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10 - PTSD: A Disorder of Recovery?

Published online by Cambridge University Press:  27 July 2009

By
Arieh Y. Shalev
Edited by
Laurence J. Kirmayer ,
Robert Lemelson  and
Mark Barad
Arieh Y. Shalev
Affiliation:
Professor of Psychiatry Hebrew University and Hadassah School of Medicine, Jerusalem, Israel; Chair Department of Psychiatry and Director, Center for Traumatic Stress, Hadassah University Hospital
Laurence J. Kirmayer
Affiliation:
McGill University, Montréal
Robert Lemelson
Affiliation:
University of California, Los Angeles
Mark Barad
Affiliation:
University of California, Los Angeles
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Summary

INTRODUCTION: A VIEW OF THE ETIOLOGY OF PTSD

Posttraumatic stress disorder is the better researched consequence of traumatic events. In its current formulation (APA, 1994) the disorder is essentially linked to the triggering event: It cannot be diagnosed in the absence of a traumatic event, and its core symptoms of reexperiencing and avoidance must refer to the traumatic event.

This perspective implies a causal link between the event and subsequent PTSD. Such a link is also intuitively appealing and frequently appears in survivors' narratives. For an external observer as well, the association between a traumatic event and PTSD appears to have some truth to it because many survivors' lives are dramatically changed by an encounter with extreme adversity or evil. Thus, from both the survivor's perspective and that of involved observers, the traumatic event is the cause of PTSD.

From a scientific point of view, however, this is only half true because many trauma survivors do not develop PTSD. A traumatic event, accordingly, is a necessary, but certainly not a sufficient cause of PTSD. If so, then what are the alternatives?

The oldest alternative to simple causation refers to individual differences in vulnerability. Historically, this mainly concerned predisposing factors, an attribution that often carried value judgments. The latter could extend from assuming a personality defect in those who broke down under stress to more understandingly relegating the causality to the wear and tear of the central nervous system by adverse living circumstances (e.g., McEwen, 2000) or birth circumstances (e.g., Meaney et al., 1991; see also Bagot et al., this volume).

Type
Chapter
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Understanding Trauma
Integrating Biological, Clinical, and Cultural Perspectives
 , pp. 207 - 223
Publisher: Cambridge University Press
Print publication year: 2007

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  • PTSD: A Disorder of Recovery?
    • By Arieh Y. Shalev, Professor of Psychiatry Hebrew University and Hadassah School of Medicine, Jerusalem, Israel; Chair Department of Psychiatry and Director, Center for Traumatic Stress, Hadassah University Hospital
  • Edited by Laurence J. Kirmayer, McGill University, Montréal, Robert Lemelson, University of California, Los Angeles, Mark Barad, University of California, Los Angeles
  • Book: Understanding Trauma
  • Online publication: 27 July 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511500008.015
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • PTSD: A Disorder of Recovery?
    • By Arieh Y. Shalev, Professor of Psychiatry Hebrew University and Hadassah School of Medicine, Jerusalem, Israel; Chair Department of Psychiatry and Director, Center for Traumatic Stress, Hadassah University Hospital
  • Edited by Laurence J. Kirmayer, McGill University, Montréal, Robert Lemelson, University of California, Los Angeles, Mark Barad, University of California, Los Angeles
  • Book: Understanding Trauma
  • Online publication: 27 July 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511500008.015
Available formats
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Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • PTSD: A Disorder of Recovery?
    • By Arieh Y. Shalev, Professor of Psychiatry Hebrew University and Hadassah School of Medicine, Jerusalem, Israel; Chair Department of Psychiatry and Director, Center for Traumatic Stress, Hadassah University Hospital
  • Edited by Laurence J. Kirmayer, McGill University, Montréal, Robert Lemelson, University of California, Los Angeles, Mark Barad, University of California, Los Angeles
  • Book: Understanding Trauma
  • Online publication: 27 July 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511500008.015
Available formats
×