Trauma and Stressor Disorders

What are they?

• Reaction to traumatic or stressful event

• Anxiety/fear

• Depressive

• Anger/aggression

• Dissociation

Reactive Attachment Disorder

A traumatic response among children, child withdraws

Disinhibited Social Engagement Disorder

Something bad happens to a child and as a result, kid doesn’t understand boundaries between people (aka: oversharing to a stronger)

Adjusmtent Disorders

Designed to be transient responses to stressful situations, adjustment problems to stressful situations

PTSD Criterion A

Exposure to death, serious injury, or sexual violence in 1 or more of the following ways:

1) Direct experience

2) In-person witness as event occurred to others

3) Learning that event occurred to close family or friend, event must be violent or accidental

4) Experiencing repeated or extreme exposure to aversive details of events

PTSD Criterion B

• One or more intrusion symptoms:

  1) Recurrent, involuntary, intrusive distressing memories

  2) Recurrent distressing dreams

  3) Dissociative reactions (e.g., flashbacks)

  4) Intense or prolonged distress at exposure to internal/external cues that symbolize/resemble part of trauma

  5) Physiological reactions to internal/external cues that symbolize/resemble part of trauma

PTSD Criterion C

Avoidance of stimuli associated with event, as evidenced by 1 or both of:

1) Distressing memories, thoughts, feelings of event

2) External reminders that arouse distressing memories, thoughts, feelings of event

PTSD Criterion D

Negative alterations in cognition or mood, as evidenced by 2 or more of:

1) Inability to remember aspect of event (dissociative amnesia)

2) Negative beliefs about self, others, or world

3) Inappropriate blame

4) Negative emotional state

5) Diminished interest/participation in activities

6) Feelings of detachment or estrangement

7) Inability to experience positive emotions

PTSD Criterion E

Alterations in arousal and reactivity, as evidenced by 2 or more of:

1) Irritable behavior and angry outbursts

2) Recklessness or self-destructive behavior

3) Hypervigilance

4) Exaggerated startle

5) Problems with concentration

6) Sleep disturbance

PTSD Criterion F

Criteria B, C, D, and E met for >1 month

• Not due to effects of substance of medical conditon

Who gets PTSD?

• Age at onset: not applicable

• Lifetime prevalence of 7%

• Prevalence for women experiencing sexual assault - 18%

• Prevalence for severe car accident - 15-20%

• Trauma translates into 1/5 of people

• Being female has 2.5 times great risk of developing PTSD

Vulnerability (risk factors)

• Poor psychological health

• Impoverished social support network

• Genetics (general propensity to respond with anxiety)

• Unexpected trauma

• Onset NOT necessarily related to trauma severity

Biological Theory

• Some genetic contribution

• Biological vulnerability to anxiety

• Stress hormones causes hippocampal damage?

Biological Treatment

• SSRI’s: some relief of depressive symptoms

• Atypical antipsychotics: tend to dissociative symptoms

• Beta Blockers: might have a preventive effect

• Lower probability people with trauma will develop PTSD if treated with propranolol around time of trauma

How well does it work?

• Mixed results

• Using SSRI’s or atypical is probably better than doing nothing at all

• Possible if you combine the two, you might get better outcomes

Psychodynamic Theory

• Repression of traumatic events

• Nothing as it seems

• Later trauma reminds you (unconsciously) of earlier trauma

Psychodynamic Treatment

• Standard psychoanalysis

• Goal: gain insight into whatever the first repressed traumatic event was

• Not a tremendous amount of data

• Found not to be better than placebo

Behavioral Theory

• PTSD classically conditioned, maintained by avoidance of cueing events

• Two-factor model again

• Don’t have to worry about initial event, everything surrounding trauma is fair game

Behavioral Treatment

• Exposure: internal sensations being avoided

• Must be gradual and gentle

• Prolonged (imaginal) exposure- focus on habituation

• Create a hierarchical memory structure of things that remind you of the trauma

• Pretty good: ~75% improved

The Problem of Prevention

• Propanol or beta blocker being administered shortly after treatment can help

• Stopping symptoms before they start

• “Potentially Harmful Treatments” - difficult to treat