In-depth Notes on PTSD and OCD

Trauma-and-Stressor Related Disorders

  • Definition: Trauma-and-stressor related disorders are characterized by exposure to actual or threatened death, serious injury, or sexual violation. Exposure can occur in multiple ways:

    • Direct Experience: Experiencing the traumatic event firsthand.

    • Witnessing: Seeing the event as it occurs to others.

    • Learning: Hearing that a close family member or friend experienced the event (must be violent or accidental in the case of death).

    • Repeated Exposure: Being repeatedly exposed to aversive details of the trauma (e.g., first responders).

Symptoms Diagnostic Criteria (PTSD)

  • Presence of Symptoms: Nine or more symptoms from the following categories must be present, beginning or worsening after the trauma:

    • Intrusion Symptoms:

    1. Distressing Memories: Recurrent, involuntary memories of the event.

    2. Distressing Dreams: Dreams related to the event.

    3. Flashbacks: Dissociative reactions where the individual feels the event is recurring.

    4. Psychological Distress: Intense distress in response to cues resembling the trauma.

    • Negative Mood:

    1. Inability to Experience Positive Emotions: Persistent feelings of apathy or numbness.

    • Dissociative Symptoms:

    1. Altered Sense of Reality: Feeling detached from surroundings.

    2. Amnesia: Inability to remember details of the trauma.

    • Avoidance Symptoms:

    1. Avoidance of Memories/Thoughts: Efforts to avoid thoughts or feelings related to the trauma.

    2. Avoidance of Reminders: Avoiding people, places, or situations that remind one of the trauma.

    • Arousal Symptoms:

    1. Sleep Disturbance: Issues with sleep such as insomnia.

    2. Irritable Behavior: Angry outbursts with little provocation.

    3. Hypervigilance: Constant state of alertness.

    4. Concentration Problems: Difficulty in focusing attention.

    5. Exaggerated Startle Response: Overreaction to unexpected stimuli.

  • Duration: Symptoms must persist for 3 days to 1 month after the trauma exposure.

  • Distress or Impairment: Symptoms must cause significant distress or impairment in functioning.

  • Not Due to Other Causes: The symptoms need to be distinct from those caused by substances or other medical conditions.

Acute Stress Disorder (ASD)

  • Similar diagnostic criteria as PTSD but symptoms arise within 3 days and do not last more than 1 month.

Prevalence of PTSD

  • Lifetime Prevalence: Approximately 6.8% in the US.

  • Women are diagnosed at approximately twice the rate of men despite men experiencing more traumatic events.

  • Significant instances of PTSD observed among survivors of events such as the 9/11 attacks or veterans from Iraq/Afghanistan.

Causes of PTSD

  1. Biological Factors:

    • Hyperactivation of the autonomic nervous system (increased amygdala activity).

    • HPA axis dysfunction resulting in elevated cortisol levels.

    • Atrophy of the hippocampus impacting memory.

  2. Psychological Factors:

    • Existing mood disorders like anxiety or depression.

    • Cognitive biases contributing to vulnerability (e.g., catastrophic thinking).

  3. Social Factors:

    • History of abuse or neglect in childhood.

    • Lack of social support and increased isolation.

  4. Sociocultural Factors:

    • Low socioeconomic status and exposure to violence.

    • Gender differences in the prevalence of PTSD.

    • Immigration status related to traumatic contexts.

Treatment of PTSD

  1. Medication:

    • SSRIs (Selective Serotonin Reuptake Inhibitors) beneficial for symptom reduction.

  2. Behavioral Therapy:

    • Exposure therapy (e.g., imagery, context exposure) to address trauma-related cues.

  3. Cognitive Approaches:

    • Cognitive restructuring to address dysfunctional thoughts and beliefs about the trauma.

Obsessive-Compulsive Disorder (OCD)

  • Definition: Characterized by obsessions (intrusive unwanted thoughts) and compulsions (repetitive behaviors).

DSM-5 Diagnostic Criteria for OCD

  • Obsessions: Persistent thoughts causing anxiety.

  • Compulsions: Repetitive actions performed to reduce anxiety or prevent a feared outcome.

  • Symptoms must consume more than 1 hour per day and cause significant distress or impairment.

  • Not attributable to other mental disorders.

Common Symptoms of OCD

  • Intrusive Thoughts: Common obsessions include fears of harm, symmetry needs, contamination fears, and religious or aggressive thoughts.

  • Compulsions: Actions such as checking, counting, washing, or ordering.

Prevalence of OCD

  • Approximately 1.6% to 2.3% life prevalence, with no significant gender differences in occurrence.

Causes of OCD

  1. Biological Factors: Dysregulation of the orbital frontal cortex affecting anxiety response.

  2. Cognitive Behavioral Factors: Inaccurate trust in memories leads to compulsive behaviors to affirm safety.

Treatment of OCD

  1. Medications: SSRIs commonly used, though they show high relapse rates upon stopping.

  2. Behavioral Therapy: Exposure and Response Prevention (ERP) is particularly effective. Often utilized with medications for severe cases.