PTSD

Question 1

Traumatic Events

Answer 1

• Direct or witnessed death or threatened death
• Direct or witnessed serious injury or threatened serious injury
• Sexual violation
• sudden unexpected death of a loved one by violent means
• repeated exposure to extreme details of trauma
  
  • rescue workers
  • homicide detectives

Question 2

How is PTSD unique

Answer 2

• Individual has to experience a traumatic event to develop the disorder

Question 3

Prevalence of trauma and PTSD

Answer 3

• Many people experience 1 or more traumatic events during their life
  
  • lifetime prevalence: 50-75%
• PTSD prevalence=much lower
  
  • lifetime prevalence: 7-9%
  • Women: 8-12%
  • Men: 4-6%

Question 4

Most common forms of traumatic experiences:

Answer 4

• Physical or sexual assault
• Witnessing someone being injured or killed
• Natural Disaster
• Being in a life threatening accident

Question 5

PTSD: Symptoms

Answer 5

• Re-experiencing
  
  • dreams
  • thoughts
  • memories
  • flashbacks
  • physiological and emotional reactions
• Avoidance
  
  • thoughts
  • memories
  • situations
  • conversations
  • people
• Alterations of thought and mood
  
  • negative beliefs
  • distorted blame
  • negative mood
  • detachment
  • loss of interest
  • difficulty experiencing emotions
• Arousal and reactivity
  
  • vigilance
  • sleep disturbance
  • startle response
  • irritability
  • anger and aggression
  • concentration problems

Question 6

PTSD: Risk factors

Answer 6

• Pre-trauma characteristics:
  
  • Gender
  • History of stressful/traumatic events
  • ACEs
  • Psychological distress
• Trauma factors
  
  • Proximity/severity/duration of trauma
  • Dissociative/panic reactions
  • Perceived life threat
  • Deliberate actions by a perpetrator
• Post-trauma factors
  
  • loss of resources
  • lack of social support
  • other stressful events

Question 7

PTSD: mental health comorbidities

Answer 7

• Depression
  
  • most common comorbidity with PTSD
    
    • prevalence rates: 30-50%
  • can be a risk factor and a consequence of PTSD
• Substance Abuse Disorders
  
  • 25% with alcohol abuse disorder have PTSD
  • 40% people with PTSD have a comorbid substance use disorder
  • 75% with sUD +PTSD have attempted suicide

Question 8

PTSD: Health Risk behaviors

Answer 8

• Problematic substance use and substance misuse are common
  
  • response to trauma
  • risk factor for additional traumatic experiences
• Sexual risk behavior
  
  • childhood abuse and sexual assault strongly associated
  • sexual risk behaviors elevated in combat PTSD populations and individuals with SUDs
• Smoking
  
  • ranges from 34-61%
  • current >40%
• Obesity:
  
  • increases risk for obesity by over 30% in women
  • >32% with PTSD were obese

Question 9

PTSD: Preventive Health Behaviors

Answer 9

• Utilize medical services at a higher rate
• less likely to engage in preventative behaviors:
  
  • 60-70% physically inactive
  • lower rates of:
    
    • not smoking following treatment
    • cancer screening
    • Condom use
    • dental care

Question 10

PTSD: Chronic health conditions associated with

Answer 10

• Arthritis (strongest association)
• Cardiovascular disease
• GI disease/symptoms & reproductive symptoms in women
• poorer outcomes with chronic health conditions
• elevated rates of chronic pain
  
  • and may be linked to idiopathic/functional pain conditions
• Gingivitis, plaque deposits, bruxism

Question 11

Treatment of PTSD

Answer 11

• Cognitive behavioral treatment (best)
• Prolonged exposure therapy
  
  • based on emotional processing model of PTSD
• Cognitive processing therapy
  
  • primary focus on stuck points (identifying and challenging maladaptive trauma related cognitions)
• OVerall individual trauma focused treatments=Best choice
• Pharmacotherapy
  
  • offered to those unwilling to engage in psychotherapy
• Non-trauma focused treatment
  
  • less effective
• Lower intensity treatments may be effective option
  
  • trauma Writing protocol
  • facilitate self-help
  • telepsychology