Lecture 5 PTSD

Question 1

DSM-5 Trauma-and Stressor-Related Disorders (5)

Answer 1

Reactive Attachment Disorder

Disinhibited Social Engagement Disorder

Posttraumatic Stress Disorder

Acute Stress Disorder

Adjustment Disorders

Question 2

Common characteristics

Answer 2

• Exposure to trauma or stress is listed explicitly as a diagnostic criterion
• Reaction to trauma or stress involves anxiety as well as other symptoms
• Related to both anxiety disorders and dissociative disorders

Question 3

Post-Traumatic Stress Disorder (7)

Answer 3

A. Exposure to actual or threatened death, serious injury, or sexual violence (1+)

B. Intrusion symptoms (1+)

C. Persistent avoidance of stimuli (1+)

D. Negative changes in cognition, mood (2+)

E. Changes in arousal, reactivity (2+)

F. duration for 1 month or more

G. Causes clinically significant distress or impairment

specifier: dissociation, delayed expression

Question 4

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: (4)

Answer 4

• Directly experiencing the traumatic event(s).
• Witnessing, in person, the event(s) as it occurred to others.
• Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
• repeated or extreme exposure to aversive details of the traumatic event(s)

Question 5

B. One or more of the following intrusions ymptoms associated with the traumatic event(s): (5)

Answer 5

• Recurrent, involuntary, intrusive distressing memories.
• Recurrent distressing dreams related to the event(s).
• Dissociative reactions (e.g., flashbacks) the individual feels or acts as if the traumatic event(s) were recurring.
• 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 6

C. Persistent avoidanceof stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following: (2)

Answer 6

• Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
• Avoidance of or efforts to avoid external reminders that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

Question 7

D. Negative alterations in cognitions and mood, evidenced by two (or more) of the following: (7)

Answer 7

• Inability to remember an important aspect of the event(s) (dissociative amnesia).
• Persistent and exaggerated negative beliefs about oneself, others, or the world after event.
• Persistent, distorted cognitions about the causes/consequences of the event(s) that lead the individual to blame him/herself or others.
• Persistent negative emotions
• Markedly diminished interest or participation in significant activities.
• Feelings of detachment or estrangement from others.
• Persistent inability to experience positive emotions

Question 8

E. Marked alterations in arousal and reactivity, as evidenced by two (or more) of the following: (5)

Answer 8

• 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

Question 9

DSM-5 Acute Stress Disorder (5)

Answer 9

• intrusion symptoms
• dissociative symptoms
• avoidance symptoms
• arousal symptoms
• duration 3 days to 1 month

Question 10

ASD intrusion symptoms

Answer 10

same as PTSD, with negative mood (persistent inability to experience positive emotions )

Question 11

ASD dissociative symptoms

Answer 11

Depersonalization, Derealization. An altered sense of the reality of one’s surroundings or oneself

Inability to remember an important aspect of the event(s) (dissociative amnesia)

Numbing, reduced awareness

risk factor for developing PTSD later

Question 12

ASD avoidance symptoms

Answer 12

same as PTSD

Question 13

ASD arousal symptoms

Answer 13

same as PTSD, except no reckless or self-destructive behavior

Question 14

Lifetime experience traumatic event

PTSD 12-month prevalence

Answer 14

60%, 1-4%

Question 15

Gender difference of PTSD

Answer 15

10-20% women, 6-8% men develop PTSD

Question 16

Distress drop within 3 months

Answer 16

75% people

Question 17

Pre-trauma risk factors

Answer 17

Childhood trauma

Prior psychiatric history

Family instability

Substance abuse

Social/economic disadvantage

Question 18

Trauma factors

Answer 18

Degree of life threat (injury, death) or loss

Severity of exposure to traumatic elements

Location of trauma (safe place vs elsewhere)

Individual’s role in the trauma (victim, helper)

Meaning (e.g., uncontrollability)

Question 19

Post-trauma factors

Answer 19

Social support

Coping style

Ongoing stressors

Question 20

treatment

Answer 20

biological:
benzodiazephine, antidepressants (SSRIs)

CBT for PTSD:
core treatment components:
-assess suitability
-psychoeducation
-anxiety management techniques
-cognitive restructuring
-prolonged exposure

CBT more effective than medication or supportive psychotherapy

• drop-out rates high
• need community-based studies, especially to test effectiveness for people with comorbid condition