Task 2 - PTSD Flashcards
DSM-5 Criteria for PTSD
A Exposure to actual or threatened death, serious injury, or sexual violence
B Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s)
2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s)
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)
5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)
C Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)
2. Avoidance of or efforts to avoid external reminders that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)
D Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred
E Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
1. Irritable behavior and angry outburst (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects
2. Reckless or self-destructive behavior
3. Hypervigilance
4. Exaggerated startle response
5. Problems with concentration
6. Sleep disturbance
F Duration of the disturbance is more than 1 month
–> prevalence of 7%
PTSD with dissociative symptoms
The individual’s symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either the following:
- Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body
- Derealization: Persistent or recurrent experiences of the unreality or surroundings
Dissociative Disorders
dissociative amnesia: patients suffer a loss of autobiographical memory for certain past experiences
dissociative fugue: amnesia covers the whole of the patient’s life and is accompanied by a loss of personal identity and physical relocation
dissociative identity disorder (DID): a patient possesses and manifests two or more distinct identities that alternate in control over conscious experience, thought, and action
dissociative disorders not otherwise specified: patients display dissociative symptoms to some degree but not to the extent that they qualify for one of the major diagnoses
–> trauma memory argument: trauma victims employ psychological defenses like dissociation to block their awareness of their trauma
PTSD with delayed expression
If the full diagnostic criteria are not met until at least 6 months after the event
Traumas leading to PTSD
Natural disasters: floods, tsunamis, earthquakes, fires, hurricanes, and tornados
Humane disasters: wars, terrorist attacks, and torture
Sexual assault: the trauma most commonly associated with PTSD
–> nearly half (46%) of sexual assault survivors develop PTSD at some point in their lives
Causes: Environmental and Social
- people who experience more severe and longer-lasting traumas and are directly affected by a traumatic event are more prone to developing PTSD
- people who have the emotional support of others after trauma recover more quickly
Causes: Psychological
- people experiencing increased symptoms of anxiety or depression before trauma occurs are more likely to develop PTSD following the trauma
- maladaptive coping strategies –> drinking, self-isolation, and detachment from the trauma
Causes: Gender and Cross-Cultural Differences
- women are at greater risk for developing PTSD
–> they experience some triggers more often, e.g., sexual abuse –> associated with stigma - men suffer more from traumas less associated with stigma –> war
- African Americans have higher rates of PTSD
Causes: Biological
- amygdala: respond more actively to emotional stimuli
- medial prefrontal cortex: less active when severe
- hippocampus: shrinkage - overexposure of neurotransmitters and hormones to the stress response
- resting cortisol levels tend to be lower –> prolonged activity in the sympathetic nervous system after stress
- hypothalamic-pituitary-adrenal (HPA) axis is unable to shut down the response of the sympathetic nervous system –> overexposure to epinephrine, norepinephrine –> overconsolidation of memories
- extreme or chronic stress during childhood (trauma)
- vulnerability to PTSD may be inherited
- abnormally low cortisol levels
Emotion-Based Reasoning (ER) and Intrusion-Based Reasoning (IR)
ER: inferring danger from the presence of anxiety responses themselves
IR: tendency to form interpretations about oneself or a situation based on the occurrence of a negative intrusive autobiographical memory regardless of objective danger information
–> anxiety responses themselves are interpreted as harbingers of impending threat
–> IR might play a role in the causation/onset and maintenance of PTSD
–> the world is interpreted as unsafe
–> ER and IR may motivate PTSD patients to search selectively for danger-confirming information
Treatment: Cognitive-Behavioral Therapy
Systematic desensitization:
- the client identifies thoughts and situations that create anxiety, ranking them from most to least provoking
- the therapist tales the client through this hierarchy, exposing the client to the trauma cues
- use of relaxation techniques
–> repeatedly and vividly imagining and describing the feared events in the safety of the therapist’s office
Treatment: Biological
- selective serotonin reuptake inhibitors (SSRIs)
- benzodiazepines
–> treat sleep problems, nightmares, and irritability
Treatment: EMDR
Eye Movement Desensitization and Reprocessing
- the patient recalls traumatic memories while simultaneously making horizontal eye movements
- during a second recall patients engage in either no dual-task or a dual task (mainly eye movements)
–> moving your eyes from side to side while recalling a memory leaves less capacity for the memory, and as a consequence, the memory should become less vivid and less emotional - imagination deflation
–> individuals who are more distracted by eye movements or other dual tasks benefit more greatly from EMDR-type processing
–> inverted U: too little and too much taking both have little or no effect on memory effects
–> the effects of eye movements are three times that of beeps
–> parallel between EMDR and mindfulness-based cognitive therapy
Treatment: Psychedelic Drugs
These drugs catalyze the psychotherapeutic process by:
- increasing the capacity for emotional and cognitive processing through pharmacologically diminishing fear and arousal
- strengthening therapeutic alliance through increased trust and rapport
- targeting processes of fear extinction and memory consolidation
MDMA, Ketamine, Classical Psychedelics, and Cannabinoids
Treatment: Trauma-Focused Psychotherapy in relation to PTSD Dissociative Subtype
- large and significant reduction in PTSD symptoms after treatment
- more than half of the patients lost their symptoms (55%)
- the decline in symptom severity is similar for individuals with DS and those without DS
- on average, patients with DS still displaced a moderate level of PTSD after treatment
- the presence of dissociative symptoms demands a longer treatment duration
–> the presence of DS does not moderate the outcome of trauma-focused treatments
