Trauma Related Disorders - U5 Pt2 Flashcards
What are 3 disorders among children/adolescence who have experienced trauma?
- PTSD
- Developmental trauma disorder
- ADHD
What are disorders among adults who have experienced trauma?
- PTSD
- Major depression
- Anxiety disorders
- Substance related disorders
- Eating disorders
What is the history behind the PTSD diagnosis?
DSM-III in 1980 was the first edition to include the diagnosis of PTSD, and it was categorized as an anxiety.
It was significant that the issue occurred outside of the individual, not inside the brain or the body*
There were tight restrictions on what was considered trauma, as it was defined as a catastrophic stressor that is outside the range of usual human experience (war, rape, accidents, natural disasters)
What is the relevant PTSD diagnosis?
DSM-5 in 2013 moved PTSD into a new category called TRAUMA AND STRESSOR RELATED DISORDERS
It used to be 3 factors, now it is 4 factors*
1. Intrusion
2. Avoidance
3. Alterations in arousal and reactivity
4. Negative alterations in cognition and mood*
- Indirect exposure to trauma was also included*
- There are new sub-types for PTSD: Dissociative type, (depersonalization or derealization)*
What are 2 of the diagnostic criteria for PTSD?
CRITERION A (one required) - the person was exposed to: death, threatened death, actual or threatened serious injury, actual or threatened sexual violence in direct exposure, witnessing, learning a friend was exposed, or indirect exposure
CRITERION B (one required) - the traumatic event is persistently re-experienced with intrusive thoughts, nightmares, or flashbacks
What are the 2 specifications of PTSD diagnostic criteria ?
DISSOCIATIVE Specification: In addition to meeting the existing criteria, there are high levels of one of the following:
- Depersonalization = experience of being detached from oneself, feeling like life is a dream
- Derealization = experience of unreality, distance or distortion, where things don’t feel real
DELAYED Specification: full diagnostic criteria is not met until at least 6 months after the trauma. Onset of symptoms may occur immediately, but there is a delayed trauma response
What are alternatives to PTSD?
The DSM has failed to recognize a range of forms of trauma and their unique effects
- Complex PTSD (C-PTSD)
- Disorders of Extreme Stress Not Otherwise Specified (DESNOS)
- Developmental trauma
CPTSD was NOT added to the DSM-5 despite the wide acceptance
ICD-11 is more recognized, and includes the symptoms of CPTSD as a distinct diagnosis
Findings from Resick et al., 2012; Criticisms of CPTSD:
There is no clear definition and lack of discriminative validity
- There is overlap between the proposed symptoms of CPTSD and PTSD, BPD, and major depressive disorder (MDD)
*With research, there has been an influence on the inclusion of CPTSD into ICD-11
Standardized tools have been developed, including the International Trauma Questionnaire (ITQ) and International Trauma Interview (ITI) which seeks to identify and differentiate PTSD and CPTSD
What is the difference with CPTSD?
Symptoms of CPTSD include several defining criteria of PTSD (avoidance, reexperiencing, and hyperarousal) and disturbances in self-organization that have been grouped into 3 categories:
1. Affect dysregulation
2. Negative self-concept
3. Disturbances in relationships
What are the implications of CPTSD?
- We can understand the differences to create better treatment for those with CPTSD
- We can be more inclusive with diagnoses, so there are less misdiagnoses
What is Borderline Personality Disorder (BPD)?
- It is a MI that severely impacts the ability to regulate emotions
- It is a disorder where maladaptive behaviours to relate to people are used to make it through difficult traumatic situations, in childhood these behaviours worked, but in adulthood it creates the symptoms of BPD
SYMPTOMS: - Engaging in self-harm, suicidal ideation
- Feeling emptiness
- Unstable relationships, struggles with attachment (attempts to get attachments to stay)
- Predominantly females are diagnosed
What is the stigma with BPD?
It makes it difficult to treat because of issues with relationships and trust. Manipulation is a feature of this illness, making it seem like the person is seeking attention*
- We create the stigma as HCP because these behaviours frustrate us
What is the overlap between BPD and CPTSD?
- The impaired interpersonal functioning, impaired sense of self, dissociation, and affect dysregulation all overlap with BPD and CPTSD
- Mood fluctuations are more prominent in BPD and are expressed through separation anxiety, and emotional reactivity (self-harming behaviour), but in CPTSD these are characterized by emotional numbing and withdrawal from social relationships
These similarities increase the risk of misdiagnosis, especially when trauma history is not fully accounted for or known - the BPD diagnosis is in DSM-5, but there is no diagnosis for CPTSD, causing confusion
What are implications for treatment with BPD?
- There is stigma around BPD, regardless of the diagnosis we need to help pt and understand the possible causes behind the illness
- Different diagnoses have different treatments. A misdiagnosis causes different treatment which may not relate to what the pt may need*
