Trauma and Stressor-Related Disorders

risk factors → event → symptoms → disorder (but don’t cause for everyone)

combat: the original trauma - known to cause psychological/physiological/neural “injuries”

  • seen in Greek dramas, Civil War (Soldier’s heart), WW 1 shell shock, WW2 combat fatigue

non-combat trauma: survivors of concentration camps, imprisonment, etc.

reintegration of Vietnam vets increased awareness of trauma, then women’s movement, then in 80s DSM 3 put it all under a label

What counts as trauma?

  • where to draw the line? what matters more, objective (what happened) or subjective (how it made you feel)

  • “Criterion A” experincing, witnessing, or learning about a loved one experiencing one of the following events

    • actual or threatened death, serious injury, or sexual violence

70-90% of people have at least one traumatic experience at least once, 40-60% of those experience post traumatic symptoms after, 5-10% of those experience PTSD

Post traumatic symptoms:

  • Intrusive symptoms- memories, dreams, etc. of event

  • Avoid trauma related stimuli- location

  • negative changes in trauma-related cognitions and moods, ex. not remembering events, repeated neg. emotions

  • changes in arousal- ex. insomnia, hyper alertness

Other consequences of trauma:

  • new or worsened depression, anxiety, personality disorder, substance use

Even after severe traumas most people’s symptoms subside over time- disorders are symptoms that don’t resolve over time

Diagnoses:

  • acute stress disorders

    • symptoms begin <4 weeks after event, last for <1 month, 50% progress to PTSD

  • PTSD

    • symptoms begin at any time, last for >1 month, 25% appear 6+ months after trauma (delayed onset)

Why don’t PTSD symptoms resolve for some people?

  • some traumas are worse than others

  • some people are more prone to PTSD

Biology in PTSD - HPA axis is dysregulated, even before trauma

Adverse childhood experiences (ACEs) increase risk for PTSD, ex. neglect, abuse, poverty etc.

Treating PTSD:

  • critical incident stress debriefing- in a group soon after trauma and talk about details (It doesn’t work)

  • cognitive processing therapy

    • psychoeducation

    • identify “stuck points”

    • cognitive restructuring

    • trauma narrative