PTSD and Adjustment Disorders

PTSD

• DSM-5 clusters:  

• Criterion A - Trauma: Exposure to actual/threatened death, serious injury, or sexual violence  

• Criterion B – Intrusion: Re-experiencing the trauma: intrusive memories, nightmares, flashbacks, intense distress, or physical reactions to reminders  

• Criterion C – Avoidance: avoiding trauma-related thoughts/feelings or external reminders (people, places, situations, etc.)  

• Criterion D: Negative mood/cognitions: Amnesia for parts of event, negative beliefs (“I’m ruined,” “world is dangerous”), distorted blame, persistent negative emotions, loss of interest, detachment, inability to feel positive emotions 

• Criterion E: Arousal/reactivity: irritability/anger, reckless or self-destructive behavior, hypervigilance, exaggerated startle, poor concentration, sleep problems 

• Criterion F – Duration: symptoms >1 month 

• Criterion G – Impairment: causes clinically significant distress or impairment in functioning  

• Criterion H – Not due to substances/medical condition  

PTSD criterion A

Trauma: Exposure to actual/threatened death, serious injury, or sexual violence  

PTSD criterion B

Intrusion: Re-experiencing the trauma: intrusive memories,

PTSD criterion C

Avoidance: avoiding trauma-related thoughts/feelings or external reminders (people, places, situations, etc.)  

PTSD criterion D

Negative mood/cognitions: Amnesia for parts of event, negative beliefs (“I’m ruined,” “world is dangerous”), distorted blame, persistent negative emotions, loss of interest, detachment, inability to feel positive emotions 

PTSD criterion E

Arousal/reactivity: irritability/anger, reckless or self-destructive behavior, hypervigilance, exaggerated startle, poor concentration, sleep problems 

PTSD criteron F

Duration: symptoms >1 month 

PTSD criterion G

Impairment: causes clinically significant distress or impairment in functioning  

PTSD criterion H

Not due to substances/medical condition  

Adjustment disorder

• Symptoms start within 3 months of the stressor 

• Must resolve within 6 months after the stressor  

• Stressor criteria: emotional or behavioral symptoms in response to an identifiable stressor 

• Nature of stressor is very broad:  

  • Single: ex. Breakup, job loss

  • Multiple: ex. Marital / work problems  

  • Recurrent: ex. Seasonal unemployment 

  • Continuous/chronic: ex. Long-term medical illness  

• Stressor may affect:  

  • Individual  

  • Family 

  • Community  

• DSM assumes there is an expectable reaction to each stressor; clinician must decide what is “too much” reaction  

acute stress disorder

• time-limited reaction to a traumatic event  

• Symptoms last from 3 days to 1 month after the trauma  

• Exposure to trauma (direct, witnessed, learning about close other, or repeated exposure to details)  

• >/= 9 symptoms from any of 5 clusters:  

  • Intrusion: memories, nightmares, flashbacks, distress to reminders 

  • Negative mood: inability to experience positive emotions  

  • Dissociation: altered sense of reality, amnesia for parts of event  

  • Avoidance: avoiding thoughts/feelings or reminders of trauma  

  • Arousal: sleep problems, irritability, hypervigilance, poor concentration, start

  • Causes clinically significant distress or impairment 

• Not due to substances, medical illness, or another mental disorder  

Diagnosis

1. Was there a qualifying traumatic event? Actual/threatened death, serious injury, sexual violence 

2. YES --> how long have the trauma-related symptoms lasted? 

a. 3 days-1 month --> think ACUTE stress disorder 

b. >1 month --> assess full PTSD criteria  

3. NO qualifying trauma --> is there an identifiable stressor? 

a. Emotional/behavioral response with distress or impairment, not better explained by another disorder --> think ADJUSTMENT disorder  

meds

Sertraline and Fluoxetine and CBT