2b: Trauma

PSYC3025 - Trauma

Fear

  • Definition: Adaptive reaction to an event or stimulus that triggers the flight or fight response.

  • Physical Reactions: Physical reactions to fearful events may exacerbate the adaptive fear response, potentially leading to increased stress and anxiety.

  • Chronic Fear: When fear becomes chronic and disproportionate to the actual threat, it can result in maladaptive responses that interfere with daily functioning.

Trauma

  • Definition: Maladaptive (poorly suited to a situation or environment) reactions following exposure to an incident or repeated event that is emotionally disturbing or life-threatening.

  • Adverse Effects: Trauma can have adverse effects on daily functioning and overall wellbeing.

  • Statistics:
      - An estimated 75% of Australian adults have experienced a traumatic event (based on Productivity Commission estimates using ABS 2009).
      - According to the 2007 National Survey of Mental Health and Wellbeing, the lifetime prevalence of PTSD in Australia is 12%.
      - Women are statistically twice as likely as men to develop PTSD (15.8% for women and 8.6% for men according to ABS 2008).
      - The 2017–18 National Health Survey revealed that approximately 1.7% of women and 1.3% of men had a lifetime prevalence of PTSD that was endorsed by a health professional.
      - The type of trauma experienced and personal characteristics (risk factors) significantly increase the risk of developing PTSD (Zohar, 2022).

Types of Trauma Events

  • Natural disasters

  • Car accidents

  • Physical and sexual assault

  • Witnessing violence or death

  • Medical trauma

  • Childhood neglect

  • Violence, war, or terrorism

  • Poverty

  • Unexplained separation

Types of Trauma

  • Acute Trauma:
      - Definition: Refers to a single event, such as a car accident.

  • Chronic Trauma:
      - Definition: Involves repeated exposure to trauma, such as ongoing emotional or sexual abuse.

  • Complex Trauma:
      - Definition: Consists of multiple and varied events, often beginning in childhood, involving interpersonal trauma, such as neglect or abandonment.

  • Secondary (Vicarious) Trauma:
      - Definition: Involves emotional and psychological reactions after witnessing or hearing about an event, commonly experienced by first responders and therapists.

Adjustment Disorder

  • Definition: When reactions to the event are disproportionate to the event itself.
      - The event may be distressing but not necessarily traumatic.
      - The reaction to the event is regarded as excessive relative to the severity of the stressor.

  • Symptoms:
      - Non-specific symptoms manifest as general distress within three months after the stressful event.

Adjustment Disorder (DSM-5 criteria)

  • Key Criteria:
      - Development of emotional or behavioral symptoms within three months from the onset of the stressor(s).
      - Symptoms resolve within six months after the stressor(s) ends. to distinguish from other conditions such as depression
      - Symptoms or behaviors are clinically significant, evidenced by:
        - a) Marked distress that is out of proportion to the stressor(s).
        - b) Significant impairment in social, occupational, or other important areas of functioning.
      - Stress response does not meet the criteria for another mental disorder and is not an exacerbation of pre-existing mental disorders.
      - Symptoms do not represent normal bereavement.

  • Specifiers:
      - Depressed mood
      - Anxiety
      - Mixed anxiety and depressed mood
      - Disturbance of conduct
      - Mixed disturbance of emotions and conduct

Acute Stress Disorder

  • Definition: A short-term reaction to a traumatic event.

Acute Stress Disorder (DSM-5 criteria)

  • Key Features:
      - Exposure to actual or threatened events involving death, serious injury, or sexual abuse:
        - Direct experience
        - Witnessing the event occur to others
        - Learning about the event
        - Experiencing extreme or repeated exposure to the event
      - Symptoms last from three days to one month.
      - Clinical significance includes distress or impaired functioning in social, occupational, or other important areas.
      - Symptoms cannot be better explained by the physiological effects of substance use or another medical condition.

Acute Stress Disorder (DSM-5 Symptoms)

  • Presence of at least 9 symptoms from the following categories:
      - Intrusive Symptoms:
        - Recurrent and involuntary distressing thoughts or memories of the event.
        - Recurrent distressing dreams where the content relates to the event.
        - Dissociative reactions (e.g., flashbacks) where the event feels recurrent.
        - Intense or prolonged psychological distress or physiological reactions to cues related to the event.
      - Negative Mood:
        - Inability to experience positive emotions (e.g., happiness, satisfaction, love).
      - Dissociative Symptoms:
        - Altered perception of surroundings or self.
        - Inability to remember important aspects of the traumatic event.
      - Avoidance Symptoms:
        - Avoiding memories, thoughts, or feelings related to the event.
        - Avoiding external reminders that prompt thoughts or feelings of the event.
      - Arousal Symptoms:
        - Sleep disturbances
        - Irritability and anger (e.g., verbal or physical aggression)
        - Hypervigilance
        - Problems concentrating
        - Exaggerated startle response

Post-Traumatic Stress Disorder (PTSD)

  • Definition: A prolonged reaction to a traumatic event.
      - Requires longer duration than one month to diagnose.

Post-Traumatic Stress Disorder (DSM-5 criteria)

  • Key Features:
      - Similar exposure requirements as Acute Stress Disorder.
      - Duration of symptoms is more than one month.
      - Clinically significant distress or impaired functioning in social, occupational, or other important areas.
      - Symptoms cannot be better explained by substance use or another medical condition.

Post-Traumatic Stress Disorder (DSM-5 Symptoms)

  • Specifically includes:
      - Intrusive Symptoms (one or more):
        - Recurrent and involuntary distressing symptoms related to the event.
        - Recurrent distressing dreams related to the event.
        - Dissociative reactions (e.g., flashbacks).
        - Intense psychological distress.
        - Physiological responses to event-related cues.
      - Avoidance Symptoms (one or both):
        - Avoiding memories, thoughts, or feelings related to the event.
        - Avoiding external reminders related to the event.
      - Negative Experience in Cognitions and Mood (two or more):
        - Inability to recall significant aspects of the traumatic event.
        - Inability to feel positive emotions.
        - Enduring negative emotional states (e.g., fear, guilt, shame).
        - Feelings of detachment from others.
        - Persistent distorted beliefs about the cause or consequences of the event, leading to self-blame.
        - Reduced interest in significant activities.
      - Arousal and Reactivity (two or more):
        - Sleep disturbance.
        - Irritability or anger (e.g., aggression).
        - Hypervigilance.
        - Concentration difficulties.
        - Exaggerated startle responses.
        - Reckless or self-destructive behavior.
      - Specify whether there are:
        - Dissociative Symptoms:
          1. Depersonalisation: Persistent feelings of being detached from one’s own mental processes (e.g., dream-like state, removed from self).

  • “I feel unreal”
          2. Derealisation: Persistent experience of unreality in surroundings (e.g., the outside world feels unreal or dream-like).

  • “the world feels unreal” ›


    - With Delayed Expression: full diagnostic criteria are not met until at least 6 months after the event

Condition Onset and Duration

Condition

Onset

Duration

Symptoms

Acute Stress Disorder

0-28 days

3 days to 4 weeks

Dissociative, depersonalization, derealization

Post-Traumatic Stress Disorder

1 month

> 1 month to years

Avoidance, heightened awareness, changes in cognition or mood

Aetiology of PTSD

  • Psychological (Cognitive) Models:
      - Maladaptive appraisals can influence the development of PTSD.
        - Event Perception: Thoughts like "I was weak because I did not…" create feelings of guilt.
        - Response Evaluation: Thoughts like "I am pathetic because I cannot cope with…" create feelings of hopelessness.
        - Environmental Factors: Beliefs like "I do not feel safe…" lead to feelings of helplessness.
      - Classical Conditioning: Can occur where event triggers (conditioned stimulus) lead to fear reactions (conditioned response) and avoidance behaviors.

  • Biological Models:
      - Extreme sympathetic arousal responses to trauma release neurochemicals (e.g., noradrenaline and adrenaline), reinforcing fear conditioning of related memories.
      - Conditioned responses lead to heightened awareness, including an increased startle response, feeling on edge, and constantly scanning the environment for danger.

  • Social Models:
      - Social support significantly influences resilience to trauma and recovery from PTSD. Strong support networks can mitigate negative effects of trauma, while lack of support may exacerbate symptoms.

Neurobiology of Trauma

  • Amygdala:
      1. Fear Conditioning: Neutral stimuli can become associated with fear, creating exaggerated responses.
      2. Emotional Memory: Emotional dysregulation may contribute to vivid and intrusive memories of traumatic events.
      3. Hypervigilance and Threat Perception: Increased sensitivity to threat cues leads to exaggerated threat perception and hypervigilance.
      4. Neuroplasticity and Treatment: Neuroplasticity of the amygdala can be targeted for reducing hyperarousal and emotional reactivity in PTSD.
      5. Interaction with Hippocampus: Disruptions in contextualizing and regulating emotional responses to traumatic memories due to the interaction with the hippocampus.

  • Hippocampus:
      1. Memory Consolidation: PTSD can alter memory consolidation, disrupting how traumatic memories are encoded and retrieved.
      2. Emotional Regulation: Dysfunction in emotional regulation can complicate differentiating past experiences from present realities, heightening emotional reactivity and arousal.
      3. Contextual Processing: Alterations contribute to difficulty in contextualizing traumatic memories, leading to flashbacks detached from their original context.
      4. Neurogenesis and Plasticity: Exposure to stress and trauma can impair neurogenesis and dendritic branching, affecting recovery from trauma.
      5. Interaction with Amygdala: Reduced hippocampal volume and function can hinder interaction with the amygdala, exacerbating hyperactivity and severity of symptoms.