Trauma and Stressor Related Disorders

Question 1

describe diagnostic criteria for PTSD

Answer 1

• 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

Question 2

describe intrustion symptoms

Answer 2

• intrusion symptoms:
  
  • dreams
  • recollections
  • feeling event reoccur
  • psychological or physiological distress when encounters symbols

Question 3

describe avoidance symptoms

Answer 3

• symptoms such as avoidance of thoughts, places or conversations that are reminders of the event

Question 4

describe negative alterations in cognition and mood

Answer 4

• persistent:
  
  • negative beliefs/expectations
  • negative emotional states
  • inability to experience positive emotion
  • diminished interest/participation in activities
  • detachment/estrangement from others
  • dissociative amnesia

Question 5

describe alterations in arousal and reactivity

Answer 5

• sleep disturbance
• irritable and angry outbursts
• reckless or self-destructive behavior
• concentration problems
• hypervigilance
• exaggerated startle response

Question 6

describe the duration, onset and vulnerable populations in PTSD

Answer 6

• 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

Question 7

describe diagnostic criteria for acute stress disorder (ASD)

Answer 7

• 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

Question 8

contrast ASD and PTSD

Answer 8

• 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

Question 9

describe neuroanatomical explanation for PTSD/ASD

Answer 9

• hyperresponsive amygdala (fear)
• underresponsive prefrontal cortex (failure to suppress fear)
• reduced volume and dysfunction of hippocampus (failure to suppress fear when in safe contexts)

Question 10

describe treatment for PTSD/ASD

Answer 10

• psychotherapy
  
  • supportive therapy offering safe environment to express feelings
  • behavioral therapy to address specific problematic behaviors (avoidance behavior)
• medications: to reduce emotionality
  
  • ADs
  • benzos

Question 11

describe diagnostic criteria for adjustment disorder

Answer 11

• 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

Question 12

describe subtypes of adjustment disorder

Answer 12

• with depressed mood
• with anxiety
• with disturbance of conduct (externalizing misbehavior, such as vandalizing)

Question 13

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

Answer 13

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

Question 14

describe treatment of adjustment disorder

Answer 14

• treatment typically involves:
  
  • learning of coping strategies in psychotherapy sessions
  • involvement in support groups
• treatment MAY involve crisis intervention
  
  • hospitalization
  • psychotropic medications

Question 15

describe reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED)

Answer 15

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

Question 16

summarize the trauma-related/stressor related disorders

Answer 16

Question 17

describe diagnostic criteria for Dissociative Amnesia (psychogenic amnesia)

Answer 17

• 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

Question 18

describe amnesia with dissociative fugue

Answer 18

• 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

Question 19

describe a differential for Dissociative Amnesia

Answer 19

• 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

Question 20

describe diagnostic criteria for Dissociative Identity Disorder (DID)

Answer 20

• 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

Question 21

describe Depersonalization/Derealization Disorder

Answer 21

• 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)

Question 22

describe diagnostic criteria for Depersonalization/Derealization Disorder

Answer 22

• 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

Question 23

describe biological correlates of dissociation

Answer 23

• amnesia:
  
  • no structural brain damage accounting for memory loss
  • primarily a dysfunction of the process of retrieving memories