Task 2 PTSD Flashcards
A exposure to actual or threatened death serious injury, or sexual violence in one or more of the following ways:
Directly experience the traumatic event
Witnessing, in person, the event(s) as it occurred to others
Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental
Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse) (does not apply to voluntary exposure e.g. TV unless it is work related)
B Presence of one or more of the following intrusion symptoms associated with the traumatic event, beginning after the event occurred
Recurrent, involuntary, and intrusive distressing memories of the traumatic event (children younger than 6 might express this as repetitive play)
Recurrent nightmares related to the trauma (In children there might be no specific content in those dreams)
Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) (In children, trauma-specific reenactment may occur in play)
Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event
C Persistent avoidance of stimuli associated with the traumatic events, as evidence by one or both of the following:
Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event
Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event
D Negative alterations in cognitions and mood associated with the traumatic event beginning or worsening after the traumatic event, as evidence by two or more of the following:
Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs)
Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others
Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame)
Markedly diminished interest or participation in significant activities
Feelings of detachment or estrangement from others
Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings)
EMarked 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
Irritable behaviour and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects
Reckless or self-destructive behaviour
Hypervigilance
Exaggerated startle response
Problems with concentration
Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep)
Other diagnostic criteria
o F Duration of the disturbance Is more than 1 month / called chronic if it persists longer than 3 months
o G the disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning
o H The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition
Co-occurrence with dissociative symptoms
Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly)
Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted)
Delayed expression
When the symptoms start 6 months after the event
Dissociative disorder and PTSD (Prevalance)
o 1/3 with PTSD also experience DD in form of dissociative amnesia and depersonalisation
o Three connections:
DD directly after trauma event predicts full blown PTSD, so a tendency to DD makes persons vulnerable for PTSD
Complex PTSD: server from of PTSD often associated with early age interpersonal trauma and with dissociative symptoms from that early age
Special DD subtype of PTSD with 30% prevalence in PTSD cases
Dissociative amnesia
patients suffer a loss of autobiographical memory for certain past experiences (often caused by trauma)
Can be sometimes explained by selective attention in trauma experience
Dissociative fugue
the amnesia covers the whole or large part of the patients life, it is also accompanied by a loss of personal identity and in many cases physical relocation (often caused by trauma)
Dissociative identity disorder
A single patient possesses and manifests two or more distinct identities that alternate in control over conscious experience, thought, and action, and typically are separated by some degree of amnesia
Depersonalisation disorder
Patients believe that they have changed in some way or are in some way no longer real (derealization accounts for same beliefs about the environment)
Commonly observed in acute stress reactions
Prominent theory: dysregulation along the hypothalamic-pituitary adrenal axis
• Sometimes successfully treated with anxiolytic or antidepressant drugs (could be primary or secondary effect)
The trauma memory argument
Dissociation might be a defence mechanism to protect themselves
People who experienced a trauma are unlikely to forget about it they even remember it more vivid
Derealization and depersonalization occur but amnesia caused by trauma not so much
Adaption: memory is enhanced for “terror” traumas, such as combat, but impaired by dissociation for “betrayal” traumas, such as incest (not scientifically supported)
Intrusion based reasoning
the tendency to interpret distressing intrusions themselves as evidence that danger is impending, regardless of objective danger information (linked to PTSD)
o Method: longitudinal study
o IR is involved onset and maintenance of PTSD symptoms
IR leads to acute stress and this leads to PTSD (acute stress is mediator)
o People with PTSD rate situations with intrusions as more dangerous
Emotion based reasoning
(anxiety related)
Inferring danger from presence of anxiety responses themselves (If anxiety, then threat).
Measured with three scenarios specific for panic disorder, social phobia and spider phobia. E-R scenarios were administered last.
Results – PTSD group showed higher danger ratings on scenarios with anxiety information relative to those without. Also, people high in ER have more difficulty distinguishing safety signals from danger signals compared to individuals low in ER.
Not connected to PTSD
Prevalence
o Risk to get PTSD until age 75 is 8.7% (USA)
o Twelve month prevalence in US 3.5 most other countries around 0.5-0.1%
o Police firefighter etc have higher risks
o Rape, military combat and captivity and genocides: ranging from one third to 50%
o Younger children show lower prevalence
o Full PTSD is less prevalent in older age but sub-threshold might be higher
Development and course
o Symptoms usually begin within 3 months but until enough criteria are met it can take years
o Duration of the symptoms: one half has completely recovered after 3 months the rest might need up to 50 years
Biological factors
Heritability of 30%
A relatively small hippocampus
Underdeveloped amygdala and VMPFC
Genetically heightened startle response and fear relevant endocrine secretion
Avoidance coping (risk factor)
increases risk of developing PTSD
Dissociation (risk factor)
before, during and after increases risk and severity of PTSD
Conditioning theory
supposes that many of the symptoms are due to classical conditioning
Might explain flashbacks
Conditioned fear responses do not extinguish because avoidance behaviour prevents processing of cues (e.g. claps for gun shot)
Emotional processing theory
creation of representation in memory that becomes strongly connected with other contextual details (e.g. car accident might lead to fear of roads or even travelling)
Again avoidance of these stimuli prevents normal associations
Traumas might be so severe that the representations differ to everyday life experiences so they are more persistent
Fixed word view might make you vulnerable to PTSD
Mental defeat (factor)
A specific frame of mind in which the individual sees themselves as a victim (also in future). This is a psychological factor that is important in making an individual vulnerable o PTSD
Perceived lack of control might lead to decreased processing of the trauma
Dual representation theory
explains PTSD by to sperate memory systems
Verbal accessible memory: registers memories that are consciously processed and retrievable
Situationally accessible memory: captures information of the vent that might be to fast for conscious processing (e.g. sounds)
• Accounts for flashbacks
Temperament (before risk factor)
These include childhood emotional problems by age 6 years (e.g., prior traumatic exposure, externalizing or anxiety problems) and prior mental disorders
Environmental (before risk factors)
• Lower socioeconomic status, lower education, exposure to prior trauma, cultural characteristics (e.g. self-blaming coping strategies) low intelligence, minority group, family psychiatric history
Genetic and physiological before risk factors
• These include female gender and younger age at the time of trauma exposure (for adults). Certain genotypes may either be protective or increase risk of PTSD after exposure to traumatic events
During risk factors
severity of the trauma, perceived life threat, personal injury, interpersonal violence and, for military personnel, being a perpetrator, witnessing atrocities, or killing the enemy. Finally, dissociation that occurs during the trauma and persists afterward is a risk factor
Posttraumatic factors that could affect PTSD
Temperamental: These include negative appraisals, inappropriate coping strategies, and development of acute stress disorder
Environmental: These include subsequent exposure to repeated upsetting reminders, subsequent adverse life events, and financial or other trauma-related losses. Social support (including family stability, for children) is a protective factor that moderates outcome after trauma
Cormobdity
o Individuals with PTSD are 80% more likely than those without PTSD to have symptoms that meet diagnostic criteria for at least one other mental disorder (e.g., depressive, bipolar, anxiety, or substance use disorders (more common among males))
o most young children with PTSD also have at least one other diagnosis, the patterns of comorbidity are different than in adults, with oppositional defiant disorder and separation anxiety disorder predominating
o there is considerable comorbidity between PTSD and major neurocognitive disorder and some overlapping symptoms between these disorders
Psychological debriefing
Structured way of trying to intervene development of PTSD directly (24-72 HOURS) after event
o CISM: showing people that they are normal individuals that have experienced something abnormal
o Lost its right, might even be disadvantageous
Exposure therapies
o What does it does: 1 helps to extinguish traumatic associations 2 helps to disconfirm irrational beliefs caused by trauma
o How: virtual reality, detailed narrative, visualizing fear (Imaginal flooding)
Cognitive restructuring
evaluate and replace intrusive or negative automatic thoughts and evaluate and change dysfunctional beliefs about the world
EMDR
o Patient recalls traumatic memories while performing a task which causes bilateral stimulation (looking from left to right/up or down or hearing sounds left and right) tackles working memory
o Eye movement adds effects that cannot be explained by only recall
o Task are used to limit capacity of working memory while recalling traumatic event with the goal to reduce vividness and emotionality of the memory
During recall memory becomes label and the recall leads to imagination inflation
SO any tasks affecting working memory can be used
Flash forwards (EMDR)
EMDR can be used to decrease the tense of prescriptive memory the same way as retrospective memories
Working memory capacity (EMDR)
people with low WM capacity respond better to EMDR
Inverted U shape (EMDR)
there needs to be a minimum of taxing, but if this taxing exceeds a certain level there will be too little room for recall. Too little and to much taxing have a negative effect
Vague memories need to be treated with low WM tax
Beeps in EMDR
Might not tax working memory but causes interhemispheric communication
Small but significant effect (eye movement has 3 times the effect of beeps)
More satisfactory than eye movement which does not predict actual effectiveness
Mindfulness and mindful breathing
Mindfulness-based cognitive therapy (MBCT): Mindful breathing is used to create emotional distance to thought, memories and impulses (esp. used in depression)
MB and eye movement have the same influence o reaction time (working memory)
MB might have the same effects as eye movement
Treatment effectivity for PTDS and DS
o DS does not decrease treatment success of PTSD, but their PTSD was more severe in the beginning and in the end but the proportion of effectiveness was similar in both groups
o PTSD treatment can even decrease DS symptoms
Acute stress disorder
similar symptoms to PTSD but shorter duration less than one month
