Assessing long-term effects of trauma: diagnosing symptoms of avoidance and numbing.

OBJECTIVE: This study compared the discovery of posttraumatic stress disorder (PTSD) symptoms by means of the Structured Clinical Interview for DSM-III-R (SCID) with a semistructured, psychodynamic clinical interview in a long-term follow-up of the survivors of the Buffalo Creek (W.Va.) flood. METHOD: Videotaped semistructured, psychodynamic clinical interviews of a small group of survivors (N=6) were compared with the results obtained in a prior group-level SCID investigation. RESULTS: Seventy-two percent of the total PTSD symptoms for the subjects studied were elicited exclusively by the psychodynamic clinical interview. PTSD cluster C symptoms of avoidance and numbing of general responsiveness were especially sensitive to discovery by this method. CONCLUSIONS: The psychodynamic clinical interview should be included in the design of studies that seek to investigate long-term effects of trauma, which are especially likely to be manifest in negative symptoms and subtle character change.

Portraits of survival. A twenty-year follow-up of the children of Buffalo Creek.

This study is a follow-up of the children of Buffalo Creek "hollow" who survived the dam collapse and flood of 1972. It was conceived as a complement to the 1988 NIMH-funded follow-up investigation of the children of Buffalo Creek conducted by the University of Cincinnati Traumatic Stress Study Center. That 1988 study utilized standardized methodology to assess levels of psychopathology present among those who were children at the time of the 1972 flood. Among the original child subjects, results demonstrated that the rates of both posttraumatic stress disorder (PTSD) and levels of other psychopathology had sharply declined as the children moved to adulthood. Several questions remained unanswered: the long-term meaning which the flood had in the survivors' lives and its impact on their adaptation as they progressed through the subsequent stages of emotional development. For these reasons, we, as psychoanalytic investigators who had been members of the original clinical assessment team, planned an interview of child and adolescent survivors as a follow-up to our interviews in 1974 with a particular focus on meaning and adaptation.

Disaster at Buffalo Creek. Family and character change at Buffalo Creek.

Psychiatric evaluation teams used observations of family interaction and psychoanalytically oriented individual interviews to study the psychological aftereffects of the 1972 Buffalo Creek disaster, a tidal wave of sludge and black water released by the collapse of a slag waste dam. Traumatic neurotic reactions were found in 80% of the survivors. Underlying the clinical picture were unresolved grief, survivor shame, and feelings of impotent rage and hopelessness. These clinical findings had persisted for the two years since the flood, and a definite symptom complex labeled the "Buffalo Creek syndrome" was pervasive. The methods used by the survivors to cope with the overwhelming impact of the disaster--first-order defenses, undoing, psychological conservatism, and dehumanization--actually preserved their symptoms and caused disabling character changes.