Psychopathology Trauma and Stress disorder

Psychological Stress Disorders

- Acute Stress Disorder

- Posttraumatic Stress Disorder

Stressors

event that create demands exceeding perceived resources

Stress response

Reaction to the demand

Stress Response

- Physical

- Emotional

- Cognitive

Trauma

actual or threatened death, serious injury, or sexual violence by:

- experiencing or witnessing a trauma

- learning about trauma of family member or close friend

- repeated, extreme exposure to details of trauma.

Example Traumas: Personally experienced

combat, prisoners of war, concentration camps, violent personal assault, being kidnapped, terrorist attacks, natural or man-made disasters, severe car accidents, diagnosis of a life-threatening illness

Example Traumas: Witnessed

serious illness, unnatural violent death, seeing dead body or body parts, experienced by others but learned about—violent personal assault or serious accident/injury of family or close friend, learning of sudden death of family or close friend.

A. Post-Traumatic Stress Disorder (PTSD)

A. Trauma exposure

B. Post-Traumatic Stress Disorder (PTSD)

B. >= 1 intrusive symptoms

- recurrent, involuntary, intrusive distressing memory of the event

- recurrent distressing dream related to the event

dissociative reaction (e.g., flashback)

- distress at internal, external cues resembles trauma

- physiological reactions to reminders of the trauma

C. Post-Traumatic Stress Disorder (PTSD)

C. Avoidance of stimuli >= 1

- Avoid distressing memories, thoughts, feelings about event

- External reminders (e.g., people, places)

D. Post-Traumatic Stress Disorder (PTSD)

D. Negative cognitive, mood changes, >=2

- Amnesia about trauma

- Negative beliefs about self, others, world

- Distorted blame of self or others about trauma

- Persistent negative emotional state (e.g., fear, horror, anger, guilt shame)

- Detachment, estrangement from others

- Inability to have positive emotions

E. Post-Traumatic Stress Disorder (PTSD)

E. Arousal/reactivity >= 2:

- irritability, aggressive behavior

- reckless, self-destructive behavior

- hypervigilance

- exaggerated startle response

- problems with concentration

- sleep disturbance

F. Post-Traumatic Stress Disorder (PTSD) duration

>= 1 month duration

PTSD vs Acute Stress Disorder

PTSD lasts > 1 month; acute stress disorder lasts < 1 month, usually 3 days - 1 month after the trauma, the criteria is looser w/ >= 9 symp w/in intrusion, negative mood, dissociative, avoidance symp, arousal symp

PTSD Prevalence, Course

-20% women, 8% men exposed to severe trauma

-76% of acute stress disorder cases develop into PTSD at 12 months

-50% of cases recover in 6 months

- ~7-12% (3.5% past year) of the adult US population lifetime

-Affected greatly by severity, duration, and proximity of trauma exposure

Risk Factors for Stress Disorder: Nature of the trauma

More severe trauma, closer exposure

Risk Factors for Stress Disorder: Biological factors

Overreactivity of brain-body stress pathways pre- and post-trauma, dysfunction in brain stress circuit, heritable overly reactive body-brain stress pathways and dysfunctional brain stress circuits

Risk Factors for Stress Disorder: Personality

more anxious before, pessimism and feel like negative events are outside of one's control

Risk Factors for Stress Disorder: Early experiences

- family history of psychopathology

- early abuse or other trauma

Risk Factors for Stress Disorder: Social support

Less family and social support, less legal support and respect

Risk Factors for Stress Disorder: Multicultural factors and SES

Hispanic women are more vulnerable and low-income 2x greater risk vs. high income

Physiology of Fight or Flight

SNS: fights, increases heart rate, dilates pupils...

PNS: calms us down, contracts pupils, slows heart rate...

Fear/Arousal pathways: SNS

- Stressors > hypothalamus, SNS, various organs- direct activation > arousal of fear

OR

- Stressors > hypothalamus > SNS > adrenal medulla—releases epinephrine and NE > various organs > arousal of fear

—direct

Fear/Arousal pathways: Hypothalamic-Pituitary-Adrenal Pathway

Stressor > Hypothalamus > pituitary glands - release ACTH > Adrenal cortex - releases corticosteroids > Various organs > Arousal and fear reaction

Development of Stress Disorders

- Infomation Processing Theory (Foa)

- Schemas = mental shortcuts; beliefs and expectations

- inappropriate assimilation (The trauma is altered to fit existing beliefs, e.g., blaming themselves to avoid believing the world is unsafe, #strethening the belief)

- over-accommodation, e.g., makes extreme, overgeneralized changes to their belief system that the world is too dangerous # Changing schema)

PTSD, Acute Stress Treatments

- medication (SSRI like Zoloft & Paxil) to treat anxiety, nightmares, panic, flashbacks, depression

- behavioral exposure -to trauma cues, e.g., prolonged exposure, cognitive processing therapy, eye movement desensitizing and reprocessing

- cognitive restructuring

More treatment

- Group therapy: share experience, get support, VA hospital, rape crises centers, etc.

- Critical incident stress debriefing: withing days of trauma, usually group processing of events and psychoeducation about normal responses

vs. Psychological first aid (focus on immediate need and not preoccupied with the trauma, e.g., after a disaster, offer food first)