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Exposure to Traumatic Events

Posttraumatic stress disorder is unusual in the psychiatric nosology in that it ascribes etiological significance to a particular type of life experience— exposure to a traumatic event. Although such ticipants who indicated that they had experienced one potential trauma reported experiencing two or more types of trauma. In the NCS, which used DSM-III-R criteria for trauma exposure and PTSD, the most frequently identified types of trauma were witnessing someone being badly injured or killed (35.6% of men and 14.5% of women); involvement in a fire, flood, or natural disaster (18.9% of men and 15.2% of women); and involvement in a life-threatening accident (25% of men and 13.8% of women).
Using a DSM-IV definition of traumatic events, a recent survey found that the unexpected death of a loved one was the most frequently reported trauma in a random sample of 18- to 45-year-old Detroit residents. Research suggests that the types of potentially traumatic events men and women experience may differ. For example, in the NCS, men were more likely than women to report witnessing injury or death, involvement in a natural disaster or life-threatening accident, involvement in a physical attack, and combat exposure. Women were more likely to report having experienced rape, sexual molestation, and childhood physical abuse. Consistent with these results, findings from a national survey of adult women in the United States, the National Women’s Study, indicated that 12.7% of participants had experienced a completed rape, 14.3% had experienced molestation or attempted sexual assault, and 10.3% had been physically assaulted. Nearly 30% of rapes reported in the NWS occurred before age 11, and approximately two-thirds occurred before age 18. Epidemiologic studies have identified various risk factors for exposure to potentially traumatic events. As suggested by findings from the NCS and substantiated by a sizable body of research, past exposure to potentially traumatic events confers increased risk of future exposure to such events. In a prospective epidemiologic study of 21- to 30year-old members of a health maintenance organization, persons who had a history of traumatic stressor exposure at baseline were nearly twice as likely to report an additional trauma during the 3-year follow-up. Exposure to traumatic stressors also varies with age, socioeconomic status, psychiatric history, substance use, personality characteristics, family history of psychiatric disorder and substance use problems, and geographic location. For example, a 1993 report by the International Federation of Red Cross and Red Crescent Societies found that in the period from 1967 to 1991, disasters affected people in developing countries as compared with developed countries at a ratio of more than 150 to 1. Epidemiologic studies also have examined the prevalence of exposure to potentially traumatic events among children and adolescents; the majority of these studies assessed physical victimization, sexual victimization, or exposure to community violence. A telephone survey of a nationally representative sample of 2000 10- to 16-year-old children found that more than 40% reported at least one experience that could be categorized as violent victimization. Consistent with these findings, Kilpatrick, Saunders, and Resnick estimated the lifetime prevalence of exposure to sexual assault, physical assault, and witnessing violence as 8%, 17%, and 39%, respectively, in a national sample of 12- to 17-year-old adolescents.
In addition, a number of school surveys evaluated rates of exposure to community violence. In one sample of more than 500 Black elementary and middle school students in Chicago, 30% said they had witnessed a stabbing, and 26% reported that they had seen someone being shot. Another survey of 2248 students in the sixth to eighth and tenth grades in an urban public school system found that 41% reported witnessing a stabbing or shooting in the past year. Another survey of 3735 high school students in six schools in Ohio and Colorado found relatively high rates of exposure to violence within the past year that varied by size and location of the school.
Among male adolescents, 3% to 22% reported being beaten or mugged in their own neighborhoods, 3% to 33% reported being shot at or shot, and 6% to 16% reported being attacked with a knife. Reported rates of most types of victimization were lower for adolescent females than males; however, more females reported sexual abuse or assault. Although a number of studies reported PTSD prevalence estimates among youths exposed to specific types of traumatic events, we were unable to identify any general population studies of PTSD prevalence among children and adolescents in the scientific literature. Thus, the remainder of this review of the epidemiology of PTSD focuses on PTSD in adults.

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