Introduction: Trauma and Its Psychiatric Consequences

In this Special ReportIntroduction: Trauma and Its Psychiatric ConsequencesViolent Behavior and Involuntary Commitment: Ethical and Clinical ConsiderationsExploring the Neurobiology of OCD: Clinical ImplicationsPharmacological Management of Violence and Violent Behavior in Psychiatric SettingsStroke in Young Adults: The Lasting Effects of Trauma

VIOLENCE AND TRAUMA

Most people are exposed to violence, accidents, wars, and disasters throughout their lifetime, and more than one-third of them are likely to develop significant psychopathology across diagnoses, including posttraumatic stress disorder. PTSD, the most studied trauma related condition, is a pervasive and debilitating disorder. It occurs in the aftermath of traumatic events involving significant exposure to, or threat of, physical harm, death, or sexual violence to oneself or another. It can persist for years and is associated with significant functional impairment, psychiatric comorbidity, suicidality, substance use, chronic pain, poor physical health, and delayed treatment.^1,2

Patients affected by exposure to trauma often avoid seeking mental health treatment: one study found that only 23% to 40% of post-9/11 veterans who screened positive for a probable mental health disorder had sought care.³ Barriers to care include inadequate education about trauma and its consequences, logistical impediments, stigma, concerns about treatment experience, and low emotional readiness. Patients who present for treatment rarely enroll in evidence-based interventions and dropout rates are high.^4,5

While PTSD is the signature psychiatric condition among people exposed to trauma, it will affect only a small proportion of those exposed. Study findings indicate that a history of trauma is common among patients with severe psychiatric disorders such as schizophrenia, bipolar illness, and substance abuse, and it may be associated with the etiology of the disorder as well as its consequences.⁶ For example, patients with bipolar illness are not only more likely to be exposed to trauma during their lives, but they are also more likely to initiate violent behaviors after symptoms of bipolar disorder manifest.⁷

The articles in this Special Report focus on the interplay between trauma and its consequences, including violent behaviors, substance use disorders, and stroke. Since violence and violent behaviors are commonly discussed in relation to trauma, efforts to develop treatments for violent behaviors and ethical and clinical considerations involving involuntary commitment are also discussed.

Taken together, the articles may contribute to a better understanding of-and treatment development for-patients exposed to trauma for whom better and more effective interventions are needed.

Disclosures:

Dr Neria is Professor of Medical Psychology, Department of Psychiatry and Epidemiology, Columbia University Irving Medical Center, New York, NY. He reports no conflicts of interest concerning the subject matter of this Special Report.

References:

1. Westphal M, Olfson M, Gameroff MJ, et al. Functional impairment in adults with past posttraumatic stress disorder: findings from primary care. Depress Anxiety. 2011;28:686-695.

2. Wang PS, Berglund P, Olfson M, et al. Failure and delay in treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:603-613.

3. Hoge CW, Castro CA, Messer SC, et al. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Eng J Med. 2004;351:13-22.

4. Steenkamp M, Litz B. Prolonged exposure therapy in Veterans Affairs: the full picture. JAMA Psychiatry. 2014;71 211-211.

5. Harpaz-Rotem I, Rosenheck R. Serving those who served: retention of newly returning veterans from Iraq and Afghanistan in mental health treatment. Psych Serv. 2011;62:22-27.

6. Neria Y, Bromet S, Sievers J, et al. Trauma exposure and posttraumatic stress disorder in psychosis: findings from a first-admission cohort. J Consul Clin Psychol. 2002;70:246-251.

7. Fazel S, Lichtenstein P, Grann M, et al. Bipolar disorder and violent crime: new evidence from population-based longitudinal studies and systematic review. Arch Gen Psychiatry. 2010;67:931-938.