Skip to main content
SpringerLink
Log in

Toward a Typology of High-Risk Major Stressful Events and Situations in Posttraumatic Stress Disorder and Related Psychopathology

  • Published:
Psychological Injury and Law Aims and scope Submit manuscript

Abstract

The diagnosis of posttraumatic stress disorder (PTSD) was introduced in 1980 with the publication of the Diagnostic and Statistical Manual of the American Psychiatric Association, Third Edition (DSM-III). DSM-III put forward a novel syndrome consisting of intrusive, avoidance/numbing, and arousal symptoms as distinctive psychopathology following exposure to traumatic events. The traumatic stressors, although expanded in later editions published in 1987 (DSM-III-R) and 1994 (DSM-IV), focus on life-threatening events and situations. However, at least 12 studies, most of them recent, have found associations between the PTSD symptoms and the PTSD symptom syndrome with stressors, such as unemployment and divorce that would not qualify, even in the broadened DSM-IV diagnosis, as traumatic stressors. These findings challenge the basic assumption on which the PTSD diagnosis is based, the assumption that exposure to life-threatening stressors is the primary cause of a unique set of stress response symptoms. The purpose of this paper is to show how to confront this challenge by developing a typology of stressful situations and events that can be tested systematically for their relation to the PTSD symptom syndrome and other relevant variables. The typology includes but is not limited to the types of situations and events defined as “traumatic” in the DSMs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Association. DSM-III.

    Google Scholar 

  • American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Association. DSM-III-R.

    Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association. DSM-IV.

    Google Scholar 

  • Breslau, N. (2002). Epidemiologic studies of trauma, posttraumatic stress disorder, and psychiatric disorders. Canadian Journal of Psychiatry, 47, 923–929.

    Google Scholar 

  • Breslau, N., Davis, G. C., Andreski, P., & Peterson, E. (1991). Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry, 48, 216–222.

    PubMed  Google Scholar 

  • Breslau, N., Davis, G. C., Peterson, E. L., & Schultz, L. (1997). Psychiatric sequelae of posttraumatic stress disorder in women. Archives of General Psychiatry, 54, 81–87.

    PubMed  Google Scholar 

  • Breslau, N., Kessler, R. C., Chilcoat, H. D., Schultz, L. R., Davis, G. C., & Andreski, P. (1998). Trauma and posttraumatic stress disorder in the community. Archives of General Psychiatry, 55, 626–632.

    Article  PubMed  Google Scholar 

  • Brown, G. W. (1998). Loss and depressive disorders. In B. P. Dohrenwend (Ed.), Adversity, stress and psychopathology (pp. 358–376). New York: Oxford University Press.

    Google Scholar 

  • Brown, G. W., & Birley, J. L. T. (1968). Crises and life changes and the onset of schizophrenia. Journal of Health and Social Behavior, 9, 203–214.

    Article  PubMed  Google Scholar 

  • Brown, G. W., & Harris, T. O. (1978). Social origins of depression: A study of psychiatric disorder in women. New York: Free Press.

    Google Scholar 

  • Brown, G. W., & Harris, T. O. (Eds.). (1989). Life events and illness. New York: Guilford.

    Google Scholar 

  • Brown, G. W., Sklair, F., Harris, T. O., & Birley, J. L. T. (1973). Life events and psychiatric disorders: I. Some methodological issues. Psychological Medicine, 3, 74–78.

    Article  PubMed  Google Scholar 

  • Canon, W. B. (1929). Bodily changes in pain, hunger, fear and rage. New York: Appleton-Century-Crofts.

    Google Scholar 

  • Cohen, S., Kessler, R. C., & Gordon, L. U. (1997). Strategies for measuring stress in studies of psychiatric and physical disorders. In S. Cohen, R. C. Kessler, & L. U. Gordon (Eds.), Measuring stress: A guide for health and social scientists. New York: Oxford University Press.

    Google Scholar 

  • Creed, F. (1985). Life events and physical illness. Journal of Psychosomatic Research, 29, 113–123.

    Article  PubMed  Google Scholar 

  • Davidson, J. R. T., Hughes, D., Blazer, D. G., & George, L. K. (1991). Posttraumatic stress disorder in the community: An epidemiological study. Psychological Medicine, 21, 713–721.

    Article  PubMed  Google Scholar 

  • Dohrenwend, B. P. (1974). Problems in defining and sampling the relevant population of stressful life events. In B. S. Dohrenwend & B. P. Dohrenwend (Eds.), stressful life events (pp. 275–310). New York: Wiley.

    Google Scholar 

  • Dohrenwend, B. P. (1983). Psychological implications of nuclear accidents: The case of Three Mile Island. Bulletin of the New York Academy of Medicine, 59, 1060–1076.

  • Dohrenwend, B. P. (1998). Theoretical integration. In B. P. Dohrenwend (Ed.), Adversity, stress and psychopathology (pp. 539–555). New York: Oxford University Press.

    Google Scholar 

  • Dohrenwend, B. P. (2000). The role of adversity and stress in psychopathology: Some evidence and its implications for theory and research. Journal of Health and Social Behavior, 41, 1–19.

    Article  PubMed  Google Scholar 

  • Dohrenwend, B. P. (2006). Inventorying stressful life events as risk factors for psychopathology: Toward resolution of the problem of intracategory variability. Psychological Bulletin, 132, 477–495.

    Article  PubMed  Google Scholar 

  • Dohrenwend, B. P. (2010). The stressor criterion in posttraumatic stress disorder: Issues, evidence, and implications. In H. B. Simpson, Y. Neria, R. Lewis-Fernandez, & F. Schneier (Eds.), Understanding anxiety: Clinical and research perspectives from the Columbia University Department of Psychiatry. New York: Cambridge University Press.

    Google Scholar 

  • Dohrenwend, B. S., & Dohrenwend, B. P. (Eds.). (1974). Stressful life events: Their nature and effects. New York: Wiley.

    Google Scholar 

  • Dohrenwend, B. S., & Martin, J. L. (1979). Personal versus situational determination of anticipation and control of the occurrence of stressful life events. American Journal of Community Psychology, 7, 453–468.

    Article  PubMed  Google Scholar 

  • Dohrenwend, B. S., Krasnoff, L., Askenasy, A. R., & Dohrenwend, B. P. (1978). Exemplification of method for scaling life events: The PERI life events scale. Journal of Health and Social Behavior, 19, 205–229.

    Article  PubMed  Google Scholar 

  • Dohrenwend, B. P., Raphael, K. G., Schwartz, S., Stueve, A., & Skodol, A. E. (1993). The structured event probe and narrative rating method (SEPRATE) for measuring stressful life events. In L. Goldberger & S. Bresnitz (Eds.), Handbook of stress: Theoretical and clinical aspects (2nd ed., pp. 174–199). New York: Free Press.

    Google Scholar 

  • Foa, E. B., Zinbarg, R., & Rothbaum, B. O. (1992). Uncontrollability and unpredictability in post-traumatic stress disorder: An animal model. Psychological Bulletin, 112, 218–238.

    Article  PubMed  Google Scholar 

  • Friedman, M. J., Resick, P. A., & Keane, T. M. (2007a). PTSD twenty-five years of progress and challenges. In M. J. Friedman, T. M. Keane, & P. A. Resick (Eds.), Handbook of PTSD: Science and practice (pp. 3–18). New York: Guilford.

    Google Scholar 

  • Friedman, M. J., Resick, P. A., & Keane, T. M. (2007b). Key questions and an agenda for future research. In M. J. Friedman, T. M. Keane, & P. A. Resick (Eds.), Handbook of PTSD: Science and practice (pp. 540–561). New York: Guilford.

    Google Scholar 

  • Grant, I., Gerst, M., & Yager, J. (1976). Scaling of life events by psychiatric patients and normals. Journal of Psychosomatic Research, 20, 141–149.

    Article  PubMed  Google Scholar 

  • Grant, I., Sweetwood, H. L., Yager, J., & Gerst, M. (1981). Quality of life events in relation to psychiatric symptoms. Archives of General Psychiatry, 38, 335–339.

    PubMed  Google Scholar 

  • Grant, K. E., Compas, B. E., Thurm, A. E., Mc Mahon, S. D., & Gipson, P. Y. (2004). Stressors and child and adolescent psychopathology: Measurement issues and prospective effects. Journal of Clinical Child and Adolescent Psychology, 30, 412–425.

    Google Scholar 

  • Gunderson, E. K. E., & Rahe, R. H. (Eds.). (1974). Life stress and illness. Springfield: Charles C Thomas.

    Google Scholar 

  • Hammen, C. (1991). Generation of stress in the course of unipolar depression. Journal of Abnormal Psychology, 100, 555–561.

    Article  PubMed  Google Scholar 

  • Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. The American Psychologist, 44, 513–524.

    Article  PubMed  Google Scholar 

  • Holmes, T. H., & Rahe, R. H. (1967). The social readjustment rating scale. Journal of Psychosomatic Research, 11, 213–218.

    Article  PubMed  Google Scholar 

  • Isherwood, J., Adam, K. S., & Hornblow, A. R. (1982). Life event stress, psychosocial factors, suicide attempt and auto-accident proclivity. Journal of Psychosomatic Research, 26, 371–383.

    Article  PubMed  Google Scholar 

  • Johnson, J. H., & Bradlyn, A. S. (1988). Assessing stressful life events in childhood and adolescence. In P. Karoly (Ed.), Handbook of child health assessment: Bio perspectives (pp. 303–331). New York: Wiley.

    Google Scholar 

  • Kendler, K. S. (1998). Adversity, stress and psychopathology: A psychiatric genetic perspective. In B. P. Dohrenwend (Ed.), Adversity, stress and psychopathology (pp. 477–485). New York: Oxford University Press.

    Google Scholar 

  • Kendler, K. S., Karkowski, L. M., & Prescott, C. A. (1999). The assessment of dependence in the study of stressful life events: Validation using a twin design. Psychological Medicine, 29, 1455–1460.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Davis, C. G., & Kendler, K. S. (1997). Childhood adversity and adult psychiatric disorder in the US national comorbidity survey. Psychological Medicine, 27, 1101–1119.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Sonnega, A., Bromet, E., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048–1060.

    PubMed  Google Scholar 

  • Kolb, L. C., & Multalipassi, L. R. (1982). The conditioned emotional response: a sub-class of the chronic and delayed posttraumatic stress disorder. Psychiatric Annals, 12, 979–987.

    Google Scholar 

  • Lejuez, C. W., Eifert, G. H., Zvolensky, M. J., & Richards, J. B. (2000). Preference between onset predictable and unpredictable administrations of 20% carbon-dioxide-enriched air: Implications for better understanding the etiology and treatment of panic disorder. Journal of Experimental Psychology, 6, 349–358.

    PubMed  Google Scholar 

  • Lewinsohn, P. M., Rohde, P., & Gau, J. M. (2003). Comparability of self-report checklist and interview data in the assessment of stressful life events in young adults. Psychological Reports, 93, 459–471.

    Article  PubMed  Google Scholar 

  • Maier, T. (2007). Weathers’ and Keane’s “The Criterion A problem revisited: Controversies and challenges in defining and measuring psychological trauma”. Journal of Traumatic Stress, 20, 915–916.

    Article  PubMed  Google Scholar 

  • Maslow, A. H. (1954). Motivation and personality. New York: Harper.

    Google Scholar 

  • McEwen, B. S. (2002). Sex, stress, and the hippocampus: Allostatis, allostatic load and the aging process. Neurobiology of Aging, 23, 921–939.

    Article  PubMed  Google Scholar 

  • McNally, R. J. (2003). Progress and controversy in the study of posttraumatic stress disorder. Annual Review of Psychology, 54, 229–252.

    Article  PubMed  Google Scholar 

  • Meyer, A. (1951). The life chart and the obligation of specifying positive data in psychopathological diagnosis. In E. G. Winters (Ed.), The collected paper of Adolf Meyer, Vol 3: Medical teaching. Baltimore: Johns Hopkins.

    Google Scholar 

  • Monroe, S. M., & Johnson, S. L. (1990). The dimensions of life stress and the specificity of disorder. Journal of Applied Social Psychology, 20, 1678–1694.

    Article  Google Scholar 

  • Monroe, S. M., & Roberts, J. E. (1990). Conceptualizing and measuring life stress. Stress Medicine, 6, 209–216.

    Article  Google Scholar 

  • Morin, C. M., & Ware, J. C. (1996). Sleep and psychopathology. Applied & Preventive Psychology, 5, 211–224.

    Article  Google Scholar 

  • Newcomb, M. D., & McGee L. (1991). Influence of senzation-seeking on general deviance and specific problem behaviors from adolescence to young adulthood. Journal of Personality and Social Psychology, 61, 614–628.

    Article  PubMed  Google Scholar 

  • Norris, F. H. (1992). Epidemiology of trauma: Frequency and impact of different potentially traumatic events on different demographic groups. Journal of Consulting and Clinical Psychology, 3, 409–418.

    Article  Google Scholar 

  • Page, L. A., Petrie, K. J., & Wessely, S. C. (2006). Psychosocial responses to environmental incidents: A review and a proposed typology. Journal of Psychosomatic Research, 60, 413–422.

    Article  PubMed  Google Scholar 

  • Paykel, E. S. (1974). Life stress and psychiatric disorder: Applications of the clinical approach. In B. S. Dohrenwend & B. P. Dohrenwend (Eds.), Stressful life events: Their nature and effects (pp. 135–149). New York: Wiley.

    Google Scholar 

  • Paykel, E. S. (1997). The interview for recent life events. Psychological Medicine, 27, 301–310.

    Article  PubMed  Google Scholar 

  • Paykel, E. S. (2001). The evolution of life events research in psychiatry. Journal of Affective Disorders, 62, 141–149.

    Article  PubMed  Google Scholar 

  • Paykel, E. S., Prusoff, B. A., & Uhlenhuth, E. H. (1971). Scaling of life events. Archives of General Psychiatry, 25, 340–347.

    PubMed  Google Scholar 

  • Pham, L. B., Taylor, S. E., & Seeman, T. E. (2001). Effects of environmental predictability and personal mastery on self-regulatory and physiological process. Personality and Social Psychology Bulletin, 27, 611–620.

    Article  Google Scholar 

  • Pitman, R. K. (1988). Post-traumatic stress disorder, conditioning, and network theory. Psychiatric Annals, 18, 182–189.

    Google Scholar 

  • Rabkin, J. G., & Struening, E. L. (1976). Life events, stress and illness. Science, 194, 1013–1020.

    Article  PubMed  Google Scholar 

  • Rahe, R. H. (1975). Epidemiological studies of life change and illness. International Journal of Psychiatry in Medicine, 6, 247–250.

    Google Scholar 

  • Rahe, R. H., & Arthur, R. J. (1978). Life change and illness studies: Past history and future directions. Journal of Human Stress, 4, 3–15.

    PubMed  Google Scholar 

  • Resnick, H. S., Kilpatrick, D. G., Dansky, B. S., Saunders, B. E., & Best, C. L. (1993). Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. Journal of Consulting and Clinical Psychology, 6, 984–991.

    Article  Google Scholar 

  • Rijsdijk, F. V., Sham, P. C., Sterne, A., Purcell, S., McGuffin, P., et al. (2001). Life events and depression in a community sample of siblings. Psychological Medicine, 31, 401–410.

    Article  PubMed  Google Scholar 

  • Robins, L. N., & Robertston, J. (1998). Exposure to “fateful” events: A confounder in assigning causal roles to life events. In B. P. Dohrenwend (Ed.), Adversity, stress and psychopathology (pp. 331–340). New York: Oxford University Press.

    Google Scholar 

  • Rowlison, R. T., & Felner, R. D. (1988). Major life events, hassles, and adaptation in adolescence: Confounding in the conceptualization and measurement of life stress and adjustment revisited. Journal of Personality and Social Psychology, 55, 432–444.

    Article  PubMed  Google Scholar 

  • Rutter, M. (1986). Meyerian psychobiology, personality development, and the role of life experiences. The American Journal of Psychiatry, 143, 1077–1087.

    PubMed  Google Scholar 

  • Sarason, I. G., & Sarason, B. R. (1985). Life change, social support, coping and health. In R. M. Kaplan & M. H. Criqui (Eds.), Behavioral epidemiology and disease prevention. A life sciences edn (Vol. 84, pp. 219–236). New York: Plenum.

    Google Scholar 

  • Sarason, I. G., Johnson, J. H., & Siegel, J. M. (1978). Assessing the impact of life changes: Development of the life experiences survey. Journal of Consulting & Clinical Psychology, 46, 932–946.

    Article  Google Scholar 

  • Schless, A. P., Schwartz, L., Goetz, C., & Mendels, J. (1974). How depressives view the significance of life events. The British Journal of Psychiatry, 125, 406–410.

    Article  PubMed  Google Scholar 

  • Schnurr, P. P., Ford, J. D., Friedman, M. J., Green, B. L., Dain, B. J., et al. (2000). Predictors and outcomes of posttraumatic stress disorder in World War II veterans exposed to mustard gas. Journal of Consulting and Clinical Psychology, 68, 258–268.

    Article  PubMed  Google Scholar 

  • Simons, A., Angell, K. L., Monroe, S. M., & Thase, M. E. (1993). Cognition and life stress in depression: Cognitive factors and the definition, rating, and generation of negative life events. Journal of Abnormal Psychology, 102, 584–591.

    Article  PubMed  Google Scholar 

  • Suaudino, K. J., Pedersen, N. L., Lichtenstein, P., Mc Clearn, G. E., & Plomin, R. (1997). Can personality explain genetic influences on life events? Journal of Personality and Social Psychology, 72, 196–206.

    Article  Google Scholar 

  • Suh, E., Diener, E., & Fujita, F. (1996). Events and subjective well-being: Only recent events matter. Journal of Personality and Social Psychology, 5, 1091–1102.

    Article  Google Scholar 

  • Theorell, T. (1974). Life events before and after the onset of a premature myocardial infarction. In B. S. Dohrenwend & B. P. Dohrenwend (Eds.), Stressful life events (pp. 101–117). New York: Wiley.

    Google Scholar 

  • Thoits, P. A. (1983). Dimensions of life events that influence psychological distress: An evaluation and synthesis of the literature. In H. B. Kaplan (Ed.), Psychosocial stress (pp. 33–303). New York: Academic.

    Google Scholar 

  • Thoits, P. A. (1995). Stress, coping, and social support processes: Where are we? What next? Journal of Health and Social Behavior, 5, 53–79.

    Article  Google Scholar 

  • Turner, R. J., & Lloyd, D. A. (1995). Lifetime trauma and mental health: The significance of cumulative adversity. Journal of Health and Social Behavior, 36, 360–376.

    Article  PubMed  Google Scholar 

  • Turner, R. J., & Lloyd, D. A. (2004). Stress burden and the lifetime incidence of psychiatric disorder in young adults: Racial and ethnic contrasts. Archives of General Psychiatry, 61, 481–488.

    Article  PubMed  Google Scholar 

  • Van Os, R., Park, S. B., & Jones, P. B. (2001). Neuroticism, life events and mental health: Evidence for person–environment correlation. The British Journal of Psychiatry. Supplement, 40, 72–77.

    Article  Google Scholar 

  • Vinokur, A., & Selzer, M. L. (1975). Desirable versus undesirable life events: Their relationship to stress and mental distress. Journal of Personality and Social Psychology, 32, 329–337.

    Article  PubMed  Google Scholar 

  • Weathers, F. W., & Keane, T. M. (2007). The Criterion A problem revisited: Controversies and challenges in defining and measuring psychological trauma. Journal of Traumatic Stress, 20, 107–121.

    Article  PubMed  Google Scholar 

  • Weisaeth, L. (1994). Psychological and psychiatric aspects of technological disasters. In R. J. Ursano, B. G. McCaughey, et al. (Eds.), Individual & community responses to trauma & disaster (pp. 72–102). New York: Cambridge University Press.

    Chapter  Google Scholar 

  • Zautra, A. J., & Reich, J. W. (1983). Life events and perceptions of life quality: Developments in a two-factor approach. Journal of Community Psychology, 11, 121–132.

    Article  Google Scholar 

  • Zuckerman, M. (1979). Sensation seeking: beyond the optimal level of arousal. Hillsdale: Erlbaum.

    Google Scholar 

  • Zuckerman, M. (1994). Behavioral expressions and biosocial bases of sensation seeking. New York: Cambridge University Press.

    Google Scholar 

Download references

Acknowledgements

This paper reports work that was supported in part by NIMH grant R01-MH059627 and grants from the Spunk Fund, Inc.

Author information

Authors and Affiliations

  1. Columbia University, New York, NY, USA

    Bruce P. Dohrenwend

  2. New York State Psychiatric Institute, New York, NY, USA

    Bruce P. Dohrenwend

Authors
  1. Bruce P. Dohrenwend
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bruce P. Dohrenwend.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dohrenwend, B.P. Toward a Typology of High-Risk Major Stressful Events and Situations in Posttraumatic Stress Disorder and Related Psychopathology. Psychol. Inj. and Law 3, 89–99 (2010). https://doi.org/10.1007/s12207-010-9072-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12207-010-9072-1

Keywords

Search

Navigation