Post Traumatic Stress Disorder

Question 1

Discuss different ways someone can experience a traumatic event

Answer 1

• direct experience by the individual
• witnessed event
• learning about something that occurred to a loved one
• repeated or extreme exposure to aversive details of trauma (police, first responders)

Question 2

Discuss factors before, during or after the event that can predispose to PTSD

Answer 2

Before
- family history of mental illness
- history of previous trauma
- previous adjustment disorder
- insecure or disorganized attachment
During
- perceived life threat
- intense emotions
- dissociation
After
- Lack of support
- life stressors
- Early symptoms

Question 3

List the diagnostic criteria for PTSD

Answer 3

Exposure to actual or threatened death, serious injury in >=1 of the following ways
- directly experiencing
- witnessing
- learning
>=1 of intrusion symptoms associated with event that begin afterwards
- recurrent, involuntary and intrusive distressing memories
- recurrent distressing dreams in which content are related to event
- dissociative reaction where feel as event is happening
- intense pschological distress at internal or external cues that symbolize event
Persistent avoidance of stimuli associated with event by >=1 of the following
- avoidance of distressing memories, thoughts, or feelings about traumatic event
- avoidance of external reminders that arouse memories
Negative alteration in cognition and mood associated with traumatic event by >=2 of the following
- inability to remember an important aspect of event
- persistent negative belief about self and world
- persistent, distorted cognition that lead to blame of self or others for event
- persistent negative emotional state
- markedly diminished interest in activities
- feelings of detachment
- unable to keep positive emotion
Marked change in arousal and reactivity shown by >=2 of the following
- irritable behaviour
- self-destructive behaviour
- hypervigilance
- exaggerated startle response
- problem with concentration
- sleep disturbance
Symptoms for >=1 months
Distress and impair functioning
No due to substances

Question 4

List the diagnostic criteria for PTSD for children

Answer 4

Traumatic event experienced, witnessed or learned
Instrusive symptoms shown by
- spontaneous and intrusive memories may not be distressing and lead to reenactment in play
- distressing dreams may not have similar content as traumatic event
Need >=1 symptom of avoidance or negative cognition
- same list for avoidance
- negative:
- increased frequency of negative emotion
- loss of interest in play or constriction in play
- socially withdrawn behaviour
- persistent reduction in positive behaviour
- not present
alteration in arousal or activity (except no self-destructive behaviour)
duration >1 month
Cause distress or impair relationships

Question 5

List the management strategies for PTSD

Answer 5

Biological
- SSRI for depressed mood, trauma or sleep disturbance
- reduce substance use
- increase healthy behaviour
Psychological
- CBT with exposure therapy
Social
- couple and family intervention
Management phases
- 1: stabilization through safety and manage symptom behaviour
- 2: trauma processing by cognitive and emotional processing of event
- 3: reintegration to baseline functioning

Question 6

List the diagnostic criteria for acute stress disorder

Answer 6

exposure to traumatic event
presence of >=9 symptoms
- intrusion symptoms
     - recurrent, involuntary and intrussive distressive memories
     - recurrent distressing dreams
     - dissociative reaction
     - intense or prolonged psychological distress
- negative mood
     - persistant inability to experience positive emotion
- dissociative symptom
      - altered sense of distressing memories, though about event
      - avoidance of external reminders that arouse memories
- arousal symptoms
        - sleep disturbance
        - irritable behaviour
        - hypervigilance
        - problem with concentration
        - exaggerated startle response
- duration is 3 days to 1 month
- cause distress or impair functioning
- not due to anything else

Question 7

List the diagnostic criteria for dissociative disorder

Answer 7

> =2 distinct personality states
- disruption in identity involves discontinuation of self and agency with changes in affect, behaviour, consciousness, memory, perception
Gaps in recall of events, personal information or traumatic event
Cause distress or impair functioning
Disturbance not in keeping with culture or region
Substance and medical condition ruled out

Question 8

List the diagnostic criteria for dissociative amnesia

Answer 8

• unable to recall important autobiographical information that is traumatic or stressful
• symptoms cause distress or impair function
• no other disorder

Question 9

List the diagnostic criteria for depersonalization/derealization disorder

Answer 9

Presence of persistent or recurrent experience of >=1 of the following
- depersonalization: experience of unreality, detachment or being outside observer with respect to thoughts, feelings, sensations
- derealization: experience of unreality or detachment from one’s surroundings
Reality testing remains intact
Cause distress or impair functioning
No other condition