The Impact of Threat Appraisal in the Development of Post-Traumatic Stress Disorder: The Role of Threat to Life and Social Threat

Abstract

There has been considerable controversy surrounding the stressor criterion in post-traumatic stress disorder (PTSD), specifically regarding the definition of what constitutes a traumatic stressor likely to lead to symptoms of PTSD. This study sought to examine the role of threat appraisal in relation to women‘s worst traumatic experiences and its association with PTSD in particular, but also with women‘s mental health in general. We propose that there exist at least two types of threat; threat to life, and social threat; the latter involving rejection and humiliation. The association between threat appraisal and psychopathology was examined in a large-scale epidemiological study on Icelandic women (N=8992). Results revealed that the experience of either primarily threat to life or primarily social threat in relation to women’s worst traumatic experience has a strong association with PTSD symptoms. Furthermore, experiencing both types of threat was associated with a six-fold risk of having a probable PTSD diagnosis, compared to women who experienced neither type of threat. The experience of a social threat was specifically associated with an increased risk of having a probable social anxiety disorder (SAD) diagnosis, such that women in this group were two to three times as likely to have a probable diagnosis than women who experienced neither type of threat. Threat appraisal was also associated with symptoms of anxiety and depression. In conclusion, the results strongly suggest that shifting the focus away from the types of events that people experience and toward different types of threats is an essential step in advancing our understanding of trauma and the development of PTSD.