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