Exposure to Trauma and Risk for Posttraumatic Stress Disorder

The world is getting to be such a dangerous place, a man is lucky to get out alive.

Posttraumatic stress disorder is one of many reactions to danger. Traumatic events signal danger to life, limb, and even one's sanity. Just how dangerous is our world? How risky is it to just wake up in the morning? Accidents represent the fifth leading cause of death in the United States, ahead of diabetes, influenza, pneumonia, and Alzheimer's disease, according to the National Center for Health Statistics. What about violence? Violence, including war, is one the most common sources of traumatic stress.

There are many dangerous places in the world. The United States Department of State issues travel advisories for dangerous countries. The United States Department of Justice reports that in 2003 for every 1,000 persons aged 12 or older, there occurred one rape or sexual assault, one assault with injury, and two robberies. There occurred about 6 murder victims per 100,000 persons in 2002, and in 2003 there were 5.4 million crimes of violence. With all this danger, the risk for exposure to traumatic stressors is real, and so is the risk for PTSD.

Personally, I have some experience in one region that many people consider extremely dangerous-the Middle East. I have visited family and friends in Israel several times, each time witnessing combat, suicide bombings, bomb threats, and other dangerous situations. My friends and family in the United States always treat me like I am crazy for going back there. Once there, however, an interesting thing happens-you adjust, as have the people who live there. I have heard many times from Israelis and Palestinians alike, "There is no such thing as security." Yet

• In 2000, 57,000 children or adolescents were murdered worldwide.

• Collective violence by groups, states, or nations have claimed 191 million victims in the twentieth century.

• There were 300,000 direct victims of violence in 2000.

• In high-income countries, 1 in 100,000 people are victims of violent death.

• In low- and middle-income countries, 6.2 in 100,000 people are victims of violent death.

• Africa has the highest violent death risk, with 32 out of 100,000 people being a victim of a violent death.

• The percentage of female murder victims killed by their husbands or boyfriends is 40 to 70 percent.

• In 2000, 199,000 youth were murdered globally.

• In 2000, 565 children or adolescents were killed per day.

they continue with their day-to-day lives, acting relatively immune on a moment-by-moment basis to the threat around them. They acknowledge the danger but keep on living. In many ways, the daily stress they encounter is not necessarily traumatic. One would think that everyone would be walking around with PTSD, but that simply is not the case. This speaks directly to the complexity of PTSD and who develops it after being exposed to traumatic events. If war, suicide bombings, missile attacks, and combat are not traumatic, then what is?

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