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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