5 - Trauma and Stressor Related Disorders Flashcards
What is in the DSM-5 chapter under Trauma and Stressor Related Disorders?
- Reactive Attachment Disorder
- Disinhibited Social Engagement Disorder
- Posttraumatic Stress Disorder
- Acute Stress Disorder
- Adjustment Disorders
Describe Reactive Attachment Disorder.
- Develops as a response to social neglect in childhood
- Children are unable to develop healthy attachments
- Usually seen with abuse situations
- Children are unable to form healthy, caring attachments
Describe Disinhibited Social Engagement Disorder.
- Children have a disturbed model of relating to others, due to growing up in neglectful situations.
- Indiscriminate and excessive attachments.
Describe Adjustment Disorders.
Exposure to a stressful (NOT traumatic) event, which individual is not able to adjust to, adversely affecting their life.
What are common elements of Trauma and Stressor Related Disorders?
- Exposure to trauma or distress (clearly defined)
- Reaction involves anxiety as well as other symptoms
- Some reactions make sense in relation to the stressor eg avoidance, others are less clearly related eg anxiety, depression, externalising, anger, self-destructive behaviours, dissociative features
What are the diagnostic criteria of PTSD according to DSM-5? (A-E) How long must the symptoms last for a diagnosis?
A. Exposure to actual danger or threat B. Intrusion Symptoms C. Persistent avoidance of Stimuli D. Negative changes in cognition, mood. E. Changes in arousal, reactivity Must last for 1 month or more.
Explain the criteria for exposure to trauma.
Exposure to; actual or threatened death, serious injury, sexual violence by;
- direct experience
- witnessing in person, the events as it occurred to others
- learning the event happened to a close friend or family member
- experiencing repeated extreme exposure to aversive details of traumatic events (eg first responders collecting human remains, police exposed repeatedly to details of child abuse)
Give examples of the intrusion symptoms required to diagnose PTSD. How many are required?
One or more needed.
- recurrent, involuntary, intrusive distressing memories
- recurrent dreams related to event
- dissociative reactions (eg flashbacks) where the individual feels the event is occurring again
- intense/prolonged psychological distress at exposure to internal/external reminders
- marked psysiological reactions to internal/external reminders
Explain the avoidance criterion for PTSD. How many are needed for a diagnosis?
One or more of avoidance of, or avoidance to;
- distressing memories, thoughts, feelings closely associated with the event
- external reminders (people, places, conversations, activities, objects, situations)
Give examples of negative alterations on mood in the diagnosis of PTSD. How many are needed for a diagnosis?
Two or more of the following:
- inability to remember important aspects of the event (due to dissociative amnesia NOT alcohol or drug use)
- persistent and exaggerated negative beliefs about oneself, others or the world after event
- negative emotions such as fear/horror/guilt/shame
- persistent distorted cognitions about causes/consequences of event that lead individual to blame themselves or others
markedly diminished interest or participation in significant activities
- feelings of detachment or estrangement from others
- persistent inability to experience positive emotions
Give examples of marked alterations in arousal and reactivity in diagnosing PTSD. How many are needed in a diagnosis?
Two or more of:
- irritable behaviour/angry outbursts expressed verbally or physically towards people or objects
- reckless or self destructive behaviour
- hypervigilance
- exaggerated startle response
- problems concentrating
- sleep disturbance
What could significant symptoms before the 1 month mark be indicative of?
Acute Stress Disorder.
60-70% who are diagnosed with acute stress disorder go on to develop PTSD. Treating acute stress disorder reduces development of PTSD.
Describe Acute Distress Disorder.
Similar to PTSD, lasting 3 days to 1 month, with an emphasis on dissociative symptoms; depersonalisation, derealisation, numbing, reduced awareness, dissociative amnesia
Describe the prognosis of immediate post-trauma phase.
- Approx 60% experience trauma.
- PTSD 12 month prevalence is 1-4%
- About 10-20 (women) and 6-8% (men) develop PTSD following trauma exposure.
- Distress is a normal reaction to trauma. In 75% of cases, distress is significantly decreased at 3 months, and critical incident debriefing can make matters worse.
What are some risk factors for later symptoms?
- Pre-trauma factors include; childhood trauma, prior psychiatric history, family instability, substance abuse and social/economic disadvantage
- Trauma factors; degree of threat/loss, severity of exposure to traumatic elements, location of trauma (eg happening in a safe place vs elsewhere), individuals role in the trauma (victim, helper), meaning (assigned to the trauma)
- Post-trauma factors; social support, coping style (avoidant tends to be associated with substance use, dissociation also has a poor prognosis), ongoing stressors.
