Lecture 3 - Trauma and Stressor Related Disorders Flashcards

Question

PTSD Criterion E

Answer 1

E. Marked alterations in arousal and reactivity associated with the traumatic event (s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: 1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. 2. Reckless or self-destructive behavior. 3. Hypervigilance 4. Exaggerated startle response 5. Problems with concentration 6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep)

Answer 2

* Symptoms typically begin within 3 months after the trauma * A delay in months or years may occur before criteria for the diagnosis are met. * Delayed Onset (DSM-IV) now termed Delayed Expression * Frequently, an individual’s reaction to a trauma initially meets criteria for Acute Stress Disorders in the immediate aftermath of the trauma. * Symptoms of PTSD and relative predominance of different symptoms may vary over time * Duration varies: * Complete recovery within 3 months occurring in approx. ½ of adults * Others symptomatic longer than 1 year or for more than 50 years.

Answer 3

Risk factors may predispose individuals to trauma or to extreme emotional responses when exposed to traumatic events. Prognostic factors: Pretraumatic (temperamental, environmental). - Peritraumatic (environmental) - Post-traumatic (temperamental, environmental).

Answer 4

* Temperamental-childhood emotional problems by age 6, prior mental disorders, personality traits e.g. negative affectivity (neuroticism) * Environmental-lower socioeconomic status, lower education, exposure to prior trauma, childhood adversity, lower intelligence, family psychiatric history. Social support protective. * Genetic and Physiological-genetic risk is modestly heritable.

Answer 5

* Environmental-severity of the trauma, perceived life threat, personal injury, interpersonal violence. Vets-being a perpetrator, witnessing atrocities, or killing the “enemy.” * Dissociation, fear, panic and other peritraumatic responses that occure during the trauma and persist afterward.

Answer 6

* Temperamental-negative appraisals, inappropriate coping strategies, development of acute stress disorder. * Environmental-subsequent exposure to repeated upsetting reminders, subsequent adverse life events, financial or other trauma related losses. High levels of daily stressors. Social support is a protective factor,

Answer 7

Research demonstrates correlations to: * High levels of medical utilization * Impaired functioning in social, interpersonal, developmental, educational, physical health, occupational domains * Poor social and family relationships, absenteeism from work, lower income, lower educational and occupational success * High levels of comorbidity to a majority of mental disorders * High Economic Costs

Answer 8

* Adjustment Disorders * Acute Stress Disorder * Anxiety Disorders and OCD * Major Depressive Disorder * Personality Disorders * Dissociative Disorders * Conversion Disorder * Psychotic Disorders * Traumatic Brain Injury

Answer 9

* Individuals with PTSD are more likely than those without PTSD to have symptoms that meet diagnostic criteria for at least one other mental disorder, such as depressive, bipolar, anxiety, or substance use disorders. * PTSD is also associated with increased risk of major neurocognitive disorder. * Women more likely to develop PTSD following a mild TBI. * In children, PTSD most likely comorbid with oppositional defiant disorder and separation anxiety disorder.

Answer 10

* Individuals with Acute Stress Disorder shortly after a traumatic event are at increased risk for PTSD., only some of the time. * Differential Dx: Acute Stress Disorder is distinguished from PTSD because symptom pattern in Acute Stress Disorder is restricted to a duration of 3 days to 1 month following exposure to the traumatic event. * Presence of nine or more of the symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event occurred. * Symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet criteria.

Answer 11

* Presentation may vary * Typically involves an anxiety response that includes re- experiencing or reactivity to the traumatic event. * Dissociative or detached presentation may occur in some individuals, they also typically will display strong emotional or physiological reactivity in response to cues. * In others a strong anger response, irritability or aggressiveness. * Often engage in catastrophic or extremely negative thoughts about their role in the event, their response, or the likelihood of future harm. * Common to experience panic attacks when triggered * May display chaotic or impulsive behavior.

Answer 12

* Adjustment disorder is a psychological response to a common stressor (e.g., divorce, death of a loved one, loss of a job) that results in clinically significant behavioral or emotional symptoms. * Symptoms begin within 3 months of the onset of the stressor and the person must experience more distress than would be expected given the circumstances or be unable to function as usual. * Beyond 6 months, the diagnosis changes. * In Adjustment Disorders, the stressor can be of any severity or type rather than that required by PTSD Criterion A. * The diagnosis of an Adjustment Disorder is used when the response to a stressor that meets PTSD Criterion A does not meet all other PTSD criteria (or criteria for another mental disorder). * An Adjustment Disorder is also diagnosed when the symptom pattern of PTSD occurs in response to a stressor that does not meet PTSD Criterion A (e.g., spouse leaving, being fired).

Answer 13

* Adjustment disorder with depressed mood (Sadness, crying, and feelings of hopelessness) * Adjustment disorder with anxiety (Worrying, nervousness, and jitters (or in children, fear of separation from primary attachment figures). * Adjustment disorder with mixed anxiety and depressed mood (A combination of anxiety and depression.) * Adjustment disorder with disturbance of conduct (Violation of the rights of others or violation of social norms appropriate for one’s age; sample behaviors include vandalism, truancy, fighting, reckless driving, and defaulting on legal obligations (e.g., stopping alimony payments).) * Adjustment disorder with mixed disturbance of emotion and conduct (Both emotional disturbance, such as depression or anxiety, and conduct disturbance (as described previously).) * Adjustment disorder unspecified (A residual category that applies to people not classifiable in one of the other subtypes.)

Answer 14

* Applies to presentations in which symptoms characteristic of a trauma and stressor related disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the category. * Used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific trauma-and stressor related disorder.

Answer 15

* Similar to Other Specified, but clinician chooses not to specify the reason that the criteria are not met * Includes situations in which there is insufficient information to make a more specific diagnosis.

Answer 16

* Different demographic, cultural and occupational groups have different levels of exposure to traumatic events * The relative risk of developing PTSD following a similar level of exposure may vary across cultural, ethnic, and racialized groups. * Variation in the type of traumatic exposure, impact on disorder severity of the meaning attributed to the traumatic event, the ongoing sociocultural context, exposure to racial and ethnic discrimination may influence risk and severity of PTSD across groups. * Some communities are exposed to pervasive and ongoing traumatic environments, rather than isolated Criterion A events; in these communities, the predictive power of individual traumatic events for the development of PTSD may diminish.

Answer 17

* In cultures where social image (e.g. maintaining a family’s “face”) is emphasized, public defamation or shaming may magnify the impact of Criterion A events. * Some cultures may attribute PTSD syndromes to negative supernatural experiences. * The clinical expression of the symptoms or symptom clusters of PTSD can vary culturally. * In many non-Western groups, avoidance is less commonly observed, whereas somatic symptoms (dizziness, shortness of breath, heat-sensations) are more common

Answer 18

* PTSD is more prevalent among women than among men across the life span. * Lifetime prevalence of PTSD ranges from 8-11% for women and 4.1%-5.4% for men based on two large U.S. population-based studies using DSM-5 criteria. * Some of the increased risk for PTSD in women appears to be attributable to a greater likelihood of exposure to childhood sexual abuse, sexual assault, and other forms of interpersonal violence which carry the highest ris of development of PTSD. * Women in the general population experience PTSD for longer duration than do men. * Other factors likely contributing to the higher prevalence in women include gender differences in the emotional and cognitive processing of trauma, as well as effects of reproductive hormones. * When responses of men and women to specific stressors are compared, gender differences in risk for PTSD persist. * PTSD symptom profiles and factor structures are similar between men and women..

Answer 19

* DSM-5 does not have a diagnosis for Complex Trauma defined as... * (1) repetitive, prolonged, or cumulative * (2 ) most often interpersonal, involving direct harm, exploitation, and maltreatment including neglect/abandonment/antipathy by primary caregivers or other ostensibly responsible adults, and * (3) often occur at developmentally vulnerable times in the victim's life, especially in early childhood or adolescence, but can also occur later in life and in conditions of vulnerability associated with disability/ disempowerment/dependency/age /infirmity, and so on.

Answer 20

* PTSD is now restricted to three symptoms: re-experiencing the trauma, avoiding reminders of the trauma, and experiencing a heightened sense of threat and arousal. * By comparison, the new Complex PTSD diagnosis is broader. It is comprised of all three symptoms of PTSD, but also includes: * Difficulty regulating emotion * Feelings of shame, guilt, or failure * Conflictual interpersonal relationships. * “The intent is to distinguish patients whose responses are focused mainly on the trauma itself from those whose difficulties ripple more widely through their lives.”

Answer 21

* Post-traumatic stress disorder (PTSD) is a disorder that may develop following exposure to an extremely threatening or horrific event or series of events. * It is characterized by all of the following: * 1) re-experiencing the traumatic event or events in the present in the form of vivid intrusive memories, flashbacks, or nightmares. These are typically accompanied by strong or overwhelming emotions, particularly fear or horror, and strong physical sensations * 2) avoidance of thoughts and memories of the event or events, or avoidance of activities, situations, or people reminiscent of the event or events; and * 3) persistent perceptions of heightened current threat, for example as indicated by hypervigilance or an enhanced startle reaction to stimuli such as unexpected noises. * The symptoms persist for at least several weeks and cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

Answer 22

* 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). * All diagnostic requirements for PTSD are met. * In addition, Complex PTSD is characterized by severe and persistent 1) problems in affect regulation; 2) beliefs about oneself as diminished, defeated or worthless, accompanied by feelings of shame, guilt or failure related to the traumatic event; and 3) difficulties in sustaining relationships and in feeling close to others. * These symptoms cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.