Stress sensitization, kindling, and conditioning

Peritraumatic dissociation following motor vehicle accidents: relationship to prior trauma and prior major depression

Individuals who dissociate at the time of a traumatic event (peritraumatic dissociation) are more likely to develop acute and chronic posttraumatic stress disorder (PTSD). However, little is known about who is at risk of peritraumatic dissociation. Motor vehicle accident subjects (N = 122) were systematically recruited and followed over 12 months. We used the Structured Clinical Interview for DSM-III-R (SCID) and the Peritraumatic Dissociative Experiences Questionnaire-Rater Version (PDEQ-RV). Younger subjects were more likely to experience peritraumatic dissociation as were white versus nonwhites, and single versus married subjects. Younger subjects reported a greater number of peritraumatic dissociative symptoms as did subjects with an injured passenger. After adjusting for age and passenger injury, prior major depression was significantly related to more peritraumatic dissociative symptoms. An interaction of age and prior major depression indicated that those who were younger and reported a history of major depression had the greatest number of peritraumatic dissociative symptoms.

Acute and chronic posttraumatic stress disorder in motor vehicle accident victims

OBJECTIVE

This study reports the rates of acute and chronic posttraumatic stress disorder (PTSD) in a suburban community study group of 122 victims of serious motor vehicle accidents and a comparison group of 42 (who had been involved in minor, non-motor-vehicle accidents) followed over 12 months.

METHOD

Motor vehicle accident victims were systematically recruited and examined with comparison subjects at 1, 3, 6, 9, and 12 months after the accident. The authors used the Structured Clinical Interview for DSM-III-R to assess DSM-III-R axis I disorders including PTSD.

RESULTS

One month after the accident, 34.4% of the motor vehicle accident victims met criteria for PTSD (versus 2.4% of the comparison subjects). Similarly, at 3 and 6 months, rates of PTSD were higher (25.2% and 18.2%) in the motor vehicle accident victims than in the comparison group. Female victims were 4.64 times more likely than male victims to have PTSD at 1 month. Victims with a history of PTSD were 8.02 times more likely at 1 month and 6.81 times more likely at 3 months to have PTSD than those without a history of PTSD. Having an axis II disorder increased the risk for PTSD at 6 months. After adjustment for a history of PTSD and potentially confounding variables, women were 4.39 times more likely than men to develop PTSD at 1 month but did not have a higher risk for chronic PTSD; at 6 months, those with an axis II disorder were at greater risk of PTSD.

CONCLUSIONS

Rates of PTSD are high in victims of serious motor vehicle accidents and remain high 9 months later. Female victims have an increased risk of acute but not chronic PTSD. Individuals with a history of PTSD are at risk of acute and chronic PTSD. An axis II disorder increases the risk for chronic but not acute PTSD.

Psychotraumatology: a two-factor formulation of posttraumatic stress

Other than the "sudden death" phenomenon, posttraumatic stress represents the most severe and incapacitating form of human stress (Everly, 1989). Posttraumatic stress is directly associated with three DSM-III-R, Axis I disorders: Posttraumatic Stress Disorder (PTSD), Multiple Personality Disorder, and Brief Reactive Psychosis (APA, 1987). It is similarly associated with the Axis II personality disorder Borderline Personality Disorder (Herman and van der Kolk, 1987). Posttraumatic stress may be indirectly related to various forms of mood disorders, substance abuse syndromes, and phobic disorders. Regarding the prevalence of posttraumatic stress, Helzer et al. (1987) found the lifetime prevalence of PTSD at around 1% in the general population. Breslau et al. (1991) found the prevalence of PTSD to be 9% in a cohort of young adults in an urban setting. They further found a prevalence of 24% in young adults who had been exposed to traumatic events. Norman and Getek (1988) have estimated that nearly one-half of all patients admitted to urban trauma centers are likely to suffer from PTSD in addition to their physical traumatization, while another 31% may suffer from a milder variant of posttraumatic stress. These data argue compellingly for the potential severity of the threat that posttraumatic stress poses to society. Yet, no one clear-cut therapy for posttraumatic stress has emerged, nor has a generally agreed-upon phenomenology emerged upon which to base such a therapy. The purpose of this paper is to present a comprehensive formulation of posttraumatic stress based upon an integration of biological and psychological evidence.