psychopathy exam two

agoraphobia

1. marked fear or anxiety about 2 or more of the following five situations

   1. using public transportation

   2. being in open spaces

   3. being in enclosed spaces

   4. standing in line or being in a crowd

   5. being outside of the home alone

2. the individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic like symptoms or other incapacitating or embarrassing symptoms 

3. the agoraphobic situations almost always provoke fear or anxiety

4. the agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety

5. the fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context 

6. the fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more

7. the fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning 

8. if another medical condition is present, the fear, anxiety, or avoidance is clearly excessive

9. the fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder

amygdala

1. emotional memories

2. fear and aggression

anxiety

response from your thoughts

anxiety disorder

1. always consider

   1. development

   2. culture

2. never due to substance use or general medical conditions

anxiety sensitivity

is a psychological trait characterized by an intense fear of anxiety-related sensations and their potential consequences

autonomic nervous sytem

a component of the peripheral nervous system that regulates involuntary physiologic processes including heart rate, blood pressure, respiration, digestion, and sexual arousal.

behavioral inhibition

a temperamental predisposition characterized by restraint in engaging with the world combined with a tendency to scrutinize the environment for potential threats and to avoid or withdraw from unfamiliar situations or people. It is often related to social anxiety and a predisposition for greater physiological reactivity to novel situations.

depersonalization

a dissociative experience characterized by a feeling of detachment from oneself, one's body, or one's thoughts. It is a common symptom that can occur in various mental health conditions, including anxiety, depression, and trauma. 

derealization

is a dissociative experience characterized by a persistent feeling of detachment from one's surroundings, making the world seem unreal, dreamlike, or distorted

emotional processing (in exposure)

1. seeing that your fear wasn’t realistic/rational

2. changing feelings about your fear

exposure hierarchy

exposure therapy

is a type of cognitive behavioral therapy (CBT) that involves gradually exposing a person to their feared situations or objects in a safe and controlled environment. The goal is to help them reduce their anxiety and avoidance behaviors. 

extinction

the gradual weakening or complete disappearance of a learned behavior. It can occur when a behavior is no longer reinforced

fear

response from immediate danger

fear circuit

the brain pathways and structures involved in processing and responding to perceived threats, primarily focusing on the amygdala and its connections, which lead to physiological and behavioral fear responses. 

generalized anxiety disorder

1. excessive anxiety and worry (apprehensive expectation) occurring more days than not for at least 6 months, about a number of events or activities 

2. the individual finds it difficult to control the worry

3. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months)

   1. restlessness or feeling keyed up or on edge

   2. being easily fatigued

   3. difficulty concentrating or mind going blank

   4. irritability

   5. muscle tensions

   6. sleep disturbance

4. the anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning 

5. the disturbance is not attributable to the physiological effects of a substance (e.g. a drug of abuse, a medication) or another medical condition (e.g. hyperthyroidism)

6. the disturbance is not better explained by another mental disorder

habituation

getting used to a behavior

hippocampus

factual memory

HPA axis

a complex endocrine system that plays a crucial role in regulating the body's response to stress. It involves three main components: 

• Hypothalamus: A region in the brain that produces corticotropin-releasing hormone (CRH). 

• Pituitary gland: A small gland located below the hypothalamus that releases adrenocorticotropic hormone (ACTH). 

• Adrenal glands: Two glands located on top of the kidneys that produce cortisol, a stress hormone. 

interoceptive sensitivity

the ability to perceive and interpret internal bodily sensations, such as heart rate, breathing, temperature, and hunger. 

expected/cued panic attacks

• Also known as situational panic attacks 

• Can be triggered by phobias, stressful situations, or anticipated situations 

• For example, someone with a fear of public speaking might have a panic attack when giving a speech 

unexpected/uncued panic attacks

• Also known as spontaneous panic attacks

• Can occur without an obvious cause or warning

• For example, someone might suddenly feel short of breath and dizzy while shopping for groceries

panic disorder

1. recurrent unexpected panic attacks

2. at least one of the attacks has been followed by one month or more of one or both of the following

   1. persistent concern or worry about additional panic attacks or their consequences

   2. a significant maladaptive change in behavior related to the attacks

3. the disturbance is not attributable to physiological effects of a substance

4. the disturbance is not better explained by another mental disorder

parasthesias

refers to an abnormal sensation of tingling, prickling, burning, or numbness in the skin or extremities. It can be temporary or chronic and may affect any part of the body. 

parasympathetic division

(PNS) is a part of the autonomic nervous system that controls the body's "rest and digest" functions. It's responsible for many automatic functions, including digestion, urination, and heart rate. 

phobia

a persistent and irrational fear of a specific object, situation, or activity that causes significant distress and avoidance behaviors

prefrontal cortex

a region of the brain located in the frontal lobe, anterior to the motor cortex. It plays a crucial role in various cognitive, emotional, and behavioral functions. 

self efficacy

the belief that you can accomplish a task or goal. It's a confidence that you can control your behavior, motivation, and social environment. 

social anxiety disorder

1. marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others

2. the individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated

3. the social situations almost always provoke fear or anxiety

4. the social situations are avoided or endured with intense fear or anxiety

5. the fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context

6. the fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more

7. the fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning 

8. the fear, anxiety or avoidance is not attributable to the physiological effects of a substance or another medical condition

9. the fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder

10. if another medical condition (e.g. parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive

specific phobia

1. marked fear or anxiety about a specific object of situation

2. the phobic object or situation almost always provokes immediate fear or anxiety

3. the phobic object or situation is actively avoided or endured with intense fear or anxiety

4. the fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context

5. the fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more

6. the fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning 

7. the disturbance is not better explained by the symptoms of another mental disorder

sympathetic division

responsible for the "fight-or-flight" response, mobilizing the body in stressful or threatening situations, characterized by increased heart rate, blood pressure, and pupil dilation, among other effects. 

basal ganglia

are a group of brain structures that affect mood, cognition, and motor control. They're involved in many psychological functions, including: 

• Emotional processing: The BG help regulate mood and emotional responses to events, such as feeling good or bad about something 

• Cognitive functions: The BG help with complex thinking, decision-making, and learning 

• Habit formation: The BG help form habits and strengthen behaviors that lead to desired outcomes 

body dysmorphic disorder

1. preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others

2. at some point during the course of the disorder, the individual has performed repetitive behaviors or mental acts in response to the appearance concerns

3. the preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning 

4. the appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder

caudate nucleus

key part of the basal ganglia, plays a crucial role in various psychological functions, including motor control, learning and memory, reward processing, and cognitive flexibility,

cingulate gyrus

a crucial part of the limbic system, plays a vital role in regulating emotions, behavior, and pain perception, and its dysfunction has been linked to various psychiatric disorders. 

compulsion

1. repetitive behaviors (including mental acts)

2. clearly excessive, not realistic

3. driver to perform; overwhelming distress if resisting

   1. not pleasant or enjoyable

4. in response to an obsession or performed in a highly ritualized way

5. aimed at preventing/reducing distress or preventing dreaded event/outcome

cortio-striatal-thalamo-cortical circuit

brain pathway that plays a crucial role in motor control, reward processing, and cognitive functions, and its dysfunction is implicated in various psychiatric disorders like OCD and ADHD. 

disconfirmatory bias

the phenomenon in which people tend to believe and accept evidence that supports their prior beliefs while dismissing evidence that refutes their beliefs.

excoriation

1. recurrent skin picking resulting in skin lesions

2. repeated attempts to decrease or stop skin picking

3. the skin picking causes clinically significant distress or impairment in social, occupational or other important areas of functioning

4. the skin picking is not attributable to the physiological effects of a substance or another medical condition

5. the skin picking is not better explained by symptoms of another mental disorder

exposure and response prevention (EXRP)

1. psychoeducation

2. development of exposure hierarchy

3. exposure to stimuli

4. prevention of compulsive ritual

5. repeated exposure over time with response prevention

hoarding disorder

1. persistent difficulty discarding or parting with possessions, regardless of their actual value

2. this difficulty is due to a perceived need to save the items and to distress associated with discarding them

3. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties

4. the hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others)

5. the hoarding is not attributable to another medical condition

6. the hoarding is not better explained by the symptoms of another mental disorder

intolerance of anxiety

a tendency to react negatively to situations involving uncertainty, potentially leading to anxiety disorders, and is often associated with excessive worry. 

negative appraisal

the process of evaluating or understanding a situation or event as having negative or harmful consequences, impacting an individual's well-being. This often involves seeing a situation as a threat, something they are unable to cope with, or something that has a negative impact on their self-esteem. 

negative emotionality

refers to a tendency or trait to experience and express negative emotions like anxiety, fear, sadness, anger, and worry

obsession

1. recurrent and persistent

2. cognitive experiences

   1. thoughts, urges, images

3. intrusive and unwanted

4. unlikely to be related to real problems

obsessive compulsive disorder

1. presence of obsession, compulsions, or both

   1. obsession defined by:

      1. recurrent and persistent thoughts, urges, or images are experience (at some time) as intrusive and unwanted, and that in most individuals cause marked anxiety or distress

      2. the individual attempts to ignore, suppress, or neutralize them with some other thought or action

   2. compulsions defined by:

      1. repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly

      2. the behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive

2. the obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

3. the obsessive compulsive symptoms are not attributable to physiological effects of a substance or another medical condition

4. the disturbance is not better explained by the symptoms of another mental disorder

orbito frontal cortex

part of the brain that plays a key role in decision-making, emotion, and learning

orbito frontal caudate circuit

linked to reward-value processing, decision-making, and goal-directed behavior, with the OFC processing emotional and motivational cues

orbito frontal striatum circuit

reward-based decision-making, evaluating risk, regulating emotions, and learning/forming habits by interacting with areas involved in sensory integration and value representation

pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)

a condition where children develop or experience worsening OCD or tic disorders after a strep infection, potentially triggered by molecular mimicr

response prevention

1. psychoeducation

2. development of exposure hierarchy

3. exposure to stimuli

4. prevention of compulsive ritual

5. repeated exposure over time with response prevention

thought fusion

individuals believe that thoughts, even if intrusive or unwanted, are equivalent to or can cause actions or have the same moral implications as real actions, often associated with obsessive-compulsive disorder (OCD)

thrichotillomania

1. recurrent pulling out of ones hair, resulting in hair loss

2. repeated attempts to decrease or stop hair pulling

3. the hair pulling causes clinically significant distress or impairment in social occupational, or other important areas of functioning

4. the hair pulling or hair loss is not attributable to another medical condition

5. the hair pulling is not better explained by the symptoms of another mental disorder

bipolar

a chronic mental health condition characterized by extreme and persistent mood swings between periods of mania (high energy and euphoria) and depression (low mood and loss of interest)

bipolar I disorder

1. at least one manic episode

2. hypomanic episodes common (not required)

3. major depressive episode, depression, and mixed experiences common (not required)

4. psychotic experiences may occur (not required)

bipolar II disorder

1. at least one hypomanic episode and at least one major depressive episode

2. mixed experiences may occur (not required)

3. no history of mania

4. no psychotic symptoms

cyclothymia

1. For at least two years there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode

2. During the above two year period, the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time

3. Criteria for a major depressive, manic, or hypomanic episode have never been met

4. The symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophrenia spectrum, and other psychotic disorder

5. the symptoms are not attributable to the physiological effects of a substance or another medical condition

6. the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functions

depression

a common mental health condition characterized by a persistent low mood, loss of interest or pleasure in activities, and other symptoms that interfere with daily functioning. 

distractibility

an individual's tendency to have their attention easily drawn away from a current task or focus by internal or external stimuli, resulting in difficulty concentrating or maintaining focus. 

dysthymia/persistent depressive disorder

1. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 year

2. presence, while depressed of two or more of the following

   1. poor appetite or overeating

   2. insomnia or hypersomnia

   3. lower energy or fatigue 

   4. low self esteem

   5. poor concentration or difficulty makin decisions

   6. feelings of hopelessness

3. during the 2 year period of the disturbance, the invidious has never been without the symptoms in Criteria A and B for more than 2 months at a time

4. Criteria for a major depressive disorder may be continuously present for 2 years

5. there has never been a manic episode or a hypomanic episode

6. the disturbance is not better explained by a persistence schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder 

7. the symptoms are not attributable to the physiological effects of a substance or another medical condition

8. the symptoms cause clinically significant distress or impairment in social occupational, or other important areas of functioning

elevated mood

1. higher than appropriate confidence, exaggerated energy and well-being

2. happiness and euphoria

3. higher mood can be infectious and pep up other people as well

euthymia

a stable and balanced emotional state characterized by: 

• Absence of significant mood disturbances:

  state where a person does not experience symptoms of depression, mania, or other mood disorders. 

• Positive affect:

  individuals typically exhibit positive emotions such as contentment, cheerfulness, and optimism. 

• Emotional stability:

  state of emotional equilibrium, where a person is able to cope with everyday stressors and maintain a relatively even mood. 

• Psychological well-being:

flight of ideas

a rapid, continuous succession of superficially related thoughts or ideas, often manifesting as hurried speech with abrupt topic shifts

grandiosity

an inflated sense of self-importance, superiority, and entitlement.

hypersomnia

chronic sleep disorder characterized by persistent, excessive daytime sleepiness, even after adequate sleep,

hypomania

1. a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least four consecutive days and present most of the day, nearly every day

2. during the period of mood disturbance and increased energy and activity, three or more of the following have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree

   1. inflated self

3. the episode is associated with an enquaiovla change in functioning that is uncharacteristic of the individual when not symptomatic

4. the disturbance in mood and the change in functioning are observable by others

5. the episode is not severe enough to cause marked impairment in social or occupational functioning or the necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic

6. 4+ days

7. not markedly impaired; unequivical change distinctly noticeable to observer

8. no psychotic symptoms

9. no hospitalization due to hypomania

major depressive disorder

1. 1+ major depressive episodes

2. no history of manic or hypomanic episodes

3.  At least one major depressive episode is not superimposed on a psychotic disorder

4. we diagnose the disorder; to do that we must identify the episodes

mania

idea of exuberance, too much energy and excitement

1. a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least one week and present most of the day, nearly every day or any duration is hospitalization is necessary

2. during the period of mood disturbance and increased energy or activity, three or more of the following symptoms are present to a significant degree and represent a noticeable change from usual behavior

   1. inflated self esteem or grandiosity

      1. comes with feelings of being special, chosen, etc

   2. decreased need for sleep

      1. someone who doesn’t need the sleep

   3. more talkative than usual or pressure to keep talking

      1. rapid, frenzy speech, can be loud, difficult to interrupt, uses gestures more exaggerated than socially expected

      2. Some patients report that their thoughts are going fast so they feel they need to get those thoughts out verbally

   4. flight of ideas or subjective experience that thoughts are racing

   5. distractibility as reported or observed

   6. increase in goal directed activity or psychomotor agitation

   7. excessive involvement in activities that have a high potential for painful consequences 

3. the mood disturbance is sufficiently sever to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features

4. the episode is not attributable to the physiological effects of a substance or another medical condition

5. 7+ days or any length if hospitalized

6. marked impairment

7. psychotic experiences may occur

8. hospitalization due to mania may occur

marked impairment

a serious limitation in one or more key areas of mental functioning, such as understanding, remembering, applying information, concentrating, and adapting, interfering with independent, appropriate, and effective functioning

mixed episode/features

a bipolar disorder episode characterized by the simultaneous presence of both manic and depressive symptoms, or rapidly alternating between them, rather than a clear separation of distinct mood states

mood

predominant emotional state and/or conscious frame of mind

mood episode

major depressive, hypomanic, and/or mixed

persistent depressive disorder

1. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 year

2. presence, while depressed of two or more of the following

   1. poor appetite or overeating

   2. insomnia or hypersomnia

   3. lower energy or fatigue 

   4. low self esteem

   5. poor concentration or difficulty makin decisions

   6. feelings of hopelessness

3. during the 2 year period of the disturbance, the invidious has never been without the symptoms in Criteria A and B for more than 2 months at a time

4. Criteria for a major depressive disorder may be continuously present for 2 years

5. there has never been a manic episode or a hypomanic episode

6. the disturbance is not better explained by a persistence schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder 

7. the symptoms are not attributable to the physiological effects of a substance or another medical condition

8. the symptoms cause clinically significant distress or impairment in social occupational, or other important areas of functioning

premenstrual dysphoric disorder

1. in the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of messes, start to improve within a few days after the onset of menses, and become minimal or absent in the week post-meses

2. one or more of the following symptoms must be present

   1. marked affective albility

   2. marked irritability or anger or increased interpersonal conflicts

   3. marked depressed mood, feelings of hopelessness, or self-deprecating thoughts

   4. marked anxiety, tensions, and/or feelings of being keyed up or on edge

3. one or more of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above

   1. decreased interest in usual activities

   2. subjective difficulty in concentration

   3. lethargy, easy fatigability, or marked lack of energy

   4. marked change in appetite, overeating, or specific food cravings

   5. hypersomnia or insomnia

   6. a sense of being overwhelmed or out of control

   7. physical symptoms such as breast tenderness or swelling, join or muscle pain, a sensation of bloating or weight gain

4. Criteria A-C must have been met for most menstrual cycles that occurred in the preceding year

5. the disturbance in not merely an exacerbation of the symptoms of another disorder

6. Criterion A should be confirmed by prospective daily rating during at least two symptomatic cycles

7. the symptoms are not attributable to the physiological effects of a substance or another medical condition 

pressured speech

a symptom characterized by rapid, intense, and often uncontrollable verbal output, frequently observed during manic episodes or related to thought disorders, and is characterized by an inability to stop talking or difficulty following through with a coherent train of though

psychomotor agitation

a state of intense restlessness and irritability marked by increased and often purposeless motor activity, reflecting underlying mental tension and anxiety

psychomotor r*

a slowing down of both thought processes and physical movements, often seen as a symptom of depression or other conditions. It's characterized by decreased energy, slower speech, and reduced physical activity. 

psychosis

a mental health condition characterized by a loss of touch with reality. It involves a significant disturbance in perception, thinking, and behavior, leading to a distorted understanding of the world

sadness

a negative emotional state characterized by feelings of unhappiness, grief, and loss

unequivocal change

a distinct period of elevated, expansive, or irritable mood and increased activity or energy, representing a noticeable and abnormal shift in an individual's functioning, easily observable by others and recognized as a change from their usual state. 

unipolar

where the focus is on persistent depressive episodes alone, without the alternating manic or hypomanic episodes characteristic of bipolar disorder; MDE, MDD, PDD, PMDD

acute stress disorder

1. Similar to PTSD in earlier phases

2. 9+ symptoms across PTSD-like symptom categories

3. Duration: 3 days to 29 days

adjustment disorder

1. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s)

2. These symptoms or behaviors are clinically significant, as evidenced by one or both of the following

   1. marked stress that is out of probation to the severity or intensity of the stressor taking into account the external context and the cultural factors that might influence symptoms severity and presentation

   2. significant impairment in social, occupational, or other important areas of functioning

3. The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder

4. The symptoms do not represent normal bereavement and are not better explained by the prolonged grief disorder 

5. once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months

avoidance

the act of steering clear of situations, people, or thoughts that cause negative feeling

equifinality

different pathways and risk factors may have the same outcome

exaggerated startle reponse

a neurological disorder characterized by an excessive and often uncontrollable reaction to sudden, unexpected stimuli, such as noises or touch, leading to exaggerated muscle spasms and reaction

eye movement desensitization and reprocessing (EMDR)

1. combines therapy and eye movements or other types of stimuli (sounds, taps)

2. helps access and and process unresolved traumatic memories

3. treats PTSD, anxiety, mood, and substance use disorders

hypervigliance

a psychological state characterized by an excessive and heightened awareness of potential threats or dangers in the environment. It involves a constant scanning and monitoring of surroundings, leading to an increased state of alertness and anxiety. 

intrusion symptoms

the persistent, unwanted, and distressing experiences associated with a traumatic event, including intrusive thoughts, memories, dreams, and flashbacks that feel so real, the person feels like they are reliving the event

multifinality

similar pathways and risk factors may have different outcomes

overgeneralization of fear

the tendency for a fear response, learned to a specific threat or stimulus, to spread or generalize to other, similar but unrelated, stimuli, contributing to anxiety and related disorders

prazosin

1. cardiovascular medication called an “alpha-blocker”

2. Relaxes blood vessels to ease blood flow

3. blocks the alpha1 receptor for norepinephrine

4. another commonly used medication is propranolol (beta blocker)

propranolol

a beta-blocker, is sometimes used "off-label" in psychiatry for anxiety and related conditions like performance anxiety, PTSD, and social anxiety, primarily to manage the physical symptoms of anxiety, such as a rapid heart rate and shaking. 

PTSD

1. Exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways

   1. directly experiencing the traumatic event(s)

   2. witnessing, in person, the event(s) as it occurred to others

   3. learning that the traumatic event(s) Occurred to a close family member or close friend. In cases of actual or threatened death of a family member of friend, the event(s) must have been violent or accidental

      1. doesn’t meet criteria if you learn family member died of cancer, heart disease, etc

   4. experiencing repeated or extreme exposure to averse details of the traumatic event(s)

2. Presence of one or more of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred

   1. recurrent, involuntary, and intrusive distressing memories of the traumatic event(s)

   2. recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s)

   3. dissociative reactions in which the individual feels or acts as if the traumatic event(s) were recurring

   4. intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)

   5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event

3. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following

   1. avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)

   2. avoidance of or efforts to avoid distressing memories, thoughts or feeling about closely associated with the traumatic event(s)

4. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two or more of the following 

   1. inability to remember an important aspect of the traumatic event(s)

   2. persistence and exaggerated negative, beliefs or expectation about oneself, others, or the world

   3. persistent, distorted conditions about the cause of consequences of the traumatic event(s) that lead the individual to blame himself/herself or others

   4. persistent negative emotional state

   5. markedly diminished interest or participation in significant activities

   6. feelings of detachment or estrangement from others

   7. persistent inability to experience positive emotions

5. Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred, as evidenced by two or more of the following

   1. irritable behavior and angry outbursts typically expressed as verbal or physical aggression toward people or objects

   2. reckless or self-destructive behavior

   3. hypervigilance

   4. exaggerated startle response

   5. problems with concentration

   6. sleep disturbance

6. Duration of the disturbance (Criteria B, C, D, and E) is more than one month

7. the disturbance causes clinically significant distress or important in social, occupational, or other important areas of functioning 

8. The disturbance is not attributable to the physiological effects of a substance (I.e. medication, alcohol) or another medical condition

resilience

the ability to adapt well to difficult life experiences, or "bounce back" from adversity. It's a process that involves mental, emotional, and behavioral flexibility

sensitized ANS and HPA

an increased or heightened responsiveness of both the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis to stress, often following exposure to severe or repeated stressors

stress

internal psychological and physiological response to a stressor

stressor

difficult life circumstance or event that places physical/psychological demand on a person

trauma

psychological and physiological response to a traumatic event

traumatic event

Experience that is deeply distressing or disturbing