Disorders involving substance dependence may also preclude appropriate diagnosis of PTSD and may substantially impact the services rendered (Harris, 1996) The type of substance used and the self-medication regimen may alter the presentation of PSTD symptoms and defense mechanisms, thus confounding treatment schemes (Grossman, Willer, Stovall, McRae, Maxwell, & Nelson, 1997). Patient’s amelioration of symptoms through self-medication also reduces their ability to accurately quantify symptom magnitude (Grossman, Willer, Stovall, McRae, Maxwell, & Nelson, 1997; Harris, 1996.
Therapeutic practice therefore suggested treatment of chemical dependency and PTSD be concurrent (Harris, 1996). Ideally, the reduction of self-medication schemes enables the therapist and patient to address core trauma issues (Grossman, Willer, Stovall, McRae, Maxwell, & Nelson, 1997). Belief as to the level of responsibility the survivor had in the traumatic event may be related to the magnitude of PTSD symptoms experienced and to the global level of functioning (Mueser et al,, 1998; Regehr, CAdell, & Jansen, 1999; Resnick, Acierno, & Kilpatric, 1997).
Persons who believe that they were in a traumatic situation that occurred regardless of their culpability, as opposed to those who assume personal responsibility for placing themselves in danger, are sometimes able to work through postrauma symptomatology with less difficulty (Ajduovic, 1998). Research indicates the existence of relationships between control and culpability, attitudes and beliefs, and the impact of stress intensity functioning (Mueser et al,, 1998; Regehr, CAdell, & Jansen, 1999; Resnick, Acierno, & Kilpatric, 1997).
Also, a study on perceived controllability suggested a relationship existed between the patients’ control beliefs, their posttrauma symptom intensity, and their perception of stress intensity during the trauma (Kushner, Riggs, Foa, & Miller, 1992). The control survivors exerted during the trauma may influence perceptions about other posttrauma events functioning (Adjukovic, 1998; Kushner , Riggs, Foa, & Miller, 1992). In work with 140 female assault victims, Kushner and colleagues found that the perceived lack of control and PSTD symptomatology could be generalized to other negatively viewed events.
Kushner and colleagues suggested that the victims’ modification of beliefs their controllability after the trauma had changed. They also suggested that the world view of the victims had become more negative and the victims were likely to initiate steps to reduce future trauma experiences, either directly or through approximations of situations. Kushner and colleagues (1992) suggested that the participants expressed varying degrees of approximations and that the approximations coincide with their level of negative world view.
Locus of control is correlated with the onset of trauma symptomatology and coping ex post facto (Regehr, Cadell, & Jansen, 1999). For example, women were raped as children responded with greater PTSD symptom reporting than those were raped as adults (Regehr, Cadell, & Jansen, 1999). Women who perceived that they had lower levels of control were more likely to display higher rates of posttraumatic stress and concordant psychological disorders than werewomen who had stronger beliefs in their level of control (Regehr, Cadell, & Jansen, 1999).