Board questions often test which factors predict persistent PTSD symptoms after trauma, especially psychiatric history, social support deficits, and ongoing threat—beyond the traumatic event itself.
A 25-year-old woman presents for treatment following a sexual assault that occurred the previous night. She was also assaulted 2 years ago.
In addition to the preceding sexual assault, what other factors may put this patient at an increased risk of post-traumatic stress disorder (PTSD)?
Answer Options:
In this item, the keyed answer (A) is consistent with current, exam-reliable risk domains, but the remediation cites an outdated (2012) guideline and the answer choices reflect an incomplete set of modern predictors. Current consensus-based guidance (e.g., APA 2017; VA/DoD 2023) emphasizes that pre-trauma psychiatric vulnerability (including prior mental health disorders and self-harm), low social support, and ongoing threat/lack of safety are associated with greater risk of persistent post-traumatic symptoms. Among the offered options, A best matches these repeatedly tested risk factors.
Clinically and on boards, the high-yield concept is that PTSD risk is not determined by trauma exposure alone: prior trauma and psychiatric history plus poor social buffering and continued threat are powerful predictors of chronicity and impaired recovery.
| Option | What It Tests / Implies | Why It’s Wrong Here |
|---|---|---|
| history of mental health difficulties, including self-harm, lack of social support, perception and/or evidence of an ongoing threat | Classic exam cluster: pre-existing mental health issues/self-harm + low support + ongoing threat perception | Best match to widely taught risk domains; includes low social support and threat perception/evidence |
| history of mental health difficulties, including self-harm, perception and/or evidence of an ongoing threat | Same as A but omits social support | Low social support is a key risk amplifier and commonly tested predictor |
| history of mental health difficulties, including self-harm, substance abuse problems, lack of social support, perception and/or evidence of an ongoing threat | Adds substance abuse to A | Substance use may correlate with risk, but this option is “too inclusive” relative to the stem/rationale set and not consistently prioritized in guideline-style summaries |
| substance abuse problems, lack of social support, perception and/or evidence of ongoing threat | Focuses on SUD + low support + threat, omits psychiatric history/self-harm | Pre-existing psychiatric history/self-harm is a major predictor; omission makes it less complete |
| history of mental health difficulties, including self-harm, substance abuse problems, lack of social support, evidence of an ongoing threat | Similar to C but missing “perception” language | The “perception and/or evidence” phrasing is important; PTSD risk relates to perceived ongoing threat even absent objective evidence |
For PTSD after sexual assault, boards repeatedly reward: prior trauma + pre-existing mental health problems + low social support + ongoing threat/safety concerns.
This is a *best-answer completeness* question: multiple options contain true statements, but the key is the option that most closely reproduces the canonical, board-tested cluster of risk factors—especially low social support and perceived ongoing threat, not just psychiatric history alone.
A 29-year-old patient is seen 48 hours after sexual assault. Which factor most increases concern for later PTSD due to impaired recovery conditions?
A 24-year-old sexual assault survivor reports she has told no one, is isolated, and has no supportive relationships in the area. What risk factor is this highlighting?
A 27-year-old patient was sexually assaulted last night. History reveals prior suicide attempt and chronic depression. Which statement best reflects board-relevant PTSD risk?
Which factor is most consistently emphasized across exam-style summaries as increasing PTSD risk after sexual assault?
A 32-year-old sexual assault survivor presents 1 week later with intrusive memories, avoidance, negative mood, and hyperarousal. Which interpretation is most board-accurate?
How would your PTSD risk assessment and follow-up plan differ for (1) a survivor with strong family support and immediate safety vs (2) a survivor who must return to shared housing with the perpetrator and has prior self-harm?
Q1: Which PTSD risk factors are most “board-reliable” after sexual assault?
A: The ABIM/AAFP-style emphasis is on prior trauma, pre-existing mental health problems (including self-harm), low social support, and ongoing threat/safety concerns.
Q2: Why does “perception of ongoing threat” matter if there’s no objective evidence?
A: Boards expect recognition that subjective safety appraisal and continuing stress exposure drive persistence of post-traumatic symptoms and avoidance/hyperarousal.
Q3: Does substance use always need to be included as a risk factor?
A: Substance use can co-occur and worsen outcomes, but exam keys more consistently prioritize psychiatric history + social support + ongoing threat when forced to choose.
Q4: What’s the testable difference between acute stress disorder and PTSD?
A: The ABIM expects duration-based recognition: significant symptoms soon after trauma can be acute stress disorder; PTSD requires persistence beyond the acute window per diagnostic criteria.
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