The challenges of trauma
Many people experience a potentially traumatic event (PTE) and develop transient distress but do not develop psychological illness, thereby meeting the scientiﬁ c deﬁ nition of “resilience”. A smaller percentage will experience similar PTEs but experience little or no distress at all, as they have “resistance”. For others a PTE will be a factor, albeit a vital factor, within a multifactorial mix triggering the onset of a psychological disorder which may be acute, chronic, mild, severe, co-morbid or complex. For some, often the youngest, there will be repeated trauma, attachment disruption and dissociative responses, with no secure place to recover to, living in a system where previous generations suffered similar and multiple PTEs. This chapter aims to give an overview of those factors of particular relevance to the conceptualisation and use of CRM. It has been necessary to be selective, and no doubt potentially helpful concepts or texts have been excluded; this chapter is in no way meant to be exhaustive or authoritative, merely illustrative of some key features. 1
This chapter reviews and summarises these issues by ﬁ rst examining what constitutes a PTE and then the clinical manifestations of post-traumatic conditions, speciﬁ cally Post-Traumatic Stress Disorder (PTSD) and Complex PTSD, and their classiﬁ cation. Thereafter the chapter focuses on: the epidemiology of PTSD including vulnerability factors and speciﬁ cally epigenetics, co-morbidity and suicide risk, and the concept of resilience.