12. PTSD Flashcards
PTSD criterion A
the person was exposed to the following: death, threatened death, actual or threatened serious injury, actual or threatened sexual violation in one or more of the following:
- experiencing the event themself
- witnessing
- learning the event occurred to a close relative/friend
- experiencing repeated or extreme exposure to aversive details of event
PTSD criterion B
intrusion symptoms associated with traumatic event, began after event, evidenced by one or more of:
recurrent involuntary intrusive distressing memories of traumative event
recurrent distressing dreams in which content or affect is related
dissociative reactions (flashbacks) where they feel or act as if the traumatic event were occurring
intense or prolonged psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the event
marked physiological reactions to reminders
PTSD criterion C and D
C: persistent avoidance of associated stimuli and numbing general responsiveness not present before trauma, indicated by three or more of:
efforts to avoid thoughts, feeleings, conversations associated
efforts to avoid activies, people or places associated
D: negative alternations in cognition and mood that began or worsened after the event, evidenced by 2 or more of:
inability to remember important aspect of traumatic event (dissociative amnesia, not due to head injury, drugs, etx. )
persistent and exaggerated negative expectations about self others and world
persistent distorted blame of self or others about the cause or consequences of traumatic event
pervasive negative emotional state
diminished interest in activities
detachment and estrangement from others
inability to experience positive emotions
PTSD criterions E and F
E. Alterations in arousal and reactivity as evidenced by three or more of:
irritable, angry, aggressive
self destructive, reckless
hypervigilance
exaggerated startle response
problems with concentration
sleep disturbance
F. Duration > 1 MO
G. significant distress
H. Not attributable to physiological effects of substance/medical condition
PTSD Specifiers
with dissociative symptoms:
- depersonalisation
- derealisation
neither due to substance or medical condition
with delayed expression: full diagnostic criteria not met until 6MO later
depersonalisation
persistent or recurrent experiences of feeling detached from, and as if one were an ourside observer of one’s mental process or bodye
derealisation
persistent or recurrent experiences of unreality of surroundings
ASD DSM 5
A. exposure to actual or threatened death, injury, sexual violation in same ways as PTSD
Presence of 9 or more of the symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance and arousal, beginning or worsening after the traumatic event occurred
pre-trauma risk factors PTSD
tendency towards anxiety and depression
prior psychiatric history
prior trauma history
PTSD peri-trauma risk factors
level of exposure to trauma both real and perceived
degree of life threat, exposure to others suffering etc.
predictability and controllability
peritraumatic dissociation and arousal
PTSD post trauma risk factors
stressful life events
level of social support: validation of experience, opportunities to process the trauma, more balanced appraisals of self and world
assessment
pre traumatic history
family history
traumatic scenario
post trauma scenario
MSE (particularly any disparity between thought content and affective response during interview
Psychometric assessments: clinician administered interviews (most preferred); trauma specific self report measures; psychophysiological assessment
Forensic assessment
theoretical rationale important
promotes compliance and sense of control over the exposure in particular
theoretical rationale
normalcy of anxiety and stress response- state that what the clients first felt after trauma was a normal reaction to an un-normal event. But these feelings are now causing much distress and interfering in their day to day functioning
Adaptive functions of anxiety- alerting signal of unknown, vague or conflictual threat
biological basis of the anxiety response: perceived threat - ANS arousal via nerve fibres, SNS releases adrenaline and noradrenaline powering up body, then results in somatic changes. Physical sensations related to FFF. Anxiety overload- body can’t keep increasing anxieyt because other enzumes eventually break down adrenaline and destroy it; PSNS kicks in for homeostasis of adrenalinee
explanation of treatment rationale for PTSD and anxiety
3 major components of anxiety
physical: recognise the forms it takes and identify tension building up in body. once this has been achieved, can control sensations before they become excessive and use strategies to reduce them
Mental: recognising unadaptive and self deefeating thinking important in gaining control over them and mastering the situation
Behavioural: by identifying avoidance reactions and practicing new ways of responding you will have less restrictive life
“therefore we will be discovering new coping strategies for the way you think when under stress and putting unwanted thoughts out of your ming, what you do to control the stress and new methods of reacting to situations that you presently avoid”
then may explain Mowrer’s two factor theory but only if client able to follow: credibility check or intellectualisation aspect to avoidance
