Classic Study of the month

Where’s the link between trauma and PTSD?

The same amount of apparent PTSD occurs whether or not trauma is present


This short study raises the important question of how central trauma really is to the presence of apparent PTSD symptoms. Specifically, the study suggests that the reaction to trauma is more important than the occurrence of the trauma itself. Further, in persons without trauma, anxiety and depressive symptoms that approximate PTSD can occur as part of clinical depression unrelated to PTSD.   

In this study, 103 patients, who had come to a psychiatric clinic for treatment of diagnosed major depressive disorder (MDD), were examined. They presented for treatment with antidepressants in clinical trials for severe depression. The clinical researchers then examined these patients in two ways. First researchers assessed whether the subjects met DSM-IV criteria for PTSD.

Then two different blinded researchers assessed whether the subjects met the DSM-IV criterion A for presence of a severe trauma.  

54 subjects were judged by both raters to have experienced severe trauma. Of this group 78% (n=42) met full criteria for PTSD.

36 subjects were judged by both raters as not having experienced severe trauma. Of this group, 78% (n=28) met full criteria for PTSD.

In other words, exactly the same percentage of patients (78%) met full criteria for PTSD whether or not a severe trauma, using the broad PTSD definition of trauma, was present.

 
Interpretation

The PTSD criterion A for trauma is as follows:

“(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) the person's response involved intense fear, helplessness, or horror.”

This kind of stressful life experience does not lead to PTSD in many persons, as described in the special article. That is why it was present in many persons in this study who did not have PTSD.  

Further, except for specific dissociative experiences like flashbacks, many remaining PTSD symptoms often reflect a state of arousal and anxiety that are present in clinical depressive episodes in persons who do not have PTSD. This is why PTSD symptoms were present in those who were judged not to have experienced severe trauma.  


The PL Bottom Line

  • The apparent presence of trauma doesn't mean someone has PTSD. 
  • The presence of PTSD-like arousal and anxiety doesn't mean someone has PTSD. 

Clinical Tip of the Month

A strict approach to PTSD would be to limit the diagnosis to someone who has experience sexual trauma in childhood or adulthood, or severe physical trauma in childhood, or military combat trauma in adulthood.  All other cases of painful life experiences would not be considered part of the PTSD syndrome, but rather psychosocial stressors that could trigger mood episodes or symptoms in persons with underlying biological susceptibility to mood conditions, such as manic-depressive illness or neurotic depression.  

PL Reflection

You’re only given a little spark of madness; you mustn’t lose it. 

Robin Williams

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Where's the link between trauma and PTSD?

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