Cutting edge

May 19, 2000

Nottingham Trent University has established a centre to research trauma - a much- misunderstood psychiatric disorder

The recent claim by ex-servicemen against the Ministry of Defence for compensation for post traumatic stress disorder (PTSD) highlights the growing recognition of a psychiatric condition that is fraught with controversy. There is antipathy towards PTSD as a legitimate psychiatric diagnosis. What is curious is that the sceptics are rarely from the ranks of practitioners and academics working in the field, but from the media, especially the tabloid press.

There is a notion that one should bear the "slings and arrows of outrageous fortune", and there has always been interest in the relationship between compensation claims and PTSD, leading to the widespread belief that psychological symptoms following traumatic events are motivated by a desire for compensation. Accident neurosis, though lacking credibility, remains influential. Why litigation claims for psychiatric injury should be less legitimate than claims made for physical injury remains a mystery.

Evidence suggests that PTSD constitutes a major health problem. A recent epidemiological survey designed to study the distribution, correlates and consequences of psychiatric disorders in the United States estimates lifetime prevalence of PTSD at 7.8 per cent. Unfortunately, there have been no similar studies in the United Kingdom. Epidemiological studies also indicate a range of vulnerability factors associated with the development of PTSD, such as previous psychiatric problems, behavioural problems in childhood, physical and sexual abuse and poverty.

It has been suggested that PTSD is a "normal reaction to abnormal events", but not all those exposed to traumatic events respond in the same way. There are many opportunities for research. For example, we do not know enough about predictive factors, or which variables influence the development of traumatic reactions. Developments are also being made in our understanding of the psychophysiology of trauma, especially in relation to the role of memory. There has been much controversy surrounding the lack of empirical evidence for the use of early interventions, or "psychological debriefing", following traumatic events, prompting calls for it to be stopped. However, the few studies carried out in this area are methodologically flawed. Another area for investigation is the effect of vicarious exposure to traumatic events.

There is also a strong scientific and ethical imperative to find therapeutic methods to ameliorate the suffering of victims and survivors of trauma. There is empirical support for cognitive behavioural therapies as a treatment of choice for a significant number of PTSD cases. Yet many sufferers continue to receive non-directive, supportive counselling, often on a long-term basis.

Nottingham Trent University's Centre for Traumatic Stress Research and Practice intends to address some of these issues by offering a therapeutic facility utilising empirically validated approaches to trauma and PTSD. The centre has no formal National Health Service link, but it will have a strong multidisciplinary, mental health focus that will include legal expertise.

In addition, the aim of the centre will be to integrate sound clinical practice, research and consultancy with our planned masters programme in trauma studies. The centre will also draw on national and international links to collaborate and contribute to teaching, learning, research and clinical practice, thus encouraging a multifaceted approach to the study of trauma.

Stephen Regel is a senior lecturer in trauma studies and director, Centre for Traumatic Stress Research and Practice, Nottingham Trent University.

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