ii !% also available in thefacts series ADHD (2nd ed.) | 9780199565030 Inflammatory Bowel Disease | 9780199230716 Alcoholism (4th ed.) | 9780199231393 Insomnia and Other Adult Sleep Problems | 9780199560837 Alzheimer’s and Other Dementias | 9780199596553 Living with a Long-term Illness | 9780198528821 Angina and Heart Attack | 9780199599288 Lung Cancer (3rd ed.) | 9780199569335 Ankylosing Spondylitis | 9780192632821 Lupus (2nd ed.) | 9780199213870 Asthma | 9780199211265 Motor Neuron Disease | 9780199206919 Autism and Asperger Syndrome | Multiple Sclerosis | 9780199652570 9780198504900 Muscular Dystrophy (3rd ed.) | Back Pain | 9780199561070 9780199542161 Borderline Personality Disorder | Myotonic Dystrophy (2nd ed.) | 9780199202966 9780199571970 Breast Cancer | 9780199558698 Obsessive–Compulsive Disorder (4th ed.) | 9780199561773 Chronic Fatigue Syndrome (2nd ed.) | 9780199233168 Osteoarthritis | 9780199211388 COPD | 9780199563685 Osteoporosis | 9780199215898 Cosmetic Surgery | 9780199218820 Panic Disorder (3rd ed.) | 9780199574698 Cystic Fibrosis (4th ed.) | 9780199295807 Polycystic Ovary Syndrome | 9780199213689 Depression (2nd ed.) | 9780199602933 Post-traumatic Stress (2nd ed.) | 9780198758112 Diabetes | 9780199232666 Prenatal Tests and Ultrasound | 9780199599301 Down Syndrome (3rd ed.) | 9780199232772 Prostate Cancer (2nd ed.) | 9780199573936 Dyslexia and Other Learning Difficulties (3rd ed.) | 9780199691777 Psoriatic Arthritis | 9780199231225 Eating Disorders (7th ed.) | 9780198715603 Pulmonary Arterial Hypertension | 9780199582921 Epilepsy (3rd ed.) | 9780199233687 Schizophrenia (3rd ed.) | 9780199600915 Epilepsy in Women | 9780199548835 Sexually Transmitted Infections (3rd ed.) | Essential Tremor | 9780199211272 9780199595655 Facts and Practice for A-level: Biology | Sleep Problems in Children and Adolescents 9780199147663 | 9780199296149 Falls | 9780199541287 Stroke | 9780199212729 Head Injury | 9780199218226 The Pill and Other Forms of Hormonal Heart Disease | 9780199582815 Contraception (7th ed.) | 9780199565764 Huntington’s Disease (2nd ed.) | 9780199212019 Thyroid Disease (4th ed.) | 9780199205714 Infertility | 9780199217694 Tourette Syndrome (2nd ed.) | 9780199298198 i thefacts Post- traumatic Stress iii thefacts Post- traumatic Stress SECOND EDITION STEPHEN REGEL Centre for Trauma, Resilience and Growth, Nottinghamshire Healthcare NHS Foundation Trust and School of Education, University of Nottingham, UK STEPHEN JOSEPH Centre for Trauma, Resilience and Growth, Nottinghamshire Healthcare NHS Foundation Trust, and School of Education, University of Nottingham, UK 1 iv 1 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 2017 The moral rights of the authors have been asserted First Edition published in 2010 Second Edition published in 2017 Impression: 1 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 2016958445 ISBN 978–0 –1 9–8 75811–2 Printed in Great Britain by Clays Ltd, St Ives plc Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up- to- date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non- pregnant adult who is not breast- feeding Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work. v SR: For Tina for her love and perseverance! and Hannah and Tom as always. SJ: For Vanessa vi vii Foreword: Terry Waite Since I wrote the forward to the first edition of this book, alas, the need for professional help to deal with the problem of traumatic stress has not dimin- ished. Increasingly more and more members of the public are aware of this condition and recognize that it can be effectively treated. The recent attacks in Paris, Nice, Tunisia, Baghdad, and Brussels and elsewhere have had a pro- found psychological impact on many people, and this book will be of signifi- cant help to those involved in such tragedies. Many years ago, when I jointly founded Hostage UK, we established a group of professionals who were willing to offer their help to former hostages and their families as and when required. This book, with its clear descriptions of the problem has played a major role in decreasing the resistance of many people who had little or no understanding of the condition but nevertheless suffered from it and sought our help. Not everyone who experiences a major traumatic incident in his or her life will suffer from the disorder. Again, this book, in a clear and concise way, presents the facts, and in so doing plays a major role in developing understanding of the condition, and enabling many to receive the help and support that they so urgently require. Terry Waite CBE vii viii ix Foreword: Atle Dyregrov People all around the globe experience events that are potentially traumatic. Unfortunately, human- made and natural disasters are on the rise, together with accidents, suicide, murder, serious criminal acts, sexual assaults, and other extremely stressful events continue to affect the mental health of indi- viduals, families, and society in general. Understanding trauma and its after- math is not easy, especially when a person is in the midst of the resulting internal and external chaos. Trauma not only challenges our beliefs, it also disrupts the lives of individuals, families, and communities. This book offers both non- professionals and professionals a better understanding of the psy- chological impact of trauma, as well as offering ways to counteract and mini- mize the risk that such events present. Trauma, in a simple way, can be divided into two types: complex trauma, usually the result of repetitive adverse childhood events, and single- event trauma, where there is one critical situation leading to after- reactions. Often there is a complex mix; people who experience a trauma have a history of previous losses or traumas that play a part in determining the resulting reac- tions. Regel and Joseph describe how pre- event, peri- event (happens dur- ing the event), and post- event factors can all determine people’s responses. Disentangling the contributing factors is not easy to determine a cause of action when aiming to reduce untoward effects. Their historical overview of our understanding of psychological trauma dem- onstrates how trauma has always been part of people’s lives. Even after the introduction of post- traumatic stress disorder (PTSD) into psychiatry and psychology in 1980, the definition of what constitutes a trauma has been shift- ing over the years. Although the trauma ‘breakthrough’ in the professional field had strong military influence (from the Vietnam War), it has since then had a significant effect on our understanding of those who experience trauma in a civilian context. Actually, the loss of a family member is thought to be one of the events that accounts for the highest levels of PTSD. Recently, research within the medical field has also opened our eyes to the many individuals who develop post- traumatic stress in relation to experiences of Intensive Care ix