Preface

The published literature on posttraumatic stress disorder (PTSD) has grown rapidly over the past 25 years, almost doubling in size since the 2009 first edition of this book. Now there are more than 10,000 journal articles and hundreds of books on this topic that are widely read by scientists, clinicians, educators, trainees, and laypersons—and increasingly by policy makers, judges and attorneys, organizational leaders, and opinion leaders in the media and popular and political culture. PTSD offers a widely accepted framework for understanding the effects of experiencing potentially traumatic events such as terrorism, domestic and community violence, physical and sexual assault, child maltreatment, human trafficking, refugee adversity homicide, disaster, life-threatening illness and accidents, torture, genocide, and the injury done to both civilians and military combatants in war. Public as well as professional awareness has grown commensurately as most people now recognize the profound impact of psychological trauma and the need for proactive and scientifically based approaches to timely prevention, humanitarian relief, and evidence-based treatment for traumatized persons, communities, and nations.

As a result, scholars, researchers, and educators in the social, biological, medical, political, and behavioral sciences need a current and comprehensive source on PTSD for their studies and teaching. The Handbook of PTSD, Second Edition (Friedman, Keane, & Resick, 2014) and The Encyclopedia of Trauma (Figley, 2012) provide snapshots of key issues and topics in the PTSD field, but practitioners, clinicians, students, and trainees in the health care and human and social services need a concise and complete overview of PTSD as their source of authoritative information on PTSD. This Second Edition of Posttraumatic Stress Disorder: Science and Practices was designed to meet that need for a comprehensive yet concise textbook on PTSD that will be useful to researchers, educators, clinicians, and trainees in graduate and advanced undergraduate courses in the mental health, health care, social and human services, and criminal justice fields.

This text covers all major topics in the traumatic stress field, from etiology to neurobiology to assessment and diagnosis to evidence-based treatment and prevention. All topics covered in the two comprehensive Encyclopedias on PTSD (Figley, 2012; Reyes, Elhai, & Ford, 2008) are addressed in this text. A balanced view of each topic includes (i) material relevant to scientific researchers and clinical practitioners; (ii) multiple theoretical vantage points; (iii) answers to questions that aspiring trainees have about becoming a traumatic stress researcher or clinician; (iv) key points for educators to use in teaching; (v) recognition in every section of the book (and special emphasis in Chapter 11) of the critical role that ethnicity, culture, gender and sexual identity, and legal and economic factors have in influencing PTSD and its assessment, treatment, and prevention; and (vi) a developmental focus on the nature of PTSD across the life span from infancy to older adulthood.

The book is written at the level suitable for both advanced undergraduate and graduate trainees, as well as for educators, clinicians, or researchers seeking an overview of the traumatic stress field. The text uses language that is free of technical jargon except for key terms that are supplemented with nontechnical definitions and examples. The focus is on describing state-of-the-art research and clinical methodologies in down-to-earth terms with interesting examples and both research and clinical case studies. The text introduces the major issues, controversies, and findings in the field, as well as highlights what is not yet known and how researchers and clinicians are (or can) make further discoveries.

Chapter 1, Understanding Psychological Trauma and Posttraumatic Stress Disorder (PTSD), describes the history of scientific knowledge and popular conceptions of psychological trauma from the earliest writings several thousand years ago to modern definitions and diagnoses. Controversies such as the nature and validity of memories of childhood traumatic exposure, potential bias in diagnosis and treatment of females and persons of color, gender and ethnocultural differences in the experience and impact of psychological trauma, major expansion in the field’s understanding of the range of problems involved in PTSD and diagnostic definitions of PTSD in the United States (the 2014 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, DSM-5) and internationally (the 2016 International Classification of Diseases, Eleventh Edition, ICD-11), and the interplay of mind and body (including genetics and brain development) in psychological trauma are highlighted. Each major topic from subsequent chapters is previewed.

Chapter 2, The Impact of Psychological Trauma, provides a description of the longitudinal course of psychological trauma and PTSD: the unfolding impact of traumatic stress from initial exposure[s] through the following months, years, and decades, and across generations. Acute reactions to psychological trauma and their biological, psychological, and sociocultural bases are described, followed by a description of positive trajectories (e.g., resistance, resilience) and problematic trajectories (e.g., acute posttraumatic stress problems, PTSD, complex PTSD) in the wake of psychological trauma—including the different manifestations of formal diagnoses of PTSD and comorbid disorders as they occur at different developmental epochs and over time.

Chapter 3, Etiology of PTSD: What Causes PTSD?, provides an overview of scientific knowledge and clinical and popular theories of the causes of PTSD. Risk factors for developing PTSD and related behavioral health disorders or sociovocational and legal problems are summarized. Protective factors and contexts that promote stress “resistance” or “resilience” are summarized. An integrative model that takes into account risk and protective factors and the impact of different types of psychological trauma at different developmental phases is presented in order to provide the reader with a unified approach to understanding how PTSD develops and can be effectively treated (discussed in Chapters 7 and 8) or potentially prevented (discussed in Chapter 9). The role of family, community, culture, and service systems in increasing risk of, or resilience/recovery from, traumatic stress disorders is illustrated through case examples.

Chapter 4, Epidemiology of PTSD, describes research on the incidence (how often something occurs) and prevalence (how commonly something is found in a population) of exposure to different types of psychological trauma, Acute Stress Disorder, PTSD, and comorbid psychiatric/addictive disorders and sociovocational and legal problems among children and adults. Differences in the extent and nature of traumatic stressor exposure and PTSD are highlighted across community, clinical (mental health), medical, and criminal justice (juvenile and adult) populations. Approaches to increasing the accuracy and completeness of epidemiological studies of psychological trauma and PTSD are discussed.

Chapter 5, Neurobiology of Traumatic Stress Disorders and Their Impact on Physical Health, distills the extensive animal and human research literatures on the biological foundations of stress and posttraumatic stress in a summary that addresses (i) alterations in the body’s stress response systems; (ii) alterations in brain chemistry, structure, and functioning; (iii) the role of genetics and epigenetics (changes in genes caused by life experiences) in PTSD; and (iv) the impact of psychological trauma and traumatic stress disorders on physical health. Classic and contemporary studies on the physiology, neurobiology, and alterations in brain functioning that may contribute to PTSD are highlighted to bring to life the complex biological underpinnings of psycho­logical trauma and its impact on physical as well as psychological health.

Chapter 6, Assessment of Psychological Trauma and PTSD, presents an overview of approaches to clinical and research assessment of people’s life history of exposure to traumatic stressors and past or current PTSD. Measures with the strongest evidence base are described, along with concise definitions of the psychometric criteria (the standards for accurate measurement) that are required for assessment to be considered to be reliable, valid, and clinical useful. Approaches to the following aspects of assessment are described: (i) screening to identify individuals who may have experienced trauma and may be suffering traumatic stress symptoms; (ii) structured interview assessment of psychological trauma history and traumatic stress disorders; (iii) standardized questionnaires assessing trauma history, PTSD and its symptoms, and key comorbid psychosocial problems; (iv) psychophysiological and neuropsychological assessment of trauma survivors; and, (v) forensic (juvenile and criminal justice, civil law) assessment of psychological trauma survivors.

Chapters 7 and 8, Treatment of Adults with PTSD and Treatment of Children and Adolescents with PTSD, describe the classic three-phase model of treatment for PTSD and discuss the essential clinical and ethical/legal ingredients that transcend any single therapeutic theory or intervention (such as engagement, working alliance, confidentiality/privilege, mandated reporting, crisis prevention and management, identifying and therapeutically...