Academic journal article European Journal of Psychotraumatology

Does Trauma Event Type Matter in the Assessment of Traumatic Load?

Academic journal article European Journal of Psychotraumatology

Does Trauma Event Type Matter in the Assessment of Traumatic Load?

Article excerpt

1. Background

With increasing rates of conflict and terror, natural disasters, and modern wars, the number of humanitarian emergencies is rising and has reached highest numbers since World War II (United Nations High Commissioner for Refugees, 2015). Thus, a better understanding of the psychological consequences of traumatic events is of highest societal and scientific relevance. Many survivors of traumatic experiences develop trauma-spectrum disorders such as Posttraumatic Stress Disorder (PTSD), which is associated with severe individual suffering, impairments in daily functioning, elevated risk for diverse physical health impairments (Glaesmer, Brahler, Gündel, & Riedel-Heller, 2011; Kubzansky et al., 2014), and suicidality (Jakupcak et al., 2009).

Cumulative exposure to traumatic events has particularly grave consequences; as the number of traumatic events experienced (traumatic load) rises, the risk for PTSD increases in a 'building-block' manner (Schauer et al., 2003). Furthermore, PTSD prevalence rates reach up to 100% at extreme levels of trauma exposure (Kolassa, Ertl, Kolassa, Onyut, & Elbert, 2010; Neuner et al., 2004). However, only a significant minority of individuals develops PTSD at lower levels of traumatic load, indicating a high relevance of individual risk factors in predicting PTSD susceptibility. Important risk factors include demographic characteristics (e.g., Sayed, Iacoviello, & Charney, 2015), personality traits (e.g., Jakšić, Brajković, Ivezić, Topić, & Jakovljević, 2012; James et al., 2015), cognition and emotion regulation (e.g., Hayes, Vanelzakker, & Shin, 2012), genetic predispositions (e.g., DiGangi, Guffanti, McLaughlin, & Koenen, 2013; Wilker & Kolassa, 2013), and molecular mechanisms (e.g., Neumeister, Seidel, Ragen, & Pietrzak, 2015; Steudte-Schmiedgen et al., 2015; Van Zuiden, Kavelaars, Geuze, Olff, & Heijnen, 2013). These individual differences are similarly important for successful PTSD treatment (Bryant et al., 2008, 2010; Felmingham, Dobson-Stone, Schofield, Quirk, & Bryant, 2013; Wilker et al., 2014), and should therefore be considered in the allocation of therapeutic resources to individuals at high risk, as well as for the individualization of treatment.

However, due to the influence of traumatic load on PTSD risk, individual risk factors for PTSD development can be identified only if trauma exposure is simultaneously assessed. Therefore, the validity of the identified risk factors will strongly depend on the quality of the trauma assessment. Unfortunately, there are no clear indicators of how trauma exposure should be best quantified, e.g., in studies investigating gene x environment interactions. Wilker et al. (2015) previously raised the question whether the number of different traumatic event types is a reliable and valid predictor of lifetime PTSD, or whether event frequencies should be additionally considered to best measure PTSD risk. Since the more time-consuming assessment of event frequencies did not improve the accuracy of PTSD prediction, they recommended using the simple summation of the number of traumatic event types as a measurement for traumatic load.

Even though the simple sum score is assumed to serve as a useful proxy to measure traumatic load, some events may be more toxic than others. Netland (2005) suggested a weighting of event list items instead of an additive summation for traumatic load calculations to increase the accuracy of predictions on PTSD risk. Furthermore, ranking traumatic events according to their predictive importance for PTSD may allow for the exclusion of less predictive traumatic event types, and therefore save time and resources in diagnostic interviews. In a study conducted by Breslau, Chilcoat, Kessler, and Davis (1999), the highest risks for PTSD were observed in individuals exposed to assaultive violence (e.g., military combat, rape, captivity, torture or kidnapping, being threatened by a weapon, being badly beaten). …

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