Trauma-Related Disorders

Question 1

Trauma and Stressor-Related Disorders

Answer 1

• Exposure to a traumatic or stressful event is a required diagnostic criterion
• • Reactive Attachment Disorder, Disinhibited Social Engagement Disorder, PTSD, Acute Stress Disorder, Adjustment Disorder

Question 2

PTSD

Answer 2

A) Exposure to actual or threatened trauma
B) Presence of one or more of the following:
—- Recurrent, intrusive memories
—- Recurrent distressing dreams of trauma
—- Dissociative reactions (e.g., flashbacks)
—- Intense psychological stress during exposure to cues
— Physiological reaction to cues
C) Avoidance
D) Negative alterations in cognitions or mood (e.g., amnesia, negative cognitive triad, self-blame)
E) Alterations in arousal (e.g., irritability, hypervigilance, sleep, disturbance)
F) Duration is more than 1 month

Question 3

PTSD: exposure to actual or threatened death, serious injury, or sexual violence by…

Answer 3

• Directly experiencing the traumatic event
• Witnessing, in person, the event as it occurred to others
• Learning that the traumatic event occurred to a close family member or close friend (death must be violent or accidental)
• Experiencing repeated or extreme exposure to aversive details of the traumatic event (e.g., police officers or first responders)

Question 4

PTSD specifiers

Answer 4

• With dissociative symptoms (depersonalization or derealization)
• With delayed expression (not met until 6 months after event)

Question 5

Depersonalization

Answer 5

Experiences of feeling detached from, and as if one were an outside observer of one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or time moving slowly)

Question 6

Derealization

Answer 6

Experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted)

Question 7

PTSD in children 6 years or younger

Answer 7

• Exposure to trauma (direct experience, witnessing in person, learning that trauma occurred to parent or CG)
• Presence of one or more intrusion symptom
• One or more avoidance or negative cognitions symptoms
• Two+ alterations in arousal/reactivity (e.g., angry outbursts, hypervigilance, problems concentrating, sleep disturbance)
• Duration is more than one month
• Same specifiers

Question 8

AL Abuse Definition

Answer 8

• Abuse: harm or threatened harm to the health or welfare of a child
• Physical abuse, sexual abuse, sexual exploitation (e.g., allowing child to engage in prostitution or pornographic photography etc.), emotional abuse
• Neglect: negligent treatment or maltreatment of a child, including the failure to provide adequate food, clothing, shelter, medical treatment, or supervision

Question 9

Adult Abuse

Answer 9

• Adult abuse: the infliction of physical pain, injury, or the willful deprivation by a caregiver or other person of services necessary to maintain mental and physical health
• Adult neglect, exploitation, sexual abuse, emotional abuse

Question 10

PTSD used to be thought of in 3 domains…

Answer 10

• 3 domains: re-experiencing, avoidance, hyperarousal

- Now there’s a shift towards a 4-factor model including dysphoria

Question 11

Re-experiencing

Answer 11

• Recollections of the event - recurrent, intrusive, distressing images, thoughts, and perceptions
• Dreams of the event that are recurrent and distressing
• Acting or feeling as if the traumatic event were reoccurring (reliving experience, dissociative flashbacks, etc.)
• Intense distress when exposed to cues that resemble trauma
• Physiological reactivity when exposed to internal/external cues that resemble trauma

Question 12

Avoidance

Answer 12

• Attempts to avoid thoughts/feelings/conversations and activities/places/people associated with trauma
• Amnesia of important aspects of the trauma
• Reduced interest/anhedonia
• Feeling detached or estranged from others
• Blunted/restricted affect
• Sense of foreshortened future

Question 13

Hyperarousal

Answer 13

• Trouble falling asleep or staying asleep
• Irritability or anger outbursts
• Trouble concentrating
• Hypervigilance
• Exaggerated startle response

Question 14

Dysphoria

Answer 14

Avoidance as just pure avoidance and hyperarousal as just hypervigilance and startle response; everything else as dysphoria

• Amnesia
• Reduced interest/anhedonia
• Feeling detached from others
• Blunted affect
• Sense of foreshortened future
• Trouble falling/staying asleep
• Irritability or anger outbursts
• Trouble concentrating

Question 15

Acute Stress Disorder

Answer 15

• PTSD symptoms immediately following traumatic events
• Usually lasts 3 days to 1 month after trauma
• If symptoms last for at least 1 month, diagnosis changed to PTSD

Question 16

Trauma Epidemiology

Answer 16

• 51.2% for women and 60.7% for men will experience a traumatic event in their lifetime
• PTSD symptoms common directly after event, but rates drop as time passes (reason for Acute Stress Disorder)
• Women 3x as likely to develop PTSD relative to men (men less likely to seek treatment? different nature of trauma?)

Question 17

Common Traumatic Stressors

Answer 17

• Disasters
• Abuse
• Combat or war-related trauma
• Common traumatic events (car accidents, unexpected death of loved one, observing someone dying, etc.)
• —higher base rates but rates of PTSD lower; more “expected”
• PTSD most common from sexual assault, prisoner of war, repeated combat exposure

Question 18

Combat & PTSD

Answer 18

• Historical labels: shell shock (WWI), Combat fatigue (WWII)
• Vietnam veterans higher rates than other wars because more hand-to-hand fighting and veterans experienced stigma rather than being celebrated

Question 19

Comorbid Disorders

Answer 19

Too many to list (over 90%)

• MDD and GAD common
• Shared dysphoria component?

Question 20

Subtypes of PTSD (Miller et al.)

Answer 20

• PTSD broadly associated with Negative Emotionality
• Simple PTSD: low internalizing, low externalizing
• Internalizing subtype: High NEM and low PEM; high comorbidity with depression and other internalizing disorders
• Externalizing subtype: High NEM and high disinhibition; higher comorbidity with substance abuse, antisocial PD, and past history of CD

Question 21

PTSD: Biological Perspective

Answer 21

• Genetics: criterion A makes difficult to study because can’t cause trauma; greater concordance rates for MZ twins
• HPA Axis: traumatic events and cortisol; DHEA (adrenal steroid) released during stress; cortisol ratio related to re-experiencing sx
• Neurotransmitters: decreased serotonin, increased norepinephrine, decreased GABA, increased dopamine

Question 22

Cognitive/Behavioral Factors

Answer 22

• Cognitive avoidance: maladaptive coping strategy
• Cognitive appraisal of the event: how global is appraisal, etc?
• Associative learning: trauma (UCD) gets associated with neutral stimuli (CS)
• Verbally Accessible Memories (VAM) and Situationally Accessible Memories (SAM): see card
• Shattered expectations: see card

Question 23

Verbally Accessible Memories (VAM) and Situationally Accessible Memories (SAM)

Answer 23

• Only certain parts of traumatic event encoded into LTM
• VAM: very aware of certain things that remind person of the trauma
• SAM: unconscious memories associated with the event (e.g., certain smell brings on flashback)

Question 24

Shattered expectations

Answer 24

• Traumatic event conflicts with prior beliefs
• Assimilation –> alter interpretation of the event
• Accommodation –> alter beliefs to accommodate new information
• Overaccommodation –> drastically change beliefs
• —-this is more likely in PTSD

Question 25

Social Support & Trauma

Answer 25

• Weak social support may contribute to trauma (shown in combat veterans)
• Feel loved and cared for –> more likely to recover
• Conservation of resources: more likely to recover from trauma if person feels like they have other resources to latch onto when their resources are threatened by trauma