Intervention and Prevention of Morbid Psychosocial Outcomes

Community awareness of emotional trauma has increased in the last decade, stimulated by such events as the Oklahoma City bombing; the Sept. 11, 2001, terrorist attacks; recent military operations in Iraq and Afghanistan; and other episodes of war, terrorism and natural disasters. There has been a notable realization of the direct effects of such traumatic situations upon individuals. In addition, adults and children have been indirectly exposed to extensive and repetitive traumatic images portrayed in media presentations of war, terrorism and other horrific occurrences. Community awareness of the effects of traumatic events has been associated with significant recognition of the importance of identifying those people most at risk for emotional consequences of trauma. Such individuals require interventions aimed at preventing morbid psychosocial outcomes.

This special report offers insights into the complexities of traumatic reactions and types of interventions that may be effective in decreasing the morbid consequences of trauma. It primarily focuses on issues pertaining to posttraumatic stress disorder, which is often comorbid with mood and anxiety disorders, suicidal behavior, and problems in social adjustment. This section highlights features of beneficial outcomes of traumatic reactions and problematic sequelae of traumatic events. It offers innovative ways of conceptualizing treatment approaches and prevention strategies. However, it provides only a glimpse at the significant mental health sequelae of trauma.

The complex relationships between exposure to traumatic events and its effects on development are not the focus of this section. Extensive efforts are required to understand how early exposure to trauma influences development of personality, emotions and behaviors. Animal studies suggest that early trauma sensitizes individuals to be more vulnerable to social and emotional impairments associated with the effects of subsequent stressful or traumatic situations. These empirical findings highlight the importance of identifying protective factors and risk factors for morbidities associated with experiences of trauma.

More is to be learned about the relationships between traumatic events and dysregulation of physiological functions. Such understanding may point toward new directions for pioneering treatment methods to decrease the morbid effects of trauma. A critical part of this movement is the acquisition of knowledge of how gene-environment interactions are associated with psychosocial outcomes of trauma.

The authors' contributions in this section broaden our perspective on the necessity of devoting rigorous research efforts to clarify the epidemiological, developmental, psychosocial and biological characteristics of trauma. The authors of these papers enhance our appreciation of the divergent directions of applying research and clinical efforts to assist those who have suffered from the consequences of traumatic experiences.