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

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