THE UTILITY OF PERITRAUMATIC EXPERIENCES IN PREDICTING POST TRAUMA PSYCHOPATHOLOGY

Abstract

Prior research has indicated that posttraumatic stress disorder (PTSD) Criterion A2 (i.e., the stipulation that an individual must experience intense fear, helplessness, or horror during an event that threatened the life or physical integrity of oneself or others to be eligible for the PTSD diagnosis; Diagnostic and Statistical Manual of Mental Disorders, 4th, ed., text rev., DSM-IV-TR; APA, 2000) is not positively predictive of PTSD diagnostic status. However, the exact reason for the poor predictive validity is unclear. It may be that changing the operational definition of Criterion A2 (e.g., broadening the definition to include additional peritraumatic reactions) will improve its predictive validity. The current investigation attempted to answer this question, as well as examining several other aspects of the peritraumatic experience. Specifically, three studies were conducted. Study 1 examined whether the ability of the peritraumatic response to predict PTSD can be improved by reconstituting the operationalization of this experience. Study 2 investigated whether this new operationalization of the peritraumatic experience can differentiate between PTSD and other psychiatric disorders (i.e., Major Depressive Disorder, Substance Use Disorders). Study 3 explored how different methodologies for assessing responses to trauma cues (i.e., retrospective reports, self-report and psychophysiological data gathered from a laboratory-based trauma monologue) compare in their ability to predict PTSD. Two-hundred thirty four female crime victims (151 victims of rape; 83 victims of physical assault) were recruited as part of a National Institute of Mental Health (Dr. Patricia Resick, Principal Investigator) prospective longitudinal study designed to examine factors associated with recovery from a recent assault. Results indicated that, consistent with past literature, the three Criterion A2 variables (i.e., peritraumatic fear, helplessness, and horror) were not predictive of PTSD diagnostic status or PTSD symptom severity. However, peritraumatic anxiety was predictive of PTSD diagnostic status, and a dimensional variable assessing the dissociative emotions was predictive of PTSD symptom severity. The predictive utility of the peritraumatic experience was found to be unique to PTSD; although peritraumatic anxiety was predictive of PTSD diagnostic status, none was predictive of the other forms of psychopathology examined (i.e., MDD, Substance Use Disorders). Finally, results indicated that several of the peritraumatic responses were predictive of both self-reported distress and measures of arousal (i.e., amplitude of skin conductance responses) during a laboratory-based trauma monologue. However, the three sets of measures (i.e., peritraumatic responses, self-reported distress, and psychophysiological responses) were differentially predictive of PTSD. Limitations of the study, as well as implications of the findings, are discussed.