PSYC 223 - PTSD

13. Know the defining features of a traumatic event according to the DSM-5, as well as the typical course for PTSD symptoms following a traumatic event.

DSM-5 Definition of a Traumatic Event (Criterion A):
A traumatic event involves actual or threatened death, serious injury, or sexual violence, experienced in one of four ways:

• Direct exposure (being there when it happens)

• Witnessing it in person

• Learning that it occurred to a close family member or friend

• Experiencing repeated or extreme exposure to aversive details of the trauma (e.g., first responders)

Typical Course of PTSD Symptoms:

• Symptoms usually appear within 1 month after the trauma.

• Delayed onset is possible (up to 6 months), though true delayed expression is rare and may reflect symptom reactivation.

• PTSD can become chronic if untreated, and symptoms may wax and wane based on stress and exposure to reminders.
  
  

Schemas

 Mental frameworks we use to understand ourselves, others, and the world (e.g., “the world is fair,” “I am a good person”).

Schema Disconfirmation:

• When an experience violates a core belief or schema.

• Trauma may shatter previously held beliefs, forcing a person to reevaluate their worldview.

Schema Confirmation:

• Trauma may reinforce existing negative beliefs, especially if someone already sees the world as dangerous or themselves as unworthy.

Assimilation:

• The traumatic experience is distorted to fit existing schemas.

• May involve denial or minimization (e.g., “It wasn’t that bad”; “It was my fault because I’m weak”).

Accommodation

• Schemas change to incorporate the new, often painful, reality (e.g., “Bad things can happen to good people”).

• This can be adaptive (gaining new perspective) or maladaptive (losing a sense of trust or safety).

14. Be sure you understand the concepts of schema disconfirmation and confirmation, as well as accommodation and assimilation, as they pertain to responses to trauma and the development of different clusters of symptoms.

In PTSD, disconfirmed schemas and maladaptive accommodation (e.g., believing the world is unsafe or that one is permanently damaged) contribute to symptom severity.

Criterion B

 Intrusion Symptoms (re-experiencing):

• Unwanted distressing memories

• Nightmares

• Flashbacks

• Emotional or physical distress when reminded of the trauma
  

Criterion C

Avoidance:

• Avoiding memories, thoughts, feelings related to trauma

• Avoiding places, people, or situations that trigger reminders (e.g., J avoiding the hospital)

 Criterion D

 Negative Alterations in Cognitions and Mood:

• Persistent negative beliefs (e.g., “I’m a failure”)

• Distorted blame of self or others

• Persistent negative emotional state (e.g., guilt, shame)

• Feeling detached from others

• Inability to experience positive emotions

Criterion E

Arousal and Reactivity:

• Irritability, anger outbursts

• Reckless or self-destructive behavior (e.g., J hitting the wall)

• Hypervigilance

• Exaggerated startle response

• Sleep problems

• Concentration difficulties