PTSD
Consequences of experiencing extreme traumas (stressors)
- became more prominent after vietnam war
Trauma
Event in which individual exposed to actual or threatened death, serious injury or sexual violation
needs to be experienced:
- directly
- witnessed
- learned it happened to someone close
- experienced repeated or extreme exposure to details of traumatic events
- wide range of specific events can induce PTSD or acute stress disorder —> can be extraordinary or common
4 Types of Symptoms
Four symptoms:
- Repeated reexperiencing of the event
- Avoidance of situations, thoughts, memories associated with event
- Negative changes in thought and mood associated with event
- Hypervigiliance & chronic arousal
can be mild to moderate –> permitting normal functioning
can be immobilizing –> deterioration at work, family & social life
Acute Stress Disorder
similar to PTSD (also consequence of experience extreme trauma)
BUT
- more short term –> symptoms occur within 4 weeks after trauma and last at max 1 month
Adjustment Disorder
similar to PTSD
symptoms arise within 3 months
- can be of any severity –> but not so extreme as on PTSD (that is difference to PTSD)
DSM-V
Criteria A
Exposure to actual/threatened death, serious injury or sexual violence in one (or more) of these ways
- direct experience
- witnessing, in person, the event occurring to other
- learning event happened to someone close
- in case of actual/threatened death it must have been violent or accidental - experiencing extreme/repeated exposure to aversive details of traumatic event
DSM-V
Criteria B
Presence of one or more of following symptoms beginning after occurrence of traumatic event
- recurrent, involuntary & intrusive distressing memories
- Distressing dreams with content and/or affect related to trauma
- Dissociative aspects (flashbacks) in which the person feels/acts as the event was recurring
- Intense/prolonged psychological distress at exposure to internal/external cues that symbolize/resemble an aspect of the event
- marked psychological reactions to internal/external cues that symbolize/ resemble an aspect of the event
DSM-V
Criteria C
Persistent avoidance of stimuli associated with the traumatic event, beginning after the event occurred, evidenced by one or both
- Avoidance of / efforts to avoid distressing memories/thoughts/feelings about the event
- Avoidance of/ efforts to avoid external reminders
DSM-V
Criteria D
Negative alterations in cognition and mood associated with the traumatic event, beginning/ worsening after it occurred as evidenced by two or more of the following
- Inability to remember an important aspect due to dissociative amnesia (not injury/substances, medications)
- Persistent & exaggerated negative beliefs & expectations
- Persistent, distorted cognitions about the cause/consequences that lead the individual to blame him/herself or others
- Persistent negative emotional state
- Diminished interest/participation in significant activities
- Feeling of detachment/estrangement form others
- Persistent inability to experience positive emotions
DSM-V
Criteria E
Marked alterations in arousal and reactivity associated with the traumatic event beginning /worsening after it occurred as evidenced by two or more of the following
- Irritable behavior and angry outbursts
- Reckless/destructive behavior
- Hypervigiliance
- Exaggerated startle response
- Problems with concentration
- Sleep disturbance
DSM -V
Criteria F
Duration of the Disturbance (B, C, D, E) is more than one month
DSM-V
Criteria G
Disturbances cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
DSM-V
Criteria H
The disturbance is not attributable to the effects of substances to another medical condition
Types of Traumas
- Natural disasters (ambulance workers highest rate getting PTSD) –> least likely leading to PTSD
- Human made disasters (Terrorist attacks, wars) –> more likely leading to PTSD
- Sexual assault –> very likely developing PTSD (about 50%, and 25% still have PTSD after 2 years)
Environmental and Social factors leading to PTSD
Severity, duration and proximity to traumatic event predict ppl. reaction to trauma
people with more social support recover faster
Psychological Factors
- general increased symptoms of anxiety/depression –> more prone
- Style of coping influences vulnerability
self-destructive/avoidant strategies (drinking, self- isolation) more likely
dissociation also increases likelihood
Gender Differences
- Women more likely than men
- may experience triggers more often (sexual abuse)
- may receive less social support - trauma more stigmatized
Cross-Cultural differences
- African Americans more likely –> more traumas of certain types
- minorities less help seeking
- Culture appears to influence manifestation of anxiety
Amygdala
stronger
more reactive to emotional stimuli
Medial Prefrontal Cortex
weaker
less able to dampen reactivity when to occurs
Hippocampus
smaller
probably because NT overload
memory problems and problems with regulation of the body’s fear response –> not returning back after threat passed
Cortisol
lower resting cortisol levels
- usually cortisol reduces sympathetic NS activity after stress
- lower levels –> prolonged activity after stress –> more easily develop conditioned fear
Hypothalamic-pituitary-adrenal (HPA) axis
- in PTDS vulnerable ppl, components of theses