Trauma and Stressor Related Disorders Flashcards
describe diagnostic criteria for PTSD
- exposure to a traumatic stressor:
- actual or threatened death or serious injury or sexual violence
- exposure may include direct experience or event, witnessing event, or learning about event to close family member/friend
- as a result, ≥ 1 symptom from each of the 4 categories of symptoms must develop:
- intrusion symptoms
- avoidance symptoms
- negative alterations in cognition and mood
- alterations in arousal and reactivity
describe intrustion symptoms
- intrusion symptoms:
- dreams
- recollections
- feeling event reoccur
- psychological or physiological distress when encounters symbols
describe avoidance symptoms
- symptoms such as avoidance of thoughts, places or conversations that are reminders of the event
describe negative alterations in cognition and mood
- persistent:
- negative beliefs/expectations
- negative emotional states
- inability to experience positive emotion
- diminished interest/participation in activities
- detachment/estrangement from others
- dissociative amnesia
describe alterations in arousal and reactivity
- sleep disturbance
- irritable and angry outbursts
- reckless or self-destructive behavior
- concentration problems
- hypervigilance
- exaggerated startle response
describe the duration, onset and vulnerable populations in PTSD
- duration: PTSD symptoms must last > 1 month
- onset: symptoms usually begin within 3 months of the trauma but can begin ANYTIME
- vulnerable populations: PTSD often occurs in young adults but can happen to anyone
- patients with sudden-onset, life threatening medical events (heart attack) can experience PTSD
describe diagnostic criteria for acute stress disorder (ASD)
- exposure to a traumatic stressor (actual or threatened death, serious injury or sexual violence)
- numerous PTSD-like symptoms must develop from the 4 PTSD symptom categories (intrusive symptoms, avoidance, etc.)
- duration of the disorder is 3 days to 1 month after trauma exposure
contrast ASD and PTSD
- ASD: symptoms start and resolve within the first 30 days after the trauma
- PTSD: symptoms start anytime after the trauma and last more than 30 days
describe neuroanatomical explanation for PTSD/ASD
- hyperresponsive amygdala (fear)
- underresponsive prefrontal cortex (failure to suppress fear)
- reduced volume and dysfunction of hippocampus (failure to suppress fear when in safe contexts)
describe treatment for PTSD/ASD
- psychotherapy
- supportive therapy offering safe environment to express feelings
- behavioral therapy to address specific problematic behaviors (avoidance behavior)
- medications: to reduce emotionality
- ADs
- benzos
describe diagnostic criteria for adjustment disorder
- development of significant (and disproportional) emotional/behavioral symptoms
- due to an identifiable stressor (often an ordinary life experience, but not necssarily)
- acute onset: symptoms develop within a few months of stressor onset
- brief duration: symptoms expected to resolve within several months after the stressor (or its consequences) have terminated
describe subtypes of adjustment disorder
- with depressed mood
- with anxiety
- with disturbance of conduct (externalizing misbehavior, such as vandalizing)
if sufficient symptoms exist after a stressor such that another’s disorder’s diagnostic criteria are met (MDD), then that other disorder is diagnosed, NOT adjustment disorder
if sufficient symptoms exist after a stressor such that another’s disorder’s diagnostic criteria are met (MDD), then that other disorder is diagnosed, NOT adjustment disorder
describe treatment of adjustment disorder
- treatment typically involves:
- learning of coping strategies in psychotherapy sessions
- involvement in support groups
- treatment MAY involve crisis intervention
- hospitalization
- psychotropic medications
describe reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED)
as a direct result of pathogenic care early in life (social neglect/repeated changes in caregiver)
-
Reactive Attachment Disorder (RAD):
- inhibited and emotionally-withdrawn behavior towads adult caregivers
-
Disinhibited Social Engagement Disorder (DSED):
- overly familar behavior with relative strangers
summarize the trauma-related/stressor related disorders
describe diagnostic criteria for Dissociative Amnesia (psychogenic amnesia)
- memory loss for autobiographical info. which doesn’t occur due to another disorder
- memory loss can be:
- localized
- total loss of personal memory during a circumscribed period
- selective
- some (but limited) recall of personal memories during a circumscribed period
- generalized
- loss of personal memory of entire life up to and including event
- localized
describe amnesia with dissociative fugue
- fugue: purposeful travel or bewildered wandering associated with amnesia for identity or other autobiographical info.
- typical features of fugue:
- brief (hours to days)
- unobstrusive lifestyle during fugue
- spontaneous termination of amnesia
- rarely recurs
describe a differential for Dissociative Amnesia
- differential: organically-based amnesia
- if organic basis: patient will have difficulty learning new info. (anterograde memory loss) in addition to past memory loss
- if psychological (dissociative) basis: pt learns new info. well, only past memory loss (retrograde memory loss) will be present
describe diagnostic criteria for Dissociative Identity Disorder (DID)
- disruption of identity characterized by ≥ 2 distinct personalities states:
- The Primary (host)
- An Alter
- inability to recall personal info. (as evidenced by frequent memory gaps in host while an alter takes control)
- DID hints: amnesia with “mistaken identity” experiences & unexpected changes in personal possessions
describe Depersonalization/Derealization Disorder
- either (or both) of the following:
- Depersonalization: experiences of unreality, detachment or being an outside observer with respect to one’s thoughts, feelings, sensations, body or actions
- Derealization: experiences of unreality or detachment with respect to surroundings (e.g. objects seem unreal or dreamlike)
describe diagnostic criteria for Depersonalization/Derealization Disorder
- reality testing remains intact (i.e. the person knows that the perceptual experience is just a misperception)
- symptoms result in functional impairment
- metabolic, neurologic, or other pathological conditions, which may cause these sensations, should be eliminated as causal agents
describe biological correlates of dissociation
- amnesia:
- no structural brain damage accounting for memory loss
- primarily a dysfunction of the process of retrieving memories
