7.1 PTSD

PTSD: post traumatic stress disorder

enduring emotion and stress after extreme helplessness, fear from a threat (traumatic event) like war, physical/sexual assault

manifests as unwanted reliving of the incident, and avoidance of cues related to the incident, and increased alertness/arousal, numb responses

Clinical Description

DSM 5 TR setting event for PTSF

experiences, witnesses actual or threatened death, serious injury, sexual violence. can be 2nd hand family or friend, or repeatedly exposed to the details

Flashback

when memories very suddenly occur and you’re reliving the event

Dissociative Subtype of PTSD

does not reexperience or get over aroused to stimuli but dissociates: have feelings of unreality.

more severe compared to reg PTSD hence why they dissociate

due to dissociation they require some different treatments

onset is the same as reg

When was PTSD first coined

in 1980 by the DSM III

How long does PTSD go back/documented?

1666 when Samuel Pepys wrote about his trauma from the Great Fire of London.

• trouble sleeping long after event

• wracked with guilt

• detached from emotions when talking about fire

How old to be diagnosed with PTSD

6 years and older

PTSD Criteria: A

traumatic event exposure/origin

1. Directly experienced traumatic event

2. Witnessed event in person happen to others

3. Hear about an event (violent or accidental) happen to a close family member/friend

4. having extreme or repeated exposure to details of a traumatic event

(never media unless work related)

one or more

PTSD Criteria B:

Intrusion symptoms

1. reoccurring, unwanted intrusive memories of the event

2. reoccurring nightmares that have affect or content related to event

3. Dissociative reactions: where they act like they are in the event again

4. has physiological reactions to internal and/or external cues that are linked to/resemble the event

one or more

note:

children may reenact the event during play

they may not recognize content of the nightmares

PSTD Criteria C:

Avoidance of related Stimuli

1. Avoids or makes an effort to avoid distressing memories, thoughts, and feelings of traumatic event

2. avoids or makes effort to avoid external reminders such as people, places, conversations, activities, objects, situations closely related to the event

one or more

PTSD Criteria D:

alteration in cognition and mood

two or more

1. Cannot remember important part of traumatic event (due to dissociative amnesia, not alcohol, etc)

2. continuous, exaggerated negative beliefs or expectations, about oneself, others, or the world

3. continuous distorted cognitions about the cause or result of the event leading them to blame themselves/another

4. persistent negative emotional state (anger, shame, etc)

5. Lack of interest in relevant activities

6. persistent inability to experience positive emotions

PTSD Criteria E:

increase in arousal / reactivity after event

1. Irritable behavior, angry outbursts like physical or verbal abuse directly to people, objects with little to no provocation

2. self destructive or reckless behaviour

3. hypervigilance

4. exaggerated startle response

5. problems with concentration

6. sleep disturbance (falling asleep, staying asleep, restless sleep)

PSTD Criteria: F, G, H

• criteria B, C, D, E, goes on for longer than a month

• it causes clinically significant distress or impairment socially, work

• symptoms not caused by substances, or another medical condition

PTSD Criteria specify if:

with dissociative symptoms?

• Depersonalization

• Derealization

• (not due to substance)

with delayed expression?

note if criteria needs to be met after 6 months of the traumatic event

Depersonalization

dissociative symptom where feeling detached from yourself, as if you were an observer of your body, mind

(feelings like your in a dream, time moving slowly, feeling of unreality)

Derealization

persistent feeling, or experiences of feeling like the world around you isn’t real. the world is dreamlike, distant, distorted.

Acute stress disorder

Similar to PTSD but only occurs within first month of trauma.

how many of those with Acute stress disorder dev PSTD

half develop PTSD, but half of those who get PTSD doesnt last for another month

why is Acute Stress Disorder considered a disorder?

because even though it doesn’t last as long, without diagnosis, people who are deeply traumatized can’t get accommodations, priority treatment

Prevalence rate for PTSD in population of air raid surviours

PTSD is lower in population who went through air raids because they werent directly seeing the impact

Prevelance rate for PTSD for individuals who have been physically, sexually assaulted

PTSD rates are 15-30%, higher because they directly experienced, witnessed. more likely to dev with close exposure

More likely to dev PTSD if you had close exposure to traumatic event

those who personally experienced, more directly, were more affeced

PTSD prevelance in the canadian population

1.5 percent of those over 15

5% of army but double for afghan missions

PTSD Causes

genealized biological vulnerablity like trait for anxiety

bio: personality traits → environment person chooses

less educated

how does generalized biological vulnerability for anxiety make it more likely one gets PTSD

becuase they have the predisposistion to get anxious, (the gene must be turned on by environmental influences)

why are less educated poeple more at risk for PTSD

because they are less educated they are more likely to find themselves in dangerous situations → traumatic experiences

How are someone’s personality traits (genetic factor) make influence PTSD

someone’s personality traits influences what environments they choose to be in:

risky ones, or safe ones

what is the generalized psychological vulnerability for PTSD

whether family makes you feel that you that the world is an uncontrollable and dangerous place. higher risk of dev PTSD

Anxiety sensitivity as an anxiety vulnerability factor

those who get a an panic reaction to their Sympathetic NS activation

Social/cultural factors: Support system PTSD

if you have a support system you are far more likely to not develop PTSD

but if you are lonley you are more likely to develop PTSD

having love and care decreases cortisol levels

HPA axis and PTSD

increased CRF cortico tropin releasing factor raises HPA activity so more stress 

changes in hippocampus PTSD

those with PTSD have damaged hippocampus: a key part of the HPA axis + learning and memory.

meaning problems with learning and memory and hyperarousal of HPA

true alarm cause learned alarm PTSD (fear response)

the true alram from traumatic experiences causes a learned alarm where survivors more reactive to stimuli that is related to the traumatic event

PTSD treatment

subject needs to be reexposed to the orignal trauma and develop coping mechanisms. but needs to be done in safe environment

often done trhough imaginal exposure

• Cognitive therapy 

Imaginal exposure

done by creating a narrative of the traumatic experience and exposing them to that situation for a long period of time (extended exposure)

how sleep is used to better exposure therapy techniques

when done after nap/sleep the subject has slow brain waves and is less anxious when facing exposure

Cognitive therapy: treating PTSD

done to change the neg assumptions, self blame, and guilt from traumatic event

(needs to be done over sessions)

treating PTSD as soon as possible

treating PTSD as soon as possible to those who need it is helpful

Donald Mechanbum’s CBT for PTSD

constructivist narrative approach:

reconstruct the story and change the meanings you orginally took away from the traumatic event

coping strategies

I’m a survivor mindset

eye-movement desensitization and reprocessing

reimagine the traumatic triggers on moving finger and this improves / makes you reprocess the event

Which PTSD treatment is most effective

exposure therapy is most effective: imagined exposure/prolonged exposure

while no changes in arousal, emotional numbing, ptsd symptoms

there was much less avoidance , cognitive reexperiencing, 

Medication Treatment for PTSD

anxiety medications like SSRIs have helped since they reduce panic attacks, symptoms