PTSD and Maltreatment 629 c

PTSD overview: Prevalence

3 to 15% in girls and 1-6% of boys

PTSD overview: Events causing

65% neglect; 18% physical abuse; 10% sexual abuse 7% psychological abuse

DSM Criteria 0-6 years old for PTSD

Removes A: 4 repeated exposure criteria; Criteria B increases focuses on behaviorally expressed symptoms, Clinical re-experiencing varies according to developmental stage (frightening dreams not related to trauma; express symptoms through play; may lack fearful reactions at the time of exposure or during re-experiencing); Criteria C: moves from three to one symptom for threshhold; Criteria D focuses on alterations in arousal and reactivity only

PTSD: Risk factors

severity of trauma; parental reaction to trauma; time proximity to trauma; comorbid mental health diagnosis

PTSD: Protective factors

Supportive social environment; Psychological resilience; Supportive environment after event

PTSD: Clinicians can demonstrate support by

Neutral reactions when learning of trauma; mindful empathy; mindful discussion of history and facts; recognize the dynamic nature of the patient’s response

PTSD treatments and management

Psychological first aid; Individual and group therapies; CBT (trauma focused CBT for persistent PTSD effective for ages 3+); EMDR (especially for those too young); Narrative exposure therapy; Family therapy

Impacts of childhood maltreatment: Biology

reduced frontal/temporal grey matter; Heightened amygdala reactivity to threat; high basal levels and blunted cortisol response to stressors; high inflammation levels, impaired adaptive immunity

Impacts of childhood maltreatment: Physical health

Obesity; cardiovascular disease; stroke; type II diabetes; chronic obstrucrtive pulmonary disease; STD; autoimmune disorders; irritable bowel syndrome; chronic pain

Impacts of childhood maltreatment: mental health

Poor emotion regulation; PTSD; other anxiety disorders; depression; ADHD; conduct disorder; psychosis; personality disorder; substance misuse

Impacts of childhood maltreatment: Behavior

Antisocial behavior; bullying; self harm; suicide; teenage pregnancy; smoking; poor education; reduced economic productivity

Medications:

Sertraline and Paroxetine (SSRI for OCD age 6+ and off label PTSD); Clonidine (off label for anxiety, sleep, dysregulated behavior); Prazosin (PTSD, nightmares)