Developmental epidemiology of PTSD: self-regulation as a central mechanism

Epidemiologic and meta-analytic studies point to consistent effects of pretrauma factors on risk for posttraumatic stress disorder (PTSD). However, our understanding of why only some individuals are vulnerable to the adverse effects of traumatic events remains limited. This article argues that a developmentally informed approach to the epidemiology of PTSD is needed to move this understanding forward. However, there are many challenges to such an approach including the historic conceptualization of PTSD as a normative response to traumatic events, the almost exclusive reliance on retrospective self-report of PTSD risk factors, and the lack of attention to current knowledge of human development in selecting risk factors for epidemiologic studies. The developmental construct of self-regulation may provide a key mechanism for understanding the effects of pretrauma factors on the vulnerability to PTSD. Pretrauma factors shown to have consistent effect on risk for PTSD in meta-analytic studies include familial psychopathology, child abuse, and preexisting psychopathology. A preliminary framework integrating these pretrauma factors with self-regulation as a central mechanism in the etiology of PTSD is presented. The implications of a developmentally informed epidemiologic approach to PTSD for theory, research, and practice are discussed.