Ptsd As A Risk Factor For Retraumatization

Several epidemiological studies have found that after an individual has experienced one high-magnitude stressor, he or she is at risk for experiencing additional traumatic events over the lifespan (Breslau, Davis, Andreski, & Peterson, 1991; Kilpatrick, Saunders, Veronen, Best, & Von, 1987). Of even greater significance is the report that, at least among rape victims, the presence of PTSD, in and of itself, contributes to risk for repeated traumatization (National Victim Center and Crime Victims Research and Treatment Center, 1992). Given these findings, it becomes critical to determine whether individuals abused as children have PTSD related to the childhood abuse and/or assault.

There has been less than a complete consensus concerning the existence of a diagnostic category that adequately captures the range of symptoms associated with a history of childhood abuse. However, the accumulation of data indicates that PTSD is a salient, if not core, component of the complex of symptoms related to childhood sexual abuse (CSA). Accumulating evidence indicates that PTSD is a central and significantly debilitating outcome of childhood abuse. The DSM-IV field trials for PTSD identified the prevalence of CSA-related PTSD as 68% in a combined community and clinical sample (Roth, Newman, Pelcovitz, van der Kolk, & Newman, 1997). A study assessing a clinical sample of 47 women with CSA found that 69% had PTSD (Rowan, Foy, Rodriquez, & Ryan, 1994). In another clinical study of 26 women with a history of CSA, 73% were diagnosed with PTSD (O'Neill & Gupta, 1991). In our own clinical sample of 98 women with CSA, Structured Clinical Interview for DSM-III-R (SCID-III-R) assessments revealed that 73% had DSM-III-R PTSD and that PTSD was the most prevalent Axis I disorder.

In a prospective study Sandberg et al. (1999) found that posttraumatic symptomatology moderated the relationship between child/adolescent sexual abuse and adult sexual abuse. Previous sexual victimization became more strongly associated with subsequent sexual victimization when posttraumatic symptomatology was taken into account. A limitation to the study was the length of the design, 10 weeks. Thirty percent (n = 98) of the sample had been sexually victimized during childhood and/or adolescence, and 8% (n = 27) had been victimized over the 10-week period. However, the study did not specify the number of women revictimized. The investigators did not find a mediating effect for posttraumatic symptomatology between childhood/adolescent sexual abuse and revictimization during said period.

Given that PTSD has been identified as a risk factor for additional sexual assaults among rape victims, it is possible that PTSD associated with CSA may be associated with even greater risk for subsequent assault than PTSD related to adulthood rape. This is because individuals who have PTSD deriving from childhood abuse are at risk for a greater portion of their lifespan, and the risk includes a period of life (childhood/adolescence) in which coping strategies for responding effectively to risk may be underdeveloped.

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