Trauma

Question 1

Describe the key features of PTSD

Answer 1

• Exposure to a traumatic event:
  
  • Direct experience
  • Witnessing
  • Learning occurence to close friend/family member (e.g., suicide)
  • Repeated/extreme exposure (e.g., first responders)
• Intrusive symptoms:
  
  • Memories
  • Dreams
  • Flashbacks
  • Psychological distress @ cues/reminders
  • Physiological reactions @ cues/reminders
• Avoidance:
  
  • Memories, thoughts, feelings
  • Reminders
• Negative changes to thoughts/feelings:
  
  • Memory loss
  • Negative beliefs self/world/others
  • Misattributions of cause/consequence of event
  • Negative emotional state
  • Diminished itnerest
  • Detachment
  • Inability to experience positive feelings
• Changes in arousal/reactivity:
  
  • Irritability/angry outburts
  • Reckless/self destructive behaviour
  • Hypervigilance
  • Exaggerated startle response
  • Concentration difficulties
  • Sleep disturbance
• Duration - 1+ month
• Specify:
  
  • Dissociative symptoms:
    
    • Depersonalisation - feel detached from world
    • Derealisation - world seems unreal

Question 2

What are the differential diagnoses of PTSD?

Answer 2

• Adjustment – stressor can be of any severity or type. Also used when response to traumatic event doesn’t meet all criteria.
• Other posttraumatic disorders – sometimes other disorders can better explain posttraumatic responses, e.g., panic attacks that occur only after exposure to traumatic reminders.
• Acute stress disorder – Duration is shorter – 3 days to 1 month; if persists after then = PTSD.
• • OCD – intrusive thoughts – not related to trauma; + compulsions; - other symptoms of PTSD
    
    • Separation anxiety – clearly related to separation, not trauma
• MDD - may/may not be preceded by traumatic event. Diagnosed if other PTSD symptoms absent.
• Personality disorders – Interpersonal difficulties after traumatic event can be PTSD rather than a PD.
• Dissociative - Dissociative amnesia, dissociative identity disorder, and depersonalization-derealization disorder may/may not be preceded by traumatic event/have co-occurring PTSD symptoms.
  
  • If full PTSD criteria met, PTSD with dissociative symptoms subtype should be considered.
• Conversion disorder – new onset of somatic symptoms within context of posttraumatic distress may be PTSD
• Psychotic disorders – PTSD flashbacks distinguished from illusions, hallucinations etc.
• Traumatic brain injury – brain injury in context of traumatic event = both PTSD and TBI can co-occur. Symptoms such as headaches, dizziness, sensitivity to light/sound, irritability, concentration deficits can occur in PTSD and TBI, and both.
  
  • Note symptoms distinctive to each presentation – re-experiencing and avoidance in PTSD; persistent disorientation and confusion in TBI.

Question 3

What are the risk factors of PTSD?

Answer 3

• Childhood problems by age 6 – prior trauma, externalising, anxiety
• Prior mental disorders – panic, depression, PTSD, OCD
• Lower SES, lower education, exposure to prior trauma, childhood adversity (e.g., parental separation or death), self-blaming/fatalistic coping strategies, lower intelligence, minority racial/ethnic status, family psychiatric history. Social support prior to trauma is protective.
• Females and younger age at time of trauma = high risk
• Certain genotypes
• Severity of trauma
• Negative appraisals of trauma; inappropriate coping strategies; acute stress disorder
• Repeated reminders, subsequent adverse life events.

Question 4

What is the model for PTSD?

Answer 4

Question 5

What are the psychological processes in PTSD?

Answer 5

• Memory and PTSD
• Dissociation (“freezing”) and “BASK”
• Cognitive / affective responses:
• Beliefs
• Cognitive coping strategies:
• Social support

Question 6

What is the BASK model of dissociation?

Answer 6