Trauma severity

How is trauma severity related to PTSD?

Exposure to at least one trauma is required for a diagnosis of PTSD. The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) determines direct traumas as threatened death, actual or threatened serious injury, or actual or threatened sexual violence. Indirect traumas include witnessing the trauma, or learning that a relative or close friend was exposed to a trauma. Differences in trauma characteristics, including the frequency and severity of exposure, can affect the risk of developing PTSD. Personal characteristics such as age and sex also influence risk.

What is the evidence for risk of PTSD after exposure to varying levels of trauma severity?

Moderate quality evidence found people with advanced-stage cancer had higher rates of PTSD than those in earlier stages (11.4% vs. 4.2%). The prevalence of PTSD in people in chronic pain is around 9.7%. The prevalence was highest in people with chronic widespread pain (20.5%). Associations were found between more pain severity and distress after a spinal cord injury and increased PTSD symptoms.

Risk factors associated with PTSD following a burn injury include (in descending order of effect); more life threat perception, pain, negative emotions or distress, acute stress symptoms, being injured by an explosion, more body surface area affected, longer hospitalisation stay, and having more surgeries.

PTSD symptoms were highest in parents of chronically-ill children with more illness severity and longer treatment duration and intensity.

Incidence of PTSD was lower in people exposed to mild flood severity (4.41%) than moderate (12.82%) or severe (20.06%) flood intensity. Prevalence of PTSD was highest in people exposed to earthquakes who were trapped, experienced fear, injury, bereavement, or witnessed injury/death. There were small to medium-sized associations between increasing disaster death toll and increasing PTSD symptoms (a dose-dependent effect). Closer proximity to the disaster, more threat to self, and more general distress all showed medium-sized associations with increased PTSD symptoms. Loss of a loved one showed a small association with PTSD symptoms.

Moderate to high quality evidence found the prevalence of PTSD in war-affected refugees and citizens was around 31%. Rates were highest in people exposed to recent conflict, torture, more potentially traumatic events, and political terror. Rates were highest in people from Cambodia, Bosnia, Kosovo, and Africa. Moderate quality evidence found the risk factors most associated with risk of PTSD in military personnel and veterans were discharging a weapon, witnessing someone being wounded or killed, experiencing severe trauma, and having longer and more deployments.

There was a small association between greater level of exposure to mass shootings (closer proximity, longer duration) and increased PTSD symptoms. There was a medium-sized association between exposure to any trauma severity and increased risk of PTSD in children and adolescents.

August 2021

Image: ©2019 Andrew Ostrovsky –

Last updated at: 11:08 pm, 11th October 2021
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