Trauma by indirect exposure, objective and subjective implication

The traumatic event is the central etiologic element of post-traumatic stre ss disorders (PTSD). However there are several types of exposure to the tra uma. In indirect exposure, the life of the subject has not been directly me naced but he feeled himself greatly emotionaly implicated The objective of this work is to demonstrate the existence of PTSD by indirect exposure and to show the existence of subjective implication in the trauma. We present a clinical case of PTSD by indirect exposure to the trauma and data from fol low-np in a department of child psychiatry of 10 on 29 children who were ta ken hostage and their parents. These children - directly exposed to the agr ession - and their parents - indirectly exposed since they were not taken h ostage but had a greate empathy - were examined to assess mental disorders with DSM-IV diagnostic criteria. The children were assessed also with self administered questionnaires for anxiety and traumatic stress. They were fol lowed rep during 7 months. Nine pupils presented a PTSD, incomplete or full syndrome. Three families had parental antecedents of mental disorders, but none had a PTSD before the hostage taking. In 5 families (50%) the parents had post-traumatic disorders: 7 fathers or mothers. One mother had an acut e stress disorder; another had art adaptation disorder with anxiodepressive symptoms and symptoms of PTSD. The sister of one of the exposed children h ad also a typical PTSD. In conclusion, our results demonstrate the reality of PTSD by indirect exposure. On a nosological paint of view, they raise th e question of the limits of the concept of traumatic stress. On a practical point of view when a child has been directly victim of an agression, it se ems important to examine also his parents and sibling, who are indirectly e xposed and may induce or maintain post-traumatic disorders of the child, pa rticularly when other risk factors are present.