In this article on the effects of chronic traumatization, research is reviewed regarding the association between chronicity of traumatization and posttraumatic stress disorder (PTSD) symptomatology. The contribution of the broader traumatic context to PTSD symptomatology is also examined. This review focuses on three populations: combat veterans, child sexual abuse survivors, and survivors of domestic violence. The challenges of defining chronicity of a traumatic event and traumatic context are addressed. Finally, suggestions for future directions are provided.
References
1.
American Psychiatric Association. (1994) Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author .
2.
Arias, I., & Pape, K. T. (1999). Psychological abuse: Implications for adjustment and commitment to leave violent partners . Violence & Victims, 14, 55-67 .
3.
Astin, M., Lawrence, K., & Foy, D. (1993). Posttraumatic stress disorder among battered women: Risk and resiliency factors . Violence & Victims, 8, 17-28 .
4.
Astin, M., Ogland-Hand, S., Coleman, E., & Foy, D. (1995). Posttraumatic stress disorder and childhood abuse in battered women: Comparisons with maritally distressed women . Journal of Consulting & Clinical Psychology, 63, 308-312 .
5.
Baum, A., O'Keefe, M., & Davidson, L. (1990). Acute stressors and chronic response: The case of traumatic stress . Journal of Applied Social Psychology, 20, 1643-1654 .
6.
Boney-McCoy, S., & Finkelhor, D. (1996). Is youth victimization related to trauma symptoms and depression after controlling for prior symptoms and family relationships? A longitudinal, prospective study . Journal of Consulting & Clinical Psychology, 64, 1406-1416 .
7.
Bramsen, I., Dirkzwager, A. J. E., & van der Ploeg, H. M. (2000). Predeployment personality traits and exposure to trauma as predictors of posttraumatic stress symptoms: A prospective study of former peacekeepers . American Journal of Psychiatry, 157, 1115-1119 .
8.
Breslau, N. (1990). Stressors: Continuous and discontinuous . Journal of Applied Social Psychology, 20, 1666-1673 .
9.
Briere, J., & Elliott, D. M. (1993). Sexual abuse, family environment, and psychological symptoms: On the validity of statistical control . Journal of Consulting & Clinical Psychology, 61(2), 284-288 .
10.
Bronfenbrenner, U. (1999). Environments in developmental perspective: Theoretical and operational models. In S. Friedman (Ed.), Measuring environment across the life span: Emerging methods and concepts (pp. 3-28). Washington, DC: American Psychological Association .
11.
Buydens-Branchey, L., Noumair, D., & Brancey, M. (1990). Duration and intensity of combat exposure and posttraumatic stress disorder in Vietnam veterans . Journal of Nervous & Mental Disease, 178, 582-587 .
12.
Card, J. J. (1987). Epidemiology of PTSD in a national cohort of Vietnam veternas . Journal of Clinical Psychology, 43, 6-16 .
13.
Cascardi, M., O'Leary, D., & Schlee, K. A. (1999). Co-occurrence and correlates of posttraumatic stress disorder and major depression in physically abused women . Journal of Family Violence, 14, 227-249 .
14.
Corcoran, C. B., Green, B. L., Goodman, L. A., & Krinsley, K. E. (2000). Conceptual and methodological issues in trauma history assessment. In A. Y. Shalev, R. Yehuda, & A. McFarlane (Eds.), International handbook of human response to trauma. The Plenum series on stress and coping (pp. 223-232). New York: Kluwer Academic/Plenum .
15.
Crocq, M. A., Hein, K. D., Duval, F., & Macher, J. P. (1991). Severity of the prisoner of war experience and posttraumatic stress disorder . European Psychiatry, 6(1), 39-45 .
16.
Dohrenwend, B. P. (2000). The role of adversity and stress in psychopathology: Some evidence and its implications for theory and research . Journal of Health & Social Behavior, 41(1), 1-19 .
17.
Dutton, M. A. (1999). Multidimensional assessment of woman battering: Commentary on Smith, Smith, and Earp . Psychology of Women Quarterly, 23, 195-198 .
18.
Dutton, M. A., Goodman, L. A., & Bennett, L. (1999). Court-involved battered women's responses to violence: The role of psychological, physical, and sexual abuse . Violence & Victims, 14, 89-104 .
19.
Dutton, M. A., & Painter, S. (1993). Emotional attachments in abusive relationships: A test of traumatic bonding theory . Violence & Victims, 8(2), 105-120 .
20.
Feinauer, L., Mitchell, J., Harper, J., & Dane, S. (1996). The impact of hardiness and severity of childhood sexual abuse on adult adjustment . American Journal of Family Therapy, 24, 206-214 .
21.
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information . Psychological Bulletin, 99, 20-35 .
22.
Foa, E. B., & Riggs, D. S. (1995). Posttraumatic stress disorder following assault: Theoretical considerations and empirical findings . Current Directions in Psychological Science, 4(2), 61-65 .
23.
Follingstad, D. R., & DeHart, D. D. (2000). Defining psychological abuse of husbands toward wives: Contexts, behaviors and typologies . Journal of Interpersonal Violence, 15(9), 891-920 .
24.
Fontana, A., & Rosenheck, R. (1999). A model of war zone stressors and posttraumatic stress disorder . Journal of Traumatic Stress, 12, 111-126 .
25.
Frye, J. S., & Stockton, R. A. (1982). Discriminant analysis of posttraumatic stress disorder among a group of Viet Nam veterans . American Journal of Psychiatry, 139, 52-56 .
26.
Golding, J. M. (1999). Intimate partner violence as a risk factor for mental disorders: A meta-analysis . Journal of Family Violence, 14(2), 99-132 .
27.
Herman, J. (1992a). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma . Journal of Traumatic Stress, 5, 377-391 .
28.
Herman, J. (1992b). Trauma and recovery. New York: Basic Books .
29.
Higgins, D. J., & McCabe, M. P. (2000). Multi-type maltreatment and long-term adjustment of adults . Child Abuse Review, 9, 6-18 .
30.
Holmbeck, G. N. (1998). Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: Examples from the child-clinical and pediatric psychology literature. In A. E. Kazdin (Ed.), Methodological issues and strategies in clinical research (2nd ed., p. 83-111). Washington, DC: American Psychological Association .
31.
Horowitz, M. J. (1986). Stress response syndromes (2nd ed.). New York: Jason Aronson .
32.
Houskamp, B., & Foy, D. (1991). The assessment of posttraumatic stress disorder in battered women . Journal of Interpersonal Violence, 6, 367-375 .
33.
Janoff-Bulman, R. (1985). The aftermath of victimization: Rebuilding shattered assumptions. In C. R. Figley (Ed.), Trauma and its wake (pp. 15-35). New York: Brunner/Mazel .
34.
Kasl, S. (1990). Some considerations in the study of traumatic stress . Journal of Applied Social Psychology, 20, 1655-1665 .
35.
Kemp, A., Green, B., Hovanitz, C., & Rawlings, E. (1995). Incidence and correlates of posttraumatic stress disorder in battered women: Shelter and community samples . Journal of Interpersonal Violence, 10, 43-55 .
36.
Kemp, A., Rawlings, E., & Green, B. (1991). Post-traumatic stress disorder (PTSD) in battered women: A shelter sample . Journal of Traumatic Stress, 4, 137-148 .
37.
Kendall-Tackett, K. A., Williams, L. M., & Finkelhor, D. (1993). Impact of sexual abuse on children: A review and synthesis of recent empirical studies . Psychological Bulletin, 113, 164-180 .
38.
Kiser, L. J., Heston, J., Millsap, P., & Pruitt, D. (1991). Physical and sexual abuse in childhood: Relationship with post-traumatic stress disorder . Journal of the American Academy of Child & Adolescent Psychiatry, 30, 776-783 .
39.
King, D. W., King, L. A., Gudanowski, D. M., & Vreven, D. L. (1995). Alternative representations of war zone stressors: Relationships to posttraumatic stress disorder in male and female Vietnam veterans . Journal of Abnormal Psychology, 104, 184-196 .
40.
Kulka, R. A., Schlenger, W. E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., et al. (1990). Trauma and the Vietnam war generation: Report of findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel .
41.
March, J. S. (1993). What constitutes a stressor? The “Criterion A” issue. In J. R. T. Davidson & E. B. Foa (Eds.), Posttraumatic stress disorder: DSM-IV and beyond (pp. 37-54). Washington, DC: American Psychiatric Press .
42.
Marshall, L. L. (1999). Effects of men's subtle and overt psychological abuse on low-income women . Violence & Victims, 14, 69-88 .
43.
McCann, L., Sakheim, D., & Abrahamson, D. (1988). Trauma and victimization: A model of psychological adaptation . Counseling Psychologist, 16, 531-594 .
44.
McFarlane, A. C., & de Girolamo, G. (1996). The nature of traumatic stressors and the epidemiology of posttraumatic reactions. In B. A. van der Kolk, A. C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body, and society (pp. 129-154). New York: Guilford .
45.
McLeer, S., Deblinger, E., Henry, D., & Orvaschel, H. (1992). Sexually abused children at high risk of post-traumatic stress disorder . Journal of Child & Adolescent Psychiatry, 31, 875-879 .
46.
Mechanic, M. B., Uhlmansiek, M. H., Weaver, T. L., & Resick, P. A. (2000). The impact of severe stalking experienced by acutely battered women: An examination of violence, psychological symptoms and strategic responding . Violence & Victims, 15, 443-458 .
47.
Mechanic, M. B., Weaver, T. L., & Resick, P. A. (2000). Intimate partner violence and stalking behavior: Exploration of patterns and correlates in a sample of acutely battered women . Violence & Victims, 15, 55-72 .
48.
Mullen, P. E., Martin, J. L., Anderson, J. C., Romans, S. E., & Herbison, G. P. (1996). The long-term impact of the physical, emotional, and sexual abuse of children: A community study . Child Abuse & Neglect, 20(1), 7-21 .
49.
Neumann, D. A., Houskamp, B. M., Pollock, V. E., & Briere, J. (1996). The long-term sequelae of childhood sexual abuse in women: A meta-analytic review . Child Maltreatment, 1, 6-16 .
50.
O'Brien, L., Hughes, S., & Steven, J. (1991). Symptoms of post-traumatic stress disorder in Falklands veterans five years after the conflict . British Journal of Psychiatry, 159, 135-141 .
51.
Oddone, P. E., Genuis, M. L., & Violato, C. (2001) A metaanalysis of the published research on the effects of child sexual abuse . Journal of Psychology, 135, 17-36 .
52.
O'Neill, K., & Gupta, K. (1991). Posttraumatic stress disorder in women who were victims of childhood sexual abuse . Irish Journal of Psychological Medicine, 8, 124-127 .
53.
Pynoos, R., Steinberg, A., & Wraith, R. (1995). A developmental model of childhood traumatic stress. In D. Cicchette & D. Cohen (Eds.), Developmental psychopathology: Vol. 2. Risk, disorder, and adaptation (pp. 72-95). New York: John Wiley .
54.
Resick, P. A. (2001). Stress and trauma. Philadelphia: Psychology Press .
55.
Resick, P. A., & Schnicke, M. K. (1993). Cognitive processing therapy for rape victims: A treatment manual. Thousand Oaks, CA: Sage .
56.
Rodriguez, N., Ryan, S., Rowan, A., & Foy, D. (1996). Posttraumatic stress disorder in a clinical sample of adult survivors of childhood sexual abuse . Child Abuse & Neglect, 20, 943-952 .
57.
Rodriguez, N., Ryan, S. W., Van de Kemp, H., & Foy, D. W. (1997). Posttraumatic stress disorder in adult female survivors of child sexual abuse: A comparison study . Journal of Consulting & Clinical Psychology, 65, 53-59 .
58.
Rodriguez, N., Van de Kemp, H., & Foy, D. W. (1998). Posttraumatic stress disorder in survivors of childhood sexual and physical abuse: A critical review of the empirical research . Journal of Child Sexual Abuse, 7(2), 17-45 .
59.
Rowan, A. B., & Foy, D. W. (1993). Post-traumatic stress disorder in child sexual abuse survivors: A literature review . Journal of Traumatic Stress, 6, 3-21 .
60.
Rowan, A., Foy, D., Rodriguez, N., & Ryan, S. (1994). Posttraumatic stress disorder in a clinical sample of adults sexually abused as children . Child Abuse & Neglect, 18, 51-61 .
61.
Sackett, L. A., & Saunders, D. G. (1999). The impact of different forms of psychological abuse on battered women . Violence & Victims, 14, 105-117 .
62.
Saunders, B. E., Villeponteaux, L. A., Lipovsky, J. A., Kilpatrick, D. G., & Veronen, L. J. (1992). Child sexual assault as a risk factor for mental disorders among women: A community survey . Journal of Interpersonal Violence, 7, 189-204 .
63.
Schlenger, W. E., Kulka, R. A., Fairbank, J. A., Hough, R. W., Jordan, B. K., Marmar, C. R., et al. (1992). The prevalence of post-traumatic stress disorder in the Vietnam generation: A multimethod, multisource assessment of psychiatric disorder . Journal of Traumatic Stress, 5, 333-363 .
64.
Shalev, A. Y. (1997). Discussion: Treatment of prolonged posttraumatic stress disorder—Learning from experience . Journal of Traumatic Stress, 10, 415-422 .
65.
Smith, P. H., Earp, J. A., & DeVellis, R. (1995). Measuring battering: Development of the Women's Experience with Battering (WEB) Scale . Women's Health: Research on Gender, Behavior, & Policy, 1(4), 273-288 .
66.
Smith, P. H., Smith, J. B., & Earp, J. A. (1999). Beyond the measurement trap: A reconstructed conceptualization and measurement of woman battering . Psychology of Women Quarterly, 23, 177-193 .
67.
Solkoff, N., Gray, P., & Keill, S. (1986). Which Vietnam veterans develop posttraumatic stress disorders? Journal of Clinical Psychology, 42, 687-698 .
68.
Solomon, Z. (1990). Does the war stop when the shooting stops? The psychological toll of war . Journal of Applied Social Psychology, 20, 1733-1745 .
69.
Solomon, Z., Mikulincer, M., & Jakob, B. R. (1987). Exposure to recurrent combat stress: Combat stress reactions among Israeli soldiers in the Lebanon war . Psychological Medicine, 17, 433-440 .
70.
Spaccarelli, S. (1994). Stress, appraisal, and coping in child sexual abuse: A theoretical and empirical review . Psychological Bulletin, 116, 340-362 .
71.
Streeck-Fisher, A., & van der Kolk, B. (2000). Down will come baby, cradle and all: Diagnostic and therapeutic implications of chronic trauma on child development . Australian & New Zealand Journal of Psychiatry, 34, 903-918 .
72.
Street, A. E., & Arias, I. (2001). Psychological abuse and posttraumatic stress disorder in battered women: Examining the roles of shame and guilt . Violence & Victims, 16(1), 65-78 .
73.
Sutker, P., Davis, J., Uddo, M., Ditta, M., & Shelly, R. (1995). War zone stress, personal resources, and PTSD in Persian Gulf War returnees . Journal of Abnormal Psychology, 104, 444-452 .
74.
Sutker, P., Uddo, M., Brailey, K., & Allain, A. N. (1993). War-zone trauma and stress-related symptoms in Operation Desert Shield/Storm (ODS) returnees . Journal of Social Issues, 49(4), 33-49 .
75.
Tolman, R. M. (1999). The validation of the Psychological Maltreatment of Women Inventory . Violence & Victims, 14, 25-37 .
76.
Walker, L. E. (1983). Victimology and the psychological perspectives of battered women . Victimology: An International Journal, 8, 82-104 .
77.
Weaver, T., & Clum, G. (1995) Psychological distress associated with interpersonal violence: A meta-analysis . Clinical Psychology Review, 15(2), 115-140 .
78.
Widom, C. S. (1999). Posttraumatic stress disorder in abused and neglected children grown up . American Journal of Psychiatry, 156, 1223-1229 .
79.
Williams, M. B. (1993). Assessing the traumatic impact of child sexual abuse: What makes it more severe? Journal of Child Sexual Abuse, 2(2), 41-59 .
80.
Wilson, J. P., & Krauss, G. E. (1985). Predicting posttraumatic stress disorders among Vietnam veterans. In W. E. Kelly (Ed.), Post-traumatic stress disorder and the war veteran patient (pp. 102-147). New York: Brunner/Mazel .
81.
Wind, T. W., & Silvern, L. (1992). Type and extent of child abuse as predictors of adult functioning . Journal of Family Violence, 7(4), 261-281 .
82.
Wolfe, D. A., Sas, L., & Wekerle, C. (1994). Factors associated with the development of posttraumatic stress disorder among child victims of sexual abuse . Child Abuse & Neglect, 18, 37-50 .
83.
Wolfe, V. V., Genile, C., & Wolfe, D. A. (1989). The impact of sexual abuse on children: APTSD formulation . Behavior Therapy, 20, 215-228 .
84.
Baum, A., O'Keefe, M., & Davidson, L. (1990). Acute stressors and chronic response: The case of traumatic stress . Journal of Applied Social Psychology, 20, 1643-1654 .
85.
Fontana, A., & Rosenheck, R. (1999). A model of war zone stressors and posttraumatic stress disorder . Journal of Traumatic Stress, 12, 111-126 .
86.
Pynoos, R., Steinberg, A., & Wraith, R. (1995). A developmental model of childhood traumatic stress. In D. Cicchette & D. Cohen (Eds.), Developmental psychopathology: Vol. 2. Risk, disorder, and adaptation (pp. 72-95). New York: Wiley .
87.
Smith, P. H., Smith, J. B., & Earp, J. A. (1999). Beyond the measurement trap: A reconstructed conceptualization and measurement of woman battering . Psychology of Women Quarterly, 23, 177-193 .
88.
Spaccarelli, S. (1994). Stress, appraisal, and coping in child sexual abuse: A theoretical and empirical review . Psychological Bulletin, 116, 340-362 .
