Tsunami in Kerala, India: Long-Term Psychological Distress, Sense of Coherence, Social Support, and Coping in a Non-Industrialized Setting
5 Etiology of PTSD
The question has arisen, to what extent personality and other predisposing fac- tors play a role in the etiology of PTSD. When PTSD was included in DSM-III, there was a consensus that the nature and intensity of the traumatic stressor was the primary etiologic factor determining the symptoms. The same holds true for the ICD-10, where “a stressful event or situation (either short- or long-lasting) of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost everyone” (World Health Organization, 1992, p.147) leads to post-traumatic stress symptoms. The previous classification systems tended to assume that symptoms would be time-limited unless some pre-existing character pathology was present that would contribute to their maintenance. This implied that the stress response was transient in nature unless the individual had some underlying vulnerability (McFarlane, 1990). Originally, PTSD was considered a normal reaction to an abnormal event. However, not everyone develops PTSD symptoms after such an event. Clini- cians have been uncertain about the normal reaction to a traumatic event and whether PTSD was a pathological state or not. Obviously, there will be a blurred division between those individuals who experience the normal stress response and those who have developed PTSD, particularly in the weeks fol- lowing the traumatic event. This confusion is also embodied in the DSM-III-R (American Psychiatric Association 1987) criteria for PTSD, where PTSD is a legitimate diagnosis only if an individual has experienced an event that would be “markedly distressing to almost everyone” (p.250). In the...
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