & Lating, 2004). Let’s examine posttrau-

matic stress disorder, and contrast it with acute stress disorder; in doing so we’ll

address other factors that can contribute to stress disorders.

Table 7.16 • Types of Traumatic Events

Large-scale traumatic events, with multiple victims

• Disasters
  ° Natural disasters, such as earthquakes or hurricanes
  ° Human-caused disasters, such as chemical spills or nuclear accidents


• War and large-scale confl ict, including police action against crowds


• Direct experience of injuring or killing others, or witnessing such events


• Mass violence against noncombatants, such as guerrilla-perpetrated atrocities and terrorist acts


• Large-scale transportation accidents, such as train derailments or airplane crashes

Unintended acts involving fewer people

• Motor vehicle accidents


• Exposure of emergency workers, such as fi refi ghters and rescue workers, to a traumatic event


• Life-threatening illnesses, such as severe heart attack and cancer

Intended personal violence

• Rape and sexual assault (the perpetrator may or may not be known to victim)


• Physical assault (the perpetrator may or may not be known to victim)


• Violence, including sexual assault, perpetrated by a spouse or intimate partner


• Torture


• Physical stalking or cyber-stalking that causes the victim to feel threatened, intimidated, afraid,
  or terrorized


• Child abuse
  Source: American Psychiatric Association, 2000; Briere, 2004.