PSYCHOSOCIAL PERSPECTIVES ON POSTTRAUMATIC STRESS

Although exposure to a traumatic event is a necessary etiological fact or in the development of posttraumatic stress disorder, it is not thou ght to be sufficient and there remains much debate over what other fac tors may be associated with more severe and chronic distress. The pres ent paper summarizes empirical work with survivors of various traumati c events. Evidence is reviewed for an integrative model of psychosocia l factors relating to adjustment following traumatic stressors. The co mponents of this model are stimulus factors, appraisal factors, person ality factors, state factors, and activity factors. It is also argued that some forms of intrusion and avoidance constitute normal processes of appraisal and activity that mediate between the traumatic event an d symptoms of increased arousal and negative affect. The social contex t of the traumatic event is also considered to be an important determi nant of appraisal and activity. Methodological issues and implications for therapeutic intervention are addressed.