The Relationship between Lifetime Trauma Exposure and the Development of Psychiatric Disorders (other than PTSD) in Individuals Exposed to a Single Traumatic Event

Background: Most people are exposed to a traumatic event at least once in their lifetime. As a result of such exposure, approximately 7% develop Post-traumatic Stress Disorder (PTSD), which affects their daily functioning and quality of life to a significant extent.

Today, it is widely believed that if a mental disorder should develop following exposure to a traumatic event, the disorder in question would be PTSD. However, the research literature shows that exposure to a traumatic event can also lead to a variety of other mental disorders. These include psychotic disorders, depression, and anxiety disorders such as social phobia, obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), and a variety of phobias and panic disorders. An individual’s past experiences can also affect the development of mental disorders. The findings of a number of studies suggest that people exposed to negative experiences in childhood have a higher likelihood of developing mental disorders in adulthood. As an example, individuals who have experienced abuse and physical harm in childhood have a higher likelihood of suffering in adulthood from depression and anxiety disorders, bipolar disorder, and schizophrenia.

This study examined the relationship between past exposure to traumatic events and the development of mental disorders other than PTSD by individuals who were exposed to an isolated traumatic event in the present time; and examined whether the individual's quality of life and ability to cope moderated the relationship between the variables.

The study hypotheses were: The greater the number of traumatic events an individual experiences in their past, the larger the number of psychiatric symptoms they will report. The second hypothesis is that the timing of the previous traumatic events would moderate the relationship between the number of previous traumatic events and the level of psychiatric functioning. Additionally, the type of previous traumatic events experienced (continuous, or an isolated event), will moderate the relationship between the number of previous traumatic events and the level of psychiatric functioning. The type of previous traumatic events experienced (either direct abuse by another individual, or an event lacking direct abuse), will moderate the relationship between the number of previous traumatic events and the level of psychiatric functioning. A further hypothesis was that individuals suffering from a psychiatric disorder will report a lower quality of life compared to individuals who do not suffer from a psychiatric disorder. Finally, individuals suffering from a psychiatric disorder will report more problem-focused coping and non-adaptive coping, and will report less emotion-focused coping, compared to individuals who do not suffer from a psychiatric disorder.                      

Method: The study was conducted using a quantitative method, and was based on data collected as part of a clinical study on preventing PTSD through early treatment, led by Prof. Arieh Shalev and Prof. Sara Freedman. The study population comprised of 732 participants of an original study, who underwent a clinical evaluation following exposure to an isolated traumatic event. This study made use of the following questionnaires: Background questionnaire; a structured clinical interview from the DSM-IV - SCID-IV; methods of coping questionnaire - Brief COPE; a shortened questionnaire to evaluate subjective quality of life - WHOQOL-BREF; a previous traumatic events questionnaire - Stressful Life Event Screening Questionnaire (SLESQ); and a global assessment of functioning questionnaire - Global Assessment of Functioning (GAF).           

Results and discussion: The current study’s findings confirm the hypothesis that there is a significant negative relationship between the number of previous traumatic events and psychiatric symptoms. However, the second hypothesis was not confirmed, with no significant difference identified with regard to the number of traumatic events, between individuals currently suffering from a psychiatric disorder and individuals without psychiatric disorders. However, it was found that those who did suffer from a psychiatric disorder in the past had experienced a greater number of traumatic events. Another confirmed hypothesis was that when a traumatic event occurs at an early age, then the greater the number of events, the greater the decrease in the level of functioning; but when the traumatic event takes place in adulthood, the level of functioning is hardly affected by the number of traumatic events. A second hypothesis which was not confirmed was that the repetition—or lack thereof—of a traumatic event does not affect the existence of psychiatric disorders. A third confirmed hypothesis was that when abuse is not carried out directly by another individual, there is no report of subsequent mental disorder; however, people who have suffered from a psychiatric disorder, in the present or in the past, tend to have a lower quality of life. The final confirmed hypothesis was that among people suffering from a psychiatric disorder, there is an increased reliance on repression, planning, dissociation, and self-blame strategies, as well as substance misuse.

The current study’s findings reinforce a central presumption in the literature, namely that traumatic events, especially those experienced early in life and those perpetrated directly by another individual, increase the likelihood of developing psychiatric disorders other than PTSD. These disorders, in turn, increase the likelihood of a low quality of life for people suffering from them. It was found that those suffering from psychiatric disorders tended to use more problem-focused coping and non-adaptive coping, while the use of emotion-focused coping is rare.

Conclusions: This study will be of use in focusing psychiatric diagnosis and providing appropriate treatment to the survivors of traumatic events, Understanding methods of coping related to the existence of a mental disorder will assist in focusing therapeutic interventions and identifying more adaptive methods of coping which will assist in better coping with a mental disorder. Understanding the relationship between quality of life and the existence of a mental disorder will assist in identifying the precise quality-of-life parameters which could improve or exacerbate an individual’s mental state.