title: Trauma at the hands of another: distinguishing PTSD patterns following intimate and nonintimate interpersonal and noninterpersonal trauma in a nationally representative sample.
abstract: OBJECTIVE
  Interpersonal trauma and violence is currently considered a global public health emergency. However, studies have not differentiated between intimate interpersonal trauma and nonintimate interpersonal trauma in their impact on posttraumatic stress disorder (PTSD) symptomatology. This cross-sectional study based on epidemiologic data examined the differential likelihoods of endorsing PTSD symptoms following 3 categories of trauma: noninterpersonal (eg, accidents, natural disasters), nonintimate interpersonal (physical assaults perpetrated by nonintimates), and intimate interpersonal (physical assaults perpetrated by intimates or caregivers and sexual assaults).
  
  
  METHODS
  DSM-IV PTSD symptom data drawn from a weighted subsample (N = 1,012) of people reporting "most severe" reactions following one of the above types of trauma in the 2007 Australian National Survey of Mental Health and Well-Being (NSMHWB) were analyzed using binary logistic regression.
  
  
  RESULTS
  Participants reporting intimate interpersonal compared with noninterpersonal trauma were significantly (P < .001) more likely to endorse core symptoms (intrusive reexperiencing, avoidance of reminders, hypervigilance, and startle response) of PTSD. The intimate interpersonal trauma group members were significantly more likely than the nonintimate interpersonal trauma group members to endorse distress at reminders (odds ratio [OR] = 3.2; P < .001; 99.7% CI, 1.3-7.9), avoiding thinking about the event (OR = 3.2; P < .001; 99.7% CI, 1.3-7.7), detachment from others (OR = 3.2; P < .001; 99.7% CI, 1.2-8.9), and restricted affect (OR = 4.1; P < .001; 99.7% CI, 1.5-11.3). Participants reporting nonintimate interpersonal and noninterpersonal traumas did not significantly differ except in endorsement of behavioral avoidance (OR = 2.8; P < .001; 99.7% CI, 1.2-6.6), hypervigilance (OR = 2.5; P = .002; 99.7% CI, 1.0-6.3), and exaggerated startle response (OR = 3.5; P < .001; 99.7% CI, 1.7-7.4).
  
  
  CONCLUSIONS
  Survivors of intimate trauma appear to experience particularly severe intrusive memories and reminders of past trauma and suppression of emotional responsivity. The unique impact of interpersonal trauma, however, intimate or otherwise, compared with noninterpersonal trauma, is the experience of an environment as unsafe and unpredictable, due to the potential of human threat. Such findings have significant implications for the assessment of and interventions for survivors of interpersonal violence.
authors.affiliation: Australian Centre for Posttraumatic Mental Health, Level 1/340 Albert St, East Melbourne, Victoria 3002, Australia dforbes@unimelb.edu.au.
authors.forename: David
authors.initials: D
authors.lastname: Forbes
authors.forename: Emma
authors.initials: E
authors.lastname: Lockwood
authors.forename: Andrea
authors.initials: A
authors.lastname: Phelps
authors.forename: Darryl
authors.initials: D
authors.lastname: Wade
authors.forename: Mark
authors.initials: M
authors.lastname: Creamer
authors.forename: Richard A
authors.initials: RA
authors.lastname: Bryant
authors.forename: Alexander
authors.initials: A
authors.lastname: McFarlane
authors.forename: Derrick
authors.initials: D
authors.lastname: Silove
authors.forename: Susan
authors.initials: S
authors.lastname: Rees
authors.forename: Cath
authors.initials: C
authors.lastname: Chapman
authors.forename: Tim
authors.initials: T
authors.lastname: Slade
authors.forename: Katherine
authors.initials: K
authors.lastname: Mills
authors.forename: Maree
authors.initials: M
authors.lastname: Teesson
authors.forename: Meaghan
authors.initials: M
authors.lastname: O'Donnell
mesh_terms: D000059:Accidents / Q000523:psychology / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004190:Disasters / Q000706:statistics & numerical data; D017579:Domestic Violence / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D012742:Sex Offenses / Q000523:psychology / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D014754:Violence / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult