Trauma-Related Disorders Flashcards
Trauma and Stressor-Related Disorders
- 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
PTSD
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
PTSD: exposure to actual or threatened death, serious injury, or sexual violence by…
- 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)
PTSD specifiers
- With dissociative symptoms (depersonalization or derealization)
- With delayed expression (not met until 6 months after event)
Depersonalization
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)
Derealization
Experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted)
PTSD in children 6 years or younger
- 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
AL Abuse Definition
- 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
Adult Abuse
- 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
PTSD used to be thought of in 3 domains…
- 3 domains: re-experiencing, avoidance, hyperarousal
- Now there’s a shift towards a 4-factor model including dysphoria
Re-experiencing
- 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
Avoidance
- 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
Hyperarousal
- Trouble falling asleep or staying asleep
- Irritability or anger outbursts
- Trouble concentrating
- Hypervigilance
- Exaggerated startle response
Dysphoria
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
Acute Stress Disorder
- 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
Trauma Epidemiology
- 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?)
Common Traumatic Stressors
- 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
Combat & PTSD
- 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
Comorbid Disorders
Too many to list (over 90%)
- MDD and GAD common
- Shared dysphoria component?
Subtypes of PTSD (Miller et al.)
- 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
PTSD: Biological Perspective
- 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
Cognitive/Behavioral Factors
- 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
Verbally Accessible Memories (VAM) and Situationally Accessible Memories (SAM)
- 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)
Shattered expectations
- 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
Social Support & Trauma
- 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
