PTSD

Emergence of formal diagnosis: PTSD

• Included in DSM 3 and after, 1987

• Early PTSD research focused on Viet Vets and rape victims 

• Late 90s, a broader view of what constituted a traumatic stressor: serious illnesses natural disasters, loss of loved one, exposure to community violence 

Criteria A- exposure to actual or threatened death, serious sexual violence in ONE or MORE of these ways

• Directly experiencing 

  • Witnessing, in person, the event(s) as it occurred to others

  • Learning that traumatic event(s) occurred to close family members or close friend

    • Must have been violent or accidental

  • Experiencing repeated or extreme exposure to aversive details of traumatic event(s)

    • Ex: first responder, police officers

  • Note: does NOT apply to exposure through media, TV, or pictures, unless it’s work-related 

Criteria B: intrusion symptoms (one or more)

• Recurrent, involuntary, and intrusive distressing memories of it (NOT a flashback)

• Nightmares in which the content and/or affect of the dream relate to the event(s)

• Dissociative reactions (ex: flashbacks) when the individual feels or acts as if the event(s) were recurring 

  • (people dissociate as a protective reaction bc we’re too scared to be in our bodies)

• Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect 

  • Ex: ambulance > time when loved one died

• Physiological reactions to in or external cues that symbolize/ resemble an aspect

Criteria C- persistent avoidance of stimuli associated with the trauma

• Avoidance or effort to avoid distressing memories, thoughts, or feelings ab or closely associated w the event(s) 

  • External reminders (people, place, conversations, activities, objects, situations) that arouse distressing memories, thoughts, feelings 

Criteria D: negative alterations in cognitions and mood (TWO or more)

• Inability to remember an important aspect of the event (typically due to dissociate amnesia, not bc of head injury, drugs, etc) 

• Persistent and exaggerated negative beliefs or expectations ab self, others, and world 

• Persistent, distorted cognitions ab cause or consequences of the event(s) > individual to blame themselves/others 

• Note: people want to make sense of the terrible event that happened

• Persistent negative emotional state (horror, fear, anger, guilt, shame)

• Diminished interest or participation in significant activities 

• Feelings of detachment from others

• Persistent inability to experience positive emotions (unable to feel happiness, satisfaction, or love) 

Criteria E: marked alteration in arousal and reactivity (TWO or more)

• NOTE: was called hyperarousal

• Irritable behavior and angry outbursts are typically expressed as verbal or physical aggression toward people/objects

  • Commonly misdiagnosed as bipolar 

• Reckless/self-destructive behavior 

  • For children (commonly seen as ADHD) 

• Hypervigilance 

• Exaggerated startle response 

• Problems w concentration 

• Sleep disturbance 

Criteria F

• duration of disturbance is more than one month

Criteria G

• disturbance causes clinically significant distress or implement is social, occupational, or other important areas of function 

Criteria H: disturbance to physiological effects of a substance or another medical condition

• Dissociative symptom: symptoms meet the criteria for PTSD and individual experiences are persistent or recurring 

  • Depersonalization > out-of-body experience 

  • Derealization > persistent or recurrent experiences of unreality of surroundings 

  • These happen WITHIN PTSD

PTSD for children

• Trauma exposure

  • disorganized/agitated behavior may be an expression of intense fear, helplessness, horror

• Re-experiencing 

  • Repetitive play may occur where themes or aspects of the trauma are expressed 

  • Scary dreams without recognizable content

  • Trauma-specific reenactments may happen (flashbacks) 

Acute stress disorder

• what you would diagnose someone within 30 days of an event occurred

Limitations of PTSD

• Don’t reflect the research done over the past 20 years 

  • Neuroscience, importance of social environment, emotional dysregulation (managing emotional experience, can’t control it), chronic exposure 

• Other ways to look at trauma symptoms 

  • ACE’s, neurology > toxic stress, complex trauma (screws up how you see the world, yourself, etc), developmental trauma disorder