Do different traumatic events invoke different kinds of post-traumatic stress symptoms?

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Abstract

Background: Characteristics of the traumatic event may influence the levels of and specific manifestation of particular symptoms of post-traumatic stress (Grimm, Hulse, Preiss, & Schmidt, 2012). For example, sexual trauma has been found to be associated with higher levels of post-traumatic stress symptoms (PTSS) than both motor vehicle accidents and sudden loss (Kelley, Weathers, McDevitt-Murphy, Eakin, & Flood, 2009). Motor vehicle accidents were associated with higher levels of hypervigilance and physiological reactivity than sudden loss. A restricted range of affect/inability to love close others, avoidance of thoughts/feelings, and detachment/estrangement were more severe in sexual abuse and sudden loss than in motor vehicle accidents. This may reflect that aspects of some traumatic events (e.g. sudden, fast, life-threatening) may induce fear conditioning, whereas other traumatic events lasting over an extended time (e.g. repeated sexual abuse, bullying) may elicit other PTSS such as thoughts that the world is generally not a kind or safe place (Wilkinson, Dodgson, & Meares, 2017). To further understand the aetiology of PTSS, it may be helpful to identify similarities and differences in PTSS across more types of trauma exposure.

Objective: To assess differential profiles of PTSS after sexual trauma, domestic violence, accidents/medical trauma, sudden loss/serious illness of a loved one, and bullying/threats.

Method: We examined the severity and profiles of symptoms of post-traumatic stress according to worst trauma reported, in a clinical sample of 4873 children and adolescents (6–18 years old, M = 14.0, SD = 2.7, 63.7% girls) referred for any reason to the general Child and Adolescent Mental Health Services in Norway. We compared the 95% confidence interval (CI) for each symptom with the 95% CI for overall PTSS within each trauma type.

Results: The overall severity of PTSS was higher for sexual trauma (n = 353) than for all other assessed traumas. Furthermore, the severity was significantly higher for domestic violence (n = 407) and bullying/threats (n = 648) than for accidents/medical trauma (n = 213) and sudden loss/serious illness of a loved one (n = 654). Across all assessed worst traumatic experiences, the most commonly endorsed symptoms were psychological cue reactivity, avoidance, and difficulties with sleeping and concentrating. In addition, sexual trauma, domestic violence and bullying/threats were associated with relatively higher levels of negative beliefs and emotions. Sudden loss/serious illness was associated with relatively higher levels of negative emotions. Accidents/medical trauma were not associated with other relatively higher symptoms than avoidance and sleeping and concentration difficulties.

Conclusions: The manifestation of PTSS may differ according to the type of trauma exposure. This may have implications for responsiveness to treatment interventions. For example, interventions that target negative beliefs (e.g. cognitive restructuring) may be particularly potent for adolescents who have experienced sexual trauma, family violence, or bullying/threats.