1
TRMA-830: TRAUMA CASE STUDY – CIVILIAN ROSE A
Comprehensive Trauma Assessment and Treatment Plan
Danny Streeter
School of Behavioral Science, Liberty University
TRMA-830
Author Note
Danny Streeter
I have no known conflict of interest to disclose.
Table of Contents
Section Page
Brief Summary 3
Introduction 4
Literature Review: Cumulative Trauma and PTSD 6
Case Presentation 10
Assessment Findings 13
Diagnostic Formulation 15
Differential Diagnosis 17
Trauma-Informed Conceptualization 18
Treatment Recommendations 20
Prognosis and Follow-Up 22
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Section Page
Ethical and Cultural Considerations 23
Conclusion 24
References 25
Appendices 28
Brief Summary
Rose is a 38-year-old mother of three. She works full-time as a pharmaceutical representative to medical
doctors in her region. Rose is in good health; she runs on her days off and works in her garden. Rose has
submitted today to a Beck Depression Inventory-2 with a score of 33 (severe depression), a Beck Anxiety
Inventory with a score of 15 (mild to moderate anxiety), and a Mini-Mental Status Exam with a score of
28 (normal cognitive functioning). Rose discusses some of her life experiences beginning from her
childhood. She discusses moving around a lot because her father was part of the diplomatic corps of the
State Department. Rose recalls her memories at 10 years old in Turkey, witnessing a bomb explosion
destroying a café nearby and seeing dead bodies of adults and children from their balcony. She
describes seeing incredible amounts of blood and having occasional nightmares. She also describes the
destruction of an earthquake in Tokyo at 12 years old. Rose continues by stating that around 15 years
old in Paris, France, she witnessed a demonstration that left some of the demonstrators badly beaten
and bleeding by the police. Rose was a good student in school and did not use drugs or alcohol.
Rose describes having a motor vehicle accident after hitting a slick spot on the highway. She states she
hit several vehicles and ended up landing in a drainage ditch upside down. Rose states that the top of
the car was crushed on her neck and head, making it difficult to breathe; “she said she felt like she was
suffocating.” Rose states that two weeks ago she started to have repeated dreams of the crash,
especially hanging upside down. Rose states her dreams began to interfere with her sleep. She calls her
dreams nightmares. Rose states she started to have daily flashbacks or memories of the accident. Rose
states her flashbacks or memories cause distress at work; this distress causes her to take a walk outside
or take a sick day from work. Rose states she began to avoid driving near the site of the accident and has
become hypervigilant while driving, constantly checking her mirrors and tensing up when another
vehicle approaches.
Introduction
Trauma exposure is a pervasive public health concern, with the majority of adults experiencing at least
one potentially traumatic event during their lifetime (Kilpatrick et al., 2013). For a subset of individuals,
, 3
exposure to trauma—particularly when it is severe, prolonged, or cumulative—can lead to
posttraumatic stress disorder (PTSD), major depressive disorder, anxiety disorders, and significant
functional impairment. Rose’s case is emblematic of a growing clinical reality: many adults present not
with a single traumatic event but with a lifetime accumulation of diverse traumatic experiences, ranging
from childhood exposure to community violence and natural disasters to adult-onset motor vehicle
accidents. The compounding effect of these events, often referred to as cumulative trauma or
polyvictimization, can amplify psychological distress and complicate both diagnosis and treatment
(Cloitre et al., 2009).
The purpose of this case study is to provide a comprehensive clinical analysis of Rose, a 38-year-old
woman who has experienced multiple traumatic events across her lifespan. Using a trauma-informed
lens, this paper will (a) review relevant literature on cumulative trauma, PTSD, and associated
comorbidities; (b) present a detailed case formulation based on Rose’s history and current presentation;
(c) discuss differential diagnostic considerations; (d) propose an evidence-based treatment plan; and (e)
address ethical and cultural factors relevant to her care. The case is grounded in the current diagnostic
criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision
(DSM-5-TR; American Psychiatric Association [APA], 2022) and incorporates best practices from the field
of traumatic stress studies.
Rose’s presentation is particularly instructive because it highlights the interaction between early-life
trauma exposure (witnessing violence and disaster) and a recent, life-threatening event (a severe motor
vehicle accident with a sensation of suffocation). Her symptom constellation—nightmares, flashbacks,
avoidance, hypervigilance, and significant depressive symptoms—raises important questions about
whether her current difficulties represent a delayed exacerbation of earlier trauma, a new-onset PTSD
secondary to the accident, or a complex posttraumatic condition shaped by cumulative adversity. By
examining Rose’s case in depth, this study aims to inform clinicians about assessment strategies and
treatment planning for individuals with a history of polyvictimization.
Literature Review: Cumulative Trauma and PTSD
Epidemiology of Trauma Exposure
Epidemiological studies consistently demonstrate that exposure to traumatic events is common. The
National Comorbidity Survey Replication (NCS-R) found that approximately 89.7% of adults have
experienced at least one DSM-IV Criterion A traumatic event (Kilpatrick et al., 2013). The most
frequently reported events include witnessing violence, accidents, and natural disasters. Importantly,
multiple exposures are the norm rather than the exception; the same survey indicated that among those
with any trauma exposure, the mean number of event types was 3.6. Rose’s history of witnessing a
bombing, an earthquake, a violent demonstration, and a serious motor vehicle accident is therefore not
unusual but does place her in a higher-risk category for adverse mental health outcomes.
Cumulative Trauma and Its Consequences
Research on cumulative trauma—also referred to as polyvictimization, multiple trauma exposure, or
complex trauma—has established a dose-response relationship between the number of traumatic
events and the severity of posttraumatic symptoms (Suliman et al., 2009). Individuals with a history of
TRMA-830: TRAUMA CASE STUDY – CIVILIAN ROSE A
Comprehensive Trauma Assessment and Treatment Plan
Danny Streeter
School of Behavioral Science, Liberty University
TRMA-830
Author Note
Danny Streeter
I have no known conflict of interest to disclose.
Table of Contents
Section Page
Brief Summary 3
Introduction 4
Literature Review: Cumulative Trauma and PTSD 6
Case Presentation 10
Assessment Findings 13
Diagnostic Formulation 15
Differential Diagnosis 17
Trauma-Informed Conceptualization 18
Treatment Recommendations 20
Prognosis and Follow-Up 22
,2
Section Page
Ethical and Cultural Considerations 23
Conclusion 24
References 25
Appendices 28
Brief Summary
Rose is a 38-year-old mother of three. She works full-time as a pharmaceutical representative to medical
doctors in her region. Rose is in good health; she runs on her days off and works in her garden. Rose has
submitted today to a Beck Depression Inventory-2 with a score of 33 (severe depression), a Beck Anxiety
Inventory with a score of 15 (mild to moderate anxiety), and a Mini-Mental Status Exam with a score of
28 (normal cognitive functioning). Rose discusses some of her life experiences beginning from her
childhood. She discusses moving around a lot because her father was part of the diplomatic corps of the
State Department. Rose recalls her memories at 10 years old in Turkey, witnessing a bomb explosion
destroying a café nearby and seeing dead bodies of adults and children from their balcony. She
describes seeing incredible amounts of blood and having occasional nightmares. She also describes the
destruction of an earthquake in Tokyo at 12 years old. Rose continues by stating that around 15 years
old in Paris, France, she witnessed a demonstration that left some of the demonstrators badly beaten
and bleeding by the police. Rose was a good student in school and did not use drugs or alcohol.
Rose describes having a motor vehicle accident after hitting a slick spot on the highway. She states she
hit several vehicles and ended up landing in a drainage ditch upside down. Rose states that the top of
the car was crushed on her neck and head, making it difficult to breathe; “she said she felt like she was
suffocating.” Rose states that two weeks ago she started to have repeated dreams of the crash,
especially hanging upside down. Rose states her dreams began to interfere with her sleep. She calls her
dreams nightmares. Rose states she started to have daily flashbacks or memories of the accident. Rose
states her flashbacks or memories cause distress at work; this distress causes her to take a walk outside
or take a sick day from work. Rose states she began to avoid driving near the site of the accident and has
become hypervigilant while driving, constantly checking her mirrors and tensing up when another
vehicle approaches.
Introduction
Trauma exposure is a pervasive public health concern, with the majority of adults experiencing at least
one potentially traumatic event during their lifetime (Kilpatrick et al., 2013). For a subset of individuals,
, 3
exposure to trauma—particularly when it is severe, prolonged, or cumulative—can lead to
posttraumatic stress disorder (PTSD), major depressive disorder, anxiety disorders, and significant
functional impairment. Rose’s case is emblematic of a growing clinical reality: many adults present not
with a single traumatic event but with a lifetime accumulation of diverse traumatic experiences, ranging
from childhood exposure to community violence and natural disasters to adult-onset motor vehicle
accidents. The compounding effect of these events, often referred to as cumulative trauma or
polyvictimization, can amplify psychological distress and complicate both diagnosis and treatment
(Cloitre et al., 2009).
The purpose of this case study is to provide a comprehensive clinical analysis of Rose, a 38-year-old
woman who has experienced multiple traumatic events across her lifespan. Using a trauma-informed
lens, this paper will (a) review relevant literature on cumulative trauma, PTSD, and associated
comorbidities; (b) present a detailed case formulation based on Rose’s history and current presentation;
(c) discuss differential diagnostic considerations; (d) propose an evidence-based treatment plan; and (e)
address ethical and cultural factors relevant to her care. The case is grounded in the current diagnostic
criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision
(DSM-5-TR; American Psychiatric Association [APA], 2022) and incorporates best practices from the field
of traumatic stress studies.
Rose’s presentation is particularly instructive because it highlights the interaction between early-life
trauma exposure (witnessing violence and disaster) and a recent, life-threatening event (a severe motor
vehicle accident with a sensation of suffocation). Her symptom constellation—nightmares, flashbacks,
avoidance, hypervigilance, and significant depressive symptoms—raises important questions about
whether her current difficulties represent a delayed exacerbation of earlier trauma, a new-onset PTSD
secondary to the accident, or a complex posttraumatic condition shaped by cumulative adversity. By
examining Rose’s case in depth, this study aims to inform clinicians about assessment strategies and
treatment planning for individuals with a history of polyvictimization.
Literature Review: Cumulative Trauma and PTSD
Epidemiology of Trauma Exposure
Epidemiological studies consistently demonstrate that exposure to traumatic events is common. The
National Comorbidity Survey Replication (NCS-R) found that approximately 89.7% of adults have
experienced at least one DSM-IV Criterion A traumatic event (Kilpatrick et al., 2013). The most
frequently reported events include witnessing violence, accidents, and natural disasters. Importantly,
multiple exposures are the norm rather than the exception; the same survey indicated that among those
with any trauma exposure, the mean number of event types was 3.6. Rose’s history of witnessing a
bombing, an earthquake, a violent demonstration, and a serious motor vehicle accident is therefore not
unusual but does place her in a higher-risk category for adverse mental health outcomes.
Cumulative Trauma and Its Consequences
Research on cumulative trauma—also referred to as polyvictimization, multiple trauma exposure, or
complex trauma—has established a dose-response relationship between the number of traumatic
events and the severity of posttraumatic symptoms (Suliman et al., 2009). Individuals with a history of
