PTSD: DSM-5 Criteria, Risk Factors, Assessment, and Treatment

What distinguishes PTSD from most other disorders?

PTSD is a disorder of nonrecovery, where researchers can pinpoint its genesis and study risk and resilience factors.

What are the symptoms and diagnostic criteria for PTSD?

PTSD requires an identifiable external event as a precursor and symptoms in four clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity.

What is the DSM-5's major change regarding PTSD?

PTSD was moved from anxiety disorders to stress and trauma disorders, allowing for a broader focus on cognitive models and emotions.

What is the minimum number of symptoms required for PTSD diagnosis?

At least one symptom from intrusion, one from avoidance, two from negative alterations in cognitions and mood, and two from alterations in arousal and reactivity.

What is the duration requirement for PTSD symptoms?

Symptoms must be present for at least one month and cause distress or functional impairment.

What is PTSD with delayed expression?

A diagnosis made when symptoms do not meet the threshold until at least six months after the traumatic event.

How does PTSD present differently in children under 6 years old?

Children may show fewer avoidance and negative alterations in cognitions and mood symptoms, with a focus on behavioral symptoms.

What is the significance of dissociative symptoms in PTSD?

Individuals with severe PTSD and dissociative symptoms are qualitatively different from those with severe PTSD without dissociation.

What constitutes a traumatic event according to DSM-5?

An event involving actual or threatened death, serious injury, or threat to physical integrity.

What was eliminated from the DSM-5 regarding PTSD criteria?

The requirement for individuals to respond with intense fear, helplessness, or horror at the time of the event.

What are the prevalence rates of experiencing trauma in the general population?

Approximately 60.7% of men and 51.2% of women experience at least one trauma in their lifetime.

What is the lifetime prevalence of PTSD in the general population?

Less than 7% of the population will have had PTSD at some point in their lifetime.

How do prevalence rates of PTSD differ between genders?

Women are almost three times as likely as men to have a lifetime diagnosis of PTSD (9.7% vs 3.6%).

What are common comorbid disorders associated with PTSD?

Major Depressive Disorder (77%), Generalized Anxiety Disorder (38%), and Alcohol Abuse/Dependence (31%).

What factors contribute to the high rates of comorbidity in PTSD?

The complexity of PTSD symptoms and the overlap with other mental health disorders.

What is the impact of trauma type on PTSD prevalence?

Events that are less personal, like accidents or natural disasters, tend to have lower rates of PTSD compared to personal traumas like sexual assault.

What does the National Stressful Events Survey indicate about trauma exposure?

89.7% of the sample reported lifetime exposure to at least one DSM-5 Criterion A event.

What is the significance of the modal number of trauma events reported?

The modal number of events was three, indicating high rates of lifetime trauma exposure.

How do men and women differ in types of trauma experienced?

Men are more likely to report physical attacks, while women are more likely to report rape and physical abuse.

What is the relationship between trauma exposure and PTSD rates in veterans?

Veterans have significantly higher rates of PTSD compared to the general population.

What is the role of empirical research in understanding PTSD?

Empirical research helps identify the prevalence and effects of trauma, shaping our understanding of PTSD.

What is the focus of recent studies on PTSD in veterans?

Studies have shown no significant sex differences in overall traumatic events experienced by male and female veterans.

What are the implications of the DSM-5's changes for PTSD research?

The changes allow for a broader understanding of PTSD beyond fear-based models, incorporating cognitive and emotional factors.

What is the importance of understanding PTSD's diagnostic criteria?

Understanding the criteria helps in accurate diagnosis and effective treatment planning for individuals suffering from PTSD.

What are the two latent dimensions underlying adult disorders?

Internalizing and externalizing dimensions.

What characterizes the externalizing subtype of PTSD?

Outward expression of distress, anger, aggression, and substance-related disorders.

What is a key feature of the internalizing subtype of PTSD?

Tendency to direct distress inwardly, leading to shame, anxiety, and depression.

What is the relationship between internalizing-externalizing subtypes and PTSD?

They help understand the heterogeneity of PTSD comorbidity.

What biological system shows increased activity in PTSD patients?

The noradrenergic system.

What is a significant marker of noradrenergic activity in PTSD?

Heightened norepinephrine reactivity to challenges.

What role does Neuropeptide Y (NPY) play during stress?

Acts as an endogenous antiadrenergic with anxiolytic and cognitive-enhancing effects.

What is the function of the Hypothalamic-Pituitary-Adrenal (HPA) axis?

Regulates stress response by releasing cortisol and other glucocorticoids.

How is Corticotrophin-releasing factor (CRF) related to PTSD?

Promotes norepinephrine release and is elevated in PTSD patients.

What is the relationship between DHEA and PTSD symptoms?

Negative relationship; higher DHEA reactivity correlates with less severe symptoms.

What neurotransmitter is the primary inhibitory neurotransmitter in the brain?

Gamma-Aminobutyric Acid (GABA).

What is the effect of benzodiazepine receptor density in PTSD patients?

Reduced density in the medial prefrontal cortex.

What is associated with decreased platelet serotonin uptake in PTSD?

Resting state of PTSD patients.

What role does dopamine play in PTSD?

Excessive release may contribute to hyperarousal and hypervigilance.

Which brain regions are implicated in PTSD?

Amygdala, medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC), and hippocampus.

How does PTSD severity relate to amygdala responsivity?

Positive association; increased responsivity correlates with severity.

What is the relationship between mPFC and PTSD?

PTSD patients show decreased mPFC activity, affecting anxiety inhibition.

What happens to hippocampal volume in PTSD patients?

Decreased volume compared to non-PTSD individuals.

What is the impact of the anterior cingulate cortex (ACC) in PTSD?

Fails to inhibit amygdala hyperactivity, contributing to symptoms.

What is a common characteristic of PTSD patients regarding emotional material?

Hyperresponsivity to both trauma-related and unrelated emotional stimuli.

What does the term 'comorbidity' refer to in the context of PTSD?

The occurrence of PTSD alongside other disorders, such as major depression.

What is the significance of cluster analytic studies in PTSD research?

They help identify subtypes of PTSD based on personality inventories.

What is a potential outcome of elevated norepinephrine levels in PTSD patients?

Increased risk of comorbid depression.

What may represent a vulnerability factor in PTSD?

Reduced hippocampal volume among those with PTSD and trauma-unexposed twins.

What are the criteria for PTSD under Criterion B?

Recurrent and intrusive recollections of the event, dreams, and flashbacks.

What does Criterion C of PTSD involve?

Avoidance of trauma-related thoughts and images.

What is described in Criterion D of PTSD?

Amnesia for the event and persistent negative beliefs about oneself, others, or the world.

What cognitive difficulties do traumatized individuals face?

Problems with both remembering and forgetting traumatic events.

What are cognitive processes in the context of PTSD?

Attempts to cope with intrusive recollections of the event or attentional bias towards potential danger cues.

What are the two types of memories stored in PTSD according to dual representation theory?

Autobiographical memories (VAM) and situationally accessible memories (SAM).

What triggers situationally accessible memories (SAM)?

Flashbacks, nightmares, or intrusive images.

What are primary emotions in PTSD?

Conditioned emotions experienced during the traumatic event, such as fear and helplessness.

What are secondary emotions in PTSD?

Emotions resulting from post hoc consideration of the traumatic event, such as anger and shame.

What is the paradox of memory in PTSD?

Individuals may struggle to intentionally access their memory of the event but experience involuntary intrusions.

What cognitive framework do PTSD symptoms focus on?

Past events rather than future dangers.

What maladaptive coping strategies might individuals with PTSD adopt?

Avoidance of thoughts about the traumatic event or ruminating on how it could have been prevented.

What are the three major assumptions that may be shattered after trauma?

Personal invulnerability, the world as a meaningful place, and the self as positive/worthy.

What are the three possibilities for individuals when traumatic events conflict with prior beliefs?

Assimilation, accommodation, and overaccommodation.

What is assimilation in the context of trauma?

Altering the interpretation of the event to maintain previously held beliefs.

What is accommodation in trauma processing?

Altering beliefs just enough to accommodate new information.

What is overaccommodation in trauma processing?

Drastically changing beliefs, such as believing one cannot trust anyone.

What cognitive beliefs do individuals with PTSD often hold?

The world is dangerous and they are completely incompetent.

What is the relationship between trauma narrative disorganization and PTSD symptoms?

Disorganized trauma narratives are associated with increased PTSD symptom severity.

What is the rebound effect in thought suppression related to PTSD?

An increase in intrusive thoughts following initial suppression attempts.

What does the modified Stroop paradigm measure in PTSD research?

The speed of naming colors of words related to trauma versus neutral words.

What is the role of cognitive avoidance in PTSD maintenance?

It contributes to the persistence of PTSD symptoms by preventing change in negative appraisals.

What is the significance of sensory detail in trauma narratives?

Trauma narratives of individuals with PTSD contain more sensory detail and negative emotion.

What is the impact of traumatic events on basic beliefs about self and the world?

They can dramatically alter beliefs about agency, safety, trust, power/control, esteem, and intimacy.

What cognitive processes are involved in recovery from trauma?

Organizing and streamlining traumatic memory.

What is the dual representation theory of PTSD?

It posits that memories of traumatic experiences are stored in both verbally accessible and nonconscious forms.

What is the relationship between cognitive content disturbance and PTSD?

There are strong correlations between maladaptive beliefs regarding safety, trust, esteem, or intimacy and PTSD symptoms among survivors of child sexual abuse.

What scale measures personal beliefs and reactions related to PTSD?

The Personal Beliefs and Reactions Scale (PBRS).

How does PTSD severity correlate with cognitive distortion?

PTSD severity is correlated with cognitive distortion on all subscales of the PBRS.

What is the Posttraumatic Maladaptive Beliefs Scale (PMBS)?

The PMBS is a short form of the PBRS that shows maladaptive cognitions significantly correlate with PTSD severity on the Clinician-Administered PTSD Scale (CAPS).

What cognitive experiences are reported by assault victims with PTSD during the traumatic event?

Victims report more mental defeat, mental planning, mental confusion, and detachment.

What are common negative appraisals reported by PTSD survivors?

Survivors report negative appraisals of initial posttrauma symptoms and perceptions of others' responses.

What factors contribute to the persistence of PTSD?

Mental defeat, mental confusion, negative appraisals of emotions and symptoms, negative responses from others, and beliefs of permanent change.

How does hopelessness function in PTSD treatment?

Hopelessness acts as both an outcome and mediator among women who experienced rape.

Which therapy shows larger reductions in hopelessness for PTSD?

Cognitive processing therapy (CPT) shows larger pre-post reductions in hopelessness compared to prolonged exposure (PE).

What emotional factors were considered before DSM-5 reclassification of PTSD?

PTSD was classified as an anxiety disorder, leading to theories around fear and anxiety being applied.

What emotions are predictive of PTSD status after a traumatic event?

Fear, helplessness, horror, shame, and anger are predictive of PTSD status.

Which emotions are more predictive of PTSD in rape victims than fear?

Sadness, humiliation, and anger are more predictive of later PTSD symptomatology.

What neural systems are engaged by emotions like guilt, shame, and sadness during trauma?

These emotions engage different neural systems than fear, often in traumas involving loss or moral injury.

What evidence exists for subtypes of PTSD based on traumatic events?

There is evidence of neural markers for subtypes of PTSD based on the nature of the worst traumatic event.

How do neuronal activity patterns differ in soldiers with danger-based traumas versus non-danger-based traumas?

Different patterns of neuronal activity are observed in the amygdala and precuneus among these groups.

What role does guilt cognition play in PTSD?

Guilt cognitions correlate highly with several different PTSD measures.

What is a significant finding regarding cognitive processing therapy (CPT) and PTSD symptoms?

Changes in hopelessness lead to changes in PTSD symptoms in CPT participants more than in PE participants.

What is the significance of negative appraisals in PTSD?

Negative appraisals of emotions and symptoms contribute to the persistence of PTSD.

What emotional experiences are common among veterans with PTSD?

Veterans with PTSD report a range of emotions, not just fear, including anger and shame.

What is the impact of perceived permanent damage on PTSD beliefs?

Beliefs of perceived permanent damage significantly impact posttrauma beliefs.

What is the 2-factor theory in relation to trauma?

It suggests that anxiety is acquired through classical conditioning, where trauma becomes associated with other stimuli, leading to conditioned emotional responses.

How does avoidance behavior relate to PTSD?

Avoidance behavior is negatively reinforced by short-term anxiety reduction, which maintains the initial anxious reaction through operant conditioning.

What is a pathological fear structure in PTSD?

It is a fear network that develops after trauma, composed of fear stimuli, responses, and meanings, activated by environmental stimuli that match its elements.

What is the outcome of activating a fear structure in PTSD?

It results in cognitive, behavioral, and arousal anxiety reactions, often triggering false alarms due to generalization to non-dangerous cues.

What role does social support play in PTSD?

Lack of social support is a significant risk factor for developing PTSD, especially during and after trauma.

What is the dose-response relationship in PTSD?

It indicates that the more traumatic events a person experiences, the more likely they are to develop PTSD.