VI - Trauma and Stressor-Related Disorders

Question 1

Definition of Psychological Trauma

Answer 1

Individual’s experience of events or conditions in which (1) ability to integrate emotional experience is overwhelmed, or (2) the individual experiences a threat to life, bodily integrity, sanity

Question 2

What are trauma and stressor related disorders (according to DSM-5)?

Answer 2

Disorders in which traumatic/stressful event is a diagnostic criterion. Close relationship between these disorders and anxiety disorders, OCD and related, dissociative disorders. Psychological distress after event is variable.

Question 3

5 Trauma and Stressor Related

Answer 3

Reactive Attachment Disorder
Disinhibited Social Engagement Disorder
*Postraumatic Stress Disorder*
*Acute Stress Disorder*
*Adjustment Disorder*

Question 4

PTSD History

Answer 4

Entered DSM in 1980 b/c Vietnam Vets. Initially viewed as normal response to abnormal stress. DSM-IV: pathological response to extreme form of stress. DSM-V criteria more stringent

Question 5

DSM-IV vs DSM-V diagnosis of PTSD

Answer 5

DSM-IV - viewed as pathological response to extreme stressor; range broadened; must feel “intense fear, helplessness or horror”; broadening -> 90% of samples with the necessary response; mostly death; women more likely
DSM-V - event must be directly experienced (not via TV, etc). Death must be close friend/relative and violent/accidental. Removal of specific emotional requirement

Question 6

PTSD Criteria (8)

Answer 6

(A) Exposure
(B) Intrusion
(C) Avoidance
(D) Negative Mood + Cognitions
(E) Alterations in Arousal and Reactivity
(F) Duration: 1 month +
(G) Clinically significant distress/impairment in functioning
(H) Not due to physiological effects of substance or another medical condition

Can be with dissociative symptoms (depersonalization or derealization) or with delayed expression - must specify

Question 7

PTSD Criterion A

Answer 7

Criterion A: Exposure to actual or threatened death, serious injury, or sexual violence by one or more:

(1) direct experience
(2) witnessing
(3) learning that somebody close experienced (violent or accidental if death)
(4) experiencing repeated or extreme exposure to aversive details of traumatic events (such as police officer and domestic abuse). Not media or images unless it is work-related

Question 8

PTSD Criterion B

Answer 8

Criterion B: Intrusion - presence of one or more of following:

(1) Recurrent, involuntary, intrusive distressing memories of event
(2) Recurrent distressing dreams where content/affect related to event
(3) Dissociative reactions/flashbacks where individual feels or acts as if event were recurring
(4) Intense/prolonged distress to internal or external cues that symbolize or resemble aspect of event
(5) Marked physiological reactions to internal or external cues that resemble aspect of traumatic event

Question 9

PTSD Criterion C

Answer 9

Criterion C: Avoidance - persistent avoidance of stimuli associated with event, 1+ of following:

(1) Avoidance distressing memories, thoughts, feelings about or closely associated with events
(2) Avoidance of external reminders that arouse distressing memories, thoughts, feelings about or associated with event

Question 10

PTSD Criterion D

Answer 10

Criterion D: Negative cognitions or mood beginning or worsening after the event - two or more:

(1) Inability to remember due to dissociative amnesia
(2) Persistent, exaggerated negative beliefs and expectations about self, others, world
(3) Persistent distorted cognitions about causes and consequences of event that lead to self/other blame
(4) Persistent negative emotional state (fear, horror, anger, guilt, shame…)
(5) Diminished interest/participation in significant activities
(6) Feelings of detachment, estrangement from others
(7) Persistent inability to experience positive emotions

Question 11

PTSD Criterion E

Answer 11

Criterion E: Arousal and Reactivity - alterations beginning or worsening after event - 2+ of:

(1) Irritable behavior and angry outbursts (little or no provocation) expressed as verbal, physical aggression towards people/objects
(2) Reckless, self-destructive behavior
(3) Hypervigilance
(4) Exaggerated startle response
(5) Problems with concentration
(6) Sleep disturbance

Question 12

Functional Consequences of PTSD

Answer 12

• Social, occupational, physical disability
• Economic costs
• High level of meds
• Impaired functioning in social, interpersonal, developmental, educational, physical health, occupational
• Poor social/family relationships, absenteeism from work, lower income, lower education, worse occupation

Question 13

Differential Diagnosis of PTSD Symptoms

Answer 13

Symptoms of PTSD may seem similar to those of other disorders such as adjustment disorders, acute stress, anxiety disorder, depression, personality, dissociative, conversion, psychotic, traumatic brain injury

Question 14

Adjustment Disorder (Differential Diagnosis of PTSD)

Answer 14

Psychological response to common stressor (divorce, death of loved one, loss of job) that results in significant behavioral/emotional symptoms that begin within 3 months. Must experience more distress that expected in circumstances or be unable to function regularly. After 6 months, diagnosis changes. Diagnosis used when response to stressor that meets PTSD criterion A does not meet all other criteria, or when symptoms of PTSD appear without A.

Question 15

Acute Stress Disorder (Differential Diagnosis of PTSD)

Answer 15

Symptoms of PTSD, but duration of 3 days to 1 month after traumatic event. If symptoms more than 4 weeks, diagnosis may be changed to PTSD.

Question 16

Anxiety (Differential Diagnosis of PTSD)

Answer 16

OCD - recurrent intrusive thoughts but not related to traumatic event; other PTSD symptoms usually absent
Panic disorder - arousal/dissociative symptoms not related to traumatic
Anxiety - avoidance, irritability, anxiety not traumatic
Separation anxiety - related to separation itself, no traumatic

Question 17

Comorbidity of PTSD

Answer 17

80% more likely than those without to have symptoms that meet diagnostic criteria for at least one other mental disorder. Substance abuse and conduct disorder more common in males. TBI. Military personnel - PTSD and mild TBI co-occurence 48%. In children, co-morbid ODD disorder, Separation Anxiety Disorder. Comorbidity between PTSD, major neurocognitive disorder.