In-Depth Notes on PTSD

Overview of PTSD

  • Post-Traumatic Stress Disorder (PTSD): A psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event.
  • Common Traumatic Events: Actual or threatened death, serious injury, or sexual violence.

Diagnostic Criteria for PTSD

  • Exposure to traumatic events through:
    • Direct experience
    • Witnessing the event in person
    • Learning of a traumatic event occurring to a close person
    • Repeated exposure to details of trauma.

Intrusion Symptoms (American Psychiatric Association, 2013)

  • Recurrent, involuntary, and intrusive distressing memories or dreams.
  • Dissociative reactions (flashbacks).
  • Intense psychological distress when confronted with cues symbolizing the event.
  • Marked physiological reactions to cues resembling the trauma.

Avoidance Symptoms

  • Persistent avoidance of distressing memories, thoughts, feelings, or external reminders of the event.
  • Negative alterations in cognitions and mood associated with the event:
    • Inability to recall significant aspects of the trauma.
    • Exaggerated negative beliefs about oneself and the world.
    • Persistent negative emotional states and diminished interest in activities.

Alterations in Arousal and Reactivity

  • Symptoms include:
    • Irritable behavior and angry outbursts.
    • Reckless or self-destructive actions.
    • Hypervigilance and exaggerated startle response.
    • Sleep disturbances and concentration difficulties.
  • Duration of symptoms must exceed one month.

Epidemiology of PTSD

  • Prevalence estimates can vary due to demographics and diagnostic criteria changes:
    • North Carolina point prevalence: 1.3%.
    • Combat-related prevalence:
    • 15.2% of US servicemen in Vietnam.
    • 8.5% of US servicewomen in Vietnam.
  • Conditional risk post-exposure: approximately 9.2% (Breslau et al., 1998).

Course of PTSD

  • Can onset at any age, including childhood.
  • Symptoms typically manifest within 3 months post-trauma.
  • Approximately:
    • 50% remit within 3 months.
    • 33% remain symptomatic despite treatment.

Historical Overview

  • Long-term recognition of trauma's impact:
    • Historical terms include "shell shock" and "battle fatigue."
    • Evolved from psychoanalytic theory through to modern awareness.

Risk Factors for PTSD

  • Severity and nature of trauma.
  • Past trauma history, behavioral/psychological issues, comorbid conditions.
  • Cognitive factors such as low IQ and poor educational opportunities.
  • Genetic predispositions and lack of social support.

Behavioral Formulation

  • Conditioned Responses:
    • Traumatic experiences can condition specific stimuli to elicit anxiety (e.g., returning to a bank after a robbery).
  • Stimulus Generalization: Increased stimuli may trigger fear responses.
  • Deficits: Specific behavioral skills may be deficient (e.g., interpersonal skills).

Cognitive Models of PTSD (Ehlers & Clark)

  • Sufferers exhibit negative beliefs:
    • “I am a victim.”
    • “I’ll never relate to people again.”
    • “I deserve bad things.”

Treatment of PTSD

  • Psychological Treatments:
    • Psychoeducation, Cognitive Restructuring, Exposure therapy (imaginal and in vivo), Mindfulness.
  • Pharmacological Treatments:
    • Antidepressants, Beta-Blockers, and Anxiolytics.

Summary of Mini-Lecture

  • Diagnostic Criteria and features of PTSD.
  • Risk Factors for PTSD.
  • Historical evolution of PTSD concept.
  • Effective treatments available for PTSD.