Stress and Trauma

Question 1

PTSD Adults

Answer 1

For adults and children older than 6
A. Exposure to actual or threatened death, serious injury, or sexual violence in 1+ of the following ways:
▪ Direct experience
▪ Indirect (witnessing) experience
▪ Learning that something has happened to a loved one
▪ Experiencing repeated or extreme exposure to aversive details of traumatic events (first responders) – does not apply to watching it in the media
B. Presence of 1+ of the following INTRUSION symptoms
▪ Recurrent, involuntary, and intrusive memories (repetitive play may occur in children older than 6)
▪ Recurrent distressing dreams related to the event (children may have frightening dreams with unrecognizable content)
▪ Dissociative reactions/flashbacks (reenactment play in kiddos)
▪ Intense or prolonged psychological distress at exposure to cues that symbolize or resemble aspects of the event
▪ Marked physiological reactions to cues like mentioned above
C. Persistent AVOIDANCE of stimuli associated with the event by 1+ of the following
▪ Avoidance of or efforts to avoid distressing memories, thoughts, feelings related to trauma
▪ Avoidance of or efforts to avoid external reminders
D. Negative alterations in COGNITIONS/MOOD as evidenced by 2+ of the following
▪ Inability to remember important aspect of trauma
▪ Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
▪ Persistent, distorted cognitions about the cause or consequences of the traumatic events (blaming self)
▪ Persistent negative emotional state
▪ Markedly diminished interest or participation in significant activities
▪ Detachment/estrangement from others
▪ Persistent inability to experience positive emotions
E. Marked alterations in AROUSAL\REACTIVITY associated with trauma 2+
▪ Irritable behavior or angry outbursts
▪ Recklessness/self-destructiveness
▪ Hypervigilance
▪ Exaggerated startle response
▪ Problems with concentration
▪ Sleep disturbance
F. Duration of the disturbance is more than 1 month
G. Clinically significant impairment or distress
H. Not due to a substance

Question 2

PTSD Specifiers

Answer 2

With dissociative symptoms (depersonalization, derealization)
With delayed expression (full criteria not met until after 6 months)

Question 3

PTSD in 6 or younger

Answer 3

A. Exposure to event
▪ Directly
▪ Witnessing
▪ Learning about event to a caregiver
B.) 1+ of the following INTRUSION symptoms
▪ Distressing memories (may be expressed as play)
▪ Distressing dreams ( may not be possible to determine if fearful content is related to trauma)
▪ Dissociative reactions
▪ Psychological distress at cues
▪ Physiological reaction at cues
C.) 1+ of the following AVOIDANCE and COGNITION symptoms
▪ Avoidance/efforts to avoid activities, places, physical reminders
▪ Avoidance/efforts to avoid people, convos that are reminders
▪ Substantially increased frequency of negative emotional states
▪ Diminished interest in activities
▪ Socially withdrawn
▪ Reduction in expression of positive emotions
D. Alterations in AROUSAL AND REACTIVITY
▪ Irritability
▪ Hypervigilance
▪ Exaggerated startle response
▪ Problems with concentration
▪ Sleep problems
E. More than 1 month
F. Significant distress or impairment
G. Not attributable to a substance
o Same specifiers

Question 4

PTSD Key Concerns

Answer 4

o Can happen at an age
o Predisposition may have some heritability
o Severity, duration, and proximity of exposure to trauma are the most important factors affecting likelihood of developing PTSD
o Higher rate of suicide
o Substance use possibility

Question 5

PTSD Assessment

Answer 5

o SCID- 5 or Clinician Administered PTSD Scale (gold standard – manualized hour long interview with 30 trauma specific questions, a screening tool for differential diagnosis, identifies duration of symptoms, identifies associated features
o Self-report PTSD Checklist (PCL)
o TSI
o MMPI-3specifically EID

Question 6

PTSD Treatment

Answer 6

o Prolonged exposure (for less cognitive people) – focuses on the classically conditioned fear
o Cognitive processing therapy - lots of writing and talking about specifically what happened and allowing the brain to process the trauma in a way that the autobiographical memory and the emotional memory match
o Monitor suicide risk and substance use

Question 7

Reactive Attachment Disorder

Answer 7

A: a consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers
B: persistent social and emotional disturbance characterized by 2 of the following:
-minimal social and emotional responsiveness
-limited positive affect
-episodes of unexplained irritability
C: the child has experienced a pattern of extreme insufficient care

Question 8

Disinhibited Social Engagement Disorder

Answer 8

A child actively approaches and interacts with unfamiliar adults

Question 9

Adjustment Disorder

Answer 9

Symptoms happen within 3 months of an event

Can specify with depressed mood, anxious features, mixed mood

Question 10

Prolonged Grief Disorder

Answer 10

Death of someone was more than 12 months ago but still affecting a person greatly