5 Trauma- and Stressor Related Disorders: Post-traumatic Stress Disorder 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 and usually seen with abuse situations
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 the 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.
What is Post-Traumatic Stress Disorder (PTSD)?
Extreme stress response after exposure to a traumatic event
- Event must include threatened or actual harm to the self/others
- Response to a wide range of traumatic events
What is the PTSD Diagnosis Criteria in DSM?
- Duration of the disturbance (B, C, D, & E) more than one month
- Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The disturbance is not attributable to the physiological effects of a substance
What are the specifiers of PTSD Criteria in DSM?
Specify whether:
- With dissociative symptoms
- With delayed expression
- A poorer prognosis - so it’s specified
Explain the criterion for exposure to trauma and which criterion it is
Criterion A
- Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
1. Directly experiencing
2. Witnessing, in person, as it occurred to others
3. Learning that the traumatic event(s) occurred to family or friend (either violent or accidental)
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event
Give examples of the intrusion symptoms required to diagnose PTSD. How many are required?
One or more needed (Criterion B)
- Recurrent, spontaneous and intrusive memories
- Recurrent distressing dreams
- Acting or feeling as if the event were recurring (flashbacks)
- Psychological distress
- Marked physiological arousal to internal or external reminders
What is an external cue in Criterion B?
In the environment that elicits the symptoms
What is an internal cue in Criterion B?
Not anywhere near the environment and have a thought
Explain the avoidance criterion for PTSD. How many are needed for a diagnosis?
One or more of the following: (Criterion C)
- Memories etc, or external reminders of the event
1. Avoidance of trauma-related thoughts and feelings, and/or
2. Avoidance of trauma-related external reminders
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: (Criterion D)
- Fear, negative beliefs about self, others, the world
1. Unable to recall key features of the trauma
2. Exaggerated negative beliefs/expectations about oneself/others/world
3. Distorted blame of self or others
4. Persistent negative emotions
5. Markedly diminished interest (ore-traumatic) in significant activities
6. Feeling alienated from others
7. 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 the following: (Criterion E)
- Anger, recklessness, self-destructive acts, sleep disturbance
1. Reckless or self-destructive behaviour
2. Irritable behaviour and angry outbursts
3. Hypervigilance
4. exaggerated startle response
5. Problems with concentration
6. 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 the development of PTSD.
Which disorder is not a current diagnosis in DSM 5?
Complex Trauma/PTSD
- Repeated, cumulative experiences in childhood of a mis-attuned environment
- Most commonly with replayed through the attachment relationship
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
What are the chances of developing PTSD after one has witnessed a trauma?
Post-traumatic reaction lasting up to 1 month
i.e. Symptoms resolve within a month
if they don’t: change the diagnosis to PTSD
Describe the prognosis of immediate post-trauma phase. (Epidemiology)
- Approx 60% experience trauma -> about 10-20% of women and 6-8 of men develop PTSD
What is the comorbidity with of those that develop PTSD following trauma exposure?
Comorbidity with depression, anxiety and substance abuse disorders
What is the normative response to trauma?
To recover
- People are distressed immediately after trauma and this is a perfectly normal reaction. Distress drops substantially within 3 months in about 75% of the people.
What are some risk factors for later symptoms at the pre-trauma level?
They load on someone’s risk on developing PTSD aka loads on coping resources
- Childhood trauma
- Psychiatric history
- Family Instability
- Substance abuse
- Social/economic disadvantage
What are some risk factors for later symptoms at the trauma level?
Characteristic of the terrible thing that has happened
- 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 (e.g. uncontrollability)
What are some risk factors for later symptoms at the post-trauma level?
Meaning they will derive from the traumatic event
- Social support
- Coping Style
- Ongoing stressors
What is the difference between Acute Stress Disorder and PTSD criteria in the DSM?
The difference between ASD and PTSD is that ASD you have dissociative symptoms as a cluster while in PTSD it was a specifier. The reason for this is because of depersonalization and derealization and the poor prognostic value
What is it called when one is debriefed after a traumatic incident within 48-72 hours after the event?
Critical Incident Stress Debriefing
- Encouraged to express feelings
- No evidence for the effectiveness
What evidence did Gist & Devilly (2002) find for the Critical Incident Stress Debriefing?
There was a paradoxical effect
- Assumption: problems will develop if no intervention immediately post-trauma
- Do not allow natural coping strategies to work
What is the manner of causation for PTSD?
The combination of predisposing, cognitive, learning and biological factors leading to PTSD development
- Pre-disposing factors->trauma->Maladaptive appraisals or fear conditoning-> avoidance strategies -> Impaired extinction -> PTSD
What are the assessment tools for PTSD?
Life Events Checklist for DSM-5 (Lec-5 Weathers et al., 2013) for Criterion A
PTSD Checklist for DSM-5 (PCL-5, Weathers et al., 2013) for Criterion B,C,D,E
Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)
- Make a current diagnosis of PTSD, lifetime diagnosis of PTSD and assess PTSD symptoms over the past week
What is the pharmacological treatment for PTSD?
Antidepressants (SSRI’s)
What are the psychological treatments for PTSD?
Cognitive Behavioural Therapy (Trauma-focused CBT)
- Psycho-education
- Anxiety management techniques
- Cognitive restructuring
- Prolonged (imaginal/in vivo) exposure
- Relapse Prevention
- Duration 9-12 months
What does psycho-education in CBT include?
How normal it is to develop this PTSD?
What does anxiety management techniques in CBT include?
Manage distress a little bit better
What does cognitive restructuring in CBT include?
Targeting beliefs of one’s self and the world
What does prolonged (imaginal/in vivo) exposure in CBT include?
Vividly imagining the traumatic event for extended periods and progressing this imaginary exposure to vivid exposures
What is the therapist’s role in Prolonged exposure for CBT?
Recall trauma in present tense from beginning to end and role of therapist is to anchor the person in the traumatic memory to emotionally process what happened
What did Harvey et al., 2003, conclude about the treatment of PTSD?
CBT: more effective than medication or supportive psychotherapy (Harvey et al., 2003)
What did Bryant et al., 1999, conclude about the treatment of PTSD?
Prevention of full-blown PTSD when CBT implemented early
What technique did Shapiro (1989; 1995) state for treatment for PTSD?
Eye Movement Desensitization and Reprocessing (EMDR)
- used to treat a variety of anxiety disorders
- Eye movements are the key components
- EMDR is best seen as an exposure technique
Compare EMDR and Trauma-Focused CBT?
- Equally effective
- Superior to all other psychographics
(Seidler & Wagner, 2006)
