Delayed Post Traumatic Stress Disorder - Research Confirmation

To test the validity of my cumulative observations of 300 schizophrenic patients, I surveyed patients with schizophrenia and major depression who experienced the one early trauma of birth of a sibling prior to age 36 months, and we compared the patients for sibling births between 12 to 24 months versus 24 to 36 months. Because of the importance of early trauma, and the birth-of-a-sibling trauma in particular, a high level of significance, substantially beyond the .001 level, was achieved with the first 50 subjects who had siblings less than 36 months younger.

In April 1995, Sarnoff Mednick was kind enough to test my findings on the 6,000 schizophrenic patients in the Finnish database, and he found a very high level of significance, confirming a substantially higher rate of schizophrenia among those with siblings less than two years younger. I estimate that the birth of a sibling accounts for approximately 30% of schizophrenia, and I anticipate that other infant traumas-when similarly identified and tested-will account for the other 70%.

Original Trauma

In nearly all 300 cases of schizophrenia studied, the infant trauma had one common denominator-a relative degree of physical or emotional separation from the mother as experienced by the infant. This separation is thought to produce intense pain and fear which overwhelm the infant and leave an indelible impression etched on the developing mind and brain.

Subsequent Trauma

A second important finding, gleaned from 25 years of cumulative observation, is that a trauma in the present-which is sufficiently intense and similar to the trauma in the past-causes the person, through a complex mental/physiological flashback mechanism, to return partially to the feelings/reality/behavior of the earlier rime. This I called the two trauma mechanism, and it is responsible for the commonly described "flashback" in posttraumatic stress disorders.

The trauma that precipitates the initial psychosis or major depression is similar to the original trauma in that it represents a separation, loss, or rejection by a "most important person" or group, whether the separation is real, imagined, anticipated, or implied. All acute stressors listed on Axis IV in the former DSM III-R were of this type.

People with drug and alcohol dependence had a positive correlation with a prolonged stress during infancy, and onset frequently coincided with, or was precipitated by, stress in the present.

In my view, the two trauma mechanism operates the same in all posttraumatic stress disorders of the delayed type. After the initial trauma is awakened, very little is required to reawaken or perpetuate it. With schizophrenia or depression, contact with original, nuclear family members was found to keep the earlier mind and brain active and to work against recovery. The same mechanism operates when the alcoholic takes a drink. In alcohol and drug-dependent individuals, recovery often depends on separation from original family members as well as from the abused substance.

Prevention

My findings and theoretical constructs allow for prevention at three levels: prevention of the original trauma, prevention of a first psychotic episode in the vulnerable individual, and prevention of a relapse in persons who have an illness.

The first level of prevention is the most effective and can be accomplished through public education designed to eliminate or modify infant traumas.

The second level of prevention is prevention of an initial psychotic episode. Vulnerable individuals, i.e., those who experienced early trauma or who exhibit precursors of schizophrenia, are treated during emotional crises or at critical stages of development, to modify the impact of the second trauma in the two trauma mechanism. When this eliminates the initial flashback, the mental disorder does not occur.

The third level of prevention is prevention of a recurrence in persons who already suffer from mental illness. This is the beginning of our treatment approach.