Following exposure to trauma, stress reactions are initially adaptive. However, some individuals’ psychological response can become maladaptive with long-lasting impairment to functioning. Most people with initial symptoms of stress recover, and thus it is important to distinguish individuals who are at risk of continuing difficulties so that resources are allocated appropriately. Investigations of predictors of PTSD development have largely focused on relational and combat-related trauma, with very limited research looking at natural disasters. This study assessed the nature and severity of psychological difficulties experienced in 101 people seeking treatment following exposure to a significant earthquake that killed 185 people. Peritraumatic dissociation, posttraumatic stress symptoms, symptoms of anxiety, symptoms of depression, and social isolation were assessed. Descriptive analyses revealed the sample to be a highly impaired group, with particularly high levels of posttraumatic stress symptoms. Path analysis was used to determine whether the experience of some psychological difficulties predicted experience of others. As hypothesised, peritraumatic dissociation was found to predict posttraumatic stress symptoms and symptoms of anxiety. Posttraumatic stress symptoms then predicted symptoms of anxiety and symptoms of depression. Depression and anxiety were highly correlated. Contrary to expectations, social isolation was not significantly related to any other psychological variables. These findings justify the provision of psychological support following a natural disaster and suggest the benefit of assessing peritraumatic dissociation and posttraumatic stress symptoms soon after the event to identify people in need of monitoring and intervention.

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Objectives: Lazarus and Folkman's (1984) stress appraisal model, widely applied in the depression literature, was uniquely applied in an expanded peritraumatic model to predict post traumatic stress disorder (PTSD) symptoms. The presented Transactional Vulnerability Model of Psychological Distress utilizes two of the most proximal determinants of PTSD symptoms identified in the stress and coping literature, peritraumatic appraisal and self-efficacy, as variables implicitly and explicitly identified in Lazarus and Folkman's (1984) primary and secondary appraisal processes. Study Design: Correlational. Participants: Participants were multiple trauma, burn and orthopedic hand injured English-speaking adults who participated in Victorson's (2003) original psychometric validation study of the Traumatic Physical Injury and Psychosocial Stress Inventory (TIPSI; N = 169). Setting: Level 1 trauma center. Measures: Selected TIPSI subscales; General Perceived Self-Efficacy Scale; Abbreviated Injury Scale; Stressful Life Experiences Screening - Short. Results: The following variables were each significantly positively related to PTSD symptoms: prior trauma (r = .272); abuse-related prior trauma (r = .187); injury severity (r = .220); and each peritraumatic primary appraisal variable: threat potential (r = .431), controllability (r = .360), predictability (r = .238), meaningfulness (r = .397), stability of impact (r = .522) and globality of impact (r = .443). Each peritraumatic secondary appraisal variable was significantly inversely related to PTSD symptoms: general self-efficacy (r = -.501) and specific self-efficacy (r = -.272). Peritraumatic primary appraisal variables together explained 40.1% of variance in PTSD symptoms (F (2, 164) = 56.503, p < .001). The Transactional Vulnerability Model of Psychological Distress examined each aforementioned construct using mostly Victorson's (2003) measures in linear regression procedures in Model A (N = 161), explaining 45.1% variance in PTSD symptoms (F (11, 149) = 12.965, p < .001); Model B (N = 66) utilized two alternate measures and explained 52.9% variance (F (10, 55) = 8.289, p < .001). These results support prior trauma and threat potential as predictors of PTSD symptoms and bespeak the importance of attributions of stability of impact and self-efficacy as proximal predictors of PTSD symptoms within an expanded Lazarus and Folkman stress appraisal model. Implications for early intervention among targeted individuals are discussed.

Prior research has indicated that posttraumatic stress disorder (PTSD) Criterion A2 (i.e., the stipulation that an individual must experience intense fear, helplessness, or horror during an event that threatened the life or physical integrity of oneself or others to be eligible for the PTSD diagnosis; Diagnostic and Statistical Manual of Mental Disorders, 4th, ed., text rev., DSM-IV-TR; APA, 2000) is not positively predictive of PTSD diagnostic status. However, the exact reason for the poor predictive validity is unclear. It may be that changing the operational definition of Criterion A2 (e.g., broadening the definition to include additional peritraumatic reactions) will improve its predictive validity. The current investigation attempted to answer this question, as well as examining several other aspects of the peritraumatic experience. Specifically, three studies were conducted. Study 1 examined whether the ability of the peritraumatic response to predict PTSD can be improved by reconstituting the operationalization of this experience. Study 2 investigated whether this new operationalization of the peritraumatic experience can differentiate between PTSD and other psychiatric disorders (i.e., Major Depressive Disorder, Substance Use Disorders). Study 3 explored how different methodologies for assessing responses to trauma cues (i.e., retrospective reports, self-report and psychophysiological data gathered from a laboratory-based trauma monologue) compare in their ability to predict PTSD. Two-hundred thirty four female crime victims (151 victims of rape; 83 victims of physical assault) were recruited as part of a National Institute of Mental Health (Dr. Patricia Resick, Principal Investigator) prospective longitudinal study designed to examine factors associated with recovery from a recent assault. Results indicated that, consistent with past literature, the three Criterion A2 variables (i.e., peritraumatic fear, helplessness, and horror) were not predictive of PTSD diagnostic status or PTSD symptom severity. However, peritraumatic anxiety was predictive of PTSD diagnostic status, and a dimensional variable assessing the dissociative emotions was predictive of PTSD symptom severity. The predictive utility of the peritraumatic experience was found to be unique to PTSD; although peritraumatic anxiety was predictive of PTSD diagnostic status, none was predictive of the other forms of psychopathology examined (i.e., MDD, Substance Use Disorders). Finally, results indicated that several of the peritraumatic responses were predictive of both self-reported distress and measures of arousal (i.e., amplitude of skin conductance responses) during a laboratory-based trauma monologue. However, the three sets of measures (i.e., peritraumatic responses, self-reported distress, and psychophysiological responses) were differentially predictive of PTSD. Limitations of the study, as well as implications of the findings, are discussed. / Psychology

Cette recherche a étudié l’évolution psychique de neuf victimes directes des attentats qui ont touché Paris durant l’année 2015 et dont les symptômes étaient atypiques, voire, inexistants, a priori. Si les symptomatologies d’états de stress post traumatiques caractéristiques sont communément admises, tant par les soignants, que par les acteurs juridiques de la réparation en dommage corporel, les états de dissociation péri et post traumatiques, lorsqu’ils sont identifiés, ne sont, en revanche, jamais envisagés autrement que comme des temps de latences augurant de futurs états de stress post traumatiques sévères. A l’aide des contenus d’entretiens cliniques réalisés à trois mois puis dix-huit mois des attentats, accompagnés de deux passations d’une échelle d’évaluation des états de stress post traumatiques (PCL/S), l’évolution psychologique de neuf victimes directes, sans symptômes caractéristiques apparents, a ainsi été effectuée. Cette étude a permis de démontrer que chez certains sujets, la confrontation au Réel de la mort se fait dans une telle violence qu’elle engendre la mise en marche de mécanismes de défense archaïques tel le déni de l’effroi décrit par Lebigot (2005) puis le clivage, et non des tableaux caractéristiques d’état de stress post traumatiques. Chez deux tiers des sujets, il a été démontré que la réassociation par le langage et le retour aux processus de symbolisation étaient néanmoins possibles, sans effondrement pathologique, mais en respectant une progression lente vers l’élaboration du traumatisme, dans le cadre d’alliances thérapeutiques étayantes et ininterrompues. Chez un tiers des sujets, en revanche, la permanence de tels tableaux cliniques, c’est-à-dire asymptomatiques pour deux d’entre eux, ou caractérisé par une amnésie dissociative pour l’un d’entre eux, n’a pas permis de déterminer le caractère adaptatif et non pathologique de tels mécanismes dissociatifs. L’ensemble des résultats démontre néanmoins la nécessité d’accroître les connaissances sur le sens, le repérage et la fonction de tels mécanismes, qui ne sont pas toujours identifiés, du fait même de leur origine qui exclue toute capacité de verbalisation de la part des victimes, mais qui nécessitent cependant des proposition soins appropriées. / This research studied the psychological evolution of nine direct victims of the terrorist attacks that struck Paris in 2015 and whose symptoms were, at first glance, atypical, or even non-existent. While the symptomatologies of post-traumatic stress disorder are commonly recognised, both by carers and legal bodies involved in physical injury compensation, peri and post-traumatic dissociative disorders, when they are identified, are never perceived as anything other than periods of latency, predicting future severe post-traumatic stress disorder.The psychological evolution of the nine direct victims lacking apparent typical symptoms was thus studied based on the content of clinical interviews carried out three months and eighteen months after the attacks, backed by two assessments using the PCLS rating scale for post-traumatic stress disorder. This study has enabled us to show that with some subjects the confrontation with the real of death occurred in such violence that it triggered archaic defence mechanisms, such as denial of the dread as described by Lebigot (2005) then splitting, and not the typical presentations of post-traumatic stress disorder. With two-thirds of the subjects, it was shown that reassociation through language and a return to the process of symbolisation were still possible, without a pathologic breakdown, by respecting a slow progression towards the formulation of the trauma as part of continuous and substantiated therapeutic relationships. However, with one third of subjects the permanence of such clinical presentations, i.e. asymptomatic for two of them or characterised by dissociative amnesia for one of them, made it impossible to determine the adaptive and non-pathological character of such dissociative mechanisms. Nevertheless, the combined results show there is a need to learn more about the meaning, identification and function of these mechanisms which are not always identified, precisely because of their cause which excludes all ability on the part of victims to express themselves, but which nonetheless require that appropriate treatment be offered.

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Posttraumatic Stress Disorder (PTSD) has been demonstrated as the primary pathway through which morbidity and mortality is achieved post-trauma. However, less is known about protective factors to PTSD, depression, and self-reported health outcomes of adults following a traumatic event. Through examination of residential fire survivors, the current project evaluated the predictive validity of protective factors of PTSD as they relate to PTSD, depression, and somatic health outcomes. Additionally, the project collapsed the three outcomes variables into a unified health construct and evaluated protective factors ability to predict health. It was hypothesized the peritraumatic emotionality, social support, and resource loss would predict PTSD, depression, and somatic health. Additionally, it was predicted that peritraumatic emotionality, social support, and resource loss would predict a unified construct of health. Participants were assessed via self-report and semi-structured interviews approximately four months post-fire. Results of the current project demonstrated strong associations amongst peritraumatic emotionality and resource loss for many of the outcome variables. However, social support was not found to be a predictor of any of the outcomes variables. When evaluating the unified health construct, resource loss was found to significant predict a resilient group of trauma survivors four months post-fire. The present study suggests lower peritraumatic emotionality and lower sustained resource loss are significant protective factors for resiliency from trauma. / Ph. D.

Cette thèse a pour visée principale de faire avancer les connaissances de la littérature concernant les différences hommes-femmes dans le trouble de stress aigu (TSA) et le trouble de stress post-traumatique (TSPT), chez une population de victimes d’actes criminels graves (VAC). L’étude comprend deux objectifs principaux. Tout d’abord, l’évaluation de la présence et de l’intensité de réactions péri-traumatiques, soit la dissociation et la détresse. Ensuite, nous avons étudié si ces facteurs étaient associés à la survenue d’un TSA, chez les VAC et s’ils prédisaient différemment le TSA en fonction du genre. Dans le cadre d’un deuxième article et comme objectif secondaire de la thèse, l’impact des réactions péri-traumatiques a aussi été vérifié, mais cette fois sur le développement subséquent d’un TSPT. Également pour cet objectif, nous nous sommes concentrés sur le rôle du genre dans la prédiction de la relation. Des entrevues d’évaluation clinique ont été effectuées auprès de 214 victimes (125 femmes). Plus précisément, le TSA a été évalué, dans le cadre de l’article 1 à l’aide de l’Acute Stress Disorder Interview (ASDI), puis le TSPT à l’aide de l’entrevue semi-structurée du SCID pour une mesure diagnostique catégorielle et avec l’échelle modifiée des symptômes traumatiques (ÉMST), dans l’article 2. Cette échelle produit un score en continu de sévérité et de fréquence des symptômes. Les variables péri-traumatiques ont été évaluées à l’aide de questionnaires auto-rapportés, soit le Questionnaire des expériences dissociatives péri-traumatiques et l’Inventaire de détresse péri-traumatique. Les résultats du premier article démontrent que les femmes vivraient globalement plus de détresse péri-traumatique que les hommes, alors qu’il n’y aurait pas de différence de genre pour les expériences dissociatives. Ces réactions péri-traumatiques seraient toutes deux des prédicteurs d’un TSA tant chez les hommes que les femmes. Des différences de genre seraient présentes dans l’association de la détresse et du TSA lorsque des évènements potentiellement traumatiques passés étaient considérés. Pour les hommes, une présence élevée de détresse péri-traumatique et plusieurs antécédents de potentiels évènements traumatiques les rendraient plus vulnérables au développement d’un TSA. Chez les femmes, de potentiels traumas antérieurs augmenteraient le risque de présenter des symptômes du TSA seulement lorsqu’un niveau élevé de détresse péri-traumatique était présent lors du crime. Le deuxième article de la thèse démontre à nouveau que les réactions péri-traumatiques sont des facteurs de risque, mais cette fois pour le développement d’un TSPT. Cependant, aucune différence de genre n’a été observée concernant la capacité prédictive de ces variables. En effet, quelques mois après l’événement, la dissociation et la détresse péri-traumatiques demeurent des variables d’intérêt à considérer pour prévenir la survenue d’un TSPT, mais ce tant pour les victimes hommes que femmes. Cette deuxième étude a également confirmé l’importance du trouble de stress aigu comme facteur de risque au développement d’un TSPT chez une population de victimes d’actes criminels violents. Ces résultats, les limites de l’étude, des pistes de recherche futures, ainsi que les implications cliniques pour le traitement du TSA et du TSPT seront discutés de manière détaillée dans cette thèse doctorale. / This thesis aimed to contribute to the acute stress disorder (ASD) and post traumatic stress disorder (PTSD) literature in terms of gender differences among crime victims. Precisely, we were interested in the intensity and presence of peritraumatic reactions namely, dissociation and distress, among men and women victims of violent crimes. Two objectives were pursued. First, we evaluated whether peritraumatic dissociation and distress were significant risk factors for ASD development and if these acute stress reactions’ predictive capacity, differed according to gender. A second objective was to investigate if peritraumatic dissociation and distress significantly predicted PTSD development according to gender. Globally, in this research project, we were interested in determining the impact of gender in the prediction of the above-mentioned relationship . Semi-structured interviews; the Acute Stress Disorder Interview (ASDI) in the first article and the Structured Clinical Interview for DSM-IV (SCID) in the second article were conducted with 214 victims (125 women, Mage=39.6yrs) to assess ASD and PTSD respectively. Data on peritraumatic variables were collected through self-report questionnaires, the Peritraumatic Dissociative Experience Questionnaire and the Peritraumatic Distress Inventory. Peritraumatic dissociation and distress were both significant risk factors for ASD in men and women. Women presented higher peritraumatic distress levels compared to men victims. Gender differences were revealed through past potential traumatic experiences, where they have a cumulative impact on ASD risk development for men, but having few past potential traumas could be a protective factor for women. In the second article, findings reveal that acute stress variables were both significantly related to more PTSD symptoms, although no gender differences were identified. An acute stress disorder diagnosis was also confirmed as an important predictor of PTSD in victims of violent crimes. These results, study limitations, directions for future research as well as clinical implications for ASD and PTSD treatment will be discussed.