Post-Traumatic Stress Disorder

Clinical Description

  • Trauma exposure
  • Continued re-experiencing   * (e.g., memories, nightmares, flashbacks)
  • Avoidance
  • Emotional numbing
  • Reckless or self-destructive behavior
  • Interpersonal problems
  • Refers to problems that persist for more than one month after the trauma   * Acute stress disorder assigned for posttraumatic symptoms lasting less than a month
  • Statistics   * 6.8% (life); 3.5% (year)   * Prevalence varies     * Most people who undergo traumatic events do not develop PTSD     * Type of trauma       * E.g., experiencing repeated sexual assault makes an individual 2 to 3 times as likely to develop PTSD     * Proximity – more likely to develop PTSD if closer to the trauma

Causes of PTSD

  • Trauma intensity – PTSD more likely with severe trauma
  • Generalized biological vulnerability   * Twin studies   * Reciprocal gene-environment interactions
  • Generalized psychological vulnerability   * Beliefs about uncontrollability and unpredictability of threatening situations
  • Poor social support = greater risk

Diagnostic Criteria

  • Exposure to actual or threatened event
  • Presence of one or more intrusional symptoms
  • Persistent avoidance of stimuli associated with traumatic event
  • Negative alterations in cognitions and mood associated with traumatic event
  • Marked alterations in arousal and activity associated with the traumatic event
  • Sleep disturbance
  • Significant distress
  • Not attributable to substance use

Neurobiological Model

  • Threatening cues activate CRF system
  • CRF system activates fear and anxiety areas   * Amygdala (central nucleus)
  • Increased HPA axis activation   * Cortisol

Treatment

  • Cognitive-behavioral treatment   * Imaginal exposure to memories of traumatic event   * Graduated or massed   * Increase positive coping skills   * Increase social support   * Highly effective
  • Psychoanalytic therapy: catharsis = reliving emotional trauma to relieve suffering
  • Medications   * SSRIs can be helpful     * Relieve heightened anxiety and panic attacks common to PTSD