PTSD

Question 1

what are physical reactions to trauma

Answer 1

muscle tension
headaches
nausea
shake and tremors 
choking sensation 
palpitations 
dizziness

Question 2

what is the most common cause of PTSD in UK

Answer 2

rape

Question 3

what happens if the flight or fight is not possible

Answer 3

FREEZE response

When the limbic brain judges that neither is possible
and death or severe injury is inevitable it will evoke

Question 4

what happens during a freeze response

Answer 4

The body goes into a ‘Shut Down’
There is an altered state of reality
The body becomes immobile
Pain sensations are reduced

Question 5

how is trauma differentiated

Answer 5

Type 1 = Simple trauma

Type 2 = complex trauma

Question 6

what is complex PTSD Sx

Answer 6

PTSD symptoms
AND
-Cognitive disturbances-low self-esteem, self-blame, hopelessness, helplessness, pre-occupation with threat

• Mood disturbances / Emotional dysregulation
• Somatisation
• Identity disturbance
• Chronic interpersonal difficulties
• Dissociation
• Tension reduction activities (binge-purging, self mutilation, substance misuse etc)

Question 7

what is the role of the hippocampus in the limbic brain

Answer 7

locating memories in the right time, place and context

Question 8

what is the role of the amygdala in the limbic brain

Answer 8

stores emotionally charged memories = connects to Medial prefrontal cortex

Question 9

what is the role of the Medial prefrontal cortex

Answer 9

regulates emotional and fear responses

Question 10

what does the amygdala control

Answer 10

autonomic emotional and sexual behaviour

Question 11

what are features of trauma memories

Answer 11

Easily triggered
Difficult to translate into words
Fragmented
Affect laden
Inability to recall some aspects of the trauma

Question 12

how can people be triggered into trauma memories

Answer 12

visual 
auditory 
smell
taste
kinaesthetic

Question 13

what are key features/symptoms of PTSD

Answer 13

flashbacks 
nightmares
avoidance
increased arousal 
emotional numbing 
dissociation

Question 14

what can trigger a flashback

Answer 14

insomnia
tiredness
stress

Question 15

how do people with PTSD wake up from nightmares

Answer 15

shouting
screaming
drenched in sweat or hot and trembling

Question 16

what are features of increased arousal

Answer 16

hyper-vigilance 
can appear threatening to others
exaggerated startle response to sounds 
irritability, burst of anger/aggression
feeling vulnerable 
inability to sleep
poor concentration 
poor memory

Question 17

what are features of emotional numbing

Answer 17

Feeling detached from the world

Unable to have loving feelings, feeling removed and alone

Loss of interest in hobbies, family and friends

Inability to look beyond the event or look forward to a future

Often the sufferer detaches himself/herself from loved ones

Question 18

what is dissociation

Answer 18

Offers temporary relief to the individual

The person may feel like they are observing themselves
from above

Or they may feel like it is not really happening

Question 19

what can dissociation present with as well

Answer 19

Dissociative flashbacks

Fugue states (when you dissociated so completely you have a temporary amnesia)

Dissociative Identity Disorder

Question 20

when is dissociation likely to happen

Answer 20

More likely to occur if trauma is

• severe
• Prolonged
• Repeated or horrific or shaming
• If the victim is very young

Question 21

what are some indicators of dissociation

Answer 21

Things look strange, colours may appear brighter or faded, tunnel vision

Sounds may appear muted or far away or Louder

The person may be rocking, tapping, twitching or grimacing

Things seem to move in slow motion

Feeling like a robot- functioning but not feeling

Feeling like a observer than a participant

Question 22

what are the responses over time that happens after trauma

Answer 22

48hrs = Acute stress reaction

up to 4 weeks = acute stress disorder

up to 3 months = acute PTSD

over 3 months = Chronic PTSD

Question 23

what is the time scale for acute stress disorder

Answer 23

occurring within 1 month of the trauma and lasting at least 2 days

Question 24

what are the Sx of acute stress disorder

Answer 24

Dissociative symptoms

• Emotional numbing
• Depersonalisation
• Derealisation
• Detachment
• Amnesia

Persistent re-experiencing

• Intrusions
• Nightmares

Increased arousal

• Anxiety
• Alertness
• Poor sleep

Question 25

what is the Tx for acute stress disorder

Answer 25

Debriefing should NOT be undertaken

If trauma symptoms are mild and present for less than 4 weeks – “watchful waiting”

Trauma focused CBT

EMDR (Eye Movement Desensitistaion and re-programming)

Question 26

when should PTSD specific treatment be done

Answer 26

only when the survivor is safely removed from the crisis