PTSD Flashcards
What are the trauma and stressor-related disorders?
-acute stress disorder
-adjustment disorders
-posttraumatic stress disorder
What causes PTSD?
-exposure to actual or threatened death, serious or sexual violence in which the sense of personal safety is threatened:
-direct experiencing of traumatic event(s)
-witnessed in person the events as it occurred to others
-learning that the traumatic events occured to person close to them
-experiencing repeated or extreme exposure to aversive details of trauma
What are the DSM requirements to receive a PTSD diagnosis?
-presence of 1 or more intrusive symptoms after the event: recurrent, involuntary and intrusive memories of event; recurrent trauma-related nightmares; dissociative reactions; intense physiologic distress at cue exposure; marked physiological reactivity at cue exposure
-persistent avoidance by 1 or both: avoidance of distressing memories, thoughts or feelings of the event(s); avoidance of external reminders of that arouse memories of event(s) [e.g., people, places, activities]
What are some changes in cognitions and mood due to PTSD?
-inability to remember an important aspect of the traumatic event(s)
-persistent distorted cognitions about cause or consequence of event that lead to blame of self or others
-persistent negative emotional state
-marked diminished interest
-feeling detached from others
-persistent inability to experience positive emotions
What are some changes in arousal and reactivity due to PTSD?
-irritable behaviour and angry outbursts
-reckless or self-destructive behaviour
-hypervigilance
-exaggerated startle response
-problems with concentration
-sleep disturbance
What are the prevalence rates of PTSD?
-7-9% of general population
-60-80% of trauma victims
-30% of combat veterans
-50-80% of sexual assault victims
-increased risk in women, younger people
-risk increases with “dose” of trauma, lack of social support, pre-existing psychiatric disorder
What are common comorbidities with PTSD?
-depression
-other anxiety disorders
-substance use disorders
-somatization
-dissociative disorders
What is Acute Stress Disorder?
-similar exposure as in PTSD
-presence of ≥ 9 of 5 categories of intrusion, negative mood, dissociation, avoidance, and arousal related to the trauma
-duration of disturbance is 3 days to 1 month after trauma
-causes significant impairment
What are the main critics of the PTSD definition?
-PTSD as a homogenous response to trauma BUT not all individuals will develop PTSD
-looks at the event, and not at the individual himself
[some will just be anxious/hyperactive for a month after an event and then it goes away; PTSD can also appear up to 1 year after the event]
What are the pre-trauma PTSD risk factors?
-genetic predisposition [twin study of Vietnam veterans: heritability of .40]
-neurological vulnerabilities
-developmental factors
-psychological vulnerabilities
-cognitive vulnerabilities
What are the during-trauma PTSD risk factors?
-peritraumatic dissociation: altered sense of self; cause unclear
-cognitive appraisal: evaluation of the situation; altered assumptions
-biological reaction: HPA deregulation
What are the post-trauma PTSD risk factors?
-[maladaptive] coping
-[lack of] social support
What are some neurological vulnerabilities (pre-trauma risk factor)?
-low cortisol levels [suppose to have a reaction to stressor so this is bad]
-increased blood flow in left hippocampus [excessive emotions but hippocampus is less able to process memories (can’t store them very well)]
-amygdala activation with PTSD
-smaller hippocampal volume as a vulnerability factor for developing PTSD symptoms
What are the developmental (pre-trauma) risk factors of PTSD?
-stress sensitization - childhood adversity
-attachment styles - secure vs insecure
-history of psychiatric illness - family & personal
What personality factors play a role in the development of PTSD?
-neuroticism: more intense reactions to stress
-impulsivity: likelihood of experiencing trauma; psychopathology
-resilience: self-efficacy, probelm-solving, coping abilities
-optimism
What are some psychological vulnerabilities (pre-trauma risk factor)?
-lack of social support: perception, availability, satisfaction
-external locus of control: less able to endure stressful events; attribution of responsibility [role of responsibility and self-blame]
What are some cognitive vulnerabilities (pre-trauma risk factor)?
-negative attributional style
-problem vs emotion focused coping
-rumination
-looming cognitive style (overestimation of the intensity of the threat)
-cognitive schemas about self, world and future
What happens when there is HPA axis deregulation (during-trauma risk factor)?
-low cortisol levels
-DST test: Vietnam Combat Veterans –> cortisol hypersuppression
-hippocampus damage
[when exposed to trauma cortisol doesn’t react (suppressed); cortisol doesn’t go up when it should which puts them at higher risk of developing PTSD (chicken or egg)]
What are some examples of maladaptive coping (post-trauma risk factors)?
-anger, shame
-negative appraisals of event, self, others, and world
-avoidance/attempts to suppress thoughts
-rumination
-attention bias for trauma-related stimuli
-experiential avoidance
What is the graph of experiential avoidance?
trauma –> avoidance (physiological, behavioural, cognitive, affective) –> temporary relief –> reexperiencing/poor coping
-exposure to trauma is a necessary but insufficient condition for the development of PTSD
What are the 4 most consistent risk factors that put an individual at the greatest risk for PTSD?
-neuroticism
-history of psychiatric illness
-perceived threat
-social support
What is the approach for treatment of PTSD?
-requires a multimodal approach that considers:
-biological predispositions
-personality/psychological factors
-social factors
