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Psychopathology > TASK 2 - PTSD > Flashcards

TASK 2 - PTSD Flashcards

1
Q

PTSD

A

= post-traumatic stress disorder

  • consequences of experiencing extreme stressors
  • 1980 named; before different names in wars
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2
Q

DSM-5 criteria

A.

A

exposure to actual/ threatened death, serious injury or sexual violence in one (or more) of the following ways

  1. directly experiencing
  2. witnessing, in person, the event occurring to others
  3. learning that it occurred to close others
  4. experiencing repeated/ extreme exposure to aversive details of a traumatic event (e.g. first responders collecting human remains)
    - trauma
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3
Q

DSM-5

B.

A

presence of one (or more) of the following symptoms beginning after the traumatic event occurred

  1. recurrent, involuntary, intrusive distressing memories
  2. distressing dreams/nightmares (content and/or affect are related to trauma)
  3. dissociative reactions (flashbacks) in which person feels/ acts as the event was recurring
  4. intense/prolonged psychological distress at exposure to internal/external cues that symbolise/resemble an aspect of event (triggers)
  5. marked psychological reactions to internal/external cues that symbolise/resemble an aspect of the event
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4
Q

DSM-5

C.

A

persistent avoidance of stimuli associated with the traumatic event, beginning after the event occurred, evidenced by one or both …

  1. avoidance of distressing memories/thoughts/ feelings about the event (internal)
  2. avoidance of external reminders
    - avoidance of stimuli
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5
Q

DSM-5

D.

A

negative alterations in cognition + mood associated with the traumatic event, beginning/ worsening after it occurred as evidenced by two (or more) of the following

  1. inability to remember an important aspect due to dissociative amnesia
  2. persistent, exaggerated negative beliefs + expectations
  3. persistent, distorted cognitions about the cause/ consequences –> leads individual to blame him/herself or others
  4. persistent negative emotional state (depression)
  5. diminished interest/ participation in significant activities
  6. feeling of detachment/ estrangement from others
  7. persistent inability to experience positive emotions
    - negative changes
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6
Q

DSM-5

E.

A

marked alterations in arousal + reactivity associated with the traumatic event beginning/ worsening after it occurred as evidenced by two (or more) of the following

  1. irritable behaviour, angry outbursts
  2. reckless/destructive behaviour
  3. hypervigilance
  4. exaggerated startle response
  5. problems with concentration
  6. sleep disturbance
    - changes in arousal/reactivity
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7
Q

DSM-5

F.

A

duration of the disturbance (B, C, D, E) is more than one month
- duration

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8
Q

DSM-5

G.

A

disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning
- impairment

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9
Q

DSM-5

H.

A

disturbance isn’t attributable to the effects of substances or another medical condition
- medical exclusion

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10
Q 
main symptoms (B)
- reexperiencing trauma
A
  • recurring nightmares, flashbacks in which they relive the event
  • when something reminds of the event
  • relives emotional
  • chronically experiences negative emotions
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11
Q 
main symptoms (B)
- emotional numbing
A
  • persistent avoidance of stimuli associated with trauma
  • become withdrawn, feel numb
  • feel detached from themselves and ongoing experiences –> especially after trauma
  • sense of foreshortened future: not expecting to reach typical milestones in life
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12
Q 
main symptoms (B)
- chronic arousal
A
  • always on guard for trauma to reoccur
  • perceptions that remind them of trauma, instantly create panic
  • survivor guilt
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13
Q

subtypes

- acute stress disorder

A

= similar to PTSD but more short-term

  • consequence of experiencing extreme stressors; response to traumas similar to those involved in PTSD
  • symptoms arise within 1 month of exposure to stressor and last no longer than 4 weeks
  • flashbacks, avoidance, chronic arousal
  • dissociative symptoms are common (numbing, detachment, depersonalisation)
  • short-term response to trauma –> high risk of PTSD
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14
Q

subtypes

- adjustment disorder

A

= emotional and behavioural symptoms (depressive, anxiety symptoms +/ antisocial behaviours)

  • symptoms arise within 3 months of experience of stressor; can be of any severity
  • people who experience emotional, behavioural symptoms following stressor –> do not meet criteria for PTSD, acute stress, anxiety/mood disorder
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15
Q

subtypes

- dissociation

A

= process in which different facets of one’s sense of self (memories/consciousness) become disconnected from one another

  • in addition to meeting criteria of PTSD experience following symptoms to stressor:
    1. depersonalisation: persistently feeling detached from, and as if one were an outside observer of one’s mental processes or body
    2. derealisation: persistent experience of unreality of surroundings
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16
Q

subtypes

- delayed expression

A

if full diagnostic criteria are not met until 6 months after the event

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17
Q

prevalence

A
  • most gradually have less symptoms

- co-morbidities: >50% (often mood, anxiety, sleep substance-related, personality disorder)

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18
Q

trauma type and prevalence

A

grosso modo = dose-response relationship

  • the more extreme/often the trauma, the higher the risk to develop PTSD
  • interpersonal violence (abuse) especially
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19
Q

risk factors

- BEFORE (vulnerability)

A
  • genetic vulnerability
  • gender (female)
  • age (young)
  • intelligence (low)
  • socio-economic status (low)
  • psychopathology
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20
Q

BEFORE

- biological factors

A
  • differences in brain areas that regulate emotion, fight-or-flight response, memory (= amygdala, hippocampus, prefrontal cortex)
  • stronger amygdala: more reactive to emotional stimuli
  • weaker medial PFC: less able to dampen reactivity in stress response
  • smaller hippocampus: memory problems –> due to overexposure to neurotransmitters/hormones in stress response
  • -> problems with regulation of the body’s fear response (doesn’t return back to normal after threat has passed)
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21
Q

BEFORE

- biochemical factors

A
  • lower resting cortisol levels: (NOT elevated stress response) –> prolonged activity following stress –> more easily develop conditioned fear of stimuli –> PTSD
  • exaggerated heart rate
  • icreased secretion of epinephrine/ norepinephrine
  • different components of stress response may not be working in sync
    1. HPA (hypothalamic-pituitary-adrenal) axis: unable to shut down response of sympathetic NS by secreting necessary levels of cortisol
    2. overexposure of brain to epinephrine, norepinephrine
    3. memories of traumatic over-consolidated
  • childhood trauma: permanently alter biological stress response (more vulnerable) –> abnormal cortisol responses to stressors as adults
22
Q

BEFORE

- gender/cultural factors

A
  • women: greater likelihood
    1) may experience some triggers more often (anxiety disorders)
    2) may receive less social support (experienced traumas are more stigmatised (sexual abuse))
  • minorities are less likely to seek treatment
  • strength of traditional sex roles:
  • -> greater sex differences (women = passive, men = strong)
23
Q

BEFORE

- social/environmental factors

A
  • available social support: people with emotional support recover more quickly after trauma
24
Q

BEFORE

- psychological factors

A
  • general increased symptoms of anxiety/ depression prior to experience
  • coping style
    a) self-destructive/avoidant strategies (e.g. drinking/ self-isolation)
    b) dissociation shortly after trauma
25
Q

risk factors

- DURING (trauma)

A
  • experienced threat/proximity (direct, indirect)
  • type of trauma
  • duration of trauma
  • severity of harm
  • -> more sever, longer-lasting traumas, more directly affected by trauma
26
Q

DURING

- trauma type (A)

A
  • involuntary act
  • natural disasters (floods, tsunamis)
  • human made disasters (wars, terrorist attacks, torture) –> soldiers + citizens
  • abuse (physical = domestic violence, sexual = rape, incest)
  • -> one most commonly associated with PTSD (46% of victims develop PTSD)
27
Q

risk factors

- AFTER (effect)

A
  • negative interpretation of symptoms + consequences of trauma
  • low social support
  • -> secondary trauma (blaming, slut-shaming)
  • changes/new life events
  • anger/guilt/shame
  • dissociation
28
Q

theories

- emotion-based vs. intrusion-based reasoning

A
  • tend to prioritise the processing of threatening information + attend selectively to trauma-related information
  • related to severity, not to actual exposure
  • becomes self-perpetuating when initial symptoms are processed in a way that produces a sense of current threat –> amplifies distress & avoidance strategies
  • -> importance of negative appraisals of initial symptoms in maintaining disease
29
Q

emotion-based reasoning (ER)

A

(phobias, anxiety disorder)
= infer danger from own anxious responses
- interpret anxiety responses themselves as evidence that threat is impending –> instead of inferring dangers only from objective information
- if anxiety, then threat
- negative appraisals of initial PTSD might incite sense of current threat –> fosters symptom persistence –> strongly linked to chronic PTSD
- internal threat (“I’m going crazy”) or external (“the world is dangerous”)

30
Q

intrusion-based reasoning (IR)

A

= inferring danger from distressing intrusions

  • interpret distressing intrusions themselves as evidence that danger is impending –> instead of inferring dangers from objective information
  • if intrusions, then threat
  • associated with lower intelligence –> fewer cognitive resources = worse coping with PTSD symptoms, more vulnerable
31
Q

ER vs. IR

- vietnam veterans

A
  • no PTSD: inferred danger from objective information
  • yes PTSD: inferred danger from intrusion (IR) & anxiety responses unrelated to PTSD (ER)
  • have difficulty supressing meaning of trauma-related words once activated
  • interpret anxiety responses & PTSD-intrusions themselves as indicator of threat
  • adjust for perceptions of uncontrollability –> effects are reduced
32
Q

ER vs. IR

- train disaster

A
  • predictors for PTSD
  • -> whether individuals interpret symptoms themselves negatively
  • -> whether they interpret situation differently based on the presence of intrusion
  • intrusions may serve as contextual cues –> different stimulus predicts harm
  • when having more intrusions about train disaster, the situation is held to be more dangerous relative to the absence of intrusion
33
Q

contribution of ER + IR to PTSD persistence

A
  • common experience of intrusions & anxiety are taken as evidence that doom is impending and the world is unsafe
  • fosters avoidance of cues that lead to the experience of anxiety
  • amplify distress –> increases frequency of intrusive thoughts
  • motivate people to search actively for danger-confirming information (confirmation bias)
  • -> predicts PTSD (2. experiment)
34
Q

theories

- memory (WM)

A
  • memory of event ≠ actual event
  • -> can be false memories after time (after a lot of recall)
  • memory of trauma = unconditioned stimulus leading to a conditioned response
    1. recall
    2. memory becomes labile
    3. while in WM memory can be changed
    4. changes influence storage in LTM
35
Q

dissociative disorder

A

= subtype; wide variety of syndromes with common core; alteration in consciousness that affects memory and identity
- “functional” in nature: not a result of injury or disease affecting the brain

36
Q

dissociative disorder subtypes

1. dissociative amnesia

A

= loss of autobiographical memory for certain past experiences (7%)

37
Q

dissociative disorder subtypes

2. dissociative fugue

A
  1. dissociative fugue = loss of awareness of one’s identity, flight from one’s typical environment
    - amnesia covers large part of the patient’s life
    - accompanied by loss of personal identity; in many cases physical relocation
38
Q

dissociative amnesia

A
  • amnesia in fugue states is retrograde (= for events pre-onset of fugue state)
  • after fugue: memory of premorbid events is restored
  • during fugue state: general semantic knowledge is preserved –> except that for identity
  • amnesias are reversible = not encoding but retrieval problem
39
Q

dissociative disorder subtypes

3. dissociative identity disorder (DID)

A

= single patient appears to have 2 or more distinct identities (alter egos)

  • alternate in control over conscious experience; typically are separated by some degree of amnesia (1,3%)
  • treatment: focused on assumption that it’s caused by childhood trauma; integration of alter egos into a single identity (success rate 9-22% but can actually increase symptoms)
40
Q

dissociative amnesia

- inter-personality amnesia

A

= one alter ego doesn’t know what another did
BUT implicit memories sometimes transfer between personalities (depends on nature of the test)
–> autobiographical memory depends on alter ego
- symmetrical pattern: two alter egos unaware of each other
- asymmetrical pattern: one aware, the other not
- amnesias are reversible = not encoding but retrieval problem

41
Q

dissociative disorder subtypes

4. depersonalisation disorder (DPD)

A

= patients believe they have changed in some way or are in some way no longer real

  • commonly observed in acute stress reactions
  • hypothesis: dysregulation along the hypothalamic-pituitary adrenal axis
  • treatment: sometimes successful with anxiolytic or antidepressant drugs (could be primary or secondary effect)
42
Q

dissociative disorder subtypes

5. dissociative disorders NOS

A

= have some symptoms but not to the extent that qualifies for one of the major diagnoses (subclinical)

43
Q

dissociative disorder

- diagnosis

A
  • very subjective due to ambiguous definition of identity, personality + amnesia
  • SCID/ SCID-D
  • DES
44
Q

dissociative disorder theories

- trauma-memory argument

A

= psychological defences (repression or dissociation) to block awareness of trauma –> amnesia caused by trauma stress itself or the defences against it
- develop different identities (dissociation) to cope with trauma
- traumatic stress interferes with consolidation of narrative memory BUT enhances nonverbal, sensory, motor representations of trauma
BUT often victims remember things all too vividly & forgetting can be explained by normal memory processes
- DID mostly attributed to extreme trauma –> no proper evidence

45
Q

dissociative disorder theories

- revised trauma-memory argument

A

(special note of trauma associated with incest/childhood sexual abuse)
= memory is enhanced for terror traumas (= combat), impaired (by dissociation) for betrayal traumas (= incest)
1. type I traumas (= simple, well-defined events) = memory enhanced
2. type II trauma (= repeated over extended period of time) = psychic numbing & dissociation

46
Q

dissociative disorder

- forensic implications

A
  • amnesic cannot assist in their own defence, cannot offer testimony to what they’ve witnessed –> raises possibility of malingering
  • DID syndrome raises question about personhood and personal responsibility of alter ego
47
Q

treatment

- CBT

A
  • trauma-focused psychotherapy
  • systematic desensitisation = expose clients to what they fear in order to extinguish that fear
    1. identify thoughts, situations that create anxiety
  • safe environment: allows to habituate to anxiety + distinguish memory from reality
    2. rank them from most anxiety-provoking to least
    3. take client through hierarchy
  • use relaxation techniques, watch for unhelpful thinking patterns (survivor guilt)
  • challenge distorted cognition
  • stress management interventions = teach client skills to overcome problems in lives that increase stress, may result from PTSD (marital problems, social isolation)
    √ effective
48
Q

treatment

- biological/medication

A
  • selective serotonin re-uptake inhibitors (SSRIs) (+ benzodiazepines to lesser extent)
  • treating symptoms like sleep problems, nightmares + irritability
    x evidence for effectiveness is mixed
49
Q

treatment

- EMDR

A

= recalling traumatic memories while simultaneously making horizontal eye movements
- eye movements decrease vividness & emotionality of memory –> have an effect
1. two tasks compete for limited WM capacity
2. eye movements require WM –> less capacity for memory
3. recall (makes reconsolidation more labile) + reconsolidation is less vivid, emotional
- imagination deflation effect = imagination deflation affects the next recall
- counter-effective with positive memories –> become less pleasant
- moderate difficulty level for task is best (= inverted U): too little/much have little or no effect
- low WM capacity (= more easily distracted) benefit more from eye
–> any task that actually taxes WM
- effective treatment for alleviating trauma symptoms
√ flashbacks + flash-forwards (= disturbing images about possible future events) become less vivid and emotional

50
Q

treatment

- mindfulness-based cognitive therapy (MBCT)

A

= mindful breathing (= eye movement) = focus on breathing —> accept thoughts that appear –> slowly draw attention back to breathing
- deep breathing calms physically + psychologically
- effective in preventing relapse after treatment for depression
√ same effects as EMDR
√ almost the same degree as eye movements

51
Q

treatment

- EMDR + beeping

A

NOT effective: beeps do not tax WM –> registering is a passive task (= need to actually do something)

52
Q

treatment

- dissociative disorder

A
  • presence of DS doesn’t moderate the outcome of trauma-focused treatments
  • amount of improvement is same for those with/ without
  • psychodynamic, insight-oriented psychotherapy: focus on uncovering, working through trauma underlying disorder + getting patient to abandon dissociative defences

Psychopathology (9 decks)

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