Elsevier

Aggression and Violent Behavior

Volume 5, Issue 5, September–October 2000, Pages 431-449
Aggression and Violent Behavior

Posttraumatic stress disorder following violence and aggression

https://doi.org/10.1016/S1359-1789(98)00017-2Get rights and content

Abstract

Posttraumatic stress disorder (PTSD) has been the focus of considerable attention, and some controversy, since it was formally recognized in 1980. The disorder appears to be relatively common among survivors of violent crime, particularly rape victims. In its more serious forms, it is a chronic and disabling psychiatric disorder associated with high comorbidity and impairment of functioning. This article provides a review of PTSD following violence and aggression, beginning with a description of the clinical characteristics and diagnostic criteria. A multifaceted approach to assessment is described, designed to improve diagnostic accuracy, with particular reference to psycholegal settings. Psychological treatment for PTSD is discussed in the context of the available outcome literature. Finally, the issue of prevention and early intervention in traumatic stress is addressed.

Section snippets

Diagnostic Criteria For PTSD

The original diagnostic criteria were updated in the revised version of DSM-III and further minor revisions occurred in DSM-IV (American Psychiatric Association, 1994). The latest version of the International Classification of Diseases (ICD-10; World Health Organisation, 1992) also contains a category of PTSD.

Not surprisingly, the first criterion to be met for a diagnosis of PTSD is experience of a traumatic event. Considerable debate has focused on the importance of this criterion in an

The assessment of ptsd

The purpose of this section is to summarize the key areas to be covered in the clinical evaluation of a trauma survivor. Detailed reviews of PTSD assessment are well covered in other work, to which the interested reader is referred for further information (e.g., Allen 1994, Carlson 1996, Wilson & Keane 1996).

There has been considerable debate in recent years regarding the extent to which symptoms of PTSD may be fabricated or exaggerated, especially when issues of compensation are involved

Treatment options

Clearly, those victims who do not recover independently, and who go on to develop longer term problems as a result of their exposure to violence, may require formal treatment. The purpose of this section is to provide a brief overview of the common psychological interventions used in the treatment of PTSD following violent crime. More detailed discussion of these approaches has been provided by other authors (e.g., Foa and Meadows 1997, Foa & Rothbaum 1998, Shalev, Bonne, & Eth 1996). A

Early intervention and prevention

In recent years, there has been considerable debate as to the extent to which it may be possible to modify the course of traumatic stress reactions, and to facilitate recovery, by means of an early intervention. Much of this debate has revolved around the area of psychological debriefing as described by Mitchell and others Mitchell 1983, Mitchell & Bray 1990. As noted by several authors Bisson & Deahl 1994, Kenardy et al. 1996, Raphael, Meldrum, & McFarlane 1995, there is a paucity of adequate

Conclusions

This article has attempted to provide a broad overview of PTSD in victims of violence. Despite considerable interest, the field remains in its infancy in terms of rigorous empirical research, and much remains to be learned about human response to violent trauma. With regard to phenomenology, the relationship between active avoidance and numbing (or passive avoidance) requires clarification, perhaps with the aim of classifying them as distinct and separate clusters in forthcoming diagnostic

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