Traumatic Stress Disorders Flashcards
gender patterns of trauma exposure
men- combat experiences and criminal assaults
women- rape and sexual assult
violent victimisation more common among?
African-American
Hispanic-American
low income communities
trauma exposure stats SA
- 75% of general population has experienced a trauma
- 1/3 have been victim of violence
- 56% have multiple traumas
Why is PTSD twice as common amongst women?
- symptoms last 4 times longer in women than in men
- women express fear more easily than men
- interprets events as more fearful
- women more disempowered in society
- women experience more everyday violence (domestic abuse)
- sexual abuse more destructive as there can be feelings of guilt and shame
why is the diagnosis of PTSD valuable?
- acknowledgement and normalisation
- reduces victim blaming and isolation (not a weakness of character)
- allows access to treatment and resources (insurance and disability compensation)
- facilitates development of targeted treatments
- reduces social and financial costs of unrecognised and untreated trauma(untreated abuse often results in the abuse of ones children. if it is not treated it is a cyclic problem)
What are the risks of PTSD diagnosis?
- the medicalisation of suffering
- locating pathology in the individual disguises social oppression of specific groups
- effects of trauma are symptoms of power imbalances in society, not of individual illness
- apolitical, decontextualised understanding of trauma and violence (strips away socio-political factors)
- marginalises survivors’ experience of injustice and exploitation
- makes the individual responsible for recovery
- maintains social inequalities
Psychological impact of prolonged abuse
- develop a wide range of symptoms not captured by the PTSD diagnosis
- abuse often occurs in crit development window periods, involves relational trauma
- Wurr and Partridge (1996) 46% of general psychiatric hospital patients reported histories of child sexual abuse in research interviews but in only 14% of cases had this history been documented in case files
- Patients with childhood abuse histories have higher rates of re-admission and are more expensive to treat than patients with no abuse histories
Complex PTSD or developmental trauma disorder (DTD)
- never made it into the DSM V
- common amongst survivors of child physical or sexual abuse (mainly women)
Complex PTSD or developmental trauma disorder (DTD) symptoms
- disturbed sense of identity
- difficulties regulating emotions (somatisation, dissociation, substance abuse, self-harm)
- difficulties with relationships (unstable / revictimisation)
Is complex PTSD the same as BPD?
- BPD is a personality defect as opposed to PTSD which is a result of unfair treatment
- having separate diagnoses means separate research
- 80-90% of BPD patients have histories of childhood abuse or neglect therefore closely linked
What happens when trauma isnt “post”?
possible Continuous Traumatic Stress response?
- threat is pervasive
- preoccupation with current and future danger rather than past event
- high levels of arousal and avoidance may be protective
- absence of protection, failure of systems of law
effects of youth of exposure to a combination of domestic and community violence
- defeat response: sense of apathy, futility, disengagement
- emotional dissociation, lack of empathy
- terminal thinking
- learning problems
- increase of aggression and conduct problems
- appetitive (rather than instrumental/reactive) aggression
- substance abuse
symptoms of PTSD have been found across many cultures though their importance varies…
- flashbacks reported even in societies with no previous exposure to PTSD construct
- avoidance/numbing symptoms often absent outside of western cultures
- post trauma nightmares very prominent in some cultures (Native American veterans)
In many countries outside of USA, United Kingdom and Europe, trauma survivors present with prominent…
- somatisation
- dissociative symptoms
- shame
- cultural bereavement
Well-documented culture-bound trauma syndromes or idioms of distress (culturally sanctioned responses to trauma):
- somatic blindness (Cambodian refugees)
- ataques de nervois (latin america)
- ‘ghosts’ of the Japanese tsunami
two competing narratives of history of PTSD
- PTSD as recognition of a disorder that has always existed
2. the cultural invention of PTSD
PTSD as recognition of a disorder that has always existed
- trauma has always had damaging effects but they have often been denied by society (eg. Freud’s theory of sexual abuse, World Wars, Vietnam war)
- 1970s: Rise of feminism and war veterans support groups in USA created a political environment that was more open to recognising the damaging effects of violence and abuse
- PTSD entered the DSM system in 1980
- “PTSD is merely the re-naming of an age-old condition”
The cultural “invention” of PTSD
- historically documented traumatic stress syndromes did not have the same symptoms as PTSD (intrusive and avoidance symptoms not prominent)
- railway spine
- hysteria
- shell shock
- PTSD has not always existed - in recent decades it has become culturally available and culturally codified as an acceptable and recognisable way to express traumatic stress in Western/Northern societies
Railway spine (1860s)
symptoms:
- anxiety
- nightmares
- forgetfulness
- somatic: headaches, hearing problems, numbness of limbs
Hysteria (late 1800s)
symptoms:
- paralysis, seizures, blindness (no organic cause)
- emotional excitability
- more consistent with Conversion Disorder and the feminine personality disorders (bpd and histrionic)
- associated with repressed rather than intrusive memories
Shell Shock (ww1) and Combat Fatigue (ww2)
symptoms:
- nightmares
- restlessness, irritability
- somatic: paralysis, seizures, muteness, blindness with no organic basis)
