Trauma and Stressor-Related Disorders

Question 1

Stress

Answer 1

Exists when there is a discrepancy between the perceived demands on an organism and its perceived ability to cope

Question 2

Stressors

Answer 2

Problematic social and nonsocial environmental factors that exceed or are close to exceeding the biological, psychological, and social resources available to the individual

Question 3

Coping Responses

Answer 3

The resources used by an individual to avoid psychological, physical, and social harm that may result from exposure to a stressor

Coping responses can be adaptive or maladaptive. They are largely the product of learning

Question 4

General Adaptation Syndrome

Answer 4

Three phases:

(1) Alarm stage: peripheral arousals systems activated
(2) Resistance phase: attempt to maintain normal functioning
(3) Phase of Exhaustion: demands outstrip ability to cope

Two modes of adaptation to chronic stress:

(1) Sustained activation of the HPA systems + reduction in SNS activity (submissive, passive, depressive mode- not unlike learned helplessness)
(2) Sustained activation of the SNS, with normal HPA activity (hyper vigilant, irritable, fearful/anxious mode)

Question 5

Stress Response:

HPA-Axis and ANS

Answer 5

(1) Corticosteroids: released into blood stream from Adrenal Cortex
(2) Glucocorticoids: facilitates the conversion of stored fat and protein into usable energy and suppresses the immune system by affecting the action of helper T cells and microphages (white blood cells)

• cortisone
• hydrocortisone
• corticosterone

Question 6

Stress Research in Male Tree Shrew Study

Answer 6

(1) Dominant- corticosteroid levels return to baseline and sympathetic ANS returns to baseline after a few days
(2) Subdominant- will avoid dominant but will defend itself; hyper-vigilant and hyper-aroused; corticosteroid levels return to baseline after a few days; sympathetic ANS remains elevated
(3) Submissive- passive, apathetic; seems to give up and will not defend itself; withdraws to a corner and rarely ventures out to eat, losing weight rapidly; sympathetic ANS returns to baseline; corticosteroid levels remain elevated

Question 7

Definition of PSTD in DSM IV

Answer 7

A reaction to a stressor that is out of the typical range of human experience that involved intense fear, helplessness, or horror

Can be viewed as the body/CNS’’ way of trying to master a stressful experience that significantly exceeds normal coping capacity and resources through often conflicting strategies of repetition and avoidance

Question 8

PSTD in DSM IV

Answer 8

Characterized by re-experiencing of an extremely traumatic event

Accompanied by symptoms of increased arousal and avoidance of stimuli associated with trauma (symptoms persist more than i month after the cessation of the event)

• Re-experiencing of trauma
• Persistent avoidance of associated stimuli (thoughts, activities, and places)
• Persistent symptoms of arousal

Question 9

PTSD: Changes from DSM IV to DSM 5

Answer 9

(1) Criterion A now requires explicit indication of whether traumatic events were experienced (1) directly, (2) indirectly, or (3) witnessed
(2) Subjective reaction quality (fear, horror, etc) no longer a diagnostic criterion

(3) The three symptoms clusters of: Arousal, Re-experiencing, and Numbing/Avoidance, has been expanded to:
- Alterations in Arousal and Reactivity (also now includes irritable, aggressive, and reckless behavior)
- Re-experiencing
- Avoidance
- Persistent Negative Alterations in Cognitions and Emotions (includes DSM IV numbing symptoms + newly re-conceptualized symptoms such as persistent negative emotional states)

Question 10

PTSD Criteria: DSM 5

Answer 10

A. EXPOSURE to actual or threatened death, injury, or sexual violence
B. Presence of one or more INTRUSION symptoms associated with the traumatic event(s), beginning after the event (memories, dreams, dissociative reactions, negative emotional and/or physiological activity to external cues associated with the event)
C. Persistent AVOIDANCE of stimuli associated with the event (avoidance of associated thoughts and feelings; avoidance of external reminders)
D. NEGATIVE ALTERATIONS in cognitions and mood associated with the event and starting after the event (persistent negative emotional state; anhedonia; feelings of social detachment; feelings of irrational self-blame or blame of others for event; negative beliefs about the self; amnesia for aspects of the event)
E. Marker ALTERATIONS IN AROUSAL and reactivity associated with the event(s) (irritability; unprovoked anger; reckless behavior; hyper-vigilance; exaggerated startle response; concentration difficulties; fragmented/disturbed sleep)

Duration: for at least 1 month

Specifiers:
With dissociative symptoms:
- Depersonalization
- Derealization
With delayed expression (if full criteria not met until 6 months after the event)

Question 11

PSTD: Facts

Answer 11

(1) TX: one of the most difficult disorders to treat. No medication is highly effective
(2) Based on a multisite study, BPD is associated with higher rates of traumatic exposure, especially sexual trauma, than other PDs
(3) Severe PDs (i.e., Schizotypal and BPD) are associated with more types of traumatic exposures and higher rates of physical assault than less severe PDs (e.g., OCPD)
(4) Risk of exposure to traumatic events increases with pre-existing

Question 12

PSTD: Facts

Answer 12

(1) TX: one of the most difficult disorders to treat. No medication is highly effective
(2) Based on a multisite study, BPD is associated with higher rates of traumatic exposure, especially sexual trauma, than other PDs
(3) Severe PDs (i.e., Schizotypal and BPD) are associated with more types of traumatic exposures and higher rates of physical assault than less severe PDs (e.g., OCPD)

Question 13

PTSD: Key Findings

Answer 13

(1) Risk of exposure to traumatic events increases with pre-existing Conduct Disorder, Substance Abuse, Family history of Mood Disorder
(2) Presence of Mood Disorder in the individual associated with a decreased risk of exposure to traumatic events
(3) Dissociative symptoms are not a risk factor for PTSD

Question 14

Acute Stress Disorder

Answer 14

Characterized by symptoms similar to those of PTSD but occur immediately in the aftermath of an extremely traumatic event

Symptoms persist for at least 3 days and less than 1 month after the cessation of the event

Question 15

Acute Stress Disorder: DSM IV

Answer 15

Requires 3 or more dissociative symptoms:

• numbing, detachment, reduced emotional responsiveness
• reduced awareness of surroundings
• derealization
• depersonalization
• dissociative amnesia

Also, persistent re-experiencing

Avoidance of associated stimuli

Marked symptoms of hyper-arousal and anxiety

Question 16

Acute Stress Disorder: DSM 5 Changes

Answer 16

(1) Criterion A now requires explicit indication of whether traumatic events were experienced: directly, indirectly, witnessed
(2) Subjective reaction quality (fear, horror, etc) no longer a diagnostic criteria

(3) Less emphasis on Dissociative symptoms: requires 9 of 14 listed symptoms from any of the five categories of:
- Intrusion
- Negative Mood
- Dissociation
- Avoidance
- Arousal

Question 17

Adjustment Disorder: DSM 5 Changes

Answer 17

(1) No longer just a residual category

(2) Re-conceptualized as an array of stress-response syndromes

Question 18

Adjustment Disorder

Answer 18

Emotional or behavioral symptoms develop in response to an identifiable stressor or stressors within 3 months of the onset of the stressor(s) plus either or both of:

(1) marked distress that is out of proportion to the severity or intensity of the stressor, even when external context and cultural factors that might influence symptom severity and presentation are taken into account and/or
(2) significant impairment in social, occupational, or other areas of functioning

The stress-related disturbance does not meet criteria for another mental disorder and is not merely an exacerbation of a pre-existing mental disorder

The symptoms do not represent normal bereavement

After the termination of the stressor (or its consequences), the symptoms persist for no longer than an additional 6 months

Question 19

Adjustment Disorder: Specifiers

Answer 19

Specifiers are used to identify subtypes of adjustment disorder:

• with depressed mood
• with anxious mood
• acute (disturbance less than 6 months)
• persistent (greater than 6 months)
• with mixed anxiety and depressed mood
• with disturbance of conduct
• with mixed disturbance of emotions and conduct
• unspecified