Acute and Posttraumatic Stress Disorders

• More common among women (2:1) and people with low income

• Can occur at any age and affect all aspects of life

• Affect at least 3.5-6 percent of people in the United States each year

• 7-9 percent of people in the United States are affected sometime during their lifetime

Triggers

Combat

• “Shell Shock” “Combat Fatigue”

Disasters and accidents

• Civilian traumas have been the trigger of stress disorders at least 10 times as often as combat traumas

Victimization

• Sexual assault and rape (1 in 6 women in a lifetime)

• More than one-third of all victims of physical or sexual assault develop PTSD

Terrorism

Torture

Why do people develop acute and posttraumatic stress disorders?

Brain-body stress pathways

• People who develop PTSD react with especially heightened arousal in SNS and HPA pathways

• May be overly reactive prior to trauma (predisposition)

• May become overly reactive after trauma

• Abnormal norepinephrine and cortisol levels

Brains stress circuit

• Includes amygdala, prefrontal cortex, anterior cingulate cortex, insula, and hippocampus

• In people with PTSD, too little activity in PFC, too much in the amygdala

• Dysfunction in the hippocampus may result in unchecked emotional memories and persistent arousal symptoms, as well as dissociations

Inherited predisposition

• If one twin develops post-traumatic stress symptoms after combat, an identical twin is more likely than a fraternal twin to develop PTSD

• Women who developed PTSD after 9/11 had babies with higher cortisol levels

Childhood experiences

• Chronic neglect or abuse

• Poverty

• Parental separation or divorce

• Family members with psychological disorders

Personal styles

• Preexisting high anxiety and negative worldview versus resiliency and positive attitudes

Severity and nature of the trauma

• More severe prolonged trauma

How do clinicians treat acute and posttraumatic stress disorder?

Antidepressant drugs

• More helpful for increased arousal and negative emotion; less helpful for recurrent negative memories, dissociation, and avoidance behaviors

• Half of PTSD patients who take antidepressants experience some symptom reduction

Cognitive behavioral therapy

• Cognitive processing therapy: deals with difficult memories and feelings

• Mindfulness-based techniques: more accepting and less judgemental of recurring thoughts, feelings, and memories

• Exposure techniques: guided to confront trauma-related objects, events, and situations

• Eye movement desensitization and reprocessing (EMDR): clients move their eyes in a rhythmic manner from side to side while flooding their minds with images of the objects and situations they ordinarily avoid

Couple or family therapy

Group therapy

Combination of some of the above