Outcomes of single versus multiple trauma exposure in a screening sample

Green, Bonnie L.; Goodman, Lisa A.; Krupnick, J.L.; Corcoran, Carole; Petty, Rachel; Stockton, Patricia; Stern, Nicole M.

doi:10.1023/a:1007758711939

Cited by 368 publications

(292 citation statements)

References 25 publications

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“…In particular, adult sexual assault, intimate partner violence, and parental verbal aggression in childhood were consistently predictive of PTSD for both genders. These findings are consistent with past research suggesting that it is important to distinguish between trauma that is interpersonal and/or criminal versus accidents, natural disasters, or events that are merely witnessed (Green et al, 2000;Stein et al, 2002). The latter appear to have less of a relationship with PTSD than the former.…”

Section: The Relationship Of Premilitary Trauma With Ptsd Symptomologysupporting

confidence: 89%

“…Multiple Trauma and PTSD. Past research suggests that those who have experienced trauma are likely to have had multiple experiences, and that PTSD rates may be highest among persons who have experienced multiple interpersonal traumas (Green et al, 2000;King et al, 1998;Martin, Rosen, Durand, Knudson, & Stretch, 2000). We computed the total number of interpersonal traumas reported by participants, including childhood sexual, physical, and verbal abuse, as well as adult intimate partner violence, sexual assault, physical assault, knife attacks, gun attacks, and muggings; 57% of the participants had experienced at least one of these events.…”

Section: The Relationship Of Premilitary Trauma With Ptsd Symptomologymentioning

confidence: 99%

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Risk assessment for posttraumatic stress disorder in a cohort of U.S. Navy personnel

Stander¹,

Olson²,

Joshi³

et al. 2002

PsycEXTRA Dataset

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Objective. This research examined vulnerability to PTSD during Navy service in relation to prior histories of trauma and stress. Using a prospective design this study: (1) assessed rates of PTSD symptomology among U.S. Navy recruits at the time they reported for basic training and documented the percentages of personnel whose symptoms met criteria for PTSD over their first 2 years of service; (2) evaluated whether participants with histories of premilitary trauma had significantly greater PTSD symptomology than did those without such histories; (3) assessed the relationship of PTSD symptomology with adjustment and job performance during military service; and (4) explored whether experiences of premilitary victimization moderated the relationship between postmilitary trauma and subsequent PTSD symptomology.Approach. During their first week of training, male and female U.S. Navy recruits were asked about their premilitary experiences of childhood sexual abuse, physical abuse, intimate partner violence, and life-threatening adult trauma such as car accidents and violent assault. They were also assessed for symptoms of PTSD using the Los Angeles Symptom Checklist (LASC). 15% of all participants reported symptoms that met the LASC classification for PTSD; 18% were classified with partial PTSD.In comparison with men, 6% more women were classified with partial PTSD and 5% more women were classified with full PTSD.6% to 20% of the participants had scores in the clinical range on the Trauma Symptom Inventory Subscales. The lowest percentages were for Anxious Arousal (6%), Depression (8%), and Sexual Concerns (8%). The highest percentage was for Dysfunctional Sexual Behavior.Longitudinally over the first two years of service (see page 18):There were significant gender differences in PTSD classification at each follow-up.However, at 12 and 24 months there were only significant differences in the percentages with partial, not full PTSD.PTSD symptoms increased significantly among participants who remained in the study between baseline and 6 months and between 1 year and 2 years. There were no significant differences from 6-months to 1-year. In multivariate analysis interpersonal and criminal traumas were most associated with PTSD. Specifically adult sexual assault, intimate partner violence, and parental verbal aggression in childhood were consistently predictive of PTSD.Sexual trauma has been particularly important in the development of PTSD for women in past research (Fontana & Rosenheck, 1998;Wolfe et al., 1998). However, we found no significant differences in the strength of the relationships of sexual versus other types of trauma with PTSD for men or women.In evaluating multiple trauma and PTSD, we found that (see page 24):Among participants reporting any type of interpersonal trauma, 60% reported multiple types of experiences.Only 8% to 9% of those who had not experienced any interpersonal trauma were categorized with PTSD, while 44% of men and 48% of women were identified with PTSD among those who reported 5 or more t...

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Section: The Relationship Of Premilitary Trauma With Ptsd Symptomologysupporting

confidence: 89%

Section: The Relationship Of Premilitary Trauma With Ptsd Symptomologymentioning

confidence: 99%

Risk assessment for posttraumatic stress disorder in a cohort of U.S. Navy personnel

Stander¹,

Olson²,

Joshi³

et al. 2002

PsycEXTRA Dataset

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“…Each symptom item is rated according to its frequency over the prior 6 months. The TSI has three validity scales (Response Level, Atypical Response, and Inconsistent Response) and 10 clinical scales (Anxious Arousal, Depression, Anger/Irritability, Intrusive Experiences, Defensive Avoidance, Dissociation, Sexual Concerns, Dysfunctional Sexual Behavior, Impaired Self-Reference, and Tension Reduction Behavior), the latter of which appear sensitive to the effects of a variety of different traumatic events (e.g., Green et al, 2000;Runtz & Roche, 1999). The variety of symptoms assessed by the TSI has resulted in the use of this measure as a broad spectrum measure of complex posttraumatic outcomes (e.g., Resick, Nishith, & Griffin, 2003).…”

Section: Posttraumatic Stress Measuresmentioning

confidence: 99%

Phenomenology and psychological assessment of complex posttraumatic states

2005

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The authors offer a framework for the assessment of psychological responses associated with exposure to early onset, multiple, or extended traumatic stressors. Six prominent and overlapping symptoms clusters are described: altered self-capacities, cognitive symptoms, mood disturbance, overdeveloped avoidance responses, somatoform distress, and posttraumatic stress. A strategy for the structured, psychometrically valid assessment of these outcomes is introduced, and specific recommendations for use of various generic and trauma-specific child and adult measures are provided. Implications of trauma assessment for treatment planning are discussed.Reactions to overwhelming psychological stressors can be viewed as residing on a complexity continuum. At one end are responses to adult-onset, single-incident, traumatic events (e.g., a motor vehicle accident, a mugging) that occur in individuals with adequate childhood development, a normoreactive nervous system, and no comorbid psychological disorders. At the opposite end are responses to early onset, multiple, extended, and sometimes highly invasive traumatic events, frequently of an interpersonal nature, often involving a significant amount of stigma or shame, that occur in individuals who, for a variety of reasons, may be more vulnerable to stress effects.Individuals at the high end of this complexity continuum are the subject of this article. These individuals are likely to experience a variety of posttraumatic symptoms and negative mood states, and often present with chronic affect regulation and interpersonal difficulties

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“…Kessler et al, 2017, 1995; Smith, Summers, Dillon, & Cougle, 2016). Besides the type of trauma, numerous studies have found that cumulative trauma, mostly defined as the number of different trauma types, is associated with greater PTSD risk and symptom severity (Green et al, 2000; Karam et al, 2014; Wilker et al, 2015). Simpson, Comtois, Moore, and Kaysen (2011) found that the prevalence of PTSD increased from 53.7% to 67.2% when patients were asked to rate their symptoms for their complete trauma history instead of for only their worst event.…”

Section: Introductionmentioning

confidence: 99%

Defining the index trauma in post-traumatic stress disorder patients with multiple trauma exposure: impact on severity scores and treatment effects of using worst single incident versus multiple traumatic events

Priebe

Kleindienst

Schropp

et al. 2018

European Journal of Psychotraumatology

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Background: A diagnosis of post-traumatic stress disorder (PTSD) requires the identification of one or more traumatic events, designated the index trauma, which serves as the basis for assessment of severity of PTSD. In patients who have experienced more than one traumatic event, severity may depend on the exact definition of the index trauma. Defining the index trauma as the worst single incident may result in PTSD severity scores that differ from what would be seen if the index trauma included multiple events.Objective: This study aimed to investigate the impact of the definition of the index trauma on PTSD baseline severity scores and treatment outcome.Method: A planned secondary analysis was performed on data from a subset (N = 58) of patients enrolled in a trial evaluating the efficacy of a 12 week residential dialectical behavioural therapy programme for PTSD related to childhood abuse (DBT-PTSD). Assessments of the severity of PTSD were conducted at admission, at the end of the 12 week treatment period, and at 6 and 12 weeks post-treatment, using the Clinician-Administered PTSD Scale. The index trauma was defined with respect to both the worst single incident and up to three qualitatively distinct traumatic events.Results: When the index trauma included multiple traumas, PTSD severity scores were significantly higher and improvements from pre- to post-treatment were significantly lower than when the index trauma was defined as the worst single incident.Conclusions: In patients with PTSD who have experienced multiple traumas, defining the index trauma as the worst single incident may miss some aspects of clinically relevant symptomatology, thereby leading to a possibly biased interpretation of treatment effects. In DBT-PTSD, treatment effects were lower when the index trauma included multiple traumatic events. More research is needed to determine the impact of the various index trauma definitions on the evaluation of other trauma-focused treatments.

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Outcomes of single versus multiple trauma exposure in a screening sample

Cited by 368 publications

References 25 publications

Risk assessment for posttraumatic stress disorder in a cohort of U.S. Navy personnel

Risk assessment for posttraumatic stress disorder in a cohort of U.S. Navy personnel

Phenomenology and psychological assessment of complex posttraumatic states

Defining the index trauma in post-traumatic stress disorder patients with multiple trauma exposure: impact on severity scores and treatment effects of using worst single incident versus multiple traumatic events

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