Psychological Trauma
Psychological Trauma, edited by Rachel Yehuda, Ph.D., is one of the publications in the American Psychiatric Press' Review of Psychiatry series, newly formatted in 1998 as individual monographs. Consisting of six chapters written by experts in the field of trauma studies, this small volume provides an intensive review of areas of current knowledge about both acute and chronic posttraumatic stress disorders.
Dr. Yehuda, who is director of the posttraumatic stress disorder (PTSD) program at the Mount Sinai School of Medicine and the Bronx Veterans Affairs Medical Center, is a well-known researcher in posttraumatic stress disorders, especially in the neuroendocrinology of PTSD. Her fellow authors, all of whom are actively involved in studying various aspects of trauma-related disorders, have made substantial contributions to our understanding of the impact of trauma on both the human brain and human behavior.
The book is obviously written for mental health professionals who have some prior understanding of the clinical presentation and treatment of PTSD; it is not intended as an introductory text for those wishing to learn basic concepts about trauma-related disorders and their treatment. Each chapter is a concisely written and thorough review of recent research, with helpful commentary on some of the strengths and weaknesses of current theoretical models of the etiology, neurobiology, and treatment of PTSD.
The first two chapters discuss the epidemiology and longitudinal development of trauma-related disorders. Next is a presentation of both structural and functional neuroimaging studies, containing valuable information on the paradigms of neuroimaging research designs that will be very helpful to many readers who are less familiar with these new research tools. Especially useful is Dr. Yehuda's contribution on the neuroendocrinology of PTSD; it is one of the most lucid explanations I have ever read of the complex role of the hypothalamic-pituitary-adrenal axis in the disorder. The book's final two chapters are on the psychopharmacology of PTSD, an area that has been previously reviewed but inadequately studied, and on psychosocial treatments of the disorder and their efficacy.
Psychological Trauma will be a welcome addition to the library of those interested in keeping informed about recent trauma research, whether they are researchers or clinical practitioners specializing in such disorders. The text focuses clearly on risk factors for PTSD, the prevalence of the disorder in the general population and in subpopulations exposed to trauma, the comorbidity of PTSD with other disorders, and evidence of the enduring neurobiological changes that occur in patients suffering from PTSD.
However, because the book does have some significant gaps, it cannot be considered a comprehensive overview of the field. Areas not addressed include recent controversies on the nature of traumatic memory and recall, the treatment of acute stress disorder, the treatment of PTSD during childhood and adolescence, and forensic issues related to trauma-related disorders, to name just a few. Psychological Trauma will be a very useful book for the specialist, but readers interested either in a general introduction to the topic or in a more comprehensive discussion of psychological trauma and its impact on individuals and society will be disappointed.
Dr. Whitley is medical director of emergency mental health services at UMass Memorial Health Care in Worcester, Massachusetts.
