Key Points

• Approximately 13% of the U.S. population has reported a lifetime exposure to natural or human-generated disaster.

• Posttraumatic stress disorder in the United States has an estimated lifetime prevalence of 8%, with women twice as likely as men to be affected.

The current understanding of "crisis" has been used as one of several core strategies in the management and treatment of trauma. The frequency of traumatic experiences is defined by the type of events called "traumatic." For example, early studies limited traumatic events to wars, natural disasters, and plane crashes, whereas more recent epidemi-ologic studies include intimate partner violence, car accidents, crime, or foreclosures. Estimates of lifetime trauma exposure vary with the definition of a "traumatic event," so community studies of exposure to lifetime trauma also varies (25%-90%). According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM IV-TR), the lifetime rate of posttraumatic stress disorder (PTSD) ranges between 1% and 14%.

Natural disasters such as earthquakes, tsunamis, hurricanes, tornadoes, and volcanic eruptions can traumatize individuals, devastate whole communities, and disturb an entire population in a large geographic area. Man-made disasters, such as 9-11 (2001), Oklahoma City (1995), suicide bombings, plane crashes, and environmental accidents, are all byproducts of the 21st century and, unfortunately, have become a part of modern life.

The prevalence of exposure to mass trauma is difficult to estimate. In one study, 13% of the U.S. population reported a lifetime exposure to natural or human-generated disaster (Burkle, 1996). The U.S. National Comorbidity Survey estimated that 18.9% of men and 15.2% of women reported a lifetime experience of a natural disaster (Kessler et al., 1995). These are merely exposure rates to trauma. Fortunately, most victims recover from traumatic exposure over time, without long-term sequelae. However, some will go on to develop posttraumatic stress disorder (PTSD). According to the National Center for Posttraumatic Stress Disorder, the estimated lifetime prevalence of PTSD among adult Americans is approximately 8%, with women twice as likely as men to be affected at some time during their life (Stein et al., 2003). Women who are victims of intimate partner violence are almost four times more likely than nonabused women to develop PTSD (Campbell, 2002).

The most common traumatic events include witnessing an injury, murder, fire, flood, or natural disaster; life-threatening accident; and combat exposure. According to the World Health Organization (WHO), 1.2 million people are killed in motor vehicle crashes and 50 million injured annually (Mayou et al., 1993). Well-known man-made disasters include the U.S. atomic bombings of Hiroshima and Nagasaki (WWII, 1945), the Chernobyl nuclear power plant accident in Russia (1986), the domestic terrorist bombing of Murrah federal building in Oklahoma City (1995), and foreign terrorist destruction of the World Trade Center in New York (2001). In addition, violence and trauma in American society continues with shootings in schools, community centers, and businesses.

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