Psychosomatics 44:523-524, December 2003
© 2003 The Academy of Psychosomatic Medicine
Benzodiazepine Exposure and History of Trauma
Randy A. Sansone, M.D.,
Judith Hruschka, M.D.,
Archana Vasudevan, M.D., Miamisburg, Ohio, and
Stephanie N. Miller, Muncie, Ind.
TO THE EDITOR: Benzodiazepine therapy may cause cognitive impairment;1–4 we wondered about the relationship between benzodiazepine use and past trauma (i.e., using benzodiazepines to  blot out painful recollections). The few available studies indicate that benzodiazepine abuse may be common among veterans with posttraumatic stress disorder5 and that chronic benzodiazepine use among the elderly is associated with alcohol dependence and borderline personality disorder6 (repeatedly associated with early developmental trauma7). Given the preceding, we hypothesized that there might be a relationship between benzodiazepine use and trauma.
Using a sampling method of convenience, we recruited male and female subjects, ages 18 and older, who were being seen for nonemergent primary care services in an outpatient medicine clinic. Exclusion criteria were cognitive or medical impairment that would preclude survey participation. Of the 68 individuals approached, 53 agreed to participate (rate of response=78%).
Each participant completed a research booklet that explored demographic information and lifetime exposure to benzodiazepines (i.e., number of different benzodiazepines ever taken, as well as total months of lifetime exposure). Participants also completed the Traumatic Life Events Questionnaire,8 a 23-item measure that explores exposure to traumatic events, such as natural disasters, motor vehicle accidents, physical violence, and sexual abuse. For each event experienced, respondents indicate the number of times and whether there was associated intense fear, helplessness, or horror. This measure is reported as valid, with acceptable test-retest reliability.8
The study group consisted of 40 women (75%) and 13 men, ages 20 to 82 (mean=45.26, SD=12.74); six participants did not indicate age. Approximately 42% were married, 30% single, 27% separated or divorced, and 2% widowed. Approximately 89% were Caucasian, 9% African American, and 2% Native American. Ten patients (20% of the entire sample) had completed a college degree. In correlations among measures of benzodiazepine use and trauma variables from the Traumatic Life Events Questionnaire, we calculated the following for 53 subjects. With the number of different benzodiazepines ever taken as a covariate, results were as follows: number of different traumatic life events reported: r=0.31, p<0.05, number of traumatic life events reported: r=0.51, p<0.001; number of traumatic life events associated with fear, helplessness, or horror: r=0.32, p<0.05. With length of benzodiazepine exposure as a covariate, results were the following: number of different traumatic life events reported: r=0.22; number of traumatic life events reported: r=0.11; total number of traumatic life events associated with fear, helplessness, or horror: r=0.29, p<0.05.
Note that the number of different traumatic experiences, the number of traumatic experiences, and the number of traumatic experiences associated with intense fear, helplessness, or horror were all significantly related to the number of benzodiazepines ever taken. The strongest correlation was between the number of traumatic experiences and the number of benzodiazepines ever taken. As for length of exposure to benzodiazepines, only the number of traumatic experiences associated with fear, helplessness, or horror was statistically significant.
These findings suggest that benzodiazepine use among patients in a primary care setting is associated with some aspects of trauma. While various neurotransmitter theories of trauma might be invoked to explain this relationship, we wonder if the cognitive characteristics of benzodiazepines offer some type of protection against reexperiencing among those exposed to traumas that were particularly emotionally intense. However, as an alternative explanation, these data might also indicate physicians' prescribing attitudes for posttraumatic states as well as misconceptions about benzodiazepine efficacy in posttraumatic stress disorder (i.e., lackluster performance9). Clearly, further research into this area is warranted.
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