Trauma and Stressor Related Disorders

Question 1

What is PTSD?
What is the DSM-5 Criterion for PTSD?

Answer 1

• Extreme stress response to a traumatic event
• Event must have threatened actual harm/death to onself or others
• Response to a wide range of traumatic events

A: Exposure
Exposure to actual threatened death, serious injury, or sexual violence in one or more of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the traumatic event(s) occurred to a close family member or close friend.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s)

B: Intrusion
1. Recurrent, spontaneous and intrusive memories
2. Recurrent distressing dreams
3. Acting or feeling as if event were recurring (flashbacks)
4. Psychological distress
5. Marked physiological arousal

C: Avoidance
1. Avoidance of trauma-related thoughts and feelings; and/or
2. Avoidance of trauma related external reminders people, places, conversations, activities, objects, or situations)

D: Negative alternations in cognitions & mood
1. Unable to recall key features of the trauma;
2. Exxagerated negative beliefs/expectations about oneself/others/world;
3. Distorted blame of self or others;
4. Persistent negative emotions;
5. Markedly dminished interest in significant activities
6. Feeling alienated from others
7. Persistent inabilty to experience positive emotions

E: Alterations in arousal and reactivity
1. Reckless or self-destructive behaviour
2. Irritable behaviour and angry outbursts
3. Hypervigilance
4. Exaggerated startle response
5. Problems with concentration
6. Sleep disturbance

• Durations of the disturbances need to have exceeded 1 month
• Cause significant clinical distress or impairment in social, occupational or other important areas of functioning.
• The disturbance is not attributable to the physiological effects of a substance or another medical condition

Question 2

What is Acute Stress disorder and what are its key differences between PTSD?

Answer 2

Same symptom clusters as PTSD
1. Intrusion
2. Negative mood
3. Avoidance Symptoms
4. Arousal Symptoms
AND
Dissociative symptoms (Depersonalization, Derealization). Important as those who are dissociating after trauma event likely to progress to PTSD

Question 3

What is Acute Stress disorder and what are its key differences between PTSD?

Answer 3

Same symptom clusters as PTSD
1. Intrusion
2. Negative mood
3. Avoidance Symptoms
4. Arousal Symptoms
AND
Dissociative symptoms (Depersonalization, Derealization). Important as those who are dissociating after trauma event likely to progress to PTSD

Acute stress disorder progresses to PTSD if symptoms last > 1 month after trauma, and dissociative symptoms are a required criterion

• Treatment while in Acute Stress Disorder reduces chance of progression into PTSD.

Question 4

What is the PTSD epidemiology and what is it highly comorbid with?

What are the pre-trauma risk factors, trauma factors and Post-trauma factors?

How do you assess someone for PTSD?

Answer 4

Lifetime prevalence rates are 6-9%
12-month prevalence rates 1-4%
High comorbidity with:
- MDD
- GAD
- Substance Abuse disorders

Pre Trauma factors:
- Childhood trauma
- Psychiatric history
- Family instability
- Substance abuse
- Social/economic disadvantage

Trauma factors:
- Degree of life threat of injury/death or loss
- Location of trauma (safe place versus elsewhere)
- individual’s role in trauma (victim, helper)
- Meaning (e.g., uncontrollability)

Post-trauma factors
- Social support
- Coping style
- Ongoing stressors

To determine PTSD diagnosis, ‘life events checklist is necessary’ - not just self report
- Clinician-Administered PTSD Scale for DSM-5

Question 5

Describe the treatment options for PTSD

Answer 5

Pharmacological: Antidepressants (SSRIs)

Psychological: CBT (Trauma-focused CBT)
- Psychoeducation
- Anxiety management techniques
- Cognitive restructuring
- Prolonged (imaginal/in vivo) exposure
- Relapse prevention (Duration: 9-12 sessions)
CBT has been shown to be more effective that medication or supportive psychotherapy
- Also prevents PTSD if implemented early

EMDR: Eye Movement and desensitization and Reprocessing
- Eye movements are said to be the key component for efficacy
- Best seen as an exposure technique
CBT and EMDR are equally effective
- Superior to all other psychotherapies
MDMA-assisted psychotherapy for PTSD (still being researched)

• Combined results from 6 RCTs wih 105 blinded subjects with PTSD showed significant improvement in symptoms
• Meta-analysis showed MDMA-psychotherapy to have equal effiacy to Prolonged Exposure, with lower dropout rates
• Meta-analysis of 21 studies showed MDMA-assisted therapy outpeformed other pharmacological-assisted therapies