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Contagion in Stress
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STRESS IN CHILDREN
CONTAGION IN STRESS An Infectious Disease Model for Posttraumatic Stress in Children Betty Pfefferbaum, MD, JD, and Rose L. Pfefferbaum, PhD, MPH
Anxiety and fear are ubiquitous and pivotal in normal development. They serve important protective functions by warning an individual of potential danger, and they play a role in both individual and species survival.1 9 Anxiety and fear may also be pathologic, with a range of biopsychosocial concomitants. Posttraumatic stress disorder (PTSD), classified as an anxiety disorder, involves the development of characteristic symptoms-persistent instrusive reexperiencing, physiologic arousal, and avoidance-after exposure to a traumatic event. 2 It is not necessary that diagnostic criteria be fully present for suffering to occur; partial symptomatology may cause profound distress and is especially important in children because of its potential influence on development. In addition, PTSD may have delayed onset, occurring some time after exposure and surprising an unsuspecting host. Physical proximity to a stressor is generally considered a factor in the development of posttraumatic stress symptoms.2· 4• 27• 34 Emotional proximity or relationship to an individual or individuals involved in the event are also powerful influences.26 Prior traumatic experiences are likely to predispose one to future stress responses and to be triggered by newly occurring stressors. 27• 34 POSTTRAUMATIC STRESS AND THE INFECTIOUS DISEASE MODEL
The concept of contagion, drawn from the study of infectious diseases, has been used in association with a variety of emotional and behavioral conditions, From the Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center (BP), Oklahoma City, Oklahoma; the Departments of Economics and Gerontology (RLP), Phoenix College, Phoenix, Arizona; and the Office of Student and Educational Development, Maricopa County Community College District (RLP), Tempe, Arizona
CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA VOLUME 7 •NUMBER 1 •JANUARY 1998
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40. Schubiner H, Scott R, Tzelepis A: Exposure to violence among inner-city youth. J Adolesc Health 14:214-219, 1993 41. Schwab-Stone ME, Ayers TS, Kasprow W, et al: No safe haven : A study of violence exposure in an urban community. J Am Acad Child Adolesc Psychiatry 34:13431352, 1995 42. Shakoor BH, Chalmers D: Co-victimization of African-American children who witness violence: Effects on cognitive, emotional, and behavioral development. J Nat Med Assoc 83:233-238, 1991 43. Shaw JA, Applegate B, Tanner S, et al: Psychological effects of Hurricane Andrew on an elementary school population. J Am Acad Child Adolesc Psychiatry 34:1185-1192, 1995 44. Spraycar M (ed): Stedman's Medical Dictionary, ed 26. Baltimore, Williams & Wilkins, 1995 45. Terr L: Too Scared to Cry. New York, Harper & Row, Publishers, 1990 46. Terr LC: Children of Chowchilla: A study of psychic trauma. Psychoanal Study Child 34:547-623, 1979 47. Terr LC: Chowchilla revisited: The effects of psychic trauma four years after a schoolbus kidnapping. Psychiatry 140:1543-1550, 1983 48. Terr LC: Family anxiety after traumatic events. J Clin Psychiatry 50(suppl):l5-19, 1989 49. Terr LC: "Forbidden games:" Post-traumatic child 's play. JAm Acad Child Psychiatry 20:741-760, 1981 50. Widom CS: Does violence beget violence? A critical examination of the literature. Psycho! Bull 106:3-28, 1989
Address reprint requests to Betty Pfefferbaum, MD, JD Department of Psychiatry and Behavioral Sciences University of Oklahoma Health Sciences Center 920 Stanton L. Young Boulevard Williams Pavilion 3470 Oklahoma City, OK 73104
STRESS IN CHILDREN
CONTAGION IN STRESS An Infectious Disease Model for Posttraumatic Stress in Children Betty Pfefferbaum, MD, JD, and Rose L. Pfefferbaum, PhD, MPH
Anxiety and fear are ubiquitous and pivotal in normal development. They serve important protective functions by warning an individual of potential danger, and they play a role in both individual and species survival.1 9 Anxiety and fear may also be pathologic, with a range of biopsychosocial concomitants. Posttraumatic stress disorder (PTSD), classified as an anxiety disorder, involves the development of characteristic symptoms-persistent instrusive reexperiencing, physiologic arousal, and avoidance-after exposure to a traumatic event. 2 It is not necessary that diagnostic criteria be fully present for suffering to occur; partial symptomatology may cause profound distress and is especially important in children because of its potential influence on development. In addition, PTSD may have delayed onset, occurring some time after exposure and surprising an unsuspecting host. Physical proximity to a stressor is generally considered a factor in the development of posttraumatic stress symptoms.2· 4• 27• 34 Emotional proximity or relationship to an individual or individuals involved in the event are also powerful influences.26 Prior traumatic experiences are likely to predispose one to future stress responses and to be triggered by newly occurring stressors. 27• 34 POSTTRAUMATIC STRESS AND THE INFECTIOUS DISEASE MODEL
The concept of contagion, drawn from the study of infectious diseases, has been used in association with a variety of emotional and behavioral conditions, From the Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center (BP), Oklahoma City, Oklahoma; the Departments of Economics and Gerontology (RLP), Phoenix College, Phoenix, Arizona; and the Office of Student and Educational Development, Maricopa County Community College District (RLP), Tempe, Arizona
CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA VOLUME 7 •NUMBER 1 •JANUARY 1998
183
194
PFEFFERBAUM & PFEFFERBAUM
40. Schubiner H, Scott R, Tzelepis A: Exposure to violence among inner-city youth. J Adolesc Health 14:214-219, 1993 41. Schwab-Stone ME, Ayers TS, Kasprow W, et al: No safe haven : A study of violence exposure in an urban community. J Am Acad Child Adolesc Psychiatry 34:13431352, 1995 42. Shakoor BH, Chalmers D: Co-victimization of African-American children who witness violence: Effects on cognitive, emotional, and behavioral development. J Nat Med Assoc 83:233-238, 1991 43. Shaw JA, Applegate B, Tanner S, et al: Psychological effects of Hurricane Andrew on an elementary school population. J Am Acad Child Adolesc Psychiatry 34:1185-1192, 1995 44. Spraycar M (ed): Stedman's Medical Dictionary, ed 26. Baltimore, Williams & Wilkins, 1995 45. Terr L: Too Scared to Cry. New York, Harper & Row, Publishers, 1990 46. Terr LC: Children of Chowchilla: A study of psychic trauma. Psychoanal Study Child 34:547-623, 1979 47. Terr LC: Chowchilla revisited: The effects of psychic trauma four years after a schoolbus kidnapping. Psychiatry 140:1543-1550, 1983 48. Terr LC: Family anxiety after traumatic events. J Clin Psychiatry 50(suppl):l5-19, 1989 49. Terr LC: "Forbidden games:" Post-traumatic child 's play. JAm Acad Child Psychiatry 20:741-760, 1981 50. Widom CS: Does violence beget violence? A critical examination of the literature. Psycho! Bull 106:3-28, 1989
Address reprint requests to Betty Pfefferbaum, MD, JD Department of Psychiatry and Behavioral Sciences University of Oklahoma Health Sciences Center 920 Stanton L. Young Boulevard Williams Pavilion 3470 Oklahoma City, OK 73104