L6: Trauma and Stressor Related Disorders, PTSD

Question 1

Which five Trauma and Stressor Related Disorders are listed in the DSM-5?

Answer 1

• PTSD
• Adjustment Disorders
• Acute Stress Disorder
• Reactive Attachment Disorder
• Disinhibited Social Engagement Disorder

Question 2

What are the 5 criteria required for a diagnosis of PTSD in the DSM-5

Answer 2

A. Exposure to actual or threatened death, serious injury or sexual violence in one or more of the following ways (see following slide)

B. Intrusion Symptoms (1 or more needed) - memories, dreams, flashbacks of the event.

C. Persistent avoidance of stimuli (1+) - memories, etc., or external reminders of the event.

D. Negative changes in cognition, mood (2+) - fear, negative beliefs about self, others, the world.

E. Changes in arousal, reactivity (2+)

F. Duration of symptoms is 1 month or more.

G. Clinically significant distress or impairment.

Question 3

What are the four ways in which the actual or threatened death, sexual violence or serious injury can be experienced?

Answer 3

• Directly experiencing the traumatic event/s.
• Witnessing, in person, the event as it occurred to others.
• Learning that the traumatic event occurred to a close family member or close friend. In the case of the actual or threatened death of a family or friend, the actual or threatened death must have been violent or accidental.
• Experiencing repeated or extreme exposure to aversive details of the traumatic events, e.g. first responders collecting human remains, police repeatedly exposed to details of child abuse.

Question 4

What are the five kinds of intrusion symptoms (1+ needed)?

Answer 4

• Recurrent, involuntary, intrusive, distressing memories.
• Recurrent, distressing dreams related to the event/s.
• Disocciative reactions (e.g. flashbacks), the individual feels or acts as though the traumatic event was reccuring.
• Intense or prolonged psychological distress at exposure to internal or external cues that are reminders of the traumatic event/s.
• Marked physiological reactions to internal or external cues that are reminders of the traumatic event/s.

Question 5

Describe the two avoidance symptoms (1+ needed).

Answer 5

• Avoidance of, or efforts to avoid, distressing memories, thoughts, or feelings, about or closely related with the traumatic events.
• Avoidance of or efforts to avoid external reminders (people, places, objects, activities, conversations, situations) that arouse distressing thoughts, feelings, or memories about or closely related with the traumatic events.

Question 6

Describe the 7 possible negative alternations in cognition or mood (2+ needed).

Answer 6

• Inability to remember an important aspect of the event(s) (due to dissociative amnesia, not to other factors such as injury, alcohol).
• Persistent and exaggerated negative beliefs about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted”).
• Persistent, distorted cognitions about the causes/consequences of the event(s) that lead the individual to blame him/herself or others.
• Persistent negative emotions (e.g., fear, horror, anger, guilt, shame).
• Markedly diminished interest or participation in significant activities.
• Feelings of detachment or estrangement from others.
• Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

Question 7

What are the 6 alterations in arousal and reactivity (2+ needed)?

Answer 7

• Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
• Reckless or self-destructive behavior.
• Hypervigilance.
• Exaggerated startle response.
• Problems with concentration.
• Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

Question 8

Describe the features of Acute Stress Disorder and how it relates to PTSD.

Answer 8

• Occurs within 3 days to 4 weeks of traumatic event
• Posttraumatic reaction lasting up to 4 weeks
  ◦i.e., symptoms resolve within 4 weeks.
  ◦if they don’t: change diagnosis to PTSD

- More emphasis on dissociative symptoms
◦depersonalisation,
◦derealisation,
◦numbing,
◦reduced awareness,
◦dissociative amnesia

Question 9

What percentage of people experience a traumatic event in their lives (as defined in PTSD criteria)?

Answer 9

• 60%

Question 10

What is the 12 month prevalence of PTSD?

Answer 10

1-4%

Question 11

What percentage of men and women develop PTSD following trauma exposure?

Answer 11

• 10-20% of women, 6-8% of men

Question 12

In what percentage of people does distress in response to a traumatic event drop substantially within 3 months?

Answer 12

75%

Question 13

What are 5 pre-trauma risk factors for PTSD?

Answer 13

• childhood trauma
• prior psychiatric history
• family instability
• substance abuse
• social/economic disadvantage

Question 14

What are 5 trauma risk factors for PTSD?

Answer 14

• Degree of life threat (injury/death) or
• Severity of exposure to traumatic elements
• Location of trauma (safe place vs. elsewhere)
• individual’s role in the trauma (helper/victim)
• meaning assigned to event (uncontrollability)

Question 15

What are three post-trauma risk factors for PTSD?

Answer 15

• coping style
• social support
• ongoing stressors