Stress Disorders Flashcards
Social readjustment rating scale
=Commonly used life stress scale
=does not differentiate if you personally feel an event was pos or neg, just uses how most people would feel
What is stress?
=challenge to our physical or emotional well being that exceeds our coping abilities and resources
-negative events
-chronic or acute
=distress: negative, causes more psychological damage
=eustress: positive events
=events can be both, ex coming to college
Adjustment disorder
=psychological response to common stressors
-victim of crime, retirement, natural disaster
=clinically significant emotional or behavioral symptoms
=most benign, least stigmatizing diagnosis
=symptoms begin within 3 months of stressor, subside by 6 months from stressor
Adjustment disorder symptoms
=withdrawing from friends
=somatic symptoms
=feeling sad or hopeless
= aggressive behavior in children
Adjustment disorder stigma
= least stigmatizing diagnosis
= sometimes used as a way to get insurance companies to pay for treatment such as therapy
-insurance companies don’t want to pay without diagnosis and patient does not meet anxiety or depression criteria
What if stress is severe?
=Acute Stress Disorder
-symptoms develop shortly after experiencing a trauma and last between 2 days and a month
= PTSD
-if the symptoms last at least one month
PTSD DSM criteria
A. exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways
- directly experiencing the traumatic event
- witnessing in person the event as it occurred to others
- learning that the traumatic event occurred to a close family member or friend
- experiencing repeated or extreme exposure to aversive details of the traumatic event
- ex first responders collecting human remains
What must be present for a PTSD diagnosis?
=trauma
-either you felt threatened or a close family or friend did
trauma
=a situation where there is real or threatened death or bodily harm
-real death ex: seeing someone die
- most common trauma in women
2. most common trauma in men
- sexual assault
2. military combat
Symptoms connected to PTSD
=reexperiencing
=avoidance
=negative cognitions or mood
=arousal
=these have to cause significant impairment
=and last greater than one month
=need to have at least one symptom in each category
Reexperiencing
=spontaneous memories of the specific event
=recurrent related dreams
=flashbacks
=or other intense prolonged psychological distress
Avoidance
=actively try to avoid distressing memories, thoughts, feelings, or external reminders of the traumatic event
=ex: avoid asian restaurants if you have PTSD from serving in Vietnam
Negative Cognitions or Mood
=similar to depression
=range from persistent and distorted sense of blame towards self or other to estrangement from others
=or significantly diminished interest in activities
=or inability to remember key aspects
Arousal
=appearance of aggressive, reckless, or self destructive behavior =sleep disturbances =higher vigilance or similar behavior -on guard for constant triggers -ex: fireworks sound like explosives
Lifetime prevalence of ptsd
= 6.8% in US
= 9.7% in women
=3.6% in men
-but exposure to traumatic events is higher for men
What determines rates of PTSD after exposure to trauma?
=type of trauma
-at hands of other humans (war, assault) is more likely to trigger ptsd than accidental traumas (natural disasters)
-lose faith in people and trust in safely of environment when humans cause trauma
=degree of direct exposure
-personal experience is more likely to cause ptsd than exposure to another’s experience
=method of assessment
-self assessment yield higher rates than clinician diagnosis
Specific consideration in the military
=92% of military in Iraq report having been attacked or ambushed
=86% report knowing someone who has been killed or seriously injured
=OEF/OIF vets have ptsd at a rate of at least 4.3%
-most conservative estimate - could be an underestimate
-stigma against seeking help is very strong in military, esp help for a mental, not physical, illness
=effect of longer and more frequent deployments
=sending those with previous psychiatric difficulties into war
=impact of higher casualty wars - impact of killing
=impact of justification for combat
=alcohol abuse, depression, aggression, and suicide also elevated
Risk Factors for trauma exposure
=male =less than college education =conduct problems in childhood =family history of psychiatric disorder =high on extraversion and neuroticism -extraversion: traumatic events are interpersonal -neuroticism: predisposition to negative mood =non white
Risk Factors for development of ptsd, given exposure to trauma
=female
=low social support
=high neuroticism
=pre-existing depression and anxiety
=family history of psychiatric difficulties
=appraisals
-blame self
-think people will be ashamed of them for their reaction
=higher risk (s/s) genotype of serotonin transporter gene
=small hippocampal volume
=in women: higher baseline cortisol
Protective Factors
=higher IQ =SES =income =education =social support
ptsd treatment
=prolonged exposure therapy
=crisis: intervention, hotlines
=psychological debriefing -talk about event immediately after, may be helpful for some and counterproductive for others
-solidify and remember all details
-some people may not have done this without the therapist telling them to
=visual spatial puzzle right after trauma
-brain does not solidify memories of trauma because it focuses on the puzzle
-ex tetris
= novel pharmacological treatments right after trauma
-cannabinoids, HDAC2
-prevent memory consolidation of trauma
