Prospective studies indicate that PTSD symptoms are almost universal in the immediate aftermath of trauma (Rothbaum et al., 1992). The majority of individuals have symptoms of re-experiencing, avoidance, and hyperarousal following a severely traumatic event. For most individuals, these symptoms steadily resolve over time, while those who meet diagnostic criteria for PTSD continue to experience the symptoms. PTSD can thus be viewed as a failure of recovery caused in part by a failure of the fear phasing out (Rothbaum et al., 2003).
Emotional processing theory holds that PTSD emerges due to the development of a fear network in memory that elicits escape and avoidance behavior. Exposure therapy assists patients in confronting their feared memories and situations in a therapeutic manner. Re-experiencing the trauma through exposure allows it to be emotionally processed so that it can become less painful (Foa et al., 1986, 1989).
Another misunderstanding is that the further you get away from the trauma, the less likely you are to get PTSD. Technically, one will not be said to have PTSD unless the symptoms last for longer than a month out from the trauma. However, people can continue to develop PTSD even years after the trauma. Delayed onset of PTSD can occur when something that happens after the trauma gives the trauma a more threatening meaning. Most individuals who develop PTSD experience its onset within a few months of the traumatic event. However, epidemiological studies have found that approximately 25 percent experience a delayed onset after six months or more (Smid et al., 2009).
Risk factors for developing PTSD include being female; younger age at trauma; lower education; lower socioeconomic status; being separated, divorced, or widowed; previous trauma; general childhood adversity; personal and family psychiatric history; reported childhood abuse; poor social support; and initial severity of reaction to the traumatic event (Van Ameringen et al., 2008; Vieweg et al., 2006 ; Liebschutz et al., 2007; Bisson et al., 2015; Brewin et al., 2000).
The percentage of people that go on to develop PTSD after a traumatic event is influenced by the patient’s characteristics and the details surrounding the inciting event (Yehuda et al., 2015). Women are four times more likely to develop PTSD than men, after adjusting for exposure to traumatic events (Vieweg et al., 2005). The rates of PTSD are similar among men and women after events such as accidents (6.3 versus 8.8 percent), natural disasters (3.7 versus 5.4 percent), and sudden death of a loved one (12.6 versus 16.2 percent). Traumatic brain injury (TBI) and PTSD have high rates of co-occurrence among civilians and, particularly, among soldiers with combat-related TBI (O’Donovan et al., 2014). As an example, 11 percent of American soldiers returning from combat in Iraq and Afghanistan were reported to screen positive for PTSD in 2008.
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