Post-traumatic Stress Disorder DSM 5 Flashcards
PTSD criteria A (adults, adolescents and children > 6 yrs)
exposure to actual or threatened death, serious injury, or sexual violence:
1. directly experiencing
2. witnessing in person that it happened to others
3. learning it occured to a close family member or friend (in cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental)
4. experiencing repeated or extreme exposure to aversive details (does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related)
PTSD B criterion
intrusion symptoms:
1. recurrent, involuntary and intrusive distressing memories
2. recurrent distressing dreams where content or affect of the dream are related to the traumatic event (in kids: can be frightening dreams without recognizable content)
3. dissociative reactions (e.g. flashbacks) in which the person feels or acts like the event is reccuring (most extreme: complete loss of awareness of present surroundings) (in kids: may occur in play)
4. distress at exposure to internal or external cues that resemble the event
5. physiological reactions to internal or external cues that resemble the event
PTSD C criterion
avoidance of stimuli:
1. avoidance of or efforts to avoid distressing memories/thoughts/feelings
2. avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects or situations) that arouse distressing memories, thoughts, or feelings about the event
PTSD D criterion
negative alterations in cognitions and mood associated with the event:
1. inability to remember an important aspect of the event (dissociative amnesia)
2. persistent and exaggerated negative beliefs or expectations about oneself, others or the world
3. persistent, distorted cognitions about the cause or consequences of the event
4. persistent negative emotional state (fear, horror, anger, guilt or shame)
5. diminished interest or participation in activities
6. feelings of detachment or estrangement from others
7. persistent inability to experience positive emotions (inability to experience happiness, satisfaction, or loving feelings)
PTSD E criterion
alterations in arousal and reactivity associated with the event
1. irritable behaviour and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects
2. reckless or self-destructive behavior
3. hypervigilance
4. exaggerated startle response
5. problems with concentration
6. sleep disturbance
PTSD F,G,H criteria
F. Duration of the disturbance (Criteria B, C, D and E) is more than 1 month.
G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
specify whether: (alles)
- dissociative symptoms
- delayed expression
specify whether: dissociative symptoms
either one:
- Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).
- Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted).
specify whether with delayed expression
If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).
the clinical presentation of PTSD varies:
in some individuals, fear-based reexperiencing may predominate. In others negative cognitions may be most distressing. Some individuals exhibit combinations of these symptom patterns
voorbeelden van directly experienced traumatic events
- exposure to war (as a combatant or civilian)
- threatened or actual physical assault (e.g., physical attack, robbery, mugging, childhood
physical abuse) - threatened or actual sexual violence (e.g., forced sexual penetration, alcohol/drugfacilitated sexual penetration, abusive sexual contact, noncontact sexual abuse, sexual trafficking)
- being kidnapped, being taken hostage
- terrorist attack
- torture
- incarceration as a prisoner of war
- natural or human-made disasters
- severe motor vehicle accidents.
hoe zit het met illnesses
life-threatening illness or medical conditions are not considered traumatic events. medical events that quality as traumatic are sudden, catastrophic events (e.g. waking up during surgery).
The disorder may be especially severe or long-lasting when the stressor is…
interpersonal and intentional (e.g. torture, sexual violence)
prevalences usa
lifetime risk: 8.7%
twelve month prevalence: 3.5%
prevalences europa, asian, africa and latin america
twelve month prevalence: 0.5%- 1.0%
Although different groups have different levels of exposure to traumatic events, the probability of developing PTSD following a similar level of exposure may also vary across cultural groups:
- lower among older adults
- higher rates among latinos, african americans and american indians, lower among asians
- highest rates across survivors of: rape, military combat, ethically or politicaly motivated imprisonment and genocide
PTSD prevalence in students
lifetime prevalence trauma:
- traffic accident: 18%
- non-sexual violence: 10.7%
- sexual violence: 6.7%
- other: 39.9%
PTSD prevalence: 7%
prevalence sub-PTSD: 8%
the development of ptsd
PTSD can occur at any age, beginning after the first year of life. Symptoms usually begin within the first 3 months after the trauma, although there may be a delay of months, or even years, before criteria for the diagnosis are met (= delayed expression)
the course of ptsd
The (dominance of) symptoms of PTSD may vary over time. Duration of the symptoms also varies, with complete recovery within 3 months occurring in approximately 50% of adults (while some individuals remain symptomatic for longer than 12 months and sometimes for more than 50 years)
symptom recurrence and intensification may occur in response to…
- reminders of the original trauma
- ongoing life stressors
- newly experienced traumatic events.
symptom recurrence and intensification may occur in response to… for older individuals
- declining health
- worsening cognitive functioning
- social isolation
pretraumatic factors:
temperamental:
- childhood emotional problems by age of 6
- prior mental disorders
environmental:
- lower SES
- lower education
- exposure to prior trauma
- childhood adversity (e.g. economic deprivation, family dysfunction, parental separation or death)
- cultural characteristics (fatalistic or self-blaming coping strategies)
- lower intelligence
- minory racial/ethnic status
- family psychiatric history
genetic and physiological:
- female
- younger age at time of trauma exposure
peritraumatic factors (during)
environmental:
- severity of the trauma (greater is more likely)
- perceived life threat
- personal injury
- interpersonal violence (particularly trauma perpetrate by a caregiver or involving a witnessed threat to a caregiver in children)
cognition:
- dissociation that occurs during the trauma and persists is a risk factor
for military personelle:
- being a perpetrator or offender
- witnessing atrocities/cruelties
- killing the enemy
posttraumatic factors
Temperamental:
* negative appraisals
* inappropriate coping strategies
* development of acute stress disorder
Environmental:
* exposure to repeated upsetting reminders
* adverse life events
* financial or other trauma-related losses.
* social support is a protective factor
differential diagnosis:
- adjustment disorders (here the stressor can be of any type or severity, e.g. spouse leaving or being fired)
- other posttraumatic disorders and conditions (e.g., symptoms of panic disorder that occur only after exposure to traumatic reminders)
- acute stress disorder (symptoms occur from 3 days to 1 month)
- anxiety and OCD: repetitive intrusive thoughts (OCD), dissociation (Panic Disorder),
avoidance and irritability (Generalized Anxiety Disorder) are similar to PTSD (but not related to a specific traumatic event) - MDD: Major depression may or may not be preceded by a traumatic event and should be diagnosed if other PTSD symptoms are absent
- personality disorders: If someone has interpersonal difficulties that started or got worse after a traumatic event, it might be a sign of PTSD. In a personality disorder, these difficulties are expected even without a traumatic event.
- Dissociative disorders: dissociative amnesia, dissociative identity disorder, and depersonalization-derealization disorder might be linked to a traumatic event or have symptoms of PTSD, but when all the criteria for PTSD are met, it’s called PTSD with dissociative symptoms.
- conversion disorder: new onset of somatic symptoms after event may indicate ptsd rather than conversion disorder
- psychotic disorders: Flashbacks in PTSD must be distinguished from illusions, hallucinations, and other perceptual disturbances that may occur in psychotic disorders, depressive and bipolar disorders with psychotic features, substance/medication-induced disorders and psychotic disorders due to another medical
condition. - traumatic brain injury: may occur at the same time as ptsd. diferences: ptsd = reexperiencing and avoidance, TBI = persistent disorientation and confusion
comorbidity of ptsd
- 80% more likely
- SUD and conduct disorder more common among males than females
- children: oppositional defiant disorder and separation anxiety disorder
Among U.S. military personnel and combat veterans who have been deployed to
recent wars in Afghanistan and Iraq, co-occurrence of PTSD and mild TBI is 48%.
Most young children with PTSD also have at least one other diagnosis
