Module 5: Stress & Trauma

Question 1

PTSD Criteria A?

Answer 1

In trauma and stressor-related disorders (DSM) there is criteria for exposure to trauma:

• Inconsistent caregiving (Reactive Attachment Disorder)
• Exposure to actual or threatened death, serious injury, or sexual violence (PTSD, Acute Stress Disorder)
• “Identifiable stressor” (Adjustment Disorders, Other Specified or Unspecified Trauma- and Stressor Related Disorder)
• Death of loved one (Prolonged Grief Disorder)

Question 2

PTSD diagnostic criteria categories?

Answer 2

B. Intrusion
C. Avoidance
D. Negative Cognition & Mood Changes
E. Altered Arousal & Reactivity
F. Duration > 1 month
G. Significant Distress or functional impairment
H. Not due to substance or medical condition

Question 3

List the symptoms of Intrusion (Criteria B).

Answer 3

• Recurrent intrusive memories
• Recurrent distressing dreams
• Dissociative reactions when individuals re-experiences event (flashbacks)
• Psychological distress when reminded of event
• Physiological reactions when reminded of event

Question 4

List the symptoms of Avoidance (Criteria C).

Answer 4

• Avoidance of thoughts, memories, feelings resembling event
• Avoidance of reminders (people, places, activities, situations) resembling event

Question 5

List the symptoms of Negative Cognition & Mood Changes (Criteria D).

Answer 5

• Inability to remember event details
• Inability to experience positive emotions
• Persistent and exaggerated negative beliefs about self
• Persistent negative emotional state (anger, fear)
• Self-blame about causing event
• Diminished interest/participation in significant activities
• Detachment from others

Question 6

List the symptoms of Altered Arousal & Reactivity (Criteria E).

Answer 6

• Irritability & angry outbursts
• Recklessness
• Hyper-vigilance
• Exaggerated Startle Response
• Concentration difficulties
• Sleep disturbances

Question 7

PTSD psychosocial treatments?

Answer 7

• Trauma-Focused CBT
• Exposure Response Therapy
• Acceptance and Commitment
• Eye Movement Desensitization and Reprocessing
• Trauma Resiliency Model (CRM sister)
• Family therapies
• Support Groups
• Psychoeducation & stress management

Question 8

PTSD psychopharm treatments?

Answer 8

• Sertraline & Paroxetine
• Ex. Prazosin for nightmares (Off-Label)

Question 9

Acute Stress Disorder diagnostic criteria?

Answer 9

• Criteria A
• Criteria B: 9 or more of the symptoms in any of the following categories (refer to PTSD slides)
  
  • Intrusion, Avoidance Symptoms, Negative Mood, Arousal Symptoms, Dissociative Symptoms
• Criteria C: Duration between 3 days-1month
• Criteria D: Causes clinically significant distress or impairment to functioning
• Criteria E: not attributable to effects of substance or medical condition

Question 10

Define Dissociation.

Answer 10

• Intrusions into awareness and behavior preventing one from accessing information or controlling mental functioning
  
  • i.e. A disconnection between patient’s perceptual experience and reality
• Often present with PTSD (but does not have to be)

Question 11

Examples of Dissociation?

Answer 11

• Depersonalization: sensation of being detached or outside of one’s body or thinking
• Derealization: sensation that surroundings are not real, distant, dreaming

Question 12

Describe some Dissociative Disorders.

Answer 12

• Dissociative identity disorder (formerly called multiple personality disorder): at least two distinct personality or identity states
  
  • Notable presence in popular culture including social media
  • Epidemiological mystery and controversial
• Dissociative amnesia: inability to recall
• Depersonalization/derealization disorder: being detached from one’s body or reality

Question 13

Define stress.

Answer 13

• A state of worry or mental tension caused by a difficult situation
• Adaptive in many time-limited and tolerable situations and helps up develop healthy coping

Question 14

How does stress affect the brain?

Answer 14

2-System Involvement:

• Sympathetic-Adrenal Medullary (SAM)
  
  • Faster
  • Epi/NE
• Hypothalamic-Pituitary-Adrenal (HPA) Axis
  
  • Slower
  • Cortisol

Question 15

List some biological factors of stressors.

Answer 15

• Epi/Genetics
• SNS sensitivity
• HPA activity

Question 16

PTSD risk factors?

Answer 16

• Extent, duration, intensity of trauma
• Violence/Trauma that is interpersonal in nature and intentional
• Familial dysfunction/disturbance
• Poor social support
• History of trauma in childhood
• Perception of the trauma
• Pre-existing mental illness
• Concurrent TBI

Question 17

Define Homeostasis.

Answer 17

HOMEOSTASIS = SAME & STEADY

• Day to day maintenance of bodily functions
• Environment is predictable
• Standard understanding of bodily regulation
• E.g. explains the expected ranges for vital signs

Question 18

Define Allostasis.

Answer 18

ALLOSTASIS = DIFFERENT & STEADY

• Adaptation made in changing environment
• Changing stressors resulting in changing baseline
• E.g. Chronic stress may result in higher baseline blood pressure in anticipation for stressful event
• Not inherently a problem or harmful

Question 19

Describe the concept of adaptation.

Answer 19

POSITIVE ADAPTATION

• Learning – change behavior for future stressor based on this experience
• Social – strengthen bonds with others
• Biology – return to homeostasis with removal of stressor

⬇

RESILIENCE

• Capacity to withstand stress & mobilize healthy coping strategies
• Can increase with time and adequate support

Question 20

Describe Coping.

Answer 20

• Behavioral or cognitive process done consciously or unconsciously in response to a stressor
• Can be helpful or unhelpful
• Problem-focused & Emotion-focused coping

Question 21

Examples of coping?

Answer 21

• Exercising
• Reaching out to a friend
• Avoid stressor
• Assuming worst possible outcome
• Use of psychoactive substance

Question 22

Describe expected outcome of coping.

Answer 22

• Different coping strategies will be needed for different situations. Over time, strategies become automatic and develop into patterns for each person.
• Successful coping with life stresses is linked to increased quality of life & physical and mental health
• Reappraisal happens after coping strategies are implemented, provides feedback about the outcomes and allows for continual adjustment

Question 23

Define Allostatic Load.

Answer 23

• A way to figuratively quantify the amount of stress an individual has accumulated
  
  • Associated biomarkers in research
• Stressor may no longer be present, but physiological effects persist
  
  • Elevated inflammatory response – arthritis, arterial disease, diabetes, abdominal fat, IBD
  • Loss of bone density
  • Hypertension, hyperlipidemia