Lecture 1: Trauma and PTSD I

Question 1

John was involved in a serious car accident about a year ago. On a bright sunny day,
he was hit by another car out of the blue. Nowadays, he still feels anxious when
driving his car, even in perfectly safe circumstances. He only recently realized that
this is mainly the case on sunny days. What is this characteristic of traumatic memory
called, according to Ehlers and Clark (2000)?

Answer 1

Affect without recollection

Question 2

Attributions of failure situations by lonely individuals have several dimensions.
Which of the following is NOT such a dimension?

A. Globality
B. Stability
C. Authenticity

Answer 2

C

Question 3

lifetime prevalence of trauma in students

Answer 3

– Traffic accident: 18.0%
– Non-sexual violence: 10.7%
– Sexual violence: 6.7%
– Other: 39.9%

Question 4

lifetime prevalence ptsd

Answer 4

• Prevalence PTSD: 7.1%
• Prevalence sub-PTSD: 8.0%

Question 5

3 outcomes of psychological trauma

Answer 5

• posttraumatic growth
• natural recovery
• trauma-related complaints or disorders

Question 6

hoeveel komt natural recovery voor

Answer 6

complete recovery within 3 months occuring in approximately one-half of adults

Question 7

kan een ziekte traumatisch zijn

Answer 7

A life-threatening illness or debilitating medical condition is not necessarily considered a traumatic event. Medical incidents that qualify as traumatic events involve sudden, catastrophic events (e.g., waking during surgery, anaphylactic shock

Question 8

voorbeeld acute life-threatening illness

Answer 8

abdominal sepsis

Question 9

chronic non-life threatening illnesses are also associated with stronger PTS symptoms

Answer 9

oke

Question 10

some conclusions on the a criterion

Answer 10

• There is a relationship between severity of event and symptoms
• Events are ‘distant causes’, ‘true causes’ lie within person (vulnerability, processing, etc.) and person- environment (i.e., event) interaction (haystack analogy). Therefore may not be helpful to include this.
• Demarcation is arbitrary/practical/political rather than objective/scientific
• We don’t do this in other disorders (e.g., depression, phobia)

Question 11

wat zegt de dsm over het ontstaan van ptsd in military personell

Answer 11

kan komen door:
- being a perpetrator
- witnissing atrocities
- killing the enemy

Question 12

prevalentie ptsd in former drug cartel soldiers

Answer 12

36% of sample

Question 13

kritiekpunten op ptsd

Answer 13

1. medicalizes normal stress -> tegenargument: some people do show chronic/abnormal symptoms in response to traumatic stress. also, ptsd patients do show specific neurobiological characteristics
2. a-criterion does not suffice: demarcation trauma, reliable reporting of trauma and (in DSM IV) accompanying emotions, relation of trauma to PTSD and other disorders
3. a lot of overlap with other disorders

Question 14

2 proposed changes

Answer 14

• abolish criterion A
• less and most characteristic/specific symptoms

Question 15

Intrusions according to Brewin

Answer 15

Reexperiencing should be present in past month or, exceptionally, on examination. Either:
- Recurrent distressing dreams related to an event now perceived as having severely threatened someone’s physical or psychological well-being, from which the person wakes with marked fear or horror, or
- Repeated daytime images related to an event now perceived as having severly threatened someone’s physical or psychological well-being, experienced as recurring in the present and accompanied by marked fear or horror

Question 16

avoidance according to brewin

Answer 16

Avoidance should be present in past month.
Either:
– Efforts to avoid thoughts, feelings, conversations, or internal reminders associated with the reexperienced event(s), or
– Efforts to avoid activities, places, people, or external reminders associated with the reexperienced event(s).

Question 17

arousal according to Brewin

Answer 17

Hyperarousal – should be present most days
in past month. Either:
– Hypervigilance, or
– Exaggerated startle response.

Question 18

er zijn nu 636120 ways to have posttraumatic stress disorder

Answer 18

oke

Question 19

verschil ptsd, acute stress disorder en adjustment disorder

Answer 19

tussen 1 maand: acute stress disorder
na 1 maand: ptsd
trauma voldoet niet aan de eisen: adjustment

Question 20

ptsd in icd 10

Answer 20

a stressful event or situation (of either brief or long duration) of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone.

Question 21

complex ptsd in icd

Answer 21

is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g. torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse).

Question 22

empirical findings over ptsd criteria

Answer 22

Less comorbid depression under ICD-11 (14%) than under DSM-IV (44%). Comorbidity is thus a function of PTSD criteria set

Question 23

lifetime prevalence of psychotrauma and ptsd in the netherlands

Answer 23

trauma: 80.7%
ptsd: 7.4%

Question 24

predictors of ptsd

Answer 24

perceived life threat
perceived support
peritraumatic emotions
peritraumatic dissociation

Question 25

welke soort factoren hebebn de grootste invloed

Answer 25

peri- and post-trauma variables (low social support, perceived life threat, peri-trauma fear, social withdrawal, cormorbid psychological problems, poor family functioning)

Question 26

conclusions

Answer 26

1. Despite heterogeneity/complexity, developing PTSD is not ‘random’
2. Effect sizes for several predictors are not trivial
3. A distinction emerges between distal (past, static) vs proximate (peri-/posttraumatic, dynamic) predictors…
4. … with the latter showing larger effect sizes and possibilities for intervention
5. Nevertheless, most variance unexplained