In this book, as in previous volumes in the American Psychiatric Press Progress in Psychiatry series edited by David Spiegel, the chapters are by leading researchers in the specific field of interest. The difficulties in conceptualization of risk factors for posttraumatic stress disorder (PTSD) and the sophisticated methodology imposed by the subject are detailed in many of the chapters. This book would be valuable to readers who are doing research in the same or related fields, but it would also be useful for clinicians, whose expanding knowledge base will better inform their work with patients.

In the last two decades, traumatologists, those who have been investigating the origin and effects of trauma, have emphasized "real" events as the exclusive origin of posttraumatic symptoms. The view that which most professional therapists endorse is Lenore Terr’s view R1574CHDGDFAB that psychological stress damages as would a "series of blows." Judith Herman R1574CHDDBAFB represented trauma as an "affliction of the powerless" in which "the victim is rendered helpless by overpowering force." However, the "hammer blow" of trauma as metaphor inevitably must raise the question of, "On what?" After all, a hammer will break glass but may not even mark some materials, and although traumatic events are ubiquitous, relatively few people develop PTSD. Some traumatologists attached to the original DSM-III concept were hesitant about blaming the victim. The examination of "risk factors" for the development of PTSD in itself turns the original concept on its head.

This book addresses the complexity of this research. Philip Harvey and Rachel Yehuda write on the overall strategies for studying risk of PTSD. Epidemiological risk factors and the difficulties in assessing them is addressed by Ronald Kessler et al. William True and Michael Lyons discuss risk factors in a twin study. Rachel Yehuda writes on parental PTSD as a risk factor. Neurocognitive risk factors are examined by Scott Orr and Roger Pitman. Arieh Shalev writes on psychophysiological expression of risk factors. A.C. McFarlane examines risk factors for acute biological and psychological response to trauma. Paula Schnurr and Melanie Vielhauer write on personality as a risk factor for PTSD. Finally, Matt Friedman does a masterful summing up of the chapters and dilemmas in keeping with the high level of the preceding chapters.

What can we do with this information? If an individual or a group have identified factors for risk of PTSD, can they be protected from traumatic risks? Can the possibility of unfortunate encounters be limited? These are still preliminary cross-sectional studies—but as studies become more refined and reliable, there may be more clearly defined preventive measures and better therapies for this continuing problem.

This book will be most valuable to those doing research in related areas. Those clinicians who work with patients with PTSD would do well to read this book also—they will become aware of current thinking and the complexity of this pervasive problem.