Lecture 5 - PTSD Flashcards
What are the DSM-5 criteria for PTSD?
A: TRAUMATIC EVENT/STRESSOR
- direct experience, witness, learn about close friend/family, repeated/extreme exposure to details
B: RE-EXPERIENCING
- recollections, nightmares, dissociative (flashbacks)
- prolonged/intense distress + physiological reactivity to trauma stimuli
C: ACTIVE AVOIDANCE
- thoughts/feelings OR external reminders
D: ALTERED MOOD/COGNITION
- dissociative amnesia
- -ve beliefs/expectations
- distorted blame of self/others
- -ve trauma-related emotions (fear, guilt, anger, shame, horror)
- diminished interest
- feel alienated
- constricted affect
E: AROUSAL
- irritable/aggressive
- self-destructive/reckless
- hypervigilant
- exaggerated startle response
- problems in concentration
- sleep disturbance
F, G, H
- 1 mth
What are the subtypes of PTSD?
- preschool: <6yrs
- dissociative: meet PTSD criteria + high levels of depersonalisation or derealisation
What is Acute Stress Disorder?
- when <1mth after trauma
- PTSD criterion A
- no mandatory symptoms from any cluster
- 9+ of intrusion, -ve mood, dissociative, avoidance, arousal
How many people with ASD go on to develop PTSD?
approx 50%
What are the PTSD associated features?
- anger
- depression
- anxiety
- substance use/abuse
- emotional lability
- impulsive/self-harming behaviour
- pysical complaints
What is the prevalence of PTSD?
- 65% M and 50% W experience trauma
- in clinical pops: up to 80%
develop PTSD after trauma
- men 8-13%
- women 20-30%
- 12mth prev: 1.5-3%
What are the common types of trauma in PTSD?
- overall: witness someone get killed/seriously injured, natural disaster, life-threatening accident
- men: physical attack, threatened with weapon, held captive, kidnapped
- women: rape, molestation, childhood parental neglect/physical abuse
What are the risk factors of PTSD?
PRE-TRAUMA
- female
- neurotic
- young
- low IQ/education
- unstable family in childhood
- pre-existing anx/mod dx
- family hx of mood/anx
- attenuate cortisol levels
TRAUMA-RELATED
- type of trauma (eg. interpersonal)
- predictability + controllability
- degree of life threat
- duration
- frequency
PERI-TRAUMA
- dissociation
- arousal (in acute post-trauma phase)
POST-TRAUMA
- social support
- validating experiences
- opps to process
What are the psychological processes associated with PTSD?
MEMORY
- contradictory: some vivid recall, some vague/error-prone
- flashback: diff to normal memory, dominated by sensory detail, disjointed, fragmented
- lower WM capacity: capacity to prevent unwanted material from intruding/affecting performance
DISSOCIATION
- common under stress
- numb, depersonalisation, derealisation
COGNITIVE-AFFECTIVE RESPONSES
- intense fear, helplessness or horror at time or trauma
COGNITIVE APPRAISAL + EMOTION
- appraisal of cause/responsibility for and future implications»_space; -ve emotions
BELIEFS
- trauma shatters beliefs/assumptions
- negative beliefs about self/world/others
What are the two key factors that difference chronic from non-chronic PTSD?
- overactivity to stimuli that symbolises stressor
- interpersonal numbing
50-60% recover
How does PTSD develop?
- classical conditioning
- single-trial learning > bc. associated with survival
- “severe stimulus” > “severe response”
What is Complex PTSD?
- for repeated/chronic traumas
- PTSD symptoms
- impairments in affective/self/relational functioning
- emotional dysregulation (intense reactions)
- interpersonal dysfunction (rship extremes ups and downs)
- self-identity difficulties (feel empty)
- profile clearly differentiable from PTSD and from BPD
What is Adjustment Disorder?
- emotional/behavioural symptoms in response to an identifiable stressor
- distress + impairment
- not normal bereavement
- NOTE: PTSD criterion A does not need to be met
- within 3mths of stressor onset; doesn’t persist more than 6mths after stressor terminated
What do we know about Adjustment Disorder and what are the problems with it?
WHAT WE KNOW
- very common in MH and PH populations
- 14% in acutely ill medical (3x MDD)
- 33% cancer
- in primary care: 1-18%
- psychiatric inpatients: 9%
PROBLEMS
- no standard diagnostic tool
- not in epidemiological studies
- “wastebasket” diagnosis
- pathologizing living?
- comorbidity unknown
- best treatment unknown
What are the 6 specifiers of Adjustment Disorder?
- depressed mood
- anxiety
- mixed anxiety and depression
- disturbance of conduct
- mixed disturbance of emotions and conduct
- unspecified
