week 7 Flashcards
What do we see in PTSD
we see symptoms in intrusion, avoidance, negative mood, and arousal; a qualifying trauma (witness close friend or family, repeated exposure)
Intrusion
recurrent memories or dreams, or dissociative reactions
Avoidance
avoiding memories, thoughts or feelings associated with the traumatic event, avoiding external reminders
what percentage of those with ASD will be diagnosed with PTSD?
50%
Negative alterations in cognition and mood
relate to not remembering negative memories, distorted thinking
Arousal/reactivity
anger outbursts, reckless or self-destructive behavior, sleep disturbance, difficulty concentration
How long do symptoms present for to be PTSD
1 month
Differences between PTSD & ASD
same criteria but the duration of symptoms between the two and the reckless self destructive behavior
Acute in ASD
Symptoms present for 3 days or more but not more than 1 month
Acute comes in 3 forms
- no criteria met: 4% will develop PTSD
- full criteria met for ASD: 80% of individuals will develop PTSD
- Subclinical presentation– some criteria but not enough to get the diagnosis: 60% will develop PTSD
F43.10 PTSD Criteria
Criterion A: one or more of the following ways:
• Directly experiencing the traumatic event(s)
• Witnessing, in person, the event(s) as it occurs to others
• Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
• Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse).
Criterion B: Presence of one (or more)
• Recurrent, involuntary, and intrusive distressing memories.
• Traumatic nightmares.
• Dissociative reactions (e.g., flashbacks) Note: Children may reenact the event in play.
• Intense or prolonged distress to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)
• Marked physiologic reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)
Criterion C: as evidenced by one or both of the following:
• Avoidance of, or efforts to avoid distressing memories, thoughts, or feelings about, or closely associated with the traumatic event(s).
• Avoidance of, or efforts to avoid external reminders (people, places conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event.
Criterion D: one or both of the following:
• Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol or drugs).
• Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., “I am bad,” “The world is completely dangerous.”).
• Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences.
• Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt or shame).
• Markedly diminished interest in (pre-traumatic) significant activities.
• Feelings of detachment or estrangement from others Persistent inability to experience positive emotions
• Persistent inability to experience positive emotions (e.g. inability to experience happiness, satisfaction, or loving feelings.
Criterion E: by two (or more) of the following:
• Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects
• Self-destructive or reckless behavior.
• Hypervigilance.
• Exaggerated startle response.
• Problems in concentration.
• Sleep disturbance.
Criterion F: Persistence of symptoms (in Criteria B, C, D and E) for more than one month.
Criterion G: functional significance
Significant symptom-related distress or functional impairment (e.g., social, occupational).
Criterion H:
Disturbance is not due to medication, substance use, or other illness.
Specify if: With dissociative symptoms.
Depersonalization (PTSD)
experience of being an outside observer of or detached from oneself (feeling as if this is not happening to me, or was a dream)
Derealization (PTSD)
experience of unreality, distance, or distortion (things are not real)
When is the full diagnosis met for PTSD for delayed expression?
Not met until at least 6 months after the trauma, although onset of symptoms may occur immediately
What type of trauma do young children experience for PTSD?
abuse, witnessing interpersonal violence, motor vehicle accidents, dog bits, medical procedures
Comorbidity
associated with increased rates of affective disorders, anxiety disorders and substance abuse these may precede, follow or emerge with PTSD
Most people who have PTSD also have
a combined illicit-substance use problem
Suicide is higher in those who have
PTSD
Intrinsic processing
naturally and without therapy trauma “symptoms” may have the adaptive capacity of driving us toward recovery
Reexperiencing Trauma can result in
growth, in which PTSD represents symptoms that overwhelm this system and inhibit growth
Sympathetic vs. Parasympathetic nervous system
help you deal with activation of your fight or flight, your survival mechanisms
Sympathetic nervous system
general alarm mechanism prepares the body to cope with emergencies: pupil dilation, increased sweating, heart rate, blood pressure, digestion stops, tunnel vision and hearing
Within Sympathetic nervous system what happens to everything around us
anything that is not related to the threat will be tuned out
Parasympathetic nervous sytem (parachute)
reestablishes equilibrium for rest and digestion, slows heart rate, increases intestinal/gland activity, relaxes gastro muscles
Amygdala
stores memories of fear, helps get back to the baseline state
Cortisol
“stress hormone”, always activating flight or fight responses,
What does PTSD do with trauma
PTSD interrupts the normal return to baseline state
Who maintains fight or flight state longer?
Males do
Who takes longer to go back to baseline state or deregulate?
Men due because females have learned how to calm themselves down for the survival of their children
PTSD symptoms
flashbacks, avoidance, hypervigilance, nightmares, re-experiencing phenomenon
PTSD and diverse cultures
women and minorities have higher rates of PTSD because of more exposure to traumatic events
Dissociation
common defensive response to ward off intensive affect in trauma
Repression and dissociation?
both defenses that banish contents of the mind from awareness
Psychodynamic does not have a good approach of what diagnosis?
PTSD
PTSD subtypes
non-dissociative type and dissociative type
non-dissociative type PTSD
emotional undermodulation, reexperiencing and hyperarousal represents failure of prefrontal inhibition (letting out the trauma)
Dissociative
emotional overmodulation of limbic system (keeping trauma repressed)
What type of treatment is needed with PTSD subtypes
mindfulness, groundfulness, help keep the person in the room when they are talking about the trauma
Countertransference in trauma
shared helplessness, disbelief, rescuer, blaming the victim
Schema theories of PTSD
People have a basic need to match trauma related information with their inner models based on old information this is through assimilation and accommodation (piaget)
Assimilation
when you have your schema and you make the information fit your schema
Accommodation
when your schema is changed to fit the information
Either assimilation and accommodation leads to
some type of resolution
Post traumatic growth (Tedeschi & Calhoun)
can be a positive outcome of a really horrible event, (ex: taken the trauma and turned it into activism)
Resilience
the ability to recover readily from illness
how do we get to the post traumatic growth?
based on supportive enviornment and beliefs as well as a life narrative looking at before and after
how does post-traumatic growth relate to a adversity difficulty
transformative responses to adversity
5 domains of post traumatic growth
spiritual development, personal strength, close relationships, greater appreciation for life, new possibilities (with PTSD these cannot happen)
3 steps to projective identification
Step 1: projection: the patient projects internal objects
Step 2: identification. The patient still identifies with what is being projected but gets the person on whom they are projecting to behave as if the target person had those same introjects
Step 3: control (through their identification) the person attempts to control the object in order to prevent being attacked by the projection
Are the steps in projective identification linear?
These aspects are not truly linear
What is schema theory?
People mold memories to fit information that already exists in their minds
