PTSD and stressor-related Disorders

Question 1

PTSD Criterion A: 1+

Answer 1

1. Exposure to traumatic event directly
2. Witnessing the event happening to another person
3. Learning the event happened to close family member/friend (violent or accidental only)
4. Repeated extreme exposure to traumatic events - first responders, collecting human remains, etc

DSM tightened this criteria - have to experience it in person. Event is usually discrete. Not chronic exposure.

Question 2

PTSD Criterion B: 1+

Answer 2

Intrusion Symptoms

• Intrusive memories
• Distressing, recurring dreams
• Dissociative reactions - flashbacks - reliving the experience
• Physical distress at exposure to cues which are reminders of the event
• Psychological distress to cues which are reminders of the event

Question 3

PTSD Criterion C: 1+

Answer 3

Avoidance of Stimuli

• avoiding memories, thoughts, feelings related to the event
• avoiding external reminders of the event (people, places, conversations, activities)

They are trying to avoid the intrusive symptoms in their heads

Question 4

PTSD Criterion D: 2+

Answer 4

Negative Changes in Cognition or Mood

• inability to remember the event or parts of the event (dissociative amnesia)
• negative beliefs about self/the world
• distorted cognitions about the event leading them to blame themselves
• persistent negative emotions
• feelings of estrangement from others
• lack of interest in activities
• loss of pleasure - inability to experience positive emotions

Question 5

PTSD Criterion E: 2+

Answer 5

Changes in Arousal/Reactivity

• Reckless and destructive behaviour
• Hypervigilance
• Exaggerated startle response
• Sleep disturbances
• Problems concentrating

Question 6

The reason why these disorders are all in the same chapter is that, even though they are related to anxiety, reactions to stress/trauma also involves other things, especially _____ symptoms. And, of course, they are all in response to an identifiable ______.

Answer 6

dissociative, stressor

Question 7

The symptoms for PTSD have to be present for ______, otherwise the person is diagnosed with _______ _______ disorder

Answer 7

1 month

acute stress

Question 8

There are two important specifiers in PTSD. These are:

Answer 8

Delayed expression - develops much later than usual - 6 months after

Dissociation - depersonalisation, derealisation and dissociative amnesia - signifies worse prognosis

Question 9

How many with PTSD will have another disorder as well? What are these?

Answer 9

80-90%
depression
substance abuse

Question 10

Acute Stress Disorder Criterion A: 1+

Answer 10

1. Exposure to traumatic event directly
2. Witnessing the event happening to another person
3. Learning the event happened to close family member/friend (violent or accidental only)
4. Repeated extreme exposure to traumatic events - first responders, collecting human remains, etc

Question 11

Acute Stress Disorder Criterion B: 9+

Answer 11

INTRUSION

• intrusive memories
• recurrent dreams
• dissociative reactions (flashbacks)
• intense or prolonged psychological or physical distress

AVOIDANCE

• efforts to avoid distressing thoughts, feelings or memories
• efforts to avoid external reminders of the event (people, places, etc)

NEGATIVE MOOD
- inability to experience positive emotions (anything else would be a normal reaction)

AROUSAL

• sleep disturbance
• poor concentration
• hypervigilance
• exaggerated startle response
• irritable behaviour or angry outbursts

DISSOCIATIVE

• inability to remember aspects of the event - dissociative amnesia
• altered sense of reality - depersonalisation, derealisation, doesn’t feel real
• -> important risk factor for developing PTSD

Question 12

Treatment of _____ ______ disorder reduces likelihood of ______

Answer 12

acute stress

PTSD

Question 13

The prevalence of PTSD is ____%, with as much as ____% in women and ____% in men

Answer 13

1-4%
10-20%
6-8%

Question 14

Normal response to trauma is to ______, gradually decreasing over ___ months, for ____% of people

Answer 14

recover, 3, 75

Question 15

Risk factors for PTSD can be divided into pre-trauma, trauma and post-trauma. Describe these.

Answer 15

pre-trauma

• childhood trauma
• another mental disorder
• family instability - social support
• substance abuse
• social/economic resources - social support and financial opportunity

trauma

• role in the event
• severity of exposure to trauma
• amount of life threat
• location of trauma - safe vs unsafe place
• meaning given to the event

post-trauma

• social support
• coping style
• ongoing stressors

Question 16

Biological treatments for PTSD are ______ and/or ________.

Answer 16

benzodiazephines

antidepressants

Question 17

Biological treatments for PTSD are ______ and/or ________. It is _____ effective than _____.

Answer 17

benzodiazephines
antidepressants
less
CBT

Question 18

Describe how CBT is conducted for PTSD

Answer 18

Cognitive restructuring + exposure

1. So meaning of the event, and how the think about the world, etc. Also normalising the intrusions (it’s ok to feel that way)
2. Assess the patient - background problems need to be resolved, and psycho-education, and anxiety management techniques needed.
3. Address reminders of the event with exposure - gradually. Eg: leave the house, go to a park, go to the park.

THEN - prolonged exposure to the event - recalling the event, in the first person, in great detail.

Question 19

Describe how CBT is conducted for PTSD

Answer 19

Cognitive restructuring + exposure

1. So meaning of the event, and how the think about the world, etc. Also normalising the intrusions (it’s ok to feel that way)
2. Assess the patient - background problems need to be resolved, and psycho-education, and anxiety management techniques needed.
3. Address reminders of the event with exposure - gradually. Eg: leave the house, go to a park, go to the park. THEN - prolonged exposure to the event - recalling the event, for a long time, in the first person, in great detail.