Review articleTrauma and women
Section snippets
Scope of the problem
Physical and sexual violence against women is an enormous problem. Intimate partners and family members perpetrate much of this violence. This violence puts women at risk for short- and long-term sequelae involving their psychological, physical, economic, and social well-being. Broadly defined, trauma includes childhood sexual and physical abuse and neglect, domestic violence, sexual and nonsexual assault, community violence, terrorism, war and civil conflict, transportation accidents, and
Prevalence of trauma exposure
The impact of trauma often differs for women and men. PTSD is one of the most common psychological sequlae of trauma. As defined by the Diagnostic and Statistical Manual of Mental Disorders [21], PTSD entails experiencing an event with helplessness, terror, or horror (the A2 criterion), which is followed by symptoms of reexperiencing (eg, nightmares), avoidance/numbness, and hyperarousal (eg, irritability, sleep disturbance). PTSD affects about 1 in 12 adults at some time in their lives, which
Resilience and trauma
Not all women who experience trauma develop psychiatric or other serious problems. Unfortunately, there has been a paucity of research into the factors that can protect some people from the damaging effects of trauma. Thus far, attachment, coping, and social support have generated promising research, especially in the area of CSA. Attachment theory posits that a child's experience with the primary caregiver leads to the child internalizing a model of self and other that influences how the
Treatment for trauma survivors
Increasing awareness of the prevalence of trauma in women's lives and its impact on the development of PTSD and other sequelae has led to an effort to design and provide effective treatments. However, compared with many other psychiatric disorders, the treatment of PTSD has received little research. This is not surprising given that PTSD was not recognized as a diagnostic entity until 1980. In general, research indicates that treatment of PTSD is helpful for most patients. Kessler and
Models of trauma treatment
Various models of psychotherapy have been used in an attempt to improve PTSD. A review of the most common treatments of PTSD indicated that they all seek to help the patient develop a realistic appraisal of the threat experienced during the trauma, overcome avoidance of internal cues and external reminders of the trauma, and work through the meaning of their traumatic experience to gain a sense of mastery over their intrusive recollections [77]. Behavioral approaches generally assume that PTSD
Complex PTSD
Though research indicates that relatively simple cases of trauma respond fairly well to treatment involving a combination of exposure, relaxation, and the replacement of trauma-based cognitive distortions with more accurate beliefs [79], complex PTSD is less responsive to treatment (for a review, see [85]). Moreover, many treatment studies do not include multiply or chronically abused individuals. For example, Tarrier and colleagues [86] excluded those participants whose primary trauma was CSA
Pharmacotherapy
Pharmacologic interventions can be helpful in treating trauma survivors. Although there have been no systematic studies comparing or combining psychotherapy and pharmacotherapy, most authors recommend prescribing medication in the context of psychotherapy [99]. Pharmacotherapy may help patients engage in trauma-focused therapy, especially if they are severely symptomatic [99]. Antidepressants can reduce the core PTSD symptoms of intrusion and avoidance as well as depression, insomnia, and
Therapeutic principles
In recent years, therapeutic principles crucial to successful treatment of trauma in women have begun to emerge. Perhaps the most important and basic tenet is that traumatized clients need to feel validated, respected, and empowered. This is critical so that treatment does not become a reenactment of the powerlessness and humiliation experienced during most types of interpersonal trauma [13]. Many traumatized women come to therapy with chaotic lives, frequent emotional crises, and high levels
Summary
Trauma is extremely prevalent in the lives of women, and the emotional, physical, social, and financial costs are often enduring and pervasive. Given its prevalence, all mental health professionals should receive training in the impact of trauma and learn the principles of its treatment. Although a considerable amount is known about the impact of trauma, much less is known about how to help survivors fully recover, especially women suffering from chronic, complex PTSD. Treatments must be
Acknowledgements
The author thanks Margaret Heffernan and Pamela Alexander for their comments on an earlier version of this manuscript.
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