Lecture 7 - Trauma and Stressor-Related Disorders

Question 1

What differentiates trauma and stressor related disorders from other disorders in the DSM-5?

Answer 1

No other group of disorders require/have as a diagnostic criteria a traumatic event.
Whilst other disorders, such as MDD, may develop due to trauma, it is not part of the diagnostic criteria.

Question 2

What are the diagnostic criteria in the DSM-5 for PTSD?

Answer 2

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

B. Presence of one (or more) of the following intrusion symptoms.

1. Recurrent, distressing, intrusive memories of the traumatic event.
2. Recurrent distressing dreams in which the content/affect is related to the traumatic event.
3. Dissociative reactions (e.g. flashbacks) in which the individual feels or acts as if the traumatic event were recurring.
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolise the traumatic event.
5. Marked physiological reactions to internal or external cues that symbolise the traumatic event, e.g. sweating, shaking, trembling.

C. Persistent avoidance of stimuli associated with the traumatic event, beginning after the traumatic event.

1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event.
2. Avoidance of or efforts to avoid people or places or contexts, conversations that bring up memories or thoughts of the traumatic event.

D. Negative alterations in mood or cognitions associated with the traumatic event that worsened or started after the traumatic event, as evidenced by two or more of the following:
1. Inability to remember an important aspect of the traumatic event, which could dissociative amnesia.
2. Persistent and exaggerated beliefs about oneself or the world, such as “I am a terrible, worthless person.”, “People cannot be trusted.” etc.
3. Persistent, distorted cognitions about the cause or consequences of the trauamtic event that lead the individual to blame themselves.
4. Persistent negative emotional state (e.g. shame or fear).
5. Markedly diminished interest or participation in activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions.

E. Marked alterations in arousal associated with the traumatic event, worsening or beginning after the traumatic event, as evidence by two or more of the following:
1. Irritable or angry behaviour, with no perceivable cause.
2. Reckless or self-destructive behaviour.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concetration.
6. Sleep disturbance.

F. Duration of the disturbance of B, C, D, and E have been occuring for 1 or more months.

G. The disturbance causes significant distress and impairment to social, occupational, or other important areas of functioning.

H. The disturbance is not attributable to the physiological effects of substance use.

Question 3

In the DSM-5, is there a specific section for diagnosing PTSD in children under 6 years old?

Answer 3

Yes.

Question 4

The first criteria for DSM-5 PTSD diagnosis is “Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways…”

What are the ways listed?

Answer 4

1. Directly experiencing the traumatic events.
2. Witnessing the traumatic events as they occurred to others.
3. Learning that the traumatic events occurred to a family member or close friends and that actual or threatened death was due to violence or an accident.
4. Experiencing repeated or extreme exposure to the aversive details of traumatic events, such as first responders, media personnel.
   This does not include media exposure.

Question 5

Is a life threatening medical condition considered to be a traumatic event that would meet DSM-5 criteria?

Answer 5

Only if the medical condition arose from an accident.

Question 6

Is using drugs, alcohol, sex etc to avoid feeling or thinking about a traumatic event a form of avoidance that would fall under criterion C of the DSM-5 diagnostic criteria of PTSD?

Answer 6

Yes.

Question 7

When would someone be diagnosed with “delayed expression” as a specifier for PTSD?

Answer 7

If the disturbances and symptoms as mentioned in the diagnostic criterion do not come about till 6 months or more after the traumatic event.

Question 8

What are the two substypes of PTSD that are included in the DSM-5?

Answer 8

1. PTSD with dissociative symptoms.
2. PTSD with delayed onset.

Question 9

What is “moral injury”?

Answer 9

Profound and persistent psychological distress that people develop when their moral expectations and beliefs are violated by their own or other’s actions.

Question 10

Was moral injury a significant response for many healthcare workers during COVID?

Answer 10

Yes.
Not being able to allow family to visit their dying loved ones was one experience of healthcare workers that lead to this sense of moral injury.

Question 11

What is Acute Distress Disorder?

Answer 11

Acute stress disorder is diagnosed when individuals meet the criteria of PTSD, but the symptoms have expressed themselves for less than one month and more than 3 days.

Question 12

When an individual has been experiencing symptoms of PTSD for more than 3 days, but less than one month, what are they likely to be diagnosed with?

Answer 12

Acute Stress Disorder.

Question 13

In a study done by Bryant et al (2015) that looked at PTSD symptoms of individuals who had had a traumatic injury, they found that there were four groups that people could be fit into 6+ years after the traumatic event.
What were the four groups?

Answer 13

1. Resilient group, where people did not develop PTSD symptooms.
2. Recovery group - where people experience PTSD symptoms that then recover from the experience.
3. Worsening/recovering - people do not develop the symptoms immediately, but a few months/years later, but then eventually recover.
4. Worsening group - individuals develop PTSD symptoms that get worse over time.

Question 14

What is the proportion of individuals in the general population that experience traumatic events?

What is the proportion of individuals with Mental Health conditions that have experienced traumatic events?

Answer 14

75% and 80%.

This higher proportion in MH population is indicative of the negative effects traumatic experiences can have have the mind and body.

Question 15

What are the most common traumatic experiences people are exposed to/experience?

Answer 15

Events where people experience people being injured or killed.

Question 16

What traumatic events are men more likely to experience?

Answer 16

Men are more likely to have experience physical/combat related attacks and events, as well as being kidnapped.

Question 17

What traumatic events are women more likely to experince?

Answer 17

Women are more likely to have experienced childhood physical abuse and neglect, and rape/sexual abuse/assault.

Question 18

What is the probability of men developing PTSD after a traumatic event?

Answer 18

8-13%

Question 19

What is the probability of women developing PTSD after a traumatic event?

Answer 19

20-30%.

This could be because women are more likely to experience traumas that more of an attack or act of violence of their personhood, sense of self, especially self-worth.

Question 20

What is the 12-month prevalence of PTSD?

Answer 20

4.4% (in Australia).

Question 21

What traumatic events are most likely to lead to the development of PTSD?

Answer 21

Rape and sexual molestation are associated with the highest risk of individuals developing PTSD.
Interestingly, natural disasters have a much lower rate of leading to PTSD development.

I think this makes sense. Rape/sexual molestation is an attack on the Self. Natural disaster is random-ish, affects a whole community. Rape/molestation is targeted, a deep disrespect and disregard enacted on the soul of the victim by another human.

Question 22

What are some of the risk factors for developing PTSD?

Answer 22

Age - young.
Gender - female.
Personality -high neuroticism.
Class.
Pre-existing mood/anxiety disorders.
Family history of mood/anxiety disorders.

Question 23

Is dissociation at time of the traumatic event correlated with developing PTSD?

Answer 23

Yes.

Question 24

What are the three post-trauma factors discussed in lecture that are associated with decreased risk of developing PTSD?

Answer 24

1. Validation of the experience.
2. Social support.
3. Opportunities to ‘process’ the experience.

Question 25

What are some factors of a traumatic event that are linked to whether this event will lead to the development of PTSD?

Answer 25

1. Type of trauma - interpersonal trauma more likely to lead to PTSD.
2. Perceived threat to life
3. Predictability and controllability
4. Duration and frequency.

Question 26

How does PTSD affect memory?

Answer 26

1. Disturbance to memory such that individual cannot remember the sequence of events of the traumatic event, or they have areas of memory loss.
2. Flashbacks, where an individual re-lives an event as though the event is happening again.
3. Often, those with PTSD have difficulty learning, retaining, and recalling new.

Question 27

What are some theories behind the way traumatic events, and the ways these events are processed, affect memory?

Answer 27

The brain may go into a state where memory formation is not a priority, i.e. the brain is in survival.
It could be a survival mechanism. We may be subconsciously avoiding certain memories.

Question 28

How is dissociation defined?

Answer 28

A breakdown in the way in which an individual experiences themselves and the world around them.
Feels like being behind a pane of glass. A thick pane wall of glass.

Question 29

Is dissociation thought to be one of the ways in which experiencing a traumatic event impacts memory?

Answer 29

Yes.

Question 30

What are some ways in which individuals with PTSD cognitively appraise the traumatic events?

Answer 30

Individuals can often feel responsible for the event, especially interpersonal traumatic events, such as sexual molestation or rape.
Individuals can also take their experience of the event and the negative emotions surrounding it and paint their future in a negative, limiting light.

Question 31

How does classical conditioning play a role in PTSD?

Answer 31

Fear conditioning appears to be a key way in which traumatic events can lead to PTSD.
A previously neutral stimulus, such as specific cologne, then becomes a fear-inducing stimulus for a rape victim as it was the cologne of the perpetrator.

Question 32

Why doesn’t everyone who experiences trauma develop PTSD?

Answer 32

A million dollar question.
There appear to be predisposing factors, as well as peri- and post-trauma factors that are either precipitate or perpetuate or protect against the development of PTSD.

Question 33

Is exposure therapy one of the most common therapeutic approaches to aiding those with PTSD?

Answer 33

Yes. Especially if there has been fear conditioning involved.

Question 34

What are some barriers that prevent individuals from accessing therapy?

Answer 34

Stigma related fear.
Low mental health literacy.
Lack of knowledge around treatment options.

Question 35

What is a disorder that was included in the ICD that is not included in the DSM-5?

Answer 35

Complex PTSD.

Question 36

According to the ICD (international classification of disease), what is complex PTSD?

Answer 36

cPTSD has many of the same symptoms as PTSD, but also include symptoms such as:
1. Emotional dysregulation.
2. Interpersonal dysfunction.
3. Difficulties in self-identity, such as feeling hollow inside.

Question 37

When is cPTSD more likely to develop?

Answer 37

When traumatic events have been recurring, chronic, such as recurrent childhood abuse and/or neglect, child soldiers.

Question 38

What are some of the symptoms that those with cPTSD have that those with PTSD do not tend to have?

Answer 38

1. Low self-worth.
2. High levels of guilt.
3. Alienation/feeling alone.
4. Interpersonal detachment.
5. Dysfunctional heightened anger.

Question 39

Cloiter et al. (2013) did a study on those that experienced traumatic events. What were the three types of groups that emerged?

Answer 39

1. Those with low PTSD symptoms.
2. PTSD symptoms as diagnosed by DMS-5.
3. PTSD symptoms as diagnosed by the DSM-5 along with other symptoms, such as low self-worth, high levels of guilt, alienation/loneliness, anger. This group was considered to be individuals with cPTSD.

Question 40

Do those with BPD and PTSD experience many of the same symptoms as cPTSD?

Answer 40

Yes.
Cloiter et al. (2014) showed this and made the case that we need to acknowledge individuals with cPTSD and not group them in with those who have BPD.

Question 41

Is there an argument that cPTSD just represent individuals with PTSD and BPD?

Answer 41

Yes.
This appears NOT to be the case.
Hence cPTSD has been included in the ICD, but not in the DSM-5.

Question 42

What is Adjustment Disorder?
What are the DSM-5 criteria for Adjustment Disorder?

Answer 42

Adjustment Disorder refers to cognitive, emotional, and behavioural responses to a life stressor that results in significant distress and impairment.

A. Development of emotional or behavioural symptoms in response to a stressor that develop within 3 months of the stress-inducing event.

B. These symptoms or behaviours are significantly distressing as evidenced by one or both of the following:
1. Marked distress that is out of proportion to the stressor, taking into account cultural context.
2. Significant impairment to social, occupational or other important areas of functioning.

C. The stress-related disturbance is not explainable by another mental health condition or not merely an exacerbation of a pre-existing condition.

D. The symptoms to not represent normal bereavement.

E. Once the stressor or stressful event has terminated the disturbance does not last longer than an additional 6 months.

Question 43

Is the criteria for Adjustment Disorder according to the DSM-5 quite vague?

Answer 43

Yes.

Lisa acknowledges that there are some benefit to this diagnosis as it allows individuals to get access to treatment, but that it quite vague.

Question 44

How is the ICD criteria for Adjustment Disorder different to the DSM-5 criteria?

Answer 44

The criteria are more clear and specific. Furthermore, one of the required features is that there is a preoccupation with the stressor and its consequences.

Question 45

Is Adjustment Disorder a common disorder that is diagnosed?

Answer 45

Yes.