Rationale For Separating PTSD, Depressive And Anxiety Disorders: A Belgian Study Based On The Terrorist Attacks Of March 22th 2016
DOI:
https://doi.org/10.29284/ijasis.12.1s.2026.455-462Keywords:
Depressive and Anxiety Disorders, PTSD, Sense of Coherence, Terrorism.Abstract
The DSM-V separates posttraumatic stress disorders (PTSD) from anxiety disorders. The authors conducted a prospective study aiming to observe the evolution of Post-traumatic Stress Disorder (PTSD); depressive and anxiety disorders symptoms (DAD); and the protective role of Sense of Coherence (SOC) after the Brussels March 2016 terrorist attacks. They collected data in a non-clinical sample of 464 participants two days (time 1) and three months (time 2) after the attacks. They measured the level of PTSD, DAD and SOC at time 1 and 2. They observed a negative relationship between SOC and both DAD (effect size of .40) and PTSD symptoms (effect size of .10). A high level of SOC enables subjects to overcome DAD symptoms (Effect size .02) faster than subjects with lower level of SOC. This effect is not present regarding the evolution of PTSD symptoms. This study presents some limitations. All scales are self-reported measures. Second, there might be a selection bias since among 2017 participants at time 1 only 464 completed the follow up questionnaire at time 2. Third, the considered trauma is a Secondary Traumatic Stress since participants were not direct victims of the attacks. However, results confirm the relevance of the current separation of PTSD from anxiety disorders. Authors propose an interpretation of this relevance taking into account the cognitive distortion observed in PTSD. At a clinical level, PTSD and DAD should benefit from different therapeutic interventions after trauma exposure.
References
[1] R. C. Kessler et al., “Trauma and PTSD in the WHO world mental health surveys,” Eur. J. Psychotraumatol., vol. 8, suppl. 5, p. 1353383, 2017.
[2] C. A. Fullerton and R. J. Urbano, “Psychological and psychopathological consequences of disasters,” in Disasters and Mental Health, J. J. Lopez-Ibor, G. Christodoulou, M. Maj, N. Sartorius, and A. Okasha, Eds. Chichester, U.K.: Wiley, pp. 13–36, 2005.
[3] P. Fossion et al., “Depression, anxiety and loss of resilience after multiple traumas: An illustration of a mediated moderation model of sensitization in a group of children who survived the Nazi Holocaust,” J. Affect. Disord., vol. 151, no. 3, pp. 973–979, 2013.
[4] N. Breslau, H. C. Wilcox, C. L. Storr, V. C. Lucia, and J. C. Anthony, “Trauma exposure and posttraumatic stress disorder: A study of youths in urban America,” J. Urban Health, vol. 81, no. 4, pp. 530–544, 2004.
[5] A. Perkonigg, R. C. Kessler, S. Storz, and H. U. Wittchen, “Traumatic events and post-traumatic stress disorder in the community: Prevalence, risk factors and comorbidity,” Acta Psychiatr. Scand., vol. 101, no. 1, pp. 46–59, 2000.
[6] J. Hunsley and E. J. Mash, Eds., A Guide to Assessments That Work. Oxford, U.K.: Oxford Univ. Press, 2008.
[7] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). Washington, DC, USA: American Psychiatric Publishing, p. 143, 2013.
[8] M. J. Friedman, P. A. Resick, R. A. Bryant, and C. R. Brewin, “Considering PTSD for DSM-5,” Depress. Anxiety, vol. 28, no. 9, pp. 750–769, 2011.
[9] A. P. Levin, S. B. Kleinman, and J. S. Adler, “DSM-5 and posttraumatic stress disorder,” J. Am. Acad. Psychiatry Law, vol. 42, no. 2, pp. 146–158, 2014.
[10] S. U. Qureshi et al., “Does PTSD impair cognition beyond the effect of trauma?” J. Neuropsychiatry Clin. Neurosci., vol. 23, no. 1, pp. 16–28, 2011.
[11] J. P. Hayes, M. B. VanElzakker, and L. M. Shin, “Emotion and cognition interactions in PTSD: A review of neurocognitive and neuroimaging studies,” Front. Integr. Neurosci., vol. 6, p. 89, 2012.
[12] N. Breslau, G. C. Davis, P. Andreski, and E. Peterson, “Traumatic events and posttraumatic stress disorder in an urban population of young adults,” Arch. Gen. Psychiatry, vol. 48, no. 3, pp. 216–222, 1991.
[13] P. Fossion et al., “Beware of multiple traumas in PTSD assessment: The role of reactivation mechanism in intrusive and hyper-arousal symptoms,” Aging Ment. Health, vol. 19, no. 3, pp. 258–263, 2015.
[14] P. Fossion et al., “Psychological and socio-demographic data contributing to the resilience of Holocaust survivors,” J. Psychol., 2014.
[15] C. Leys et al., “Perspectives on resilience: Personality trait or skill?” Eur. J. Trauma Dissociation, 2018.
[16] M. Eriksson and B. Lindström, “Validity of Antonovsky’s sense of coherence scale: A systematic review,” J. Epidemiol. Community Health, vol. 59, no. 6, pp. 460–466, 2005.
[17] P. Fossion et al., “Disentangling sense of coherence and resilience in case of multiple traumas,” J. Affect. Disord., vol. 160, pp. 21–26, 2014.
[18] M. Eriksson and B. Lindström, “Life is more than survival: Exploring links between Antonovsky’s salutogenic theory and the concept of resilience,” in Wayfinding Through Life’s Challenges: Coping and Survival, K. W. Gow and M. Celinski, Eds. New York, NY, USA: Nova Science Publishers, pp. 31–46, 2011.
[19] O. Braun-Lewensohn and S. Sagy, “Community resilience and sense of coherence as protective factors in explaining stress reactions: Comparing cities and rural communities during missile attacks,” Community Ment. Health J., vol. 50, no. 2, pp. 229–234, 2014.
[20] O. Braun-Lewensohn, S. Sagy, and G. Roth, “Adolescents under missile attacks: Sense of coherence as a mediator between exposure and stress-related reactions,” J. Adolesc., vol. 34, no. 1, pp. 195–197, 2011.
[21] N. R. Chumbler, M. R. Rittman, and S. S. Wu, “Associations in sense of coherence and depression in caregivers of stroke survivors across two years,” J. Behav. Health Serv. Res., vol. 35, no. 2, pp. 226–234, 2008.
[22] U. Frommberger et al., “The concept of sense of coherence and the development of posttraumatic stress disorder in traffic accident victims,” J. Psychosom. Res., vol. 46, no. 4, pp. 343–348, 1999.
[23] I. M. Engelhard, M. A. van den Hout, and J. W. Vlaeyen, “The sense of coherence in early pregnancy and crisis support and posttraumatic stress after pregnancy loss: A prospective study,” Behav. Med., vol. 29, no. 2, pp. 80–84, 2003.
[24] A. Mehnert and U. Koch, “Prevalence of acute and post-traumatic stress disorder and comorbid mental disorders in breast cancer patients during primary cancer care: A prospective study,” Psycho-Oncology, vol. 16, no. 3, pp. 181–188, 2007.
[25] B. Lindström and M. Eriksson, “Salutogenesis,” J. Epidemiol. Community Health, vol. 59, no. 6, pp. 440–442, 2005.
[26] A. Antonovsky, Unraveling the Mystery of Health: How People Manage Stress and Stay Well. San Francisco, CA, USA: Jossey-Bass, p. 189, 1987.
[27] K. Gana and S. Garnier, “Latent structure of the sense of coherence scale in a French sample,” Pers. Individ. Dif., vol. 31, no. 7, pp. 1079–1090, 2001.
[28] L. R. Derogatis, R. S. Lipman, K. Rickels, E. H. Uhlenhuth, and L. Covi, “The Hopkins Symptom Checklist (HSCL): A self-report symptom inventory,” Syst. Res. Behav. Sci., vol. 19, no. 1, pp. 1–15, 1974.
[29] L. R. Derogatis, R. S. Lipman, and I. Covi, “The SCL-90: An outpatient psychiatric rating scale,” Psychopharmacol. Bull., vol. 9, pp. 13–28, 1973.
[30] T. Bean, I. Derluyn, E. Eurelings-Bontekoe, E. Broekaert, and P. Spinhoven, “Validation of the multiple language versions of the Hopkins Symptom Checklist-37 for refugee adolescents,” Adolescence, vol. 42, no. 165, pp. 51–67, 2007.
[31] M. Horowitz, N. Wilner, and W. Alvarez, “Impact of Event Scale: A measure of subjective stress,” Psychosom. Med., vol. 41, no. 3, pp. 209–218, 1979.
[32] D. S. Weiss and C. R. Marmar, “The Impact of Event Scale-Revised,” in Assessing Psychological Trauma and PTSD, J. P. Wilson and T. M. Keane, Eds. New York, NY, USA: Guilford Press, pp. 399–411, 1997.
[33] J. P. Wilson and T. M. Keane, Eds., Assessing Psychological Trauma and PTSD. New York, NY, USA: Guilford Press.
[34] A. Brunet, A. St-Hilaire, L. Jehel, and S. King, “Validation of a French version of the Impact of Event Scale-Revised,” Can. J. Psychiatry, vol. 48, no. 1, pp. 56–61, 2003.
[35] L. C. Terr, “Childhood traumas: An outline and overview,” Am. J. Psychiatry, vol. 148, pp. 10–20, 1991.
Downloads
Published
Issue
Section
License

This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

