PTSD, abnormal psych

Post-Traumatic Stress Disorder

• PTSD is defined as an extreme response to a severe stressor, including increased anxiety, avoidance of stimuli associated with the trauma, and a numbing of emotional responses

presumed etiology

• A traumatic event or events that the person has directly experienced or witnessed involving the deaths of others, threatened death to oneself, serious injury, or a threat to the physical integrity of self or others

3 major clusters of symptoms in PTSD

1. Intrusion symptoms associated with the traumatic event (flashbacks, intrusive thoughts, nightmares)
2. Persistent avoidance of stimuli associated with the event

3. Marked alterations in arousal and reactivity

PTSD criteria

3 major symptom clusters (intrustion, avoidance, alterations in arousal & reactivity)
• distress or impairment
• symptoms must not be caused by medication, substance abuse, or other illness
• may experience dissociation –depersonalization or derealization
• symptom onset may be delayed

In the DSM-5, hearing about the traumatic experience of a family member or close friend is considered to be sufficient exposure for that person to develop PTSD.

Criteria for PTSD – First responders

First responders who did not witness the event but were exposed to the aftermath qualify for the diagnosis of PTSD if they develop the requisite symptoms

Purpose of excluding others from the diagnosis of PTSD

What may have been the purpose of the decision to include family, close friends, and first responders, but to exclude regular medical staff as well as therapists

Acute stress disorder

• The proportion of people who develop an acute stress disorder varies with the type of trauma they have experienced

• Acute stress disorder has symptoms that are similar to those in PTSD but can be diagnosed within 28 days of the trauma

• In some people symptoms of acute stress disorder go away before day 29. Others go on to develop PTSD The proportion of people who develop an acute stress disorder varies with the type of trauma they have experienced.

PTSD DSM

The inclusion in the DSM of severe stress as a significant causal factor of PTSD was meant to reflect a formal recognition that the cause of PTSD is primarily the event, not some aspect of the person

Prevalence of PTSD

• Lifetime prevalence of PTSD in Canada is almost 1 in 10.

• One-month prevalence is about 1 in 25 Canadians

• Prevalence varies depending on the severity of the trauma experienced.
  

Risk Factors of PTSD

Exposure to trauma and severity of trauma
• Gender (more females)
• Perceived threat to life
• Family history of psychiatric disorders
• Presence of pre- existing psychiatric disorders
• Early separation from parents

Previous exposure to traumas
• Dissociative symptoms (including amnesia and out-of-body experiences) at the time of the trauma
• Trying to push memories of the trauma out of one’s mind.
• Tendency to take personal responsibility for failures
• Coping with stress by focusing on emotions
• Attachment style

Protective Factors

• Being exposed to less severe events

• Having high intelligence

Cognitive theories of PTSD

• Characterize PTSD as a disorder of memory.

• The hallmark feature is the constant involuntary recollection of the traumatic event

• There is a robust association between PTSD and memory impairment and this tendency is stronger for verbal memory than visual memory

Psychodynamic theory of PTSD

Memories of the traumatic event occur repeatedly in the person’s mind and are so painful that they are either consciously suppressed (by distraction,
for example) or repressed

Biological theories of PTSD

• Genetics

• specific domains of noradrenergic system - trauma raises this

Crisis intervention

A promising approach for people who have been sexually assaulted is a CBT strategy that involves, in combination, exposing clients to trauma-related cues in imagination, teaching them relaxation, and helping them think differently about what happened.

Eye movement desensitization and reprocessing

• requiring only one or two long sessions and more effective than the standard exposure procedures

• The client imagines a situation related to the trauma, such as the sight of a horrible automobile accident

• Keeping the image in mind, the client follows with his or her eyes the therapist’s fingers as the therapist moves them back and forth about a foot in front of the client.

• This process continues for a minute or so or until the client reports that the distress they feel about the memory has been reduced

• The therapist has the client verbalize whatever negative thoughts are going through the client’s mind, again while following the moving target with his or her eyes

• Exposure therapy more effective

MMDA and PTSD

• One controversial development is the recent use of ecstasy (MMDA) in the treatment of PTSD.

• Conducted an RCT with 12 PTSD patients receiving ecstasy and 8 PTSD patients in the control condition receiving a placebo