TRAUMA AND SEVERE
MENTAL ILLNESS
University at Buffalo
Epidemiology of trauma an PTSD

Most people experience at least one
traumatic event serious enough to lead to
PTSD, but only a few people go on to
develop PTSD.

People with PTSD are at higher risk for other
psychiatric and substance abuse disorders.
Epidemiology cont’d

Three uniform risk factors for PTSD:



Pre-existing psychiatric disorder
Family history of PTSD
Childhood trauma
Trauma exposure and PTSD in individuals
with a serious mental illness

Growing evidence that individuals with a
diagnosis of serious mental illness are at
elevated risk for trauma exposure and
subsequent PTSD.

Intersection between trauma exposure, PTSD
and serious mental illness is still unclear.
Trauma exposure cont’d

Multiple methods:




Early trauma can be risk factor for both major
depression and PTSD.
Serious mental illness may heighten likelihood of
trauma exposure through homelessness and
substance abuse.
Serious mental illness may increase vulnerability
to PTSD development at any given level of
trauma.
Psychosis itself may constitute DSM-IV criterion A
trauma.
Trauma exposure cont’d



Serious mental illness: nearly 3% of U.S.
population.
Rates of trauma exposure and PTSD in
individuals with a diagnosis of serious mental
illness not yet adequately determined due to
nosologic, psychometric and sampling
issues.
Emerging evidence about high rates of
trauma exposure and PTSD in individuals
with a diagnosis of serious mental illness.
Exposure cont’d


Individuals with a diagnosis of serious mental
illness: 34-35% report childhood sexual or
physical abuse and 43-81% report some
victimization over life course.
PTSD in individuals with a diagnosis of
serious mental illness: Seven recent studies
report prevalence rate of 28-43% for PTSD in
individuals with a diagnosis of serious mental
illness, as opposed to 9.2% lifetime
prevalence rate in the general population.
Treatment and service delivery
implications.

Need to develop effective treatment for this
co morbid condition. (PTSD and serious
mental illness).

Not yet any empirically validated treatments
for SMI clients with PTSD, but efforts
beginning to evaluate group and individual
models using cognitive behavioral therapy,
exposure therapy and cognitive restructuring.
Treatment cont’d

Assessment of individuals with a diagnosis of
serious mental illness should always include
assessing for trauma exposure and potential
PTSD. Both inpatient and outpatient
assessment protocols must do so.