A broader view of trauma: a biopsychosocial-evolutionary view of the role of the traumatic stress response in the emergence of pathology and/or growth

Clin Psychol Rev. 2004 Mar;24(1):75-98. doi: 10.1016/j.cpr.2003.12.003.

Abstract

The main goal of this paper is to articulate a biopsychosocial evolutionary approach to understanding the traumatic stress response. The secondary goal of this paper is to draw out the general clinical implications of this approach. I articulate seven interconnected and overlapping empirically grounded theoretical conclusions: (1) Stress is best understood as a prerational form of biopsychological feedback regarding the organism's relationship with its environment; (2) The normal outcome of traumatic stress is growth, rather than pathology; (3) Most psychopathology is a function of the maladaptive modulation of the stress response; (4) Trauma always leaves the individual transformed on a biological, as well as psychological, level; (5) The general biological process underlying stress responses is universal, but the specific dynamics are always a function of the unique sociocultural environment and psychological makeup of the individual; (6) The biology underlying stable psychopathological symptoms may change even as the psychological symptoms remain the same; and (7) Rationality is humanity's evolutionarily newest and most sophisticated stress-reduction behavioral mechanism, and the most important aspect of restoring psychological health to the trauma victim.

Publication types

  • Review

MeSH terms

  • Adaptation, Psychological
  • Biological Evolution
  • Humans
  • Hydrocortisone / metabolism*
  • Life Change Events*
  • Psychological Theory*
  • Psychology
  • Receptors, Glucocorticoid / metabolism*
  • Stress Disorders, Post-Traumatic / metabolism*
  • Stress Disorders, Post-Traumatic / psychology*

Substances

  • Receptors, Glucocorticoid
  • Hydrocortisone