Trauma And Stressor-Related Disorders

Question 1

Post traumatic stress disorder (PTSD)

Answer 1

Anxiety disorder that may develop after a traumatic experience that is characterised by:
(a) repeated re-experiencing of the traumatic event
(b) avoidance of stimuli associated with the trauma Eg thoughts and reminders
(c) negative changes in cognitions and mood, emotional numbing, being unable to recall important aspects of the trauma
(d) increased arousal
These symptoms have to be present for at least 1 month.

Question 2

Prevalence of PTSD

Answer 2

20.4% of women and 8.2% of men who experienced a traumatic event ever developed PTSD.
More sever traumas lead to more severe PTSD.
Men are more likely to be exposed to trauma, but women are 2 times more likely to develop PTSD.
Also depends on the type of trauma, eg 55% of rape victims develop PTSD, only 7.5% of accident victims develop PTSD.

Question 3

Risk factors for the development of PTSD

Answer 3

History of psychological disturbance predating the trauma.
Prior traumatic experience.
Lower intelligence levels.
Female gender.
More severe traumatic exposure.
Low social support after the traumatic experience.

Question 4

Aetiology of PTSD: cognitive models

Answer 4

Maladaptive appraisals or interpretations of the traumatic event (eg I was weak because I didn’t stop the rape).
Individuals responses to it (eg I am worthless because I’m not coping well).
Environment after the trauma (eg I can never feel safe again).

Question 5

Aetiology of PTSD: learning accounts

Answer 5

Involve the application of classical conditioning principle to trauma. Strong fear elicited by the trauma will lead to strong associative conditioning between the fear and the events surrounding the trauma.

Question 6

Aetiology of PTSD: biological accounts

Answer 6

Arousal strengthens the fear-conditioning process.
Extreme sympathetic arousal at the time of traumatic event leads to release of stress neurochemicals into cortex, resulting in strong conditioning of fear responses with associated memories.

Question 7

Aetiology of PTSD: avoidance

Answer 7

Avoidance of trauma reminders maintains the PTSD.

Avoidance prevents people from learning that the perceived threats are no longer realistically dangerous.

Question 8

Treatment of PTSD

Answer 8

Pharmacology: SSRI. 
CBT is treatment of choice. 
Psychoeducation. 
Anxiety management techniques. 
Cognitive restructuring. 
Prolonged imaginal exposure, in vivo exposure.

Question 9

Prevention of PTSD

Answer 9

Early intervention programs using CBT strategies, especially for individuals experiencing trauma symptoms.

Question 10

Challenges for treatment of PTSD

Answer 10

High rates of drop out from treatment.
Need to better prepare patients to tolerate the distress of exposure therapy.
Potentially augment CBT by enhancing extinction.
Also need to develop community-based treatments.

Question 11

Adjustment disorders

Answer 11

Responses to stress within 3 months of the onset of the stressor.
Emotional and behavioural symptoms are present.
Distress is out of proportion to the ‘expected’ physical, emotional and behavioural reactions to the stressor.
Must cause marked distress and impairment to functioning.
Not part of normal bereavement of loss.
Once the stressor is removed, the person should begin to adjust and cope and symptoms subside within 6 months - if not - condition better fits with other diagnosis eg PTSD, anxiety, depression.

Question 12

What are people adjusting to?

Answer 12

Bullying in the workplace, workplace sexual harassment.
Change: retirement, children leaving home, moving.
Loss: person, job, objects, relationships, animals.
Starting university.
Moving out of home.

Question 13

Symptoms of adjustment disorder

Answer 13

Feeling sad more often than not. 
Decreased self-esteem. 
Loneliness. 
Hopelessness. 
Loss of pleasure. 
Sense of shame (especially if lost job). 
Anxiety such as worry, fear, nervousness. 
Sense of being overwhelmed. 
Suicide ideation. 
Self-harm. 
Difficulty making decisions. 
Trouble concentrating. 
Decreased appetite.

Question 14

Treatment for adjustment disorder

Answer 14

Remove person from the stressor. 
Normalise experience. 
Social support. 
Teach coping skills. 
Medication. 
Physical activity. 
Pleasurable events. 
Challenge thinking.

Question 15

Adjustment disorder: when do people get better?

Answer 15

When the stressor is removed or resolved.
When people learn to cope by reaching out, doing things they enjoy, challenging their thinking, being healthy, communicating feelings, resolving issues.
Medication can help coping.