PSYCH310: PTSD

What is needed for a diagnosis of PTSD

Definition of trauma (Judith Herman)

Extraordinary events involving threats to life or violence that overwhelm ordinary human adaptations.

Definition of PTSD

A mental health problem after experiencing or witnessing a traumatic event that overwhelms coping capacity.

DSM-5 trauma exposure

Direct exposure, witnessing, learning about a loved one's trauma, or hearing repeated details.

DSM-5 intrusion symptoms

Involuntary distressing memories, flashbacks, and nightmares accompanied by physiological distress.

DSM-5 avoidance symptoms

Avoidance of internal memories or external reminders associated with the traumatic event.

DSM-5 duration requirement

Disturbance must persist for more than one month after the trauma.

PTSD gender prevalence

Developed by approximately 20% of exposed women and 8% of exposed men.

Key risk factors of PTSD

Human-inflicted violence, prior trauma, early-life trauma, and lack of post-trauma support.

Biological model/explanation of PTSD

Adrenaline, noradrenaline, and cortisol, producing extreme sympathetic arousal (fight, flight, or freeze).

Learning model mechanism of PTSD

Classical conditioning pairs trauma with fear; avoidance maintains it by preventing extinction.

Neurological explanation of PTSD

Trauma memories laid down differently to normal memories - not integrated with normal autobiographical memory. Memories are sensation-based, piecemeal, and disconnected from normal autobiographical memory.

Cognitive model perspective

Trauma shatters beliefs about safety and invincibility, resulting in various cognitive distortions.

Biological treatments

SSRIs are commonly prescribed, though effect sizes are generally lower than psychological treatments.

Key psychological treatments

Psycho-education, safety establishment, prolonged exposure, EMDR, and cognitive restructuring.

Critique of the PTSD diagnosis

Medicalises social problems, ignores power inequities, and overlooks historical or intergenerational trauma.

What is needed for a diagnosis of PTSD

• Exposure to a traumatic event including actual or threatened death.

Intrusion (re-experiencing):

• One more of the following: involuntary distressing

memories, flashbacks, nightmares, accompanied by distress and physiological

response to trauma cues.

• Avoidance: One or both of avoidance of memories or external reminders.

• Negative alterations in cognition and mood: Two or more of amnesia for trauma, negative beliefs about self and world, self-blame or blaming of others, persistent negative emotional states, diminished interest in activities. Feeling of detachment, persistent inability to experience positive emotions.

• Arousal: Two or more of irritability, recklessness or self-destructive behaviour,hyper-vigilance, exaggerated startle response, concentration problems, sleep difficulties,

• Disturbance for more than one month after trauma.

What are the common cognitive destortions related to the post-traumatic recovery

‘I am permanently damaged’

‘People will blame me’

‘I am going mad

What are the common cognitive destortions related to managing the effects – related to avoidance

‘I must not think about the trauma’

‘I must control my feelings’

‘I must keep away from situations’

‘I must keep away from people’