PTSD Assessment - PSYC 385 Final Exam

Trauma

the experiences or witnessing of events in which there is actual or threatened “death, serious injury, or violence)

PTSD

develops after exposure to a traumatic event

• referred to as a failed recovery

• constant “fight-or-flight” response

• lack of extinction of fear

• disruption of the natural recovery processes

Onset of PTSD

can occur at any age

• symptoms usually within the first three months after trauma

  • can be “delayed expression”

• usually starts as acute stress disorder

  • most recover within 3 months

  • when symptoms persist → most likely PTSD

Is PTSD more common in men or women?

women → ~10% of women and ~4% of men

Stressor Criterion of PTSD

exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

• directly experiencing

• witnessing in person

• learning about event

• repeated or extreme exposure

Symptom Clusters of PTSD

1. re-experiencing

2. avoidance

3. negative mood and cognitions

4. hypervigilance

History of Assessment of PTSD

“shell shock”

• didn’t appear until the 1980’s

• categorized as an anxiety disorder

• used to be 3 symptom clusters: intrusive recollections, avoidant/numbing, and hyperarousal

• Criterion A event needed to elicit intense fear, helplessness, or horror

Current DSM-5-TR Standards

PTSD placed into the new category of Trauma- and Stress-Related Disorders

• removed emotional “numbing” → avoidance

• addition of negative mood and cognitions symptom cluster

• Criterion A

  • indirect trauma exposure added

  • removed intense fear, helplessness, or horror

Life Events Checklist (LEC)

a self-report measure

• lists 17 different types of possible stressful events

• person can indicate all events that may have happened, and mark how they experienced them

PTSD Checklist (PCL)

PCL-5 — addressed symptoms from the DSM-5

• a self-report measure with 20 questions on a Likert Scale

• answer questions for how much each symptom bothered them within the past month

• keeping the most bothersome traumatic events in mind

• 37 and less → likely no PTSD; 38 and above → likely PTSD

Clinician-Administered PTSD Scale for DSM-5 (CAPS)

gold standard for diagnosing PTSD

• structured interview, with standardized prompts

  • can ask for clarification questions as needed

Scoring for PTSD

ask about frequency and intensity of each symptom to make an overall severity score for symptom

• some items ask specifically whether or not the symptom is trauma-related

• examiners NEED to be reliable → training needed

Dissociative Specifier

depersonalization and derealization questions asked

• these two questions are scores the same with a severity score, BUT do NOT count towards the overall severity of the PTSD diagnosis

PTSD Factors to Take into Account

• when the trauma occurred

  • childhood vs. adult

• may have to tease apart aspects of symptoms for proper coding

  • negative emotions vs. negative beliefs of self

• response styles

  • noted as “global validity” in the CAPS

Comorbidities

PTSD is very likely to be diagnosed along with another disorder

• depression

• substance use disorder

• suicide

• other anxiety disorders

• TBI (traumatic brain injury)

Amygdala (neurobiological effects)

increased activity

Hippocampus (neurobiological effects)

decreased in activity and reduced volume

Prefrontal Cortex (neurobiological effects)

reduced volume

Stress Hormones (neurobiological effects)

• decreased serotonin levels

• increased dopamine levels

Prolonged Exposure (PE)

confronting memories and situations that have been avoided since trauma

Cognitive Processing Therapy (CPT)

how to change negative thoughts about the trauma

Eye Movement Desensitization and Reprocessing (EMDR)

thinking about images and feelings that distress while doing rapid eye movements; changes how person reacts to trauma memories