Changes in traumatic categories and the severity scores of the PTSD measures were unrelated to the participant’s diagnosis and symptom severity ratings (Mueser, Salyers, Rosenberg, Ford, Fox, & Carty, 2001). Domestic violence and mental illness are a pretrauma and postrauma risk factor for PSTD (Brewin, Andrews, & Valentine, 2000; Morell & Ruben, 2001). Other pretrauma risk factors include family mental illness, gender, acculturation, substance abuse, clinical depression, and lower education (Morell & Rubin, 2001).
Posttrauma risk factors include anxiety, depression, dissociative characteristics, emerging symptoms of PTSD, social support network, substance abuse, and other life stress (Morell & Rubin, 2001). Brewin and colleagues (2000) suggested that three factors relating to events after the trauma convey the strongest risk for PSTD: greater trauma severity; lack of social support; and more life stress.
The relationship among trauma severity, the type of trauma such as sexual and/or physical abuse, and the duration of the abuse have been linked to long-term behavioral problems in children (Cauffman, Feldman, & Waterman, 1998; Deary, Alistair, & Austin, 1998; Dubner & Motta, 1999). Sexually and physically abused children may receive diagnoses of anxiety disorders, depressive disorders, attention deficit-hyperactivity disorder, oppositional disorder, separation disorders, and psychosis (Cauffman, Feldman, & Waterman, 1998).
Assessing PTSD is more difficult in asymptomatic children and in children with limited vocabulary and verbal skills (Cauffman, Feldman, & Waterman, 1998; Dubner & Motta, 1999). PTSD is more likely to be diagnosed in later adolescence and young adulthood, when PTSD-related symptomatology is more prevalent and verbalized (Dubner & Motta, 1999). In addition, depression and PTSD are higly related in trauma populations (Erickson, Wolfe, King, king, & Sharkansky, 2001).
Research supports a bidirectional relationship between depression and PSTD, with initial PTSD symptoms “more strongly predictive of later depression than vice versa” (Erickson, Wolfe, King, king, & Sharkansky, 2001, pp. 3,12). The likelihood of depression leading to PSTD in young woman was almost as strong as that for PTSD predicting clinical depression.
However, symptom management in trauma-exposed individuals may curtail the development of secondary disorders or attenuate the signs of early onset (Erickson, Wolfe, King, King, & Sharkansky, 2001). The association among victimization, PTSD, and substance use appears to be particularly strong (Brown, Stout, & Mueller, 1999; Dansky, Byrne, & Brady, 1999; Volpicelli, Balaraman, & Hahn, 1999). Research has identified a strong association between alcohol use and PTSD (Volpicelli, Balaraman, & Hahn, 1999).
Poststress alcohol consumption tends ti increase in combat veterans, women exposed to childhood rape, and survivors of catastrophic events (Volpicelli, Balaraman, & Hahn, 1999). Demographic differences regarding comorbid PTSD and substance use disorders have not been thoroughly researched (Dansky, Brady, Saladin, Killeen, Becker, & Roitzsch,1996). Brown and colleagues (1999) research with 51 women and 44 men receiving inpatient substance abuse treatment found that 48 were also diagnosed PTSD.
Dansky and colleagues (1999) studying involving 33 women and 58 men receiving outpatient treatment cocaine dependence found that 46% met the criteria for PTSD at same point in their lifetime. Victimization was found to be a key variable in the continued use of cocaine and opiate derivatives in the Dansky and colleagues study (1999). Cocaine and opiate derivatives users were 10 time more likely than nonusers to meet the criteria for PSTD (Dansky et. al. , 1999).