PTSD + Stress disorders

Stress disorders

disorders that develop after a stressful or traumatic life event.

• Post-traumatic stress disorder (PTSD)

• Acute stress disorder

• Adjustment disorder

• Complex PTSD (not recognized in the DSM 5 but is recognized in ICD 11)

Criterion A Stressors

• Exposure to actual/threatened death, serious injury, sexual violence including:

  • Direct exposure

  • Witnessing trauma

  • Learning that trauma happened to close relative or friend

  • Indirect exposure to aversive details of teh trauma, professional duties (ex. therapists, first responders

Re-experiencing

nightmares, intrusive memories, flashbacks

• Ex. car accident survivor hears a car horn and feels as though they are back in the crash

  • Seeing someone who resembles the assailant.

Avoidance

avoiding intense feelings or reminders of the event through emotional numbing, avoiding people/places etc.

• Ex. Domestic violence survivor avoiding dating/close relationships

  • First responder avoiding parts of town.

• Avoiding emotions: avoiding watching a sad movie or scary things.

Negative changes to mood/cognition

symptoms that affect thoughts, emotions and beliefs about oneself, others and world.

• ex. police officer feels emotionally detached and unable to feel joy

  • Shutting down emotion symptoms.

Reactivity

disturbed sleep, hypervigilance, increased startle response.

• Overactivation of the nervous system; specifically amygdala

• Difficulty sleeping, keep waking up

• Hypervigilance; constantly being aware of surroundings/handle of room and where everyone is, exits located.

• Increased startled response; quicker reflexes/responses to fear

  • Ex. shooting survivor jumps or panics when hearing fireworks.

Delayed expression

PTSD specifier; PTSD symptoms do not fully appear until at least 6 months after traumatic event.

• Some people may suppress/disconenct from trauma until a trigger (stress or new trauma) brings it to surface.

• Trigger for onset may be a lack of distraction (ex. retirement)

Dissasociative symptoms

PTSD specifier; applies when an individual with PTSD experiences significant dissasociation in response to trauma.

• Someone has all symptoms but also has dissasociative symptoms.

Dissasociation

a symptom that may appear in various disorders:

a disconnection between thoughts, memories, identity, emotions, and perception of reality.

• Brains coping mechanism that helps survivors manage extreme distress of overwhelming emotions.

• Ranges from normative (ex. daydreaming, zoning out) to disordered.

Depresonalization

feeling detached from oneself (feel like watching self from outside)

Derealization

feeling like world isn’t real (everything is foggy and dreamlike)

PTSD causes

• Anxious predisposition; wired for threats

• Intensity or severity of trauma (pos relationship with PTSD likeliness)

• Stress hormones changing the brain/patient feels “stuck” in their trauma (overactive amygdala, shrinking hippocampus)

• Lack social support

Neuroplasticity

Brain adapts to trauma by reinforcing fear pathways in the amygdala and weakening memory regulation in the hippocampus.

• Stress = keeps circuits active leading to complex ptsd

• Avoidance behaviour reinforce reprocessing traumatic memories

Imaginal (prolonged) exposure with relaxation training

• Type of CBT

• Mentally revisiting traumatic events in a safe setting while practicing relaxation techniques (ex. deep breathing).

  • “reprocess” the trauma, help us file it away through talking about it.

Eye-movement desensitization and reprocessing (EMDR)

• Clients recall traumatic memories while following bilateral stimulation (eye movements, tapping).

  • Following a movement with eyes, tapping parts o fbody, buzzers.

  • Helps the brain reprocess trauma and reduce emotional intensity

    • Activates prefrontal cortex to reduce the emotional impact

Both psychological treatments help brain by:

• Reduce amygdala hyperactivity (lower fear response)

• Strengthen hippocampal function (improve memory processing)

• Rewire neural pathways through gradual exposure to trauma-related cues.

• Moving trauma memories from survival mode (amygdala) to rational processing (prefrontal cortex).

• Allow new, adaptive beliefs to replace fear-based thinking.

SSRI

• regulate brain’s overactive fear response and mood alterations.

  • Seratonin balances neurochemicals.

Repetitive Transcranial Magnetic Stimulation (rTMS)

magnetic pulses stimulate underactive (sometimes overactive) brain regions associated with PTSD symptoms.

• can strengthen connections w prefrontal and amygdala for emotional regulation

• stimulate prefrontal = less stimulation in amygdala

Acute stress disorder

• occurs up to 1 month after a traumatic event

  • can be short-term PTSD

  • can resolve and not lead to PTST but significant risk factor (40-80%)

Complex PTSD

• Not recognized in DSM-5-TR but ICD-11

• Prolonhued exposure to traumatic events, often interpersonal in nature, such as long-term abuse

• Symptoms of PTSD plus:

  • Emotional dysregulation

  • Interpersonal problems

  • Complex changes in self-concept (ex. feeling “othered”, lacking identity)

Complex PTSD impact + treatment

• Problems with trust, intimacy and tendency to avoid relationships or indulge in unhealthy relationships

• May require longer-term psychotherapy that focuses not only on coping with traumatic memories but also on imrpoving emotional regulation, self-concept, and relaitonship skills (ex. DBT)