Attitudes to emotional expression and personality in predicting post-traumatic stress disorder

Objectives. To test hypotheses derived from a suggestion of Williams (1989) that negative attitudes towards emotional expression act as a predisposing or maintaining factor for post-traumatic stress reactions following a trau matic event. Design. The stud, employed a prospective design in which attitudes to emoti onal expression, the 'Big Fine' personality factors (Costa & McCrae, 1992a) and initial symptoms and injury severity within 1 week of a road traffic a ccident were used to predict the development of post-traumatic stress disor der 6 weeks post-accident. Method. Sixty victims of road traffic accidents randomly selected from atte nders at a large A&E department were assessed by questionnaire and intervie w. Measures comprised a 4-item scale relating to emotional expression, stan dardized scales for intrusion and avoidance features of traumatic experienc es, and for anxiety and depression and the NEO-FFI Five Factor Personality Inventory. Forth-five of these participants responded to a postal questionn aire follow-up. In this survey the battery was repeated and also included a self-report diagnostic measure of posttraumatic stress disorder (PTSD). Results. The percentage of the sample meeting DSM-IV diagnostic criteria fo r PTSD at 6 weeks post-trauma was 30.8 %. A small but significant relations hip was found for negative attitudes to emotional expression at 1 week to p redict intrusive symptoms and diagnosis at 6 weeks, over and above the inde pendent relationships of initial symptoms. initial injury severity, persona lity and coping. The emotional expression measure was largely stable betwee n che two points of measurement. More negative attitudes to emotional expre ssion were related to less openness, extraversion and agreeableness persona lity domains. Conclusions. Some support for the hypotheses was found in relation to the d evelopment of PTSD and for the status of attitudes to emotion as a stable t rait related to pc personality factors. The potential importance of attitud es to emotional expression in therapy and other work is discussed.