class 3

Question 1

Definition and symptoms of PTSD and acute stress disorder (know the specific DSM-V criteria)

Answer 1

--Intrusion (4) 
Negative Mood (1)
Dissociative Symptoms (2)
Avoidance Symptoms (2)
Arousal Symptoms (5)
Diagnosis requires nine symptoms from any of the five clusters which eliminates DSM-IV-TR requirement of at least three Dissociative symptoms and at least one symptom from other clusters

Question 2

DSM makes adjustments in diagnostic criteria for children under 6 years of age

Answer 2

Trauma Exposure:
In children, disorganized or agitated behavior may be an expression of intense fear, helplessness, or horror
Re-Experiencing:
In young children, repetitive play may occur in which themes or aspects of the trauma are expressed (intrusive thoughts).
In children, there may be frightening dreams without recognizable content (dreams).
In young children, trauma-specific reenactments may occur (flashbacks)

Question 3

History of the diagnosis of PTSD as outlined in Judith Herman’s book

Answer 3

-Judith Herman argues that Freud was forced to renounce this theory because of its radical social implications; that so many women had been sexually abused as children by grown men (and male family members) was not something society could accept at that time. Freud’s male medical colleagues in Vienna were scandalized by the theory and its implied allegations of widespread abuse.

Question 4

Differences in PTSD in children vs. adults

Answer 4

• -children will often demonstrate their experience of trauma and PTSD through their play, drawings, and stories.
• behavioral patterns, including increased irritability, oppossitionality, impulsivity, aggression, and inattention.
• Poor performance in school, social withdrawal, and isolation is common.
• Regressive behaviors such as bedwetting (enuresis and encopresis) or thumb sucking may emerge.
• -Children and adolescents will often have no goals for their future, no fantasies about marriage or career and demonstrate a foreshortened sense of the future.

ADULTS:

Question 5

Factors (risk, protective, etc.) associated with PTSD

Answer 5

Risks:
Psychodynamic: repetition compulsion
Cognitive: cognitive schemas of trauma
Biological: neurotransmitters, structural changes, endocrine dysfunctions
Behavioral: classical learning and failure of extinction
Developmental: interaction between the trauma and meeting the cognitive, social, and emotional milestones of development
Factors:
Type of trauma: single vs. chronic
Dose of trauma: magnitude and severity of the traumatic event
Physical proximity to the event: in general the closer the proximity the more traumatic
Emotional proximity: the closer the child is to the loss emotionally the more risk that they will develop PTSD
Age: some argue that trauma has less effect on younger children (they are wrong – but depends on the type of trauma)
Gender: some studies have found that girls report symptoms more often than boys
Cognitive appraisal factors: did the child think they were in a safe place?, guilt, shame, and extreme fear can contribute
Social factors: family support, SES
-Exposure to previous trauma
Previous diagnosis of anxiety disorder or other psychiatric disorders

Question 6

Other psychiatric illnesses associated with trauma

Answer 6

eating disorders, substance abuse, depression, anxiety, suicidality, dissociation, psychosis

Question 7

Developmental Trauma Disorder (as per readings)

Answer 7

A. Exposure
1. Multiple or chronic exposure to one or more forms of developmentally adverse INTERPERSONAL trauma (e.g. abandonment, betrayal, physical sexual assaults, threats to bodily integrity, neglect, coercive practices, emotional abuse, witnessing violence and death)
. Subjective Experience
(e.g. rage, betrayal, fear, resignation, shame)

Question 8

protective factors

Answer 8

An internal locus of control
A sense of self efficacy and a lack of feelings of helplessness
An optimistic cognitive schema
Social Support / Buffering effect of Caregiver
Lack of ongoing psychosocial stressorsA. Exposure
1. Multiple or chronic exposure to one or more forms of developmentally adverse INTERPERSONAL trauma (e.g. abandonment, betrayal, physical sexual assaults, threats to bodily integrity, neglect, coercive practices, emotional abuse, witnessing violence and death)