Post-Traumatic Stress Disorder ! Flashcards
PTSD DSMV
Major changes (in addition to being moved to own chapter). Some initial criteria far more explicit in what constitutes a traumatic event. Now lists 4 clusters instead of 3: re-experiencing event, heightened arousal, avoidance, and negative thoughts and mood or feelings. 2 new subtypes: preschool subtype (children < 6); dissociative subtype (experiences of feeling detached from one's own mind or body, world seems unreal or distorted).
DSM5 diagnosis
A. exposure to actual or threatened death, serious injury or sexual violence in one + of following ways.
- directly experiencing.
- witnessing.
- learning that TW occurred to close relative/friend.
- experiencing repeated or extreme indirect exposure to aversive details of TE.
B. presence of one+ intrusive symptoms:
- recurrent, involuntary distressing memories.
- distressing dreams with related content.
- dissociative reactions (eg. flashbacks).
- intense prolonged distress at exposure cues.
- marked physiological reactions to internal and eternal cues.
C. persistent avoidance of stimuli associated with TE:
- avoidance of or efforts to avoid distressing memories, thoughts or feelings associated.
- Avoidance… external reminders that arouse memories.
D. Negative alterations in cognitions and mood associated with event (at least 2):
eg. inability to remember important aspect of event, persistent and exaggerated negative beliefs, persistent distorted cognitions about cause or consequence etc.
E. marked alterations in arousal and reactivity (at least 2):
eg. irritable behaviour or angry outbursts, reckless or self destructive behaviour, hypervigilance etc.
F. Duration of disturbance more than one month.
G. The disturbance causes clinically significant distress or impairment.
H. Disturbance is not attributable to the physiological effects of a substance or another medical condition.
Acute stress disorder (ASD)
PTSD diagnosis can only be made after one month of symptoms.
For shorter periods, acute stress disorder is more likely- much the same symptoms, just less persistent.
Important to treat ASD- reduce likelihood of developing PTSD.
PTSD stressors
Diagnosis restricted to ‘exceptionally threatening and distressing events’.
Everyday traumatic events don’t apply- divorce, loss of a job etc.
- extreme reaction to these may be adjustment disorder.
Key factors:
- loss of life (potential loss).
- threat to life or to personal integrity.
- reaction of fear, horror, or hopelessness.
- emotional responses (guild, shame, intense anger or emotional numbing).
PTSD - potential traumatic events
Natural disasters: floods, tsunami, earthquakes etc.
- group experience but individual differences- not all affected experience PTSD.
- rescue workers can be prone to PTSD as witnesses.
Abuse: domestic violence, rape, emotional abuse- individual experience.
- 60-75% of sexual victims experience PTSD.
Child abuse: incest, physical, emotional abuse.
- childhood rape survivors 60% lifetime risk.
PTSD vulnerability
Many people experience trauma, but who is more likely to develop PTSD?
May depend on subjective perception of traumatic event (in addition to objective facts).
eg. Someone threatened with a replica gun but believe they are about to be shot may develop PTSD.
Not just those directly affect by event- also applies to witnesses, perpetrators, and those who help sufferers.
People at risk include: victims of violent crime; members of the armed forces/police/emergency personnel etc; victims of war/torture/terrorism/refugees; survivors or disasters/accidents etc etc.
Some vulnerability factors: environmental and social
Environmental and social factors: severity, duration and proximity.
PTSD more likely for soldiers on front line; or those repeatedly raped rather than less violently.
Social support- those who have social support likely to recover more quickly.
Vulnerability factors: psychological
Psychological factors:
- shattered assumptions- many hold assumptions about themselves and the world; things happen for a reason; bad things happen to bad people? Sudden trauma can shatter assumptions.
- pre-existing distress- PTSD more likely to develop in those with existing anxiety and depression.
Vulnerability factors: coping styles
Negative coping styles increase likelihood of PTSD:
- self destructive or avoidant strategies (eg. drinking alcohol, self isolation).
- dissociation (detachment from trauma).
Positive coping style reduce likelihood:
- making sense of trauma (look for reasons for event).
- popular with psychodynamic and existential theorists (gain sense of mastery- Freud).
Vulnerability: biological factors
Physiological hyperactivity: increased activity shown in several brain areas (PET/MRI).
- esp. areas involved in emotion regulation and memory.
- amygdala overactive in PTSD patients.
- hippocampus shrunken.
Hormones and neurotransmitters:
- resting levels of cortisol lower in PTSD patients- cortisol shuts down SNS activity after stress.
- increased epinephrine and norepinephrine.
PTSD prevalence
Most people will experience at least one traumatic event (Kessler et al, 95).
PTSD more likely to occur as a result of interpersonal violence and combat- accidents and disasters less so (Creamer et al, 01).
Men more likely to experience traumatic events than woman- but woman more likely to develop PTSD (Kessler et al, 95).
Incidence
Risk of developing PTSD after TE: 8.1% for men; 20.4% for women (Kessler et al, 95).
Risk in urban populations higher:
- overall risk 23.6%.
- 13% for men; 30.2% for women (Breslau et al, 97).
Treatments: pharmacological
BZs: not generally recommended.
- withdrawal can make symptoms worse; increased risk of co-dependence with alcohol/drugs (not uncommon abuse).
TCAs: some evidence of self-rated symptom improvement- but not evidence improving anxiety.
- generally negative outcome in RCTs.
MOAIs: evidence not strong.
SSRIs: much better evidence of symptom improvement (often first line).
SNRIs: no evidence that any better.
Antipsychotic meds: may improve symptoms; may be useful if SSRIs fail.
Psychological treatments: Behavioural
Direct-exposure: client repeatedly exposed to feared stimuli.
- those most associated.
- may have been conditioned.
Taught to relax during recall.
Evaluation: Offers some of the best outcomes, especially when combined with cognitive techniques.
- anxiety management.
- relaxation and breathing training.
- emotional processing.
- cognitive restructuring.
Psychological treatments: cognitive
Focus on ‘feelings’ during recall.
- rape victims may be asked to describe attack.
- war veterans may recall through virtual reality video.
Highly effective symptom reduction.
CBT: PTSD patients often have irrational thoughts (feelings of blame and guilt).
Highly effective- focus on behaviour and thought.
Eye movement desensitisation and reprocessing (EMDR): client visualises single negative aspect of trauma then asked to think about something positive. Therapist moves finger quickly back & forth which causes saccades. Aim to replace negative thought with positive one.
- some evidence of success but controversial.
