Most people will experience a traumatic event in their lifetime and as progression through the life cycle continues, exposure to deaths of loved ones or friends is likely to increase. Some people are able to adapt to traumatic events while others are less capable of adapting. There are four possible outcomes following a traumatic event. The first is a resilience trajectory which involves an initial period of discomfort followed by an eventual return to adaptive functioning in one to two years. The second outcome is the recovery phase during which there is an initial period of moderate to severe distress and dysfunction that dissipates over weeks to months. The third phase is a chronic outcome during which there is a persistent high level of distress and dysfunction. The fourth outcome is delayed distress, which involves an increase in symptoms over time after little to no immediate reaction following the traumatic event.
The term resilience is defined as the ability to maintain a state of equilibrium following a traumatic event, whereas adaptation is the ability to return to pretrauma functioning. Adaptation allows us to adjust to both good and bad events so that we do not remain in a state of despair or elation, and adaptation may occur rapidly or occur slowly over time. Resilience, in relation to loss and trauma, is the ability of adults who are exposed to a highly disruptive event to maintain relatively healthy levels of physical and psychological functioning. Resilience studies done on individuals who experienced traumatic events showed that the respondents were doing well and that coping with the traumatic event included avoidance, problem-solving strategies, and social support. Resilience is more than the absence of pathology. Resilience is a separate but interdependent construct associated with mental health.
PTSD is the most documented mental health consequence of experiencing a traumatic event. However, acute stress disorder and dissociative states are often comorbid conditions. Epidemiological research on the lifetime prevalence of PTSD is 7.9% for adults, and the lifetime prevalence for women is twice that of men. Epidemiological studies also show that 69% of people report having experienced a traumatic event in their lifetime, which leaves about a 50% disparity in experiencing a traumatic event and actually developing PTSD. In an extensive review of the literature on PTSD in adults it was found that the characteristics of the individual experiencing the trauma—history of psychopathology, gender, age, education, socioeconomic status, and intelligence—were predictors in the development of PTSD. Stronger predictors of the development of PTSD following a trauma included perceived life threat, perceived support, emotional state at the time of the trauma, and peritraumatic dissociation, which is a temporary dissociative state that occurs around the time of the trauma.
Dissociative states are a strategy to alleviate painful emotions that mostly develop from childhood traumas and are thought to serve as a defense mechanism against intolerable, trauma-associated feelings and memories; these include symptoms of numbing, depersonalization, dissociative amnesia, and reduced awareness. Dissociation results from the disintegration of consciousness from the memories of the traumatic event and are considered a chronic and complex posttraumatic pathology. Dissociative disorders may also accompany other psychiatric disorders, including acute stress disorder.
Acute stress disorder includes symptoms of re-experiencing, avoidance, hyperarousal, and dissociation from a traumatic event. Acute stress disorder typically occurs two to four weeks after the traumatic event. Features of acute stress disorder include disturbances in sleep that may be transient or long term. Temperamental characteristics including trait anxiety are strong determinants of acute stress disorder, whereas resilience is a protector against stress disorder.
It is important to find treatment as soon as possible for prevent chronicity and providing an eclectic approach to treatment is important for healing. Treatments include those that are standard protocol at Kinder in the Keys (psychoeducation, exposure, CBT, DBT, etc.). With treatment, there is a reduction of symptoms, reduce hyperarousal, reduce avoidant behaviors, lessen the risk of relapse, reduce anxiety/depression symptoms, reduced comorbidities like substance abuse and improve adaptive behaviors.
This is an overview of the dissertation by Dr. Laura Tanzini. Citations have been removed for ease of reading are available upon request.