Running Head: POST-TRAUMATIC STRESS DISORDER: UNCOMMON POPULATIONS 1

Post-Traumatic Stress Disorder: A View through Uncommon Populations

MarTaze Gaines
Morehouse College
POST-TRAUMATIC STRESS DISORDER: UNCOMMON POPULATIONS 2

Post-Traumatic Stress Disorder(PTSD) is a disorder that can be traced back to a disorder

called Gross Stress Reaction in the 1952 Edition of the Diagnostic and Statistical Manual of

Mental Disorders. However, it wasnt until 1980 when it became known under the current

moniker. It was primarily a diagnosis given to veterans. It came with great opposition, mainly

because it was a disorder with an explicit cause. This was a rare occurrence for the DSM. Post-

Traumatic Stress Disorder is now classified in a new category in the Diagnostic and Statistical

Manual of Mental Disorders(DSM-5). This category, called trauma- and stressor-related

disorders, contains similar disorders like acute stress disorder and adjustment disorder. Post-

Traumatic Stress Disorder is a disorder that plagues ones mind after an extremely stressful and

abnormal event. This disorder is most often associated with traumas, such as, warfare, sexual

assault, traffic collisions and threats to ones safety.

For a diagnosis of Post-Traumatic Stress Disorder to be given, there are a few things that

must be in place. These include: the exposure to an actual or threatened death, serious injury, or

sexual violence, the presence of one or more intrusive symptoms, persistent avoidance of stimuli

associated with the traumatic event, negative alterations in cognitions and mood associated with

the traumatic event, marked alterations in arousal and reactivity associated with the traumatic

event, duration of the disturbances for more than one month, the disturbance causes clinically

significant distress or impairment, and the disturbance is not attributable to the physiological

effects of a substance. (Butcher, Hooley, Mineka). There is also now a requirement that a

persons response include intense fear, helplessness or horror. The current criteria have helped

open the doors for Post-Traumatic Stress Disorder to be diagnosed in people who have lost a

close friend or relative, been diagnosed with a life-threatening illness, or learning about trauma

events that others have experienced. These are examples of some uncommon populations, which
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will be further discussed throughout this paper, who are diagnosed with Post-Traumatic Stress

Disorder. This disorder comes with many symptoms including, recurrent, involuntary and

intrusive distressing memories, flashbacks, irritable behaviors, reckless behaviors, hyper

vigilance, exaggerate startle response, sleep disturbance, feelings of detachment, diminished

interest or participation in significant activities, inability to remember important aspects of the

traumatic event, persistent an exaggerated negative beliefs about oneself, distorted cognitions

about the cause of the traumatic events, persistent negative emotional state, among many other

symptoms.

When viewing Post-Traumatic Stress Disorder among the general population, it is has a

higher prevalence in women than men. There is a suggested lifetime prevalence at 6.8% in the

United Stated according to National Comorbidity Survey-Replication. Many studies show that

men are more likely to be exposed to traumatic events, but women are more likely to be exposed

to certain types of events, like sexual assault. It is also very common for people to develop Post-

Traumatic Stress Disorder after disasters, natural and human-caused. The lowest rated of PTSD

are in areas where there are fewer natural disasters and violence. However, PTSD is more

commonly developed from event that are caused by human intent as opposed to accidents or

natural disasters. Rates are also higher for those who are directly exposed to the traumatic event,

when compared to other populations like first responders.

There are some risk factors for Post-Traumatic Stress Disorder including individual,

biological, and sociocultural factors. Some individual risk factors that increase exposure to

trauma include being a male, not being college educated, occupation, and a family history of

psychiatric disorders. The risk factors that increase risk of developing Post-Traumatic Stress

Disorder include being a female/woman-identified, lower levels of social support, family history
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or preexisting problems of depression and anxiety, among many others. There is still much

research being conducted to figure out if there are biological factors that increase the risk of

developing Post-Traumatic Stress Disorder. Some that have been looked at include levels of

stress hormones, isolating certain genes that can be linked, and brain abnormalities. The

biological factors are still undergoing research because of times these factors can be linked to

other problems, such as, depression. There are some sociocultural risk factors as well, including,

belonging to a minority group, or being in an unsupportive and negative social environment.

Post-Traumatic Stress Disorder can have long-term effects. Most often, we are faced with

veterans not being able to readjust to normal societal life. However, if left unaddressed, the

symptoms of this disorder can be present for a very long time. This can lead to depression and

anxiety, in addition to, having to deal with the symptom directly associated with Post-Traumatic

Stress Disorder. People with this disorder can stop participating in activities that remind them of

the traumatic event in any way. They can experience reoccurring thoughts, dreams, and

flashbacks.

As mentioned previously, Post-Traumatic Stress Disorder is most commonly associated

with active and veterans of the military. We are also aware of the high chance of women

developing PTSD because of a higher likelihood of experiencing a specific type of trauma, such

as, sexual assault. However, there hasnt been as much research that looks at Post-Traumatic

Stress Disorder in uncommon populations. These populations include, civilians in countries that

are war-torn, people who are exposed to community violence, and children. This paper will try to

explore current research on these populations and what Post-Traumatic Stress Disorder is like for

them. This paper will close with some treatment options that are used by veterans, women, and

how they are similar of different from the treatments used by the uncommon populations.
POST-TRAUMATIC STRESS DISORDER: UNCOMMON POPULATIONS 5

In a cross-sectional study of Karachi, Pakistan, researchers expected the prevalence of

Post-Traumatic Stress Disorder to be high because of the high rate of crime in the city. Karachi is

a city plagued by violence among a population of over 20 million people. The city faces

economic and political issues that continue to create an environment conducive of more violence.

This study took a feat by studying a non-western community and by focusing on a traumatic

event that is consistent. The study used 320 of 351 university students to gather information on

lifetime exposure to traumatic events and post-traumatic stress disorder symptoms. The

researchers had to be knowledgeable of social and cultural norms, therefore questions about

combat in war, rape, and sexual molestation were excluded from interviews. The study, however,

used an open-ended interview at the end of the study for participants to share personal

experiences about traumatic events.

93.4% of participants reported having exposure to at least one traumatic event throughout

their life. The two most common events being unexpected death of a loved one and assaultive

violence. The study yielded significant correlation between exposure to community violence and

current levels of Post-Traumatic Stress Disorder. 26.1% of the undergraduate students screened

positive for PTSD, which is much greater than other parts of the world. (Khan, Haider, Sheikh,

Ali, Khalid, Tahir, Malik, Salick, Lakhani, Yousuf, Khan, & Saleem, ). This supports the claims

of high rates of community violence leading to higher rates of trauma due to community

violence. The study provides more evidence for the linking of persistent trauma and Post-

Traumatic Stress Disorder, especially in youth population.

Continuing with PTSD from a non-western perspective, Leshem, Jah-Yahia, and

Guterman researched the role of support from individuals close to a student in PTSD symptoms

among Palestinian adolescents exposed to community violence. The study looked at the role of
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family and teacher support specifically. Palestine is a community that has been tormented by

military violence for years. Often, veterans of these war conflicts are studied to research Post-

Traumatic Stress Disorder. The civilians usually experience the traumas of war first hand and are

rarely studied to see the lasting psychological impacts. This study aimed to test the effectiveness

of family and teach support in protecting adolescents from negative outcomes after exposure to

community violence.

The study had a sample of 1930 Palestinian students from junior and senior high schools,

ages 12-19. The age range is due to cultural aspects such as finishing school after leaving jail or

starting school early because of the lack of any of other option. The research team translated all

standard measures into Arabic and were tested for reliability. The scales included the My

exposure to violence scale, the University of California, Los Angeles Post-Traumatic Stress

Disorder Index, and the Perceived Social Support Family Tool. A multiple regression analysis

was run to test the ability of support to counter Post-Traumatic Stress Disorder symptoms. The

study found that exposure to community violence had a significant main effect on prevalence of

symptoms of PTSD on adolescents from Palestine. The findings also support the hypothesis of

higher family support being linked to lower levels of PTSD symptom. However, support from

teachers had a moderate, but not statistically significant, impact on prevalence on Post-Traumatic

Stress Disorder symptoms (Leshem, Haj-Yahia, Guterman).

This research provides evidence for a few claims. First, it supports claims that PTSD

looks similar in non-Western communities that are also plagued by community violence. It

supports existing research that exposure to community violence can lead to symptoms associated

with Post-Traumatic Stress Disorder. Lastly, the research provides evidence for healthy support

systems as means of avoiding those negative psychological symptoms. This research continues
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the efforts of focusing on uncommon populations that are impacted by traumatic event and how

to lower ones risks of developing the disorder.

In the past few years, there has been research done to study Post-Traumatic Stress

Disorder in adolescents in low-income communities in the United States. In a similar study done

to the Palestinian research, Paxton, Robinson, Shah, and Schoeny looked at psychological

distress for African-American males who were exposed to community violence. The study puts

forth that youth under 24 are more likely to experience violent crimes as the victim (Berton and

Stabb). This would make it extremely important to study PTSD in communities that have a large

population of youth that experience higher rates of violence. The study also explored social

support as a factor to curtail the impacts of the community violence. The study used 77 students

from an inner-city high school in the Midwestern United States. The participants completed a

host of instruments that were designed to gauge things such as exposure to community violence,

social support, depression, and symptoms of Post-Traumatic Stress Disorder.

The study used a regression analysis to look for significance among the variables. This

study revealed that exposure to violence was a normal part of life for this sample. The study also

found, like many other studies, that exposure to violence is significantly associated with both

depression and Post-Traumatic Stress Disorder. The scores revealed high levels of distress. The

researchers used Pearson Correlations to study the relationships between social support and

depression and PTSD. The study did not find social support to be a significant moderator of the

exposure and the symptoms. This study provide evidence for thee need to study Post-Traumatic

Stress Disorder in this population because there is a high likelihood of PTSD symptoms existing

due to the exposure the community violence.

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Bertram and Dartt research similar things to provide evidence to researchers and mental

health providers when faced with youth from violent, impoverished communities. The

researchers urge that community violence is a constant traumatic stressor that creates the

opportunity for symptoms of Post-Traumatic Stress Disorder to present themselves. The study

examines and compared both populations, youth from impoverished communities and active

soldiers in war zones, and creates parallels between them. There are many parallels including

being constantly in the path of danger, feelings of helplessness, losing loved one and friends, and

elevated levels of anxiety. According to the research of Bertram and Dartt, both populations

experience the most tell-tale signs of Post-Traumatic Stress Disorder, which are hyper-arousal,

reexperiencing, and maladaptive coping. Though war veterans are most often linked to this

disorder, there are many similarities that are shared with other populations including youth in

violent, impoverished communities. The study urges more research to be done to test social

support as a protective factor against the community violence.

The findings of this study are important because they shift the mindset that we often view

these communities with. With an analysis of diagnostic frameworks, the compared the

experiences of both soldiers and youth from the low-income, high violence areas. This study

could lead to findings of this study are important because they shift the mindset that we often

view these communities with. With an analysis of diagnostic frameworks, the compared the

experiences of both soldiers and youth from the low-income, high violence areas. This study

could lead to youth being treated for Post-Traumatic Stress Disorder symptoms as opposed to

being over-diagnosed with Attention Deficit Hyperactive Disorder or conduct disorder.

In a study done by Berton and Stabb, the study explored Post-Traumatic Stress Disorder-

like symptoms in adolescents in a major metropolitan area. The study aimed to find what
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variable or variables were the best predictor for PTSD scores. 97 high school juniors from a

southern United States metropolitan area volunteered for this cross-sectional study. Two PTSD

scales were completed as well as demographic questions. The researched also searched to see if

there were differences in PTSD scores based on demographics.

Based on frequency distributions, 25% of the students produced scores indicative of Post-

Traumatic Stress Disorder symptoms. The study found that self-reported exposure to violence

was the only significant predictor for PTSD scores on both scales used. The other variables such

a crime rates and being make did not significantly predict scores of PTSD. This is important

because it supports other research that looks at this populations as being vulnerable to develop

PTSD.

The final study by Verduijn, Vincken, Meesters and Engelhard focused on emotional

reasoning in acutely traumatized children and adolescents. Participants were recruited within a

week of a traumatic event who visited the hospital or victim services. The 49 participants

completed an emotional reasoning task, a child PTSD scale, a subjective trauma assessment and

the child anxiety sensitivity index. This study found that higher levels of emotional reasoning

were associated with higher levels of Post-Traumatic Stress Disorder symptoms.

Through all the studies presented, they share many things. Firstly, and most importantly,

the studies support and provide evidence for the claim that exposure to community violence

leads to higher risks and rates of developing Piost-Traumatic Stress Disorder. Violence in inner

cities seems to be a constant trauma that people must live through and with every day. These

studies chose to focus on post-traumatic stress disorder from a non-traditional lens. This opens

the conversation about other people being exposed to traumatic events on a more consistent basis

and what distress looks like for them.

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References

Khan, Abdul., Haider, G., Sheikh, M., Ali, A., Khalid, Z., Tahir, M., Malik, T., Salick, M,

Lakhani, L., Yousuf, F., Khan, M. & Saleem, S. (2015). Prevalence of Post-

Traumatic Stress Disorder Due to Community Violence Among University

Students in the Worlds Most Dangerous Megacity: A Cross-Sectional Study

from Pakistan. Journal of Interpersonal Violence, 31(13), 2302-2315.

Leshem, B., Haj-Yahia, M., Guterman, N. (2016). The role of family and teacher support in post-

traumatic stress symptoms among Palestinian adolescents exposed to community

violence. Journal of Child and Family Studies, 25, 488-502.

Berton, M., Stabb, S. Exposure to violence and post-traumatic stress disorder in urban

adolescents. Adolescence, 31(122).

Verdujin, N., Vincken, M., Mesters, C., Engelhard, I. (2015). Emotional reasoning in acutely

traumatized children and adolescents: an exploratory study. Journal of Child

and Family Studies, 24, 2966-2974.

Paxton, K., Robinson, W., Shah, S., Schoeny, M. (2004). Psychological Distress for African-

American adolescent males: exposure to community violence and social

support as factors. Child Psychiatry and Human Development, 34(4), 281-295.

Bertram, R. and Dartt, J. (2009). Pot traumatic stress disorder: a diagnosis for youth from

violent, impoverished communities. Journal of Child and Family Studies,

18, 294- 302.

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Hooley, J. M., Butcher, J. N., & Mineka, S. (2013). Abnormal psychology. Upper Saddle River.

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