Traumatic Stress

Traumatic Stress

Edited by Bessel A. van der Kolk, Alexander C. McFarlane and Lars Weisaeth
Textbook for clinicians with research findings on post traumatic stress disorder (PTSD) examines multiple effects of trauma on individuals with research findings on causes and treatment of PTSD in civilians and veterans.
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This textbook for clinicians, researchers, and academic professors is a classic volume on the theory and research findings on posttraumatic stress disorder (PTSD). Key topics include why certain people cope successfully with traumatic experiences while others do not, the neurobiological processes underlying PTSD symptomatology, enduring questions surrounding traumatic memories and dissociation, and the core components of effective interventions. A highly influential work that laid the foundation for many of the field's continuing advances, this volume remains an immensely informative and thought-provoking clinical reference and text. May also serve as a text in graduate-level courses and residency programs.

ISBN# 1-57230-457-X
Pages 596 pages, 6 x 9, softcover
Year 2007


Bessel A. van der Kolk, M.D., is Director of the Trauma Center at Human Resources Institute in Boston Massachusetts, a center for the treatment and study of traumatized children and adults. He is an Associate Professor of psychiatry at Harvard Medical School and the past President of the International Society of Traumatic Stress Studies. He has done extensive research on developmental and biological aspects of the human adaptation to trauma, including studying the nature of traumatic memories. He was co-principal investigator for the DSM-IV Field Trial for PTSD. He is the author of two previous books on the human response to trauma: PTSD: Psychological and Biological Sequelae (1984) and Psychological Trauma, (APA Press, 1987).

Lars WeisaethM.D., Ph.D., is Professor of Disaster Psychiatry at the University of Oslo, Norway, and frequent consultant to the United Nations and other international organizations regarding approaches to treating traumatized civilians and soldiers.

Alexander C. McFarlane, M.D., is Professor of Psychiatry at the University of Adelaide and Head of the Department of Psychiatry at the Queen Elizabeth Hospital in South Australia. His research in the field of trauma is wide ranging and began following a large bushfire disaster which affected his community in 1983. His clinical work is with victims of a variety of traumas, including accidents, disasters, torture, and war.


I. Background Issues and History

1. The Black Hole of Trauma, Bessel

2. Trauma and Its Challenge to Society

3. History of Trauma in Psychiatry

II. Acute Reactions

4. Stress versus Traumatic Stress: From Acute Homeostatic Reactions to Chronic Psychopathology

5. Acute Posttraumatic Reactions in Soldiers and Civilians

II. Adaptations to Trauma

6. The Classification of Posttraumatic Stress Disorder

7. The Nature of Traumatic Stressors and the Epidemiology of Posttraumatic Reactions

8. Resilience, Vulnerability, and the Course of Posttraumatic Reactions

9. The Complexity of Adaptation to Trauma: Self-Regulation, Stimulus Discrimination, and Characterological Development

10. The Body Keeps the Score: Approaches to the Psychobiology of Posttraumatic Stress Disorder

11. Assessment of Posttraumatic Stress Disorder in Clinical and Research Settings

IV. Memory: Mechanisms and Processes

12. Trauma and Memory

13. Dissociation and Information Processing in Posttraumatic Stress Disorder

V. Developmental, Social, and Cultural Issues

14. Traumatic Stress in Childhood and Adolescence: Recent Developments and Current Controversies

15. Prior Traumatization and the Process of Aging: Theory and Clinical Implications

16. Legal Issues in Posttraumatic Stress Disorder

17. Trauma in Cultural Perspective

VI. Treatment

18. A General Approach to Treatment of Posttraumatic Stress Disorder

19. Prevention of Posttraumatic Stress: Consultation, Training, and Early Treatment

20. Acute Preventive Interventions

21. Acute Treatments

22. Cognitive-Behavioral Therapy for Posttraumatic Stress Disorder

23. The Psychopharmacological Treatment of Posttraumatic Stress Disorder

24. Psychoanalytic Psychotherapy of Posttraumatic Stress Disorder: The Nature of the Therapeutic Relationship

25. The Therapeutic Environment and New Explorations in the Treatment of Posttraumatic Stress Disorder


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Part III begins with a chapter that delineates the background issues for the development of PTSD as a diagnostic category in DSM-III and DSM-IV. Since the placement of psychiatric problems within diagnostic systems determines how clinicians and investigators conceptualize the inner structure of a disorder, this raises the very important question of whether PTSD is most appropriately classified as an anxiety disorder. This chapter examines the rationale for establishing a separate axis for stress disorders in the DSM system of diagnostic classifications, which could include dissociative disorders, adjustment disorders, grief reactions, and a variety of characterological adaptations.

The next two chapters of this section—Chapter 7, on the nature of the stressor, and Chapter 8, on vulnerability and resilience—examine the interactions between external events and subjective response. In this regard, the meaning of the trauma, the physiological response, preexisting personality structures and experiences, and the degree of social support are all critical factors in a person’s ultimate response to trauma. The stressor criterion defines who is and who is not included in the diagnosis, and hence this determines the prevalence of PTSD. Chapter 8 summarizes the epidemiological studies conducted to date, which emphasize the importance of traumatic stress as a public health issue. It further examines the relative importance of the traumatic event itself, in contrast to vulnerability or predisposing factors. The conclusion is that issues of predisposition and vulnerability may be more relevant to understanding recovery from acute symptomatology and the individual’s long-term resilience than to understanding acute patterns of response to a stressor. Vulnerability factors may also define the patterns of comorbidity, which play an important role in chronic PTSD. Critical in these considerations is the emergence of chronic patterns of adaptation, in which lack of involvement in current reality, rather than preoccupation with the past, are the most pathological features.

Chapter 9, on the complex nature of adaptation to trauma, examines the intricate ways in which psychological and biological processes interact with development to produce a range of problems with self-regulation, attention, the ways people view themselves, and the ways they make their way in the world. Chronic trauma is associated with dissociative disorders, somatization, and a host of self-destructive behaviors (e.g., suicide attempts, self-mutilation, and eating disorders). In addition, trauma at different developmental levels has different effects on further personality development. This theme of complexxivity of adaptation continues in Chapter 10, which examines the biology of PTSD, including both hormonal and autonomic nervous system dimensions. Topics covered include the unusual patterns of cortisol, norepinephrine, and dopamine metabolite excretion; the role of the serotonergic and opioid systems; and receptor modification by processes such as kindling. This chapter also examines the involvement of central pathways involved in the integration of perception, memory, and arousal, as well as the impact of these central pathways on patterns of information processing in PTSD.

Part III concludes with a chapter on research methodology, which discusses the currently available diagnostic and assessment tools that are helpful in both clinical and research settings. There is often conflict between clinical realities and research paradigms in PTSD. Because of forensic as well as research issues, the problem of a valid and reliable diagnosis is of paramount importance. This question is given further relevance by the fact that a number of studies demonstrate low rates of PTSD in exposed populations. Whereas strict standards of diagnosis for PTSD are essential for good research, broader definitions may be helpful in clinical settings to assess the full extent of disability. Over time some people’s PTSD may become subclinical, and yet it may continue to influence their level of functioning.

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