What are the symptoms of PTSD? (APA, 2013)
Symptoms lasting at least 1 month
Some sort of exposure to a traumatic event
At least 1 symptom from each of the following categories:
Intrusive - nightmares, recurring thoughts, flashbacks
Avoidance - thinking about it, seeing it, talking about it
Change to mood or thoughts - irritable, fear, shame, guilt, dissociative amnesia
Change in arousal and reactivity - sleep disturbance, startle response, hypervigilance, angry outbursts
What are the differential DX of PTSD? (APA, 2013)
80% comorbidity for other disorders
Look for reality testing - make sure flashbacks aren’t associated with psychosis
Substance use - SXS associated with SA include delerium, anxiety, psychosis
What did Freud say about trauma? (1914)
Trauma alters the foundation in the person’s life
Impairs their ability to live in the present due to ongoing effort to reconcile past trauma and its impact on the present and future
Overwhelms the capacity to cope and renders the person helpless
What did Freud say about PTSD? (1908)
Traumatic event is likely defended against via repression in response to anxiety
Ego recognizes certain ideas, events, wishes, and desires arouse anxiety
Original idea/event or wish/desire is repressed to prevent it from reaching the conscious awareness
Likely unacceptable feelings associated with the event - need to ID these
No repression is totally successful resulting in anxiety
What are the citations for Freud’s perception of trauma and PTSD?
Trauma - Freud, 1914
PTSD - Freud, 1908
What is Kernberg’s (1975) etiological perspective of PTSD?
Splitting is used as a defense mechanism - developmentally associated with the ego’s inability to unify the bad and good aspect of self and other
Difficulty integrating the bad me (the one who experienced the trauma) and the good me
Results in anxiety associated with PTSD
Difficulty integrating the selves may be due to a lack of role model for this task and development of one stable identity
What is the citation for Kernberg’s etiology of PTSD?
What is the basis of a CBT perspective of PTSD?
Information processing (Lang, 1985) Elaborated by Foa et al., 1989
Foa et al.’s (1989) etiological perspective of PTSD?
Associations once considered neutral/safe may now be connected with fear
Dysfunctional cognitive structures - overgeneralize fear and anxiety, difficulty distinguishing from past events
Unable to see that the danger is no longer imminent and the event is not currently occurring
Fear reactions elicited that become conditioned to respond to environmental cues that are associated with the traumatic event
What are the biological etiological considerations with PTSD?
Overactivation of the amygdala (Stahl, 2010)
Predispositions from family histories with trauma result in certain neurotransmitters being unable to sustain long periods of changes to severe and uncontrollable stress (Van der Kolk et al., 1984)
What are the citations for the biological considerations?
amygdala - Stahl, 2010
Family history - Van der kolk et al., 1984