In-Depth Notes on Post-Traumatic Stress Disorder (PTSD)

Overview of PTSD
  • PTSD (Post-Traumatic Stress Disorder): A mental health condition triggered by experiencing or witnessing a terrifying event.
Required Prior Readings
  • Rieger (2017): Chapter 4 on trauma and stressor-related disorders.
Diagnostic Criteria for PTSD
Exposure to Trauma
  • Direct experience of traumatic events or witnessing them.
  • Learning of trauma occurring to close family members or friends.
  • Repeated exposure to distressing details of traumatic events.
Intrusion Symptoms
  • Recurrent, involuntary, and distressing memories.
  • Distressing dreams related to the trauma.
  • Flashbacks where the individual feels as if the event is occurring again.
  • Psychological distress triggered by cues resembling the trauma.
  • Physiological reaction to cues symbolizing the trauma.

Reference: American Psychiatric Association, 2013, pp. 271-272.

Avoidance Symptoms
  • Persistent avoidance of memories, thoughts, or feelings related to the trauma.
  • Avoidance of reminders that induce distressing memories.
Negative Alterations in Cognitions and Mood
  • Inability to recall aspects of the trauma.
  • Exaggerated negative beliefs about oneself and others.
  • Distorted thoughts leading to self-blame.
  • Persistent negative emotional states and loss of interest in significant activities.
Alterations in Arousal and Reactivity
  • Increased arousal responses post-trauma:
    • Irritable behavior and angry outbursts.
    • Reckless behavior.
    • Hypervigilance and exaggerated startle response.
    • Sleep disturbances and concentration issues.
  • Duration: Symptoms must last more than one month.

Reference: American Psychiatric Association, 2013, pp. 271-272.

Prevalence of PTSD
  • Estimates can vary: Changes in diagnostic criteria and demographics.
  • North Carolina point-prevalence: 1.3%.
    • Combat-related PTSD: 15.2% males and 8.5% females from Vietnam.
    • Conditional risk after trauma: 9.2% (Breslau et al., 1998).
Course of PTSD
  • Can onset at any age, often within 3 months of the trauma.
  • Many derive from Acute Stress Disorder, around 50% remit within 3 months.
  • Approximately 33% remain symptomatic despite treatment.

References: American Psychiatric Association, 2000; Andrews et al., 1994.

Historical Overview of PTSD
  • Trauma long regarded as significant in psychological illness (e.g., psychoanalytic theory).
  • Terms from history: "Shell shock", "Battle fatigue" for war veterans.
Risk Factors for PTSD
  • Severity of trauma and history of prior stress or abuse.
  • Comorbid psychological issues and cognitive factors like low IQ.
  • Genetic predisposition and social support deficiencies.

Reference: Yehuda et al., 2002.

Behavioral Formulation of PTSD
After the Traumatic Event
  • Conditioned Stimulus: Triggers (e.g., being at a bank).
  • Unconditioned Stimulus: Actual trauma (e.g., being held at gunpoint).
  • Conditioned Responses: Fear and anxiety associated with the environment post-trauma.
Positive Punishment and Avoidance
  • Approach to the bank induces anxiety, leading to avoidance and reinforced fear responses.
Cognitive Models of PTSD
  • Ehlers & Clark’s model emphasizes negative self-appraisal in PTSD sufferers:
    • Examples include beliefs of being a victim or deserving bad outcomes.
Treatment of PTSD
Psychological Treatments
  • Psychoeducation: Understanding PTSD.
  • Cognitive Restructuring: Challenging negative beliefs.
  • Behavioral Experiments: Testing thoughts through action.
  • Exposure Strategies: Both imaginal and in-vivo.
  • Mindfulness Practices: To manage symptoms.
Pharmacological Treatments
  • Common medications include antidepressants, beta-blockers, and anxiolytics.
Conclusion of Mini-Lecture
  • This lecture covered diagnostic criteria, risk factors, historical context, and effective treatment approaches for PTSD.