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