Post Traumatic Stress Disorder (PTSD) Flashcards
HMS
Chapter by Flecher (2006)
High Magnitude Stressor (HMS)
Multiple HMS common- 18% have two and 10% 3
Majority do not develop PTSD
Depends on complex interaction of the event itself (e.g. nature, cause, severity, duration, etc.). the child’s cognitive emotional, and psychobiological, and behavioral responses to the event; personal characteristics, previous exposure to and reaction other stressors, developmental stage, age, gender, and characteristics of the social environment.
PTSD vs. Acute Stress Disorder (ASD)
chronic vs. acute
Emotional Reaction
Requires emotional reaction of horror, fear, or helplessness to the high magnitude stressor.
Appraisals and Attributions
i. Appraisals
1. Evaluations concerning the importance of an event. Appraised an inescapable.
ii. Attributions
1. Self blame or guilt
2. Global attributions of causality.
Neurobiological Changes Due to Stressful Experiences
HMS lead to changes in brain structure and functioning, particularly in the hypothalamic-pituitary adrenal (HPA) axis (controls reactions to stress).
Biological factors
Not one gene involved (many genes)
Strengths and vulnerabilities
- Sense of self-efficacy (self-esteem)
- Previous exposure to high stressors
- Previous experience dealing with high stressors/Coping strategies
Social Factors
- Social support
- Parenting style
- Family dynamic
Shared Characteristics of the Three Posttraumatic Stress Syndromes
i. Reexperiencing, avoidance of reminders, and overarousal due to reminders of the stressful event(s).
ii. Difference is the time frame
PTSD Type 1 vs. Type 2
i. Division of traumatic events
1. Type 1 –acute high- magnitude (natural disasters, death, etc.) → usually results in ASD
2. Type 2 – prolonged duration (e.g. sexual and physical abuse) → usually results in complex PTSD
Prevalence
1 to 14% in children
Girls exhibit more internalizing vs. Boys more externalizing
Ethnic differences
- All experience it
- When exposed to type 1, non-European descent are more symptomatic
a. Hurrican Hugo → African American symptoms> Whites
b. African American & Hispanics not as good at coping - For type 2, Asians handle it best. However, they contemplate suicide more.
v. Cultural background affect how PTSD symptomology is manifested.
vi. Cultural bound syndromes
Criteria for DSM IV PTSD
A. Stressor B. Intrusive Recollection C. Avoidant/numbing D. Hyper-arousal E. Duration F. Functional Significance
Acute: if duration of symptoms is less than three months
Chronic: if duration of symptoms is three months or more
With or without delay onset: Onset of symptoms at least six months after the stressor
Acute Stress Disorder distinctions vs. PTSD
timing…before 6 months or after 6 months
dissociative symptomology…
i. extreme emotional disconnection; difficulty experiencing pleasure; temporary amnesia, or “dissociative amnesia” if the loss of memory centers more around the traumatic event itself; depersonalization (survivors feel detached from their traumatic experience); and derealization (survivors’ worlds seems strange and unfamiliar, and they may feel as though they are not “real”).
ASD good predictor of PTSD
Criteria for DSM IV Acute Stress Disorder
A. Event with both present:
- witnesses HMS
- response involved intense fear, helplessness, or horror
B. Either while experiencing or after experiencing the distressing event, the individual has three (or more) of the following dissociative symptoms:
(1) a subjective sense of numbing, detachment, or absence of emotional responsiveness
(2) a reduction in awareness of his or her surroundings (e.g., “being in a daze”)
(3) derealization
(4) depersonalization
(5) dissociative amnesia (i.e., inability to recall an important aspect of the trauma)
recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or distress on exposure to reminders of the traumatic event.
D. Marked avoidance of stimuli that arouse recollections of the trauma (e.g., thoughts, feelings, conversations, activities, places, people).
E. Marked symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness).
F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual’s ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience.
G. The disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the traumatic event.
H. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition, is not better accounted for by Brief Psychotic Disorder, and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.
