Class 6 Flashcards
Psychologically, the bottom line of trauma is a feeling of
utter helplessness.
Women prevalence vs men PTSD
women 2: Men 1
What type of trauma do men usually have
violent perpetrated by non-significant other; physical
What type of trauma do women usually have
violence perpetrated by significant other; sexual
x% of Canadian adults report some form of abuse before age 16
32%
Most prevalent form of childhood abuse
neglect
Prevalance of child abuse in mental health patients
70%
Automatic Response to Threat
12 msec: cortisol adrenaline =BP/ HR, blood flow, oxygenation, glucose
Cascade of survival responses
attach cry, flight, fight, freeze, feigned death
If the body has used an immobilizing defense,
, the nervous system does not get a cue to turn off
Amygdala keeps firing to signal persistence of threat
Catecholamines continue to be secreted, long after the threat has passed
3 main parts of brain
Humain brain: cortex, rational thinking
Mammal brain: limbic system, emotions
Reptile brain: brainstem, automatic response
Under threat, in the brain
limited access to prefrontal cortex, the reptile brain is running the show. The link between the amygdala and the hippocampus is broken. The memory gets stored in the implicit memory system by the amygdala where they’re encoded as sensations, smells, sounds, images, tastes, emotions, fragments of events
instead of in the explicit memory system in the hippocampus.
Usually brain encodes memory:
sensory input= thalamus= amygdala=hippocampus= prefrontal cortex
Amygdala has direct connection to
reptilian brain through hpa axis
After the encoded of the memory in the implicit memory system, the amygdalae acts like
a smoke detector, it sounds the alarm whenever it detects anything resembling the trauma
Truncated mobilizing defenses
Catecholamines
Hyper-responsive catecholamine system
↓ Cortisol
Hypo-responsive HPA axis
Hypervigilance
Increased startle
Hyperarousal
PTSD fMRI Findings
Smaller hippocampus Reversible with treatment Hyper-responsive amygdala During Flashbacks: R brain > L brain ↑ amygdala ↑ visual cortex ↓ Broca’s area
PTSD name all symptoms + number needed + specifiers
Intrusion: 1 Memories Flashbacks Nightmares Distress with triggers
Avoidance: 1
Internal (memories, thoughts, feelings)
External (people, places, situations)
Mood/ cognition:2
Amnesia
Neg. beliefs (“I’m bad,” “World dangerous,” “Trust no-one”)
Self-blame
Persistent negative emotions (fear, anger, guilt, shame)
Difficulty experiencing positive emotions
Diminished interest
Detachment from others
Arousal: 2 Hypervigilance Startle reflex Irritability / aggression Reckless / self-destructive behavior Poor concentration Poor sleep
Specifiers
with dissociative symptoms
with delayed onset
Scales
PCL-5 - PTSD Checklist :20 items, self report, cut-off > 33
IES – Impact of Events Scale - DSM-IV : 22 items, self-report, cut-off > 24
CAPS – Clinician-Administered PTSD Scale :30 items, clinician rated, cut-off > 20
For dissociation:
DES: self-report 28 items
MDI:L self-report 30 items, need to request it
ACE Questionnaire for childhood aversity
Complex PTSD, what kind of trauma
Child abuse, neglect, combat, urban violence, concentration camps, battering relationships, forced dislocation, and enduring deprivation.
Complex PTSD symptoms
Core symptoms of PTSD and: Emotion regulation issues: Self-harm Substance abuse Eating disorders Shoplifting, hoarding, gambling Picking, trichotillomania Outbursts
Relational difficulties: Reenactments Isolation / mistrust Abusive relationships / revictimization Therapeutic ruptures Parenting difficulties
Alteration in consciousness:DID
Adverse belief system:Negative core beliefs (“I’m bad/damaged/worthless”)
Somatic distress: Functional syndromes
Fibromyalgia, chronic pain
Non-epileptic seizures, headaches
