PTSD and Trauma Related Dxs Flashcards
PTSD
Criteria:
A. Exposure to _____ or ______ death, serious _____, or _____ violence in ___ of the following ways
Name the 4 ways.
For number 4, who counts and who doesn’t count?
if ≤ age 6:
Number 3 must be what?
A. actual or threatened; serious injury; sexual violence; in 1 of the following ways
- Directly experiencing
- Witness occurring to others
- Learning occurred to close other (if actual or threatened death of family or friend must be violent or accidental)
- Experience repeated or extreme exposure to aversive events or details.
Police and 1st responders count
Exposure through electronic media, TV, etc, do not count unless work related
if ≤ age 6, number 3 “other” must be parent or caregiver
PTSD
Criteria:
B. ≥ 1 Sx post trauma
- Recurrent, distressing _______ (for children it can be __________)
- Recurrent distressing _________ related to trauma (for children it can be frightening _____ with no recognizable content)
- ________ reactions/flashback - feels as if trauma _______
(for children it can be trauma _________) - Psychological distress at ______ that ______
- Physiological distress at _______ that ______
- memories; children can be repetitive play
- dreams related to trauma; children it can be frightening dreams
- Dissociative; trauma reoccurring; children can be trauma play enactment
- at cues that remind
- at cues that remind
PTSD
Criteria:
C. Avoidance - ≥ 1 Sx post trauma
- Avoids ______, ______, and _______ reminders
- Avoids _____, _______, & _________ situations
What are the rules for criteria C and D PTSD < age 6 and how many symptoms do they need?
- activities, places, and physical reminders
- people, conversations, and interpersonal situations
- Combine C (avoidance) with a Revised D (negative cognition/mood) and they only need 1 Sx from combined criteria
PTSD
Criteria:
D. Negative Cognition/Mood - ≥ 2 Sxs post-trauma
- Unable to remember _________ of trauma
- Persistent ______ ______ (self, other, world)
- Persistent distorted ideas re: trauma’s _______ or ______ leads to ________
- Persistent negative ______
- Markedly decreased ________/______ in activities
- Feeling _______ from others
- Persistently unable to feel __________
for < age 6
Revised Criteria D
Minor modifications, mostly to make Sxs more observable (socially withdrawn vs. feeling detached from others)
Why do they make these changes?
What are the rules for criteria C and D PTSD < age 6 and how many symptoms do they need?
- important aspects
- negative beliefs
- cause or consequences leads to self-blame
- emotions (fear, anger, etc.)
- interest/participation
- detached
- positive emotions
for < 6
These changes are made because kids will find it difficult to explain their feelings. Observation is the only way to gather Sx profile.
Combine C (avoidance) with a Revised D (negative cognition/mood) and they only need 1 Sx from combined criteria
PTSD
Criteria:
E. Arousal/Reactivity - ≥ 2 Sxs post-trauma
- _______/_______ w/ little to no provocation
- _______/________ behavior
- Hyper-________
- Exaggerated _______ response
- _________ problems
- _______ disturbance
How long must the disturbance last?
It must cause clinically significant _____ or _____ impairment
Not due to the ______ effects of ______ or another ________
What are the changes to Criteria E for PTSD < 6 years old?
- Irritability/angry outbursts
- reckless/self-destructive
- hyper-vigilance
- exaggerated startle response
- concentration problems
- Sleep disturbance
Disturbance must last ≥ 1 month
distress or functional impairment
physiological effects of substance or another medical condition
For PTSD < 6 years old, Criteria E includes:
- temper tantrums when describing angry outbursts
- No Sx regarding reckless/self-destructive behavior
PTSD
Subtypes:
With dissociative Sxs - Meets PTSD criteria and has one recurrent or persistent Sxs with one of these forms of dissociation. What are these 2 forms? Describe them.
- Depersonalization - feeling detached from, and as if one were an outside observer of, one’s mental processes or body.
- Derealization - Unreality of one’s surroundings (e.g., world around one is experienced as unreal, dream-like, distant, distorted)
PTSD
Specifier:
With delayed expression
Explain what delayed expression means.
Full Dx criteria not met until at least 6 months after event (although some Sxs may onset earlier)
PTSD:
Trauma-informed care shifts the focus from…
“What is wrong with you?”
to
“What happened to you?”
How many people experience trauma during their lifespan and what is the PTSD lifetime prevalence rate?
~50-60% of people experience during lifespan
PTSD lifetime prevalence rate is 7-8.7%
What are the characteristics of a person that makes PTSD more likely?
- Female
- Increased number of prior traumas
- Pre-existing psychopathology
What environmental characteristic makes PTSD more likely?
The amount of social support. More social support = less likelihood
What are the characteristics of an event that make PTSD more likely? There are 3.
- Physical proximity to trauma
- Degree of injury/impact
- Type of trauma (interpersonal and man-made)
PTSD
Etiology:
There are a number of biological mechanisms implicated. What are they?
Neurotransmitters - serotonin, GABA, glutamate, noradrenaline
HPA axis reactivity
PTSD
Etiology:
How the event is processed in memory makes a difference. How are trauma memories stored differently from normal memories?
Memories of trauma are not time-tagged and they are easily triggered by the environment.
When triggered, the experience comes on in a way that can replicate the initial experience in terms of feeling. This is why individuals with PTSD are consistently trying to avoid triggers of the memory.
PTSD
Tx:
Explain Trauma Focused CBT (TF-CBT)
Individuals are exposed to trigger, possibly through virtual reality.
Cognitive restructuring occurs as trauma is processed.
The nonresponse for CBT for PTSD can be as high as 50%
PTSD
Tx:
Explain EMDR.
What’s the controversy with EMDR?
Eye Movement Desensitization and Reprocessing
“Unfreezing” traumatic experience by focusing on it
Become aware of negative thinking
Substitute the negative thinking with positive thinking.
Eye movements help people relax enough to think clearly, sort out trauma, and process it more easily. It provides an external stimulus to focus on rather than the trauma memory alone.
Controversy:
What’s crucial in EMDR? Eye movement or exposure?
Almost identical to TF-CBT - exposing self to memory and cognitively restructuring it.
PTSD
Treatment Efficacy:
- TF-CBT = to which other therapy?
- Which other therapy seems effective but has less data?
- Anti-depressants (SSRI/SNRIs) are better than what in reducing Sxs? But they are not as good as…?
- For what kinds of therapy is there promising evidence?
- EMDR
- IPT
- Placebos; not as goo as TF-CBT
- CAMS (Collaborative Assessment and Management of Suicidality = neurofeedback, yoga, acupuncture, TMS, etc.)
PTSD
Tx:
Explain the argument made against exposure therapy (TF-CBT) in “The Evil Hours”.
Which therapy was better for him?
Idea was to categorize PTSD as a learning disorder. The prolonged exposure in TF-CBT included telling story over and over again in presence of therapist - eventually the story loses its traumatic charge and becomes just like another memory.
Interviewee felt like he was connecting more to all of his memories of being in Iraq rather than just the one he was focusing on. He could feel physical changes in his body in a negative way. Focusing on a single traumatic event was inappropriate because he had a multitude of traumas beyond a single episode that was not being addressed.
He tried Cognitive Processing Therapy - which is derived from CBT - where he examined is thoughts about the world and how these impact his feelings. It uses reality testing to see if his beliefs and thoughts about the world were accurate. He found it to be meditative and helpful for him. He felt it allowed to “let sleeping dogs lie”. Similar to DID treatment - should we let the trauma elements exist as they are and allow the client make the choice of exposing themselves to it? He felt TF-CBT was recreating the trauma and was being done TO HIm. This may not be the experience we want to recreate in therapy. We want them to experience control.
Acute Stress Dx:
Define this disorder and its duration.
Exposure to actual or threatened death, serious injury, or sexual violation.
It lasts for 3 days to 1 month after trauma.
Pre-PTSD diagnosis as indicated by the time difference. PTSD ≥ 1 month.
Adjustment Disorders:
Define Adjustment Disorders.
How quickly do they have to occur after stressor?
What are the different behavioral expressions?
Emotional or behavioral Sxs in response to an identified stressor.
They must occur within 3 months of stressor.
Behavioral expressions:
- With depressed mood
- With anxiety
- Mixed anxiety and depressed mood
- With disturbance of conduct
- With mixed disturbance of emotions and conduct
- Unspecified
Adjustment disorders were once considered what? Hint: They were subclinical.
What’s different about them now?
V-code disorders.
They are diagnosable disorders now but they aren’t as fleshed out as other disorders. There’s fewer diagnostic criteria. This is the hallmark of disorders that were once in the back of the book as V-code disorders but have not yet assumed the status of the other full disorders.
Their main use is when people don’t quite make the criteria for PTSD but have had symptoms for too long to have Acute Stress Dx.
Reactive Attachment Dx (RAD) and Disinhibited Social Engagement Dx:
What do both of these Dxs have in common?
Both of these involve the child being exposed to a history of insufficient care (neglect, unable to form stable attachments) responsible for a certain pattern behavior.
Reactive Attachment Dx (RAD) and Disinhibited Social Engagement Dx:
What’s different about these Dxs?
Children with RAD are inhibited, emotionally withdrawn, and fearful of non-threatening adult caregivers. Children with DSE have little reticence towards unfamiliar adults and are intrusive.
RAD children do not seek or respond to comforting They have minimal to no interest in caregivers. DSE kids do very little checking with caregivers before exploring and lack appropriate social and physical boundaries.
RAD kids have limited positive affect. They have episodes of unexplained irritability, sadness, or fear around familiar caregivers. They have minimal social and emotional responsiveness. DSE kids willingly and unhesitatingly go off with strangers and are attention seeking (sometimes aggressively). They act overly familiar with strangers, often to a point that it makes adults uncomfortable.
Disinhibited Social Engagement Dx:
What intellectual disorder do you have to distinguish DSE from?
Williams Syndrome - an intellectual disorder where child tends to be highly verbally engaged with strangers but less physically engaged as kids with DSE
