Descriptive Psychopathology: The Signs and Symptoms of ...

346 Section 3: Examination domainsexperience signs and symptoms similar to bereavement. Children of divorcedparents, depending on their age, exhibit sadness and aggressiveness, and transientacademic difficulties. 66 Unless persistent, these behaviors do not indicatepsychopathology.Natural disasterAcute stress reactions are common in persons who have been in a natural disaster(e.g. flood, tornado, and hurricane). These reactions are characterized by anxiety,sadness, and sleep disturbances, tremulousness, feeling of “shock” and numbness,and health-related complaints. 67Typically, symptoms abate within a month and for most such persons communitysupport is all that is needed. The symptoms should not be consideredpsychopathology, as most persons under severe stress experience them and inmost persons the symptoms resolve. Only a small proportion of persons withacute stress-related features develop chronic psychopathology following naturaldisasters. 68 The most salient risk factor for chronic PTSD is previous psychiatricillness. Other risk factors are female gender and the intensity of the subjectiveresponse to the acute trauma. 69Body injuryPainful and disfiguring body injury from accident, assault, and medical proceduresalso elicit acute stress responses characterized by sleep disturbance, anxiety,and sadness. 70 In children conduct problems and cognitive difficulties alsooccur. 71 A third to a half of burn victims experience a disabling stress response,particularly if the face is involved. Persons with pre-burn depressive illness orabnormal personality traits of low behavioral activation and high behavioralinhibition are at increased risk. 72Sexual traumaSexual traumas in childhood and adulthood have similar outcomes. 73 Sexualtrauma in childhood is associated with subsequent depressive illness, eating andchronic anxiety disorder, substance abuse, and lability of emotional expression,impulsivity, and self-injury that elicits the diagnosis of borderline personality.Likely contributing factors rarely considered in studies of such patients are thehigh heritability of the behaviors and the effects of chronic trauma and substanceabuse on the maturation of brain systems subserving the behaviors. 74 Assessmentby standardized personality scales finds women who experienced childhoodsexual trauma to be high on traits of behavioral inhibition and low on behavioralactivation. 75 Chronic PTSD, non-melancholic depression, and to a lesser extenteating disorder may follow rape in adulthood. 76