L6 - Trauma & Stressor-related Disorders

Question 1

List some DSM Trauma & Stressor Related Disorders:

Answer 1

• PTSD
• Acute Stress Disorder
• Adjustment Disorder
• Reactive Attachment Disorder (childhood).
• Disinhibited Social Engagement Disorder (childhood).

Question 2

What are the criteria for a DSM-5 PTSD diagnosis?

Answer 2

A) exposure to actual or threatened death, serious injury, sexual trauma (not through media).
B) Intrusive symptoms.
C) Persistent avoidance.
D) Negative changes in cognition, mood.
E) Marked alterations in arousal. 
≥ 1 month duration

Question 3

What are PTSD intrusions (B)?

Answer 3

• Intrusions may be dreams, flashes, or nightmares of the aversive event.
• Psychological and/or physiological distress of cues/reminders.

Question 4

What is PTSD avoidance (C)?

≥2 necessary.

Answer 4

• Avoidance of memories/feelings/thoughts about events.

- Avoidance of cues (obviously linked or not - generalised).

Question 5

What are the negative changes in cognition, mood (D) in PSTD?
≥2 necessary.

Answer 5

• Memory issues about event - fragmentation.
• Persistent exaggerated negative beliefs about oneself, others, the world - after event.
• Distorted cognitions about causes/consequences of event(s) that lead to self/other blame.
• Decreased interest/participation in significant activities.

Question 6

What is the difference between PTSD and Acute Stress Disorder?

Answer 6

• PTSD like symptoms for < 1 months.
• Symptoms resolve or shift to PTSD diagnosis.
• More emphasis on dissociative symptoms (depersonalisation, derealisation, numbing, reduced awareness, dissociative amnesia).

Question 7

What percentage of Acute Stress diagnosed individuals go on to develop PTSD without treatment?

Answer 7

60-70%

Question 8

What percentage of people experience a traumatic event, and what percentage of them have a normal reduction in stress after 3 months?

Answer 8

About 60% of people experience a traumatic event, however for 75% of them, distress returns to normal after 3 months.

Question 9

What is the prevalence of PTSD?

Answer 9

11% lifetime prevalence.
1-4% 12 month prevalence.
Women: 10-20%; Men: 6-8%.

Question 10

What are the 3 risk factors for later problems of PTSD?

Answer 10

• Pre-trauma
• Trauma
• Post-trauma

Question 11

What are the pre-trauma risk factors for PTSD?

Answer 11

• Childhood traumas
• Prior psychiatric history
• Family instability
• Substance abuse
• Socioeconomic disadvantage

Question 12

What are the trauma risk factors for PTSD?

Answer 12

• Degree of life threat (injury/death)
• Severity of exposure
• Location of trauma (safe place vs. elsewhere)
• Individual’s role in trauma (victim, helper)
• Meaning (uncontrollability)

Question 13

What are the post-trauma risk factors for PTSD?

Answer 13

• Social support (very important)
• Coping style
• Ongoing stressors

Question 14

Who is most likely to develop PTSD?

Answer 14

• Rape victims -> 50-60% (interpersonal events are most likely to lead to PTSD)
• Combat veterans -> 30-40%
• Motor vehicle accidents -> ~10%

Question 15

What are the treatment options for PTSD?

Answer 15

• Biological (benzodiazepines, antidepressants) - usually first,
• CBT

Question 16

What are the core treatment components of CBT for PTSD?

Answer 16

1) Assess suitability (fragility to exposure)
2) Psychoeducation (why/how?)
3) Anxiety management techniques
4) Cognitive restructuring
5) Prolonged exposure (mainly to memories - in present tense)

Question 17

What is a possible problem with CBT for PTSD?

Answer 17

CBT is more effective than medication or supportive psychotherapy, however drop out rates are high.

High drop out rates are likely due to the aversive experience of recalling the event during exposure.

Cessation of medication tends to see the return of symptoms/disorder.