The Multiple and Changing Faces of Psychotrauma and its Psychological Consequences

The concepts of psychotrauma and post-traumatic stress disorder or PTSD have become increasingly popular in recent decades, not only in scientific literature and in therapy rooms, but also in the media and in everyday language. Yet the concept of PTSD only exists since 1980. This dissertation contributes to the knowledge about the manifestations of psychotraumatic events and their psychological consequences by investigating how PTSD emerged and whether the symptoms described in the PTSD concept correspond to those of traumatized patients. From a historical perspective, a literature review examined how posttraumatic disorders developed and under what circumstances and influences this took place. A great diversity of described symptoms and syndromes was found over the past century and a half. It turned out that these often arose under time-bound social, political, legal and scientific circumstances and were accompanied by intense debates about their right to exist. Research was then conducted using various statistical methodologies. In a study on the traumatic stressor criterion it was shown that, among other things, traumatic events, but also re-experiencing symptoms, did not occur specifically in PTSD alone, but also in various other mental disorders like unipolar mood disorders. Subsequently, Latent Profile Analysis (LPA) was used in two studies within two large samples of traumatized patients with a veteran and refugee background, respectively. Three subgroups of patients were identified which were characterized by symptom severity. The subgroups showed a wide range of PTSD, depression, anxiety and somatization symptoms, which were closely interrelated. Specific trauma types, coping styles, personality traits, and gender were associated with certain symptom severity subgroups. Finally, a study was conducted among a sample of both traumatized police officers and veterans to examine the associations between PTSD criteria and treatment outcome with Linear Mixed Model analyses (LMM). 51% Of participants reported clinically significant improvement for PTSD symptoms and 45% for symptoms of general psychopathology. Trauma characteristics and the severity of the four PTSD symptom clusters pre-treatment were not associated with changes in total PTSD scores from pre- to post-treatment. However, some trends were found like e.g., that higher severity of cluster C symptoms before treatment tended to be associated with smaller improvement in cluster E, and higher severity on cluster D with greater improvement of the same cluster D. The dissertation ends with a proposal for a hybrid diagnostic model for patients with post-traumatic complaints with both categorical and dimensional diagnostic elements. This model consists of both subtypes that can be defined in addition to PTSD and the concept of staging. In this way, the heterogeneity of post-traumatic symptomatology can be described in a more personalized way and treatment can be applied in a more tailor-made manner.