Individual Differences in Posttraumatic Response: Problems with the Adversity-Distress Connection

Individual Differences in Posttraumatic Response: Problems with the Adversity-Distress Connection

Individual Differences in Posttraumatic Response: Problems with the Adversity-Distress Connection

Individual Differences in Posttraumatic Response: Problems with the Adversity-Distress Connection

Synopsis

This book challenges the assumptions of the event-dominated DSM model of posttraumatic stress disorder. Bowmam examines a series of questions directed at the current mental health model, reviewing the empirical literature. She finds that the dose-response assumptions are not supported; the severity of events is not reliable associated with PTSD, but is more reliably associated with important pre-event risk factors. She reviews evidence showing the greater role of individual differences including trait negative affectivity, belief systems, and other risk factors, in comparison with event characteristics, in predicting the disorder. The implications for treatment are significant, as treatment protocols reflect the DSM assertion that event exposure is the cause of the disorder, implying it should be the focus of treatment. Bowman also suggests that an event focus in diagnosis anad treatment risks increases the disorder because it does not provide sufficient attention to important pre-exisiting risk factors.

Excerpt

This book grew out of my lifelong interest in the ways in which people respond to adversity. This interest has led me to research in coping, clinical work with people who have suffered bad accidents, and an avocational obsession with autobiographical accounts of people who have both suffered and achieved on a scale that seems larger than life. in learning how people respond to nasty and even horrible events I have been struck by the tremendous range of responses. Some individuals become significantly disorganized and distressed by what was a minor event by any objective criterion, while others who experience a vastly more terrible event often show a remarkable resilience. Despite this, the idea that terrible life events have a significant power in affecting mental health has become entrenched in a number of assumptions within professional mental health disciplines and in popular thinking. in particular, the post-traumatic distress disorder diagnosis has served as a prototype for this thinking.

In my attempt to make sense of the diversity of responses that I observed, I studied coping behaviors earlier in my research career, looking at the connections between stress, coping, and distress for evidence concerning the power of life experiences to account for chronic emotional problems that were attributed to life "stressors." the factors that moderate the adversity-distress relationship have been extensively examined in experimental and correlational studies within the fields of stress and coping, in personality studies of emotionality, and in social psychology through studies of attributional processes and their effects on behavior. It became clear that clinical practice is based on an exaggerated idea of the power of life events, and a correspondingly significant inattention to pre-existing factors. Long-standing personal-

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