Predictors of More Severe Stress?

In some of the published studies of reactions to 9/11 events, certain symptoms appear to be more suggestive than others of a greater degree of functional impairment and the development of threshold PTSD, some experts maintain. These limited findings echo previous research on trauma victims, including those in Oklahoma City following the 1995 bombing of the Alfred P. Murrah Federal Building.

Criterion C for PTSD in the DSM-IV-TR includes “persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness,” as displayed by a number of different presentations. Carol North, M.D., a professor of psychiatry at Washington University in St. Louis, told Psychiatric News that her work in Oklahoma City with direct victims of the bombing showed that avoidance and numbing symptoms that appeared soon after the event were highly predictive of developing full PTSD in the following months.

North believes it might be possible to identify trauma victims who may be at higher risk of developing PTSD by looking for early presentation of criterion C symptoms. These individuals could be followed more closely and offered earlier intervention, if necessary.

John Markowitz, M.D., an associate professor of psychiatry at Cornell University Medical College, agreed. “Criterion C is how you handle or process the event,” he told Psychiatric News. “Either you handle it or you don’t. And if you can’t process it, then maybe you end up with PTSD.”

Roxanne Cohen Silver, Ph.D., a professor of psychology and behavioral sciences at the University of California at Irvine, has studied responses to traumatic events for more than 20 years and believes that the criterion C symptom group may indeed help identify persons who are going to have more difficulty as time goes on following a trauma. “Criterion C relates to function,” she told Psychiatric News. “I’ve seen it across other data sets; ruminations and rethinking of the events don’t necessarily impair functioning, but the group C symptoms do suggest dysfunction. Day-to-day function should be the key to who might require intervention.”