Trauma & PTSD Flashcards
trauma
*a deeply distressing or disturbing experience
*emotional shock following a stressful event or a physical injury, which may lead to long-term neurosis
PTSD - DSM-5 diagnostic criteria
A. stressor
B. intrusion symptoms
C. avoidance
D. negative alterations in cognition and mood
E. alterations in arousal and reactivity
F. duration
G. functional significance
H. exclusion
PTSD criterion A - stressor
person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows (one required):
1. direct exposure
2. witnessing, in person
3. indirectly, by learning that a close relative or close friend was exposed to trauma; if the event involved actual or threatened death, it must have been violent or accidental
4. repeated or extreme indirect exposure to aversive details of the event, usually in the course of professional duties (first responders, collecting body parts; professionals repeatedly exposed to details of child abuse)
PTSD criterion B - intrusion symptoms
the traumatic event is persistently re-experienced in the following way(s) (one required):
1. recurrent, involuntary and intrusive memories
2. traumatic nightmares
3. dissociative reactions (flashbacks) which may occur on a continuum, from brief episodes to complete loss of consciousness
4. intense or prolonged distress after exposure to traumatic reminders
5. marked physiologic reactivity after exposure to trauma-related stimuli
PTSD criterion C - avoidance
persistent effortful avoidance of distressing trauma-related stimuli after the event (one required):
1. trauma-related thoughts or feelings
2. trauma-related external reminders (people, places, conversations, activities, objects, or situations)
PTSD criterion D - negative alterations in cognition and mood
negative alterations in cognitions and mood that began or worsened after the traumatic event (2 required):
1. inability to recall key features of the traumatic event
2. persistent (often distorted) negative beliefs and expectations about oneself or the world
3. persistent distorted blame of self or others for causing the traumatic event or for resulting consequences
4. persistent negative trauma-related emotions
5. markedly diminished interest in (pre-traumatic) significant activities
6. feeling alienated from others (detachment or estrangement)
7. constricted affect: persistent inability to experience positive emotions
PTSD criterion E - alterations in arousal and reactivity
trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event (2 required):
1. irritable or aggressive behavior
2. self-destructive or reckless behavior
3. hypervigilance
4. exaggerated startle response
5. problems in concentration
6. sleep disturbance
PTSD criterion F - duration
persistence of symptoms for more than 1 month
*full dx is not made until at least 6 months after the trauma, although sx may begin immediately
PTSD criterion G - functional significance
significant symptom-related distress or functional impairment
PTSD criterion H - exclusion
disturbance is not due to medication, substance use, or other illness
PTSD through the lens of learning theory (Mowrer’s Two-Factor Theory)
*classical conditioning (ex. fireworks becoming a conditioned stimulus to a veteran who associates “boom” or explosion with distress)
*operant conditioning (ex. fireworks are a trigger, leading to avoidance behavior; avoiding fireworks decreases anxiety, causing negative reinforcement, increasing the behavior to avoid that stimulus)
*habituation can be a successful treatment
cognitive theories and PTSD
*not the event itself, but rather our interpretation of a traumatic event leads to difficulty
*therapy is about helping people become aware of dysfunctional interpretations
*emotions linked to specific thought patterns:
-anger (perception that others have wronged you)
-guilt (perception that one has behave in a wrong or unfair way)
-sadness (perception of fundamental loss)
-anxiety (perception of danger)
schemas and PTSD
*the way that we think about the world might alter how we respond to a traumatic event
example: “sometimes bad things happen outside of our control” vs. “no matter what, I am in control of what happens to me”
adverse childhood events (ACEs)
*abuse - psychological, physical, sexual
*household dysfunction - violence against mother, substance abuse, mental illness, criminal behavior
correlation between ACEs and risk for common health problems
*heart disease
*cancer
*stroke
*bronchitis or emphysema
*diabetes
