Skip to main content
SpringerLink
Log in

Post-Traumatic Stress Disorder: Definition, Prevalence, and Risk Factors

  • Chapter
  • First Online:
Post-Traumatic Stress Disorder

Abstract

In this chapter, we provide the definition and diagnostic criteria for post-traumatic stress disorder (PTSD). Next, the prevalence data for this disorder are reviewed, with a particular focus on how prevalence rates vary with demographic characteristics (e.g., gender) and trauma type. The literature on risk and resilience factors for the development and maintenance of PTSD is then discussed. The chapter concludes with a discussion of contemporary statistical methods that may be used to advance our knowledge and understanding of PTSD.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Barlow, D. (2002) Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic. 2nd ed. New York: Guilford.

    Google Scholar 

  2. Keane, T. M., and Barlow, D. H. (2002) Posttraumatic stress disorder. Barlow, D. H., ed., Anxiety and Its Disorders. 2nd ed. New York: Guilford: 418–53.

    Google Scholar 

  3. American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association.

    Google Scholar 

  4. Keane, T. M. (2008) Posttraumatic stress disorder: future directions in science and practice. J Rehab Res Dev 45, vii–ix.

    Google Scholar 

  5. Schnurr, P. P., and Green, B. L. (2004) Understanding relationships among trauma, posttraumatic stress disorder, and health outcomes. In: Schnurr, P. P., and Green, B. L., Trauma and Health: Physical Health Consequences of Exposure to Extreme Stress. Washington, DC: American Psychological Association: 217–43.

    Chapter  Google Scholar 

  6. Jordan, B. K., Marmar, C. R., Fairbank, J. A., et al. (1992) Problems in families of male Vietnam veterans with posttraumatic stress disorder. J Consult Clin Psychol 60, 916–26.

    Article  PubMed  CAS  Google Scholar 

  7. Koss, M. P., Koss, P. G., and Woodruff, W. J. (1991) Deleterious effects of criminal victimization on women' health and medical utilization. Arch Intern Med 151, 342–47.

    Article  PubMed  CAS  Google Scholar 

  8. Kulka, R. A., Schlenger, W. E., Fairbank, J. A., (1990) Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.

    Google Scholar 

  9. Walker, E. A., Katon, W., Russo, J., Ciechanowski, P., Newman, E., and Wagner, A. W. (2003) Health care costs associates with posttraumatic stress disorder symptoms in women. Arch Gen Psychiatry 60, 369–74.

    Article  PubMed  Google Scholar 

  10. American Psychiatric Association. (1980) Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Association.

    Google Scholar 

  11. Breslau, N., Davis, G. C., Andreski, P., and Peterson, E. (1991) Traumatic events and posttraumatic stress disorder in an urban population of young adults. Arch Gen Psychiatry 48, 216–22.

    PubMed  CAS  Google Scholar 

  12. Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., and Nelson, C. B. (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 52, 1048–60.

    PubMed  CAS  Google Scholar 

  13. Kessler, R. C., Berglund, P., Demler, O., Jin, R., and Walters, E. E. (2005) Lifetime prevalence and age of onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62, 592–602.

    Google Scholar 

  14. Lloyd, D. A., and Turner, R. J. (2003) Cumulative adversity and posttraumatic stress disorder: evidence from a diverse community sample of young adults. Am Orthopsychiatry 73, 381–91.

    Article  Google Scholar 

  15. Beals, J., Manson, S. M., Whitesell, N. R., Spicer, P., Novins, D. K., and Mitchell, C. M. (2005) Prevalence of DSM-IV disorders and attendant help-seeking in two American Indian reservation populations. Arch Gen Psychiatry 62, 99–108.

    Article  PubMed  Google Scholar 

  16. Kilpatrick, D. G., Edmunds, C. N., and Seymour, A. K. (1992) Rape in America: A Report to the Nation. Arlington, VA: National Victim Center.

    Google Scholar 

  17. Resnick, H. S., Kilpatrick, D. G., Dansky, B. S., Saunders, B. E., and Best, C. L. (1993) Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. J Consult Clin Psychol 61, 984–91.

    Article  PubMed  CAS  Google Scholar 

  18. Litz, B. T., Orsillo, S. M., Friedman, M., Ehlich, P., and Batres, A. (1997) Posttraumatic stress disorder associated with peacekeeping duty in Somalia for U.S. military personnel. Am J Psychiatry 154, 178–84.

    PubMed  CAS  Google Scholar 

  19. Gray, M. J., Bolton, E. E., and Litz, B. T. (2004) A longitudinal analysis of PTSD symptom course: delayed-onset PTSD in Somalia peacekeepers. J Consult Clin Psychol 72, 909–13.

    Article  PubMed  Google Scholar 

  20. Wolfe, J., Brown, P. J., and Kelley, J. M. (1993) Reassessing war stress: exposure and the Persian Gulf War. J Soc Issues 49, 15–31.

    Article  Google Scholar 

  21. Perconte, S. T., Wilson, A. T., Pontius, E. B., Dietrick, A. L., and Spiro, K. J. (1993) Psychological and war stress symptoms among deployed and non-deployed reservists following the Persian Gulf War. Mil Med 158, 516–21.

    PubMed  CAS  Google Scholar 

  22. Sutker, P. B., Uddo, M., Brailey, K., and Allain, A. N. (1993) War-zone trauma and stress-related symptoms in Operation Desert Shield/Storm ODS returnees. J Soc Issues 49, 33–50.

    Article  Google Scholar 

  23. Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., and Koffman, R. L. (2004) Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med 351, 13–22.

    Article  PubMed  CAS  Google Scholar 

  24. Schnurr, P. P., Lunney, C. A., Sengupta, A., and Waelde, L. C. (2003) A descriptive analysis of PTSD chronicity in Vietnam veterans. J Trauma Stress 16, 545–53.

    Article  PubMed  Google Scholar 

  25. Schnurr, P. P., Ford, J. D., Friedman, M. J., Green, B. L., Dain, B. J., and Sengupta, A. (2000) Predictors and outcomes of posttraumatic stress disorder in World War II veterans exposed to mustard gas. J Consult Clin Psychol 68, 258–68.

    Article  PubMed  CAS  Google Scholar 

  26. Vasterling, J., Proctor, S., Amoroso, P., Kane, R., Heeren, T., and White, R. (2006) Neuropsychological outcomes of army personnel following deployment to the Iraq war. JAMA 296, 519–529.

    Article  PubMed  CAS  Google Scholar 

  27. Fazel, M., Wheeler, J., and Danesh, J. (2005) Prevalence of serious mental disorder in 7,000 refugees resettled in Western countries: a systematic review. Lancet 365, 1309–14.

    Article  PubMed  Google Scholar 

  28. De Girolamo, G., and McFarlane, A. C. (1996) The epidemiology of PTSD: A comprehensive review of the international literature. In: Marsella, A. J., Friedman, M. J., Gerrity, E. T., and Scurfield, R. M., Ethnocultural Aspects of Posttraumatic Stress Disorder: Issues, Research, and Clinical Applications. Washington, DC: American Psychological Association: 33–85.

    Chapter  Google Scholar 

  29. Charney, M. E., and Keane, T. M. (2007) Psychometric analysis of the Clinician Administered PTSD Scale (CAPS)-Bosnian Translation. Cultural Diversity Ethnic Minority Psychol 13, 161–68.

    Article  Google Scholar 

  30. Hollifield, M., Warner, T. D., Lian, N., et al. (2002) Measuring trauma and health status in refugees: a critical review. JAMA 288, 611–21.

    Article  PubMed  Google Scholar 

  31. Keane, T. M., Kaloupek, D. G., and Weathers, F. W. (1996) Ethnocultural considerations in the assessment of PTSD.In:Marsella, A. J., Friedman, M. J., Gerrity, E. T., and Scurfield, R. M., eds. Ethnocultural Aspects of Posttraumatic Stress Disorder: Issues, Research, and Clinical Applications. Washington, DC: American Psychological Association: 183–205.

    Chapter  Google Scholar 

  32. Green, B. L., Lindy, J. D., Grace, M. C., et al. (1990) Buffalo Creek survivors in the second decade: stability of stress symptoms. Am J Orthopsychiatry 60, 43–54.

    Article  PubMed  CAS  Google Scholar 

  33. Green, B. L., Grace, M. C., Lindy, J. D., Gleser, G. C., Leonard, A. C., and Kramer, T. L. (1990) Buffalo Creek survivors in the second decade: comparison with unexposed and nonlitigant groups. J Appl Soc Psychol 20, 1033–50.

    Article  Google Scholar 

  34. McFarlane, A. (1989) The aetiology of post-traumatic morbidity: predisposing, precipitating and perpetuating factors. Br J Psychiatry 154, 221–228.

    Article  PubMed  CAS  Google Scholar 

  35. Gidron, Y. (2002) Posttraumatic stress disorder after terrorist attacks: a review. J Nerv Ment Dis 190, 118–21.

    Article  PubMed  Google Scholar 

  36. Schlenger, W. E., Caddell, J. M., Ebert, L., et al. (2002) Psychological reactions to terrorist attacks: findings from the National Study of Americans’ Reactions to September 11. JAMA 288, 581–88.

    Article  PubMed  Google Scholar 

  37. Galea, S., Ahern, J., Resnick, H., et al. (2002) Psychological sequelae of the September 11 terrorist attacks in New York City. N Engl J Med 346, 982–87.

    Article  PubMed  Google Scholar 

  38. Bromet, E., Sonnega, A., and Kessler, R. C. (1998) Risk factors for DSM-III-R posttraumatic stress disorder: findings from the National Comorbidity Survey. Am J Epidemiol 147, 353–61.

    PubMed  CAS  Google Scholar 

  39. Anisman, H., Grimmer, L., Irwin, J., Remington, G., and Sklar, L. S. (1979) Escape performance after inescapable shock in selectively bred lines of mice: response maintenance and catecholamine activity. J Comp Physiol Psychol 93, 229–41.

    Article  PubMed  CAS  Google Scholar 

  40. Lyons, M. J., Goldberg, J., Eisen, S. A., et al. (1993) Do genes influence exposure to trauma? A twin study of combat. Am J Med Genet 48, 22–27.

    Article  PubMed  CAS  Google Scholar 

  41. True, W. R., Rice, J., Eisen, S. A., et al. (1993) A twin study of genetic and environmental contributions to liability for posttraumatic stress symptoms. Arch Gen Psychiatry 50, 257–64.

    PubMed  CAS  Google Scholar 

  42. Koenen, K. C., Harley, R., Lyons, M. J., et al. (2002) A twin registry study of familial and individual risk factors for trauma exposure and posttraumatic stress disorder. J Nerv Ment Dis 190, 209–18.

    Article  PubMed  Google Scholar 

  43. Stein, M. B., Jang, K., Taylor, S., Vernon, P. A., and Livesley, W. J. (2002) Genetic and environmental influences on trauma exposure and posttraumatic stress disorder symptoms: a twin study. Am J Psychiatry 159, 1675–81.

    Article  PubMed  Google Scholar 

  44. Roy-Byrne, P., Arguelles, L., Vitek, M. E., et al. (2004) Persistence and change of PTSD symptomatology: a longitudinal co-twin control analysis of the Vietnam Era Twin Registry. Soc Psychiatry Psychiatr Epidemiol 39, 681–85.

    Article  PubMed  Google Scholar 

  45. Orr, S. P., Metzger, L. J., Lasko, N. B., et al. (2003) Physiological responses to sudden, loud tones in monozygotic twins discordant for combat exposure: association with posttraumatic stress disorder. Arch Gen Psychiatry 60, 283–88.

    Article  PubMed  Google Scholar 

  46. Ozer, E. J., Best, S. R., Lipsey, T. L., and Weiss, D. S. (2003) Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull 129, 52–73.

    Article  PubMed  Google Scholar 

  47. Brewin, C. R., Andrews, B., Valentine, J. D. (2000) Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol 68, 748–66.

    Article  PubMed  CAS  Google Scholar 

  48. McLeod, D. S., Koenen, K. C., Meyer, J. M., et al. (2001) Genetic and environmental influences on the relationship among combat exposure, posttraumatic stress disorder symptoms, and alcohol use. J Trauma Stress 14, 259–75.

    Article  PubMed  CAS  Google Scholar 

  49. Comings, D. E., Comings, B. G., Muhleman, D., et al. (1991) The dopamine D2 receptor locus as a modifying gene in neuropsychiatric disorders. JAMA 266, 1793–1800.

    Article  PubMed  CAS  Google Scholar 

  50. Comings, D., Muhleman, D., and Gysin, R. (1996) Dopamine D-sub-2 receptor (DRD2) gene and susceptibility to posttraumatic stress disorder: a study and replication. Biol Psychiatry 40, 368–372.

    Article  PubMed  CAS  Google Scholar 

  51. Gelernter, J., Southwick, S., Goodson, S., Morgan, A., Nagy, L., and Charney, D. S. (1999) No association between D2 dopamine receptor DRD2: “A” system alleles, or DRD2 haplotypes, and posttraumatic stress disorder? Biol Psychiatry 45, 620–25.

    Article  PubMed  CAS  Google Scholar 

  52. Breslau, N., Chilcoat, H. D., Kessler, R. C., Peterson, E. L., and Lucia, V. C. (1999) Vulnerability to assaultive violence: further specification of the sex difference in post-traumatic stress disorder. Psychol Med 29, 813–21.

    Article  PubMed  CAS  Google Scholar 

  53. Cardozo, B., Bilukha, O., Gotway, C., Wolfe, M., Gerber, M., and Anderson, M. (2005) Mental health of women in postwar Afghanistan. J Womens Health 14, 285–93.

    Article  Google Scholar 

  54. Friedman, M. J., Schnurr, P. P., Sengupta, A., Holmes, T., and Ashcraft, M. (2004) The Hawaii Vietnam Veterans Project: is minority status a risk factor for posttraumatic stress disorder? J Nerv Ment Dis 192, 42–50.

    Article  PubMed  Google Scholar 

  55. Beals, J., Manson, S. M., Shore, J. H., et al. (2002) The prevalence of posttraumatic stress disorder among American Indian Vietnam veterans: disparities and context. J Trauma Stress 15, 89–97.

    Article  PubMed  Google Scholar 

  56. Breslau, N., Peterson, E. L., Poisson, L. M., Schultz, L. R., and Lucia, V. C. (2004) Estimating posttraumatic stress disorder in the community: lifetime perspective and the impact of typical traumatic events. Psychol Med 34, 889–98.

    Article  PubMed  CAS  Google Scholar 

  57. Bowman, M. L., and Yehuda, R. (2004) Risk factors and the adversity-stress model. In: Rosen, G. M., Posttraumatic Stress Disorder: Issues and Controversies. New York: Wiley: 15–38.

    Chapter  Google Scholar 

  58. Erickson, D., Wolfe, J., King, D., King, L., and Sharkansky, E. (2001) Posttraumatic stress disorder and depression symptomatology in a sample of Gulf War veterans: a prospective analysis. J Consult Clin Psychol 69, 41–49.

    Article  PubMed  CAS  Google Scholar 

  59. Najavits, L. M. (2000) Seeking Safety: A Cognitive Behavioral Treatment for Substance Abuse and PTSD. New York: Guilford.

    Google Scholar 

  60. Bryant, R. A., and Guthrie, R. M. (2005) Maladaptive appraisals as a risk factor for posttraumatic stress. Psychol Sci 16, 749–52.

    Article  PubMed  Google Scholar 

  61. Norris, F. H., Kaniasty, K., Conrad, M. L., Inman, G. L., and Murphy, A. D. (2002) Placing age differences in cultural context: a comparison of the effects of age on PTSD after disasters in the United States, Mexico, and Poland. J Clin Geropsychol 8, 153–73.

    Article  Google Scholar 

  62. Tucker, P., Pfefferbaum, B., Nixon, S. J., and Dickson, W. (2000) Predictors of post-traumatic stress symptoms in Oklahoma City: exposure, social support, peri-traumatic response J Behav Health Serv Res 27, 406–16.

    Article  PubMed  CAS  Google Scholar 

  63. Rosenman, S. (2002) Trauma and posttraumatic stress disorder in Australia: findings in the population sample of the Australian National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry 36, 515–20.

    Article  PubMed  Google Scholar 

  64. Norris, F. H., Murphy, A. D., Baker, C. K., and Perilla, J. L. (2003) Severity, timing, and duration of reactions to trauma in the population: an example from Mexico. Biol Psychiatry 53, 769–78.

    Article  PubMed  Google Scholar 

  65. Schnurr, P. P., Lunney, C. A., and Sengupta, A. (2004) Risk factors for the development versus maintenance of posttraumatic stress disorder. J Trauma Stress 17, 85–95.

    Article  PubMed  Google Scholar 

  66. Dunmore, E., Clark, D. M., and Ehlers, A. (2001) A prospective investigation of the role of cognitive factors in persistent posttraumatic stress disorder PTSD after physical or sexual assault. Behav Res Ther 39, 1063–84.

    Article  PubMed  CAS  Google Scholar 

  67. Marmar, C., R., Weiss, D. S., Schlenger, W. E., et al. (1994) Peritraumatic dissociation and posttraumatic stress in male Vietnam theater veterans. Am J Psychiatry 151, 902–7.

    PubMed  CAS  Google Scholar 

  68. Gershuny, B. S., Cloitre, M., and Otto, M. W. (2003) Peritraumatic dissociation and PTSD severity: do event-related fears about death and control mediate their relation? Behav Res Ther 41, 157–66.

    Article  PubMed  Google Scholar 

  69. Halligan, S. L., Michael, T., Clark, D. M., and Ehlers, A. (2003) Posttraumatic stress disorder following assault: the role of cognitive processing, trauma memory, and appraisals. J Consult Clin Psychol 71, 419–31.

    Article  PubMed  Google Scholar 

  70. Marshall, G. N., and Schell, T. L. (2002) Reappraising the link between peritraumatic dissociation and PTSD symptom severity: evidence from a longitudinal study of community violence survivors. J Abnorm Psychol 111, 626–36.

    Article  PubMed  Google Scholar 

  71. Ehlers, A., and Clark, D. M. (2000) A cognitive model of posttraumatic stress disorder. Behav Res Ther 38, 319–45.

    Article  PubMed  CAS  Google Scholar 

  72. King, D. W., Taft, C. T., King, L. A., Hammond, C., and Stone, E. R. (2007) Directionality of the association between social support and posttraumatic stress disorder: a longitudinal investigation. J Appl Soc Psychol 36, 2980–92.

    Article  Google Scholar 

  73. King, D. W., King, L. A., Gudanowski, D. M., and Vreven, D. L. (1995) Alternative representations of war zone stressors: relationships to posttraumatic stress disorder in male and female Vietnam veterans. J Abnorm Psychol 104, 184–96.

    Article  PubMed  CAS  Google Scholar 

  74. King, D. W., King, L. A., Foy, D. W., and Gudanowski, D. M. (1996) Prewar factors in combat-related posttraumatic stress disorder: structural equation modeling with a national sample of female and male Vietnam veterans. J Consult Clin Psychol 64, 520–31.

    Article  PubMed  CAS  Google Scholar 

  75. King, L. A., King, D. W., Fairbank, J. A., Keane, T. M., and Adams, G. A. (1998) Resilience-recovery factors in post-traumatic stress disorder among female and male Vietnam veterans: hardiness, postwar social support, and additional stressful life events. J Personal Soc Psychol 74, 420–34.

    Article  CAS  Google Scholar 

  76. King, D. W., King, L. A., Foy, D. W., Keane, T. M., and Fairbank, J. A. (1999) Posttraumatic stress disorder in a national sample of female and male Vietnam veterans: risk factors, war-zone stressors, and resilience-recovery variables. J Abnorm Psychol 108, 164–70.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. Terence M. Keane
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brian P. Marx
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Denise M. Sloan
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

    Rights and permissions

    Reprints and permissions

    Copyright information

    © 2009 Humana Press, a part of Springer Science+Business Media, LLC

    About this chapter

    Cite this chapter

    Keane, T., Marx, B., Sloan, D. (2009). Post-Traumatic Stress Disorder: Definition, Prevalence, and Risk Factors. In: LeDoux, J., Keane, T., Shiromani, P. (eds) Post-Traumatic Stress Disorder. Humana Press. https://doi.org/10.1007/978-1-60327-329-9_1

    Download citation

    • DOI: https://doi.org/10.1007/978-1-60327-329-9_1

    • Published:

    • Publisher Name: Humana Press

    • Print ISBN: 978-1-60327-328-2

    • Online ISBN: 978-1-60327-329-9

    • eBook Packages: MedicineMedicine (R0)

    Publish with us

    Policies and ethics

    Search

    Navigation