Crisis, Trauma, and PTSD Final Flashcards
Reasons why it is important to understand the technical diagnosis of PTSD
Misdiagnosis is common
Misunderstandings are common
Great reason not to focus on other issues
Serious but treatable when it is present
Typically, NOT present alone
Diagnostic Criterion A
Exposure (exposed to death, threatened death, actually or threatened serious injury, or actual or threatened sexual violence as follows.
Diagnostic Criterion B
Intrusive Symptoms
Diagnostic Criterion C
Persistent effortful avoidance of distressing trauma-related stimuli after the event
Diagnostic Criterion D
Negative alterations in congitions and mood that began or worsened after the traumatic event
Diagnostic Criterion E
Trauma-related alteration in arousal and reactivity that began or worsened after the traumatic event
Conceptualization of PTSD
Might need to be reconceptualized as a spectrum disorder in which several distinct pathological posttraumatic phenotypes are distinguished symptomatically and psycho-biologically
Optimal treatment for one phenotype might not necessarily be the best treatment for another
Acute stress and PTSD
• No mandatory symptoms from any cluster • Nine (or more) of the following (with onset or exacerbation after the traumatic event) o Intrusion (4) o Negative mood (1) o Dissociative (2) o Avoidance (2) o Arousal (5)
Risk factors for PTSD
- Being female
- Being poor
- Less education
- Bad childhood; adverse childhood experiences (ACE)
- Previous psychological problems
- Strength or severity of the trauma
Characteristics of the trauma (NOT in a vacuum)
Greater perceived life threat
Feeling helpless
Unpredictable, uncontrollable events
After the trauma
- Degree of social support
- Degree of life stress
PTSD Profile
- No one clinical picture, but it is not like it is shown on television or movies
- Should NOT stereotype
“Hallmarks” of PTSD
oNightmares oPoor sleep oAnger oNumbness or sadness oAvoidance of groups
BKTS C1 Loss of self
Difficult to engage in intimate relationships
•Hard to trust yourself or anyone else
o Learning to trust = goal (trust self – determination and self)
•Shame
o Objective or misguided – difficulty to confront and address
BKTS C1 Numbing
•Limited repertoire of emotions
o Not always in head/soul, but physiological
o Can’t engage in other emotions in frontal cortex
Physically unable
•A sense of being disconnected
•For many, only able to feel intense emotions, so avoid certain triggers
BKTS C1 Reorganization of Perception
•Trauma is superimposed on everything
o Leads to difficulty discerning what is going on
•Loose “mental flexibility” and access to imagination
o Loss of future orientation – hope
•Pulled back into the past
BKTS C1 Stuck in Trauma
•Questions where to belong
o Those who know (get it, lived it) and those who don’t
o Results in social alienation
o Event becomes source of pain and sole source of meaning (identity)
o Ironically, the ‘brotherhood’ is both a source of connection and a source of social disconnect from other social support
•Fundamentally recognizes the way the mind and brain manages perceptions
•How we think and what we think about as well as our very capacity to think
•In the midst of sharing, unless addressed, the body remains hyper-vigilant
o The body has to learn danger is in the past, I’m in the present
BKTS C2 Inescapable Shock & Learned Helplessness
- Opportunity to escape does not mean freedom
- Secrete stress hormones long after the trauma has passed
- Seek refuge, even in the familiar, even when it is not safe
- Experiencing pain or adversity repeatedly, without finding a way to escape it, will eventually lead to giving up on how to avoid it.
- When someone believes they have no power over anything that happens to them, they continuously act, think, and feel as if they don’t
- This is not a trait anyone is born with; therefore, it is learned over time, through conditioning
BKTS C2 Addicted to trauma
•Attractors – attracted to things that cause pain
•Re-experiencing the trauma
o Exposure can offer relief from the anxiety – sense of release
•Experiencing trauma and pain makes us feel intense emotions and later, when trying to get away from bad or painful stimuli, our body reacts as though it excites us, despite it being harmful
•When replacing scary or painful behaviors with better ones, it may be better to do something that may still scare someone, but is relatively normal and exciting, like sky diving, marathon running, rock climbing, etc.
•Strong emotions can block pain, like veterans in combat not requesting morphine
BKTS C2 Adaptation or Disease
•Brain disease model overlooks 4 fundamental units
o Our capacity to destroy one another is matched by our capacity to heal one another. Restoring relationships and community is central to restoring wellbeing.
o Language gives us the power to change ourselves and others by communicating our experiences, helping us to define what we know, and finding a common sense of meaning
o We have the ability to regulate our own physiology, including some of the so-called involuntary functions of the body and brain, through such basic activities as breathing, moving, and touching
o We can change social conditions to create environments in which children and adults can feel safe and where they can thrive
BKTS C3 Analogy: understanding a car’s engine by studying gasoline
•PET scans and fMRI allowed us to watch the brain as it processed memories, sensations and emotions and begin to map the circuits of mind and consciousness. The earlier technology of measuring brain chemicals like serotonin or norepinephrine had enabled scientists to look at what fueled neural activity, which is like trying to understand the car’s engine by studying the gasoline. Neuroimaging lets us see inside the engine.
BKTS C3 Speechless Horror
- Lose ability to talk a lot about feelings/situation
- Can’t relay what happened to them
- Without functioning, you cannot put your thoughts into words (Broca’s area)
BKTS C3 Shifting to One Side of the Brain
•Lost left (logical) side of brain
•Unable to rationalize
o Blame others
•Normal: both sides work together seamlessly to give us a cohesive experience
•Left communicates through speech
o Explains experience and order
•Impacts capacity to organize and translate feelings and perceptions into words
•Right communicates through non-verbal
o Memories of sounds, touch, smell
o Experiences pass trauma in present
BKTS C3 Stuck in Fight or Flight
- Stay in this after event
- Retriggers through memories
- Mind has forgotten but body still remembers and acts on it
- Normal: temporary then leaves
- Trauma: longer to go back, maybe never until the issue is resolved
- Body continues to “keep score”
