PSYCH66 - PTSD and Trauma

Traumatic event definition

a person is exposed to actual or threatened death, serious injury, or sexual violation

What is trauma and trauma response talking about?

stressor v. stress response

• threatening stressors = increased stress response (arousal and fear)

• related to fight, flight, or freeze (as in anxiety d/o) but traumatic threats are not vague

• we are talking about arousal or as it’s called in our book The Features of Arousal

Where does PTSD start in the brain?

the hypothalamus

Fundamentals of the hypothalamus

Hypothalamus —> releases neurotransmitters that cause neurons to fire + activate…

1. Autonomic Nervous System

2. Endocrine system

What does the ANS (autonomic nervous system) do?

1. connect CNS to other organs

2. control involuntary activities of organs

3. important relationship here w/ some symptoms of Acute Stress d/o and PTSD

What is and does the Endocrine system do?

a network of glands located throughout the body

releases hormones —> bloodstream —> various body organs

What do we first feel when we are in danger?

Hypothalamus —> autonomic NS —> sympathetic NS + HPA

What is the Sympathetic Nervous system?

pathway that the body uses to produce arousal

What is the HPA?

Hypothalamic-Pituitary-Adrenal (HPA) pathway - second pathway to stimulate and arouse the body

• related to various hormones including cortisol

What normally happens in the Nervous System after danger passes?

Parasympathetic NS activates to calm the body down

• this is the nerve of fibers of ANS that help return bodily processes to normal

Flowchart for what is activated when the body is aroused

Hypothalamus —> pituitary gland —> secrete adrenocorticotopic hormone (ACTH) —> adrenal cortex —> secretes stress hormones (aka corticosteroids) including hormone cortisol

What is the adrenocorticotropic hormone released by and what does it do?

• released by the pituitary gland

• Stimulates the adrenal glands to produce cortisol

• AKA body’s “major stress hormone”

Info about cortisol and humans

• modern day humans experience higher levels of cortisol than needed due to the seemingly constant stress + pressure of our lives

• there are very negative physical effects of having too much cortisol in our bodies too much of the time

How is the nervous and endocrine system related to trauma and PTSD?

• FFF response prepares our body to deal with danger

• Issues with these can result in us not being able to calm down even though the danger has already passed

• symptoms last a long time when the danger is big or scary

What is the main and only difference between Acute Stress Disorder and PTSD?

timeline: Acute stress d/o symptoms last no more than a month

What is PTSD?

Post traumatic Stress d/o

• exposure to actual/threatened danger, serious danger or sexual violence by either direct experience, witnessing, learning abt it (very common in kids), or experiencing repeated or extreme exposure (first responders)

Info on PTSD

Presence of one or more of the following for at least one month

• Recurrent distressing memories/dreams related to event

  • “My granny is the lady from The Grudge

• Flashbacks (reliving the event)

  • “it’s like a movie in my head”

• Intense prolonged distress when exposed to triggers associated with event

  • can resemble panic attacks or can appear as aloof or distant, dissociation

• Physiological reactions to triggers

  • hyper vigilance, exaggerated startle response, chills, screaming, throwing, hitting, etc.

Diagnostic Criteria - Acute and Post Traumatic Stress Disorder

• Person exposed to traumatic event — death, threatened death, severe injury, sexual violation

• experiences at least one of the following intrusive symptoms (uncontrolled + unwanted)

  • repeated, uncontrolled, and distressing memories

  • repeated and upsetting trauma-linked dreams

  • dissociative experiences such as flashbacks

  • significant upset when exposed to trauma-linked cues

  • pronounced physical reactions when reminded of the event(s)

• Continually avoids trauma-linked stimuli

• experiences negative changes in trauma-linked cognitions + mood (unable to remember key features of event/experiencing repeated negative emotions)

• displays conspicuous changes in arousal or reactivity such as excessive alertness, extreme startle responses, or sleep disturbances

• experiences significant distress or impairment, with symptoms lasting more than a month (for PTSD only)

How old do people have to be to experiences PTSD?

you can experience it at any age in life

• even in very little children (under 5 years old)

Does PTSD discriminate?

NO

• all ages, all genders, all identities, all relationships, all socioeconomic status

• trauma = widespread in society

Do some people experience other symptoms that may be related to trauma? If so, what are they?

Yes

• feeling on edge —> think it’s anxiety

• Can’t focus —> think it’s ADHD

• Mood swings —> think it’s depression or bipolar d/o

What is “survival mode”?

brain is flooded w/ emotion, logical thinking is not present, and executive functioning is highly impaired

• hard to concentrate + make decisions, hard to prioritize

How does PTSD impact suicide rates?

Heavily increases

• More than 20% of people with PTSD attempt suicide bc their experiences are too much to handle for them

What causes one person to develop a stress d/o but another does not? (theories)

Developmental Psychopathology Perspective

What is the main theory of the Developmental Psychopathology Perspective?

there is a biological predisposition — either inherited or acquired — for over reactivity in their brain-body stress routes and dysfunction in brain’s stress circuit

What is an inherited predisposition?

it runs in the individual’s genes

What is an acquired predisposition?

the person grows up with trauma that impacts how the brain develops —> creates overreactivity in brain

• changes the biology of our brain especially in really young children

How does the biological predisposition affect the development of PTSD?

makes people more vulnerable to but does not guarantee the development of PTSD

• poor coping skills + ineffective support systems —> more vulnerable to PTSD

Why may a child not experience PTSD even if they do have the predisposition?

they could have protective factors for managing stress + have a loving supportive family —> protect child from PTSD

Besides the biological predisposition, what is another factor that has a significant impact on how the trauma will affect a person? Who does it usually impact the most? Why?

timing of experiencing stressors + trauma

• mostly impacts children due to the developing brain in childhood

Extreme stress/trauma during childhood interrupts and changes the child’s “brain-body stress routes” that are developing and the brain stress circuit have a higher chance to operate poorly over the course of life

What age group is more predisposed to developing PTSD and why?

Younger children; because of the extreme plasticity of the brain at a young age

What is multifinality?

where two people start at the same/similar spot but go down different paths (divergence)

• depends on presence, timing, and intersections of various factors

• ex: both child has predisposition but only one develops Acute/PTSD

What is equifinality?

two people start out at different places and end up in the same/similar circumstances (converge)

• depends on presence, timing, and intersections of the various factors

• ex: only one child has the predisposition but both end up developing Acute/PTSD (one has acquired predisposition)

What is a factor in acquiring a biological predisposition for PTSD?

Adverse childhood experiences (ACES)