Acute versus chronic post-traumatic stress disorder.

A photographic lens and filter model is presented which outlines six steps between a person's perception of stressful life events and their possible eventual development of an illness. Persons developing acute post-traumatic stress disorder differ markedly in their processing of early steps in the model compared to those who go on to suffer from chronic post-traumatic stress disorder. Persons with the acute disorder, with high likelihood of recovery, generally have had enriching early life experiences, use psychological defenses to a moderate degree, and demonstrate ample coping capabilities. Those going on to the chronic disorder, who frequently don't recover, often report impoverished early life experiences, employ psychological defenses to an extreme degree, and show a paucity of coping skills. These differences are illustrated by histories from survivors of a terrorist bombing and by observations made by the author of returned prisoners of war and civilian hostages.