*Lecture 6 - Trauma-Related Disorders (PTSD)

Question 1

What are the “Trauma and Stressor Related Disorders” in DSM-5?

Hint: There are 5!

Answer 1

• Posttraumatic Stress Disorder
• Acute Stress Disorder
• Adjustment Disorders
• Reactive Attachment Disorder
• Disinhibited Social Engagement Disorder

Question 2

What are the criteria for PTSD?

Answer 2

A. Exposure to actual or threatened death, serious injury, or sexual violence

B. Intrusion symptoms (1 or more needed)
◦ Memories, dreams, flashbacks of the event

C. Persistent avoidance of stimuli (1+)
◦ memories etc, or external reminders of the event

D. Negative changes in cognition, mood (2+)
◦ Fear, negative beliefs about self, others, the world

E. Changes in arousal, reactivity (2 +)
◦ Anger, recklessness, self-destructive acts, sleep
disturbance

AND Duration of symptoms is 1 month or more

Question 3

Acute Stress Disorder….

Answer 3

• Occurs within 3 days to 4 weeks of traumatic event
• if symptoms don’t resolve, change diagnosis to PTSD

More emphasis on dissociative symptoms:
◦ depersonalisation
◦ derealisation
◦ numbing
◦ reduced awareness
◦ dissociative amnesia

Question 4

What is the 12-month prevalence of PTSD? Please give a % range.

Answer 4

1-4%

Question 5

What is considered to be the ‘normal’ response to trauma?

Answer 5

Normative response to trauma is to get over it.
◦ People are distressed immediately after traumatic event
◦ This is a perfectly normal reaction
◦ Distress drops substantially within 3 months in about 75% of people.

Question 6

What % of women and men develop PTSD following a trauma?

Answer 6

About 10-20 % of women and

About 6-8 % of men

Question 7

What are 5 pre-trauma factors that indicate risk for later problems?

Answer 7

◦ Childhood trauma
◦ Prior psychiatric history
◦ Family instability
◦ Substance abuse
◦ Social/economic disadvantage

Question 8

What are 5 trauma factors that indicate risk for developing a disorder?

Answer 8

1. Degree of life threat (injury, death) or loss
2. Severity of exposure to traumatic elements (grotesque sites, duration of the trauma etc.)
3. Location of trauma (safe place vs elsewhere)
4. Individual’s role in the trauma (victim, helper)
5. Meaning (e.g., uncontrollability) (meaning can change and lead to change in person’s symptoms) (e.g. raped but found out from police later that could have been killed.)

Question 9

What are 3 post-trauma factors that indicate risk for developing a disorder?

Answer 9

1. Social Support
   one of the most important predictors.
   eg. soldiers of war, unpopular war, soldiers not welcomed well etc.
2. Coping Style
   People more problem orientated tend to be more likely to cope, rather than avoidant.
3. Ongoing stressors
   e. g. law case, etc.

Question 10

Treatments include… (2)

Answer 10

Biological treatments

Cognitive Behavioural Therapies

Question 11

What are the core components for CBT in the treatment of PTSD?

Answer 11

1. Assess suitability
2. Psychoeducation
3. Anxiety management techniques
4. Cognitive restructuring
5. Prolonged exposure

Question 12

What are 2 biological (i.e. pharmaceutical) treatments for PTSD?

Answer 12

1. Benzodiazephines

2. Antidepressants (SSRIs)

Question 13

What did Harvey et al., 2003, conclude about the treatment of PTSD?

What were some limitations?

(Harvey et al, 2003)

Answer 13

CBT is more effective than medication or
supportive psychotherapy

◦ Drop-out rates are high
◦ Need community-based studies, especially to test effectiveness for people with comorbid conditions

Question 14

Roughly what % of these accidents lead to PTSD?

• motor accidents
• other accidents
• combat veterans
• rape victims

Answer 14

• motor accidents - only about 10%
• other accidents - 7-8%
• combat veterans - 30-40%
• rape victims - 50-60%

Events that are more interpersonal themselves are more likely to cause PTSD