ABSTRACT

The prevailing model used by clinical psychologists, psychiatrists, and other MH professionals predicts that toxic events will normally trigger clinically significant distress symptoms in a dose-response manner. This event-focused model is very poorly supported by the evidence. When prospective and representative samples are followed, most people do not respond to toxic events with serious and long-term distress disorders in the way that is assumed to be a normal, traumatic response in both professional and popular models. Toxic events occur in very high frequencies even in civilian life in peacetime, yet this high prevalence is not matched by high prevalence rates for event-attributed distress disorders such as Acute Stress Disorder and PTSD. The lifetime prevalence ofPTSD symptoms and fresh incidence rates ofPTSD after a toxic event are both quite low and do not represent a majority response. When we study large samples exposed to common adversity, distress reports of clinical magnitude are not predictable and normative, but instead represent minority responses. Various intensities of exposure to toxic events do not reliably show the central features of a dose-response relationship, in that most exposed individuals do not report significant acute or chronic or delayed distress condition, while some individuals with minimal or even vicarious exposure do report significant distress that is ascribed to events.