Are traumatic events necessary to elicit symptoms of posttraumatic stress?

Abstract

A diagnosis of posttraumatic stress disorder (PTSD) has been conceptualized as being precipitated by a particularly traumatic (e.g., combat exposure, rape, and violent assault). Recent research suggests that common stressful events (e.g., relational problems, divorce, and expected death of a loved one) may also be capable of eliciting posttraumatic symptomatology. The current study replicated and extended these previous findings, examining three groups of exposure: those who reported experiencing only traumatic events in the past year, those who reported experiencing only significant stressful life events in the last year, and those who experienced both types of events. Consistent with previous findings, we found that all three groups of exposure, including those experiencing only stressful life events, experienced similar amounts of PTSD symptomatology across symptom clusters. These data add to the growing literature that suggests that the type of events that cause symptoms of PTSD may be broader than the current diagnostic criteria indicate, and as such calls for more rigorous research in this area to better understand the diagnostic implications of these findings. Since the formal inclusion of posttraumatic stress disorder (PTSD) into the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-III; American Psychiatric Association (APA), 1980), controversy has arisen with the diagnosis, much of it centered on Criterion A1 (the stressor criterion). In DSM-III, this criterion held that an individual had to experience an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone (APA, 1980). One of the first critiques of PTSD came from Breslau and Davis (1987), who claimed that the connection between this criterion and the symptom constellation of the PTSD diagnosis had not been adequately tested in an empirical manner. An additional criticism of this early criterion concerned the definition of a traumatic as one that occurred rarely in the population. Epidemiological studies have shown that traumatic stressors are relatively common, with most people experiencing at least one traumatic within their lifetime (Breslau, Davis, Andreski, & Peterson, 1991). In addition to these early criticisms of PTSD as a construct, several research studies have documented that events not necessarily considered traumatic elicit the symptom constella- tion thought to be associated with PTSD, raising questions con- cerning the disorder's symptom specificity. A study conducted by Joseph, Mynard, and Mayall (2000) on English adolescents found a relationship between high scores on measures of posttraumatic stress symptoms and stressful life events that normally would not be classified as traumatic by the current PTSD inclusion criteria (e.g., parental separation, trouble with the police, and family member with a drug or alcohol prob- lem). Additionally, Mol and colleagues (2005) used a general population sample to examine whether stressful events could gen- erate symptoms of PTSD and found that those who identified a stressful life as their worst subjective experience endorsed higher levels of PTSD symptoms than did those whose worst experience was a traumatic event. Similarly, Gold, Marx, Soler- Baillo, and Sloan (2005) divided college undergraduate partici- pants into two groups: those who endorsed a traumatic consistent with the A1 criterion of PTSD and those who experi- enced a negative life not consistent with that criterion. Consistent with previous research, individuals who reported expe- riencing negative life events not consistent with the traumatic nature of the A1 criterion showed equal, if not more, posttraumatic symptomatology than did those who indicated the experience of a traumatic in their life. A more recent study using structured clinical interviews found similar results in a sample of people seeking treatment for major depression (Bodkin, Pope, Detke, & Hudson, 2007). These recent findings underscore a perceived problem with the construct of PTSD and the criterion that has received increased attention as we move closer to the release of DSM (5th ed.). These studies also highlight the importance of additional research in this area to further explore the A1 criterion of PTSD and the stressors that can lead to a posttraumatic stress symptom constellation.