Medical Disorders as a Cause of Psychological Trauma and Posttraumatic Stress Disorder

Elizabeth Mundy; Andrew Baum


Curr Opin Psychiatry. 2004;17(2) 

In This Article


As the study of psychological trauma and posttraumatic stress disorder (PTSD) has evolved, it has broadened to include non-traditional stressors or situations that share characteristics of the criteria for psychological trauma but differ in important ways. For the past 30 years, combat veterans and disaster victims have been the modal populations for studies of PTSD, and much of what we know about PTSD and subsyndromal stress conditions is derived from them.[1,2] More recent studies have investigated more commonly occurring potential sources of trauma, including motor vehicle accidents, sexual assault, and terrorism or human caused disasters.[3,4,5,6,7] Because research on trauma has shown that the types of events that cause or enable PTSD are more common than uncommon (e.g., rape, assault),[8] the Diagnostic and Statistical Manual of Mental Disorders (DSM) 4th edition[9] has changed criterion A of PTSD by omitting the description of the stressor as 'outside the range of normal human experience'. Instead, criterion A now requires that the individual's experience in response to the stressor must include intense fear, helplessness or horror. This definition expands the type of traumatic events that qualify for PTSD to include violent personal assault, motor vehicle accidents, natural or manmade disasters, learning about the sudden, unexpected death of a family member or a close friend, learning that one's child has a life-threatening disease, or being diagnosed with a life-threatening disease. Research has increasingly targeted serious or life-threatening illnesses as traumatic events, and a growing literature on PTSD among medical patients has developed (e.g. cancer, myocardial infarct, HIV diagnosis). These developments have helped broaden and enrich the investigation of psychological trauma, but differences between medical stressors and more traditionally studied sources of trauma raise questions about the application of PTSD to this population. This review considers some of these issues.