Stress and Trauma disorders

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Questions and Answers

Which is a characteristic symptom of Complex PTSD (CPTSD)?

  • Withdrawal from social activities (correct)
  • Symptoms solely due to accidents
  • Delayed Expression
  • Exaggerated startle response

What is a common misconception about the relation between dissociative symptoms and stress disorders?

  • They are solely linked to traumatic events.
  • They are indicative of greater impairment.
  • They should not include emotional detachment.
  • They only occur in combat veterans. (correct)

Which condition is specifically characterized by symptoms lasting longer than one month?

  • Survival guilt
  • Post-traumatic stress disorder (PTSD) (correct)
  • Dissociative disorder
  • Acute stress disorder

What is a primary condition that can lead to Acute and Post-Traumatic Stress Disorders?

<p>Exposure to actual or threatened death, serious injury, or sexual violence (B)</p> Signup and view all the answers

Which of the following experiences is NOT a recognized method of trauma exposure leading to PTSD?

<p>Learning about a trauma through social media (C)</p> Signup and view all the answers

Which group is at risk from inappropriate sexual experiences mentioned in the context of trauma exposure?

<p>Children, regardless of the presence of violence (A)</p> Signup and view all the answers

What type of exposure is considered extreme and can lead to trauma, specifically illustrated by first responders?

<p>Experiencing repeated exposure to aversive details of the traumatic events (D)</p> Signup and view all the answers

In what circumstance must the traumatic event involve a family member or close friend for it to contribute to PTSD?

<p>If the event was violent or accidental in nature (D)</p> Signup and view all the answers

What emotional response does the individual report experiencing while performing his duties as a security guard?

<p>He experiences boredom and excessive time for reflection. (C)</p> Signup and view all the answers

How does the individual cope with intrusive memories related to his traumatic experiences?

<p>He avoids socializing with friends from his Reserve unit. (B)</p> Signup and view all the answers

What is the primary source of stress for flight attendant Doreen Welsh during flights?

<p>Memories of a near-drowning experience during the crash. (B)</p> Signup and view all the answers

What physiological reaction does the flight attendant describe in response to stress?

<p>Experiencing an adrenaline rush and heart palpitations. (B)</p> Signup and view all the answers

Which of the following best describes the nature of the memories the security guard experiences?

<p>They are intrusive and occur daily without details being shared. (D)</p> Signup and view all the answers

Which factor has been shown to increase the risk of developing PTSD?

<p>Family history of PTSD (B)</p> Signup and view all the answers

Which of the following best describes Complex PTSD (CPTSD)?

<p>A special case of PTSD due to repeated trauma (A)</p> Signup and view all the answers

Which of the following factors is NOT considered a risk for developing trauma and stress-related disorders?

<p>Robust coping mechanisms (A)</p> Signup and view all the answers

Which of the following is NOT a hallmark symptom associated with chronic hyperarousal in trauma-related disorders?

<p>Increased energy levels (C)</p> Signup and view all the answers

Which of the following conditions is characterized by symptoms lasting more than one month as a result of traumatic events?

<p>Post-traumatic stress disorder (A)</p> Signup and view all the answers

Which symptom is indicative of dissociative symptoms in stress disorders?

<p>Emotional detachment (B)</p> Signup and view all the answers

Which of the following scenarios is associated with an increased risk of developing Acute and Post-Traumatic Stress Disorders?

<p>Learning about the violent death of a close friend (A)</p> Signup and view all the answers

What is a possible way an individual could be exposed to traumatic details that may lead to stress disorders?

<p>Experiencing repeated exposure to details as a first responder (C)</p> Signup and view all the answers

Which of the following best describes the nature of inappropriate sexual experiences as a form of trauma in children?

<p>Can occur without any violent behavior (C)</p> Signup and view all the answers

What type of exposure is recognized as directly increasing the risk of PTSD in individuals?

<p>Witnessing traumatic events first-hand (D)</p> Signup and view all the answers

Which requirement must be met for a traumatic event involving a family member to potentially lead to PTSD?

<p>The event must have involved a violent or accidental death (B)</p> Signup and view all the answers

What is a significant difference between Complex PTSD (CPTSD) and traditional PTSD?

<p>CPTSD includes changes in personal worldview and relationships. (B)</p> Signup and view all the answers

Which therapeutic approach relies on the visualization of trauma-related cues to address fear responses?

<p>Exposure therapy (C)</p> Signup and view all the answers

In the context of trauma therapy, what does 'sublimation' refer to?

<p>Finding personal meaning in a tragic event. (B)</p> Signup and view all the answers

What phase of Critical Incident Stress Debriefing involves soliciting symptomatology and suggesting coping strategies?

<p>Symptom phase (B)</p> Signup and view all the answers

What is a primary criticism of therapies such as EMDR and Polyvagal therapy?

<p>They are based on questionable neurological models. (D)</p> Signup and view all the answers

What emotional response does the security guard report while performing his duties?

<p>Boredom and time to think excessively (A)</p> Signup and view all the answers

What is a key behavior that the security guard exhibits in relation to his traumatic experiences?

<p>He avoids reminders of his past experiences. (D)</p> Signup and view all the answers

What physical reaction does flight attendant Doreen Welsh specifically mention experiencing during stressful flights?

<p>An adrenaline rush making her heart skip a beat (B)</p> Signup and view all the answers

What aspect of the experiences reported by the flight attendant contributes significantly to her stress during flights?

<p>Visions of potential catastrophic outcomes (B)</p> Signup and view all the answers

What type of memory does the security guard experience daily related to his traumatic past?

<p>Intrusive memories without wanting to share details (D)</p> Signup and view all the answers

What primary emotional state does the 10-year-old girl exhibit following the traumatic earthquake experience?

<p>Sadness and fear (A)</p> Signup and view all the answers

Which symptom is NOT reported by the 27-year-old infantryman related to his post-traumatic stress?

<p>Emotional numbness (A)</p> Signup and view all the answers

Following her traumatic experience, how did the 10-year-old girl’s temperament compare to her pre-morbid state?

<p>She became less interactive and withdrawn (B)</p> Signup and view all the answers

What aspect of the infantryman's behavior reveals his struggle with social interaction following his tours?

<p>He often spends time alone to avoid snapping at people (B)</p> Signup and view all the answers

What is a significant symptom exhibited by the girl that suggests the development of acute stress disorder?

<p>Disturbing dreams and hypervigilance (A)</p> Signup and view all the answers

Which form of exposure to traumatic events does NOT relate specifically to direct personal experience?

<p>Having a violent nightmare related to the event (B)</p> Signup and view all the answers

What type of exposure can lead to PTSD when it involves learning of a traumatic event affecting someone close?

<p>Learning about the event's violent or accidental nature (D)</p> Signup and view all the answers

Which of the following scenarios involves a repeated form of exposure that may cause trauma?

<p>Witnessing the aftermath of an accident repeatedly as a first responder (D)</p> Signup and view all the answers

Which of the following methods of exposure is NOT included in the criteria for PTSD?

<p>Watching a documentary about traumatic events (B)</p> Signup and view all the answers

In what situation does exposure to a traumatic event lead to the potential for PTSD?

<p>Experiencing the death of a family member through violent means (D)</p> Signup and view all the answers

Which system helps return your heart rate back to normal?

<p>parasympathetic NS (B)</p> Signup and view all the answers

What does the sympathetic nervous system release in response to a stressor?

<p>Adrenaline (epinephrine) and norepinephrine (A)</p> Signup and view all the answers

What does the HPA pathway release in response to a stressor?

<p>ACTH then Cortisol (A)</p> Signup and view all the answers

What is the structure and function of the autonomic nervous system (ANS)?

<p>A bundle of nerve fibers that connects your CNS to all other organs in the body, it regulates involuntary bodily functions such as heart rate and digestion (A)</p> Signup and view all the answers

Which areas of the brain are affected by PTSD?

<p>All of the above (D)</p> Signup and view all the answers

What is the result of the dysfunction between the amygdala, prefrontal cortex, and hippocampus associated with PTSD?

<p>Difficulty in emotional regulation (A)</p> Signup and view all the answers

Derealization is _______, while depersonalization is _______.

<p>The feeling of disconnect from surroundings; the feeling of disconnect from self (D)</p> Signup and view all the answers

Which group has the highest risk for sexual assault?

<p>non-college women aged 18-24 (A)</p> Signup and view all the answers

What kind of symptoms would be more common in non-westernized cultures for PTSD?

<p>Somatic (physical) symptoms like dizziness or pain (A)</p> Signup and view all the answers

Which of the following avoidant lifestyle factors can hamper PTSD recovery? (Select all that apply)

<p>all of the above (A)</p> Signup and view all the answers

Flashcards

Traumatic Stress Exposure

Exposure to actual or threatened death, serious injury, or sexual violence, either directly experiencing it, witnessing it, learning about it happening to a loved one, or experiencing repeated exposure to details. (Children can include inappropriate sexual experiences.)

Direct Experience

Personally experiencing a traumatic event.

Witnessing

Observing a traumatic event happening to someone else.

Learning about a loved one's trauma

Discovering that a close family member or friend experienced a traumatic event.

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Repeated Exposure to Averse Details

Ongoing and extreme exposure to graphic details of a traumatic event, such as first responders dealing with remains.

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Death of a loved one

The death of a close family member or friend, must have been violent or accidental in order to be traumatic.

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Post-Traumatic Stress Disorder (PTSD)

A mental health condition that can develop after a person experiences or witnesses a traumatic event, such as a serious accident, natural disaster, or military combat.

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Intrusive recollections

Unwanted and recurring memories of a traumatic event, appearing as flashbacks or nightmares.

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Acute Stress Disorder

A mental health condition triggered by a terrifying event that involves intense fear, horror, or helplessness. Symptoms usually start immediately after the event and last for a month or less.

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Dissociative symptoms

A detachment from reality or one's own body, often seen in stress disorders, increasing impairment.

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Chronic hyperarousal

A heightened state of alertness and anxiety, characterized by exaggerated startles, insomnia, vigilance, and restlessness.

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U.S. Airways Flight 1549

A commercial flight that had to make an emergency water landing on the Hudson River in 2009.

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Acute stress disorder (ASD)

A disorder characterized by severe anxiety following a traumatic event, lasting for 2 to 4 weeks (from trauma).

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Captain 'Sully' Sullenberger

The pilot who safely guided the U.S. Airways Flight 1549, which led to the water landing.

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Traumatic Experiences

Events or situations that cause overwhelming fear, horror, or helplessness, leaving lasting psychological effects on an individual.

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Post-traumatic stress disorder (PTSD)

A disorder that develops after experiencing or witnessing a traumatic event, and lasting longer than four weeks (from trauma).

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Delayed Expression PTSD

Signs of PTSD don't appear fully in the acute phase; symptoms develop later over months until diagnosable.

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Intrusive Memories

Unwanted, recurring thoughts or images related to a traumatic event which repeatedly disrupt daily life.

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Complex PTSD (CPTSD)

A type of PTSD triggered by prolonged trauma, often ongoing.

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Avoidance

A defense mechanism to cope with stress by avoiding people or places associated with a traumatic experience.

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Difficult Security Guard Duties

Security guard work that is described as boring and distracting, prone to cause stress and anxiety to a concerned person.

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Survival guilt/shame

Feeling of guilt for surviving a traumatic event where others died, coupled with a feeling of marginalization, unworthiness.

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Dissociative amnesia

A form of forgetting that is often triggered and seen frequently in combat veterans as part of trauma and stress disorder symptoms.

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Female Military Sexual Assault

23% of female service members report a history of sexual assault.

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Combat PTSD Prevalence

18% of combat veterans and 70% of prisoners of war (POWs) develop PTSD; 30% and 78% have lifetime PTSD.

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PTSD Duration

PTSD typically lasts 1-2 years, but can be lifelong for some veterans (30%) and POWs (78%).

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Resilience to PTSD

80+% of individuals exposed to combat are resilient to PTSD.

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Prior PTSD and Military Service Effect

Individuals with pre-existing PTSD who did not experience direct combat often find military service psychologically beneficial, reducing PTSD symptoms. Conversely, combat exposure can exacerbate PTSD symptoms.

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Risk Factors for PTSD

Severity and chronicity of trauma, family history of depression, anxiety, and/or PTSD, racial/ethnic minority status, poor coping habits, and lack of social support.

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Intergenerational Trauma

Trauma that is passed down through generations, potentially impacting individuals' responses to stress, through learned avoidance mechanisms or epigenetic effects. This is potentially evidenced in cultural belief systems.

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Complex PTSD

A specific type of PTSD resulting from repeated trauma over months or years.

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Trauma Exposure

Experiencing or witnessing a serious event like death, injury, or sexual violence. Can include seeing it happen to others, learning about it happening to loved ones or chronic exposure to details.

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Direct Trauma Exposure

Personally experiencing a traumatic event.

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Witnessing Trauma

Observing a traumatic event happening to someone else.

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Trauma Exposure to Loved Ones

Learning a loved one experienced trauma.

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Repeated Exposure to Trauma Details

Constant or extreme exposure to the graphic details of a traumatic event.

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Violent Death of a Loved One

The violent or accidental death of a close family member or friend.

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Acute Stress Disorder (ASD)

Severe anxiety lasting 2-4 weeks after a traumatic event.

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Post-Traumatic Stress Disorder (PTSD)

A disorder that develops after a traumatic event and lasts longer than 4 weeks.

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Boring Security Guard Job

A security guard job that is monotonous, leading to excessive thinking and causing stress.

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Intrusive recollections

Unwanted, repeated memories of a trauma, appearing as flashbacks or nightmares.

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Dissociative symptoms

Detachment from reality or one's body, common in stress disorders, increasing impairment.

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Easily Startled

A tendency to be startled by noises and movements, especially in those experiencing trauma.

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Chronic hyperarousal

Heightened alertness and anxiety, with exaggerated startles, insomnia, vigilance, and restlessness.

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Intrusive Memories

Unwanted, recurring memories of a traumatic event, often causing distress.

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Survival guilt/shame

Feeling guilty for surviving while others died, coupled with feeling unworthy or marginalized.

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Avoiding Friends

A coping mechanism where individuals avoid people associated with their traumatic experiences.

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Acute stress disorder (ASD)

Severe anxiety lasting 2-4 weeks after a traumatic event.

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Acute Stress Disorder (ASD)

A mental health condition triggered by a traumatic event with symptoms lasting less than a month.

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Post-traumatic stress disorder (PTSD)

A disorder lasting longer than 4 weeks, developing after a traumatic event.

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Post-Traumatic Stress Disorder (PTSD)

A mental health condition resulting from a traumatic event with symptoms lasting longer than one month.

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U.S. Airways Flight 1549

A commercial airliner that made a successful water landing on the Hudson River in 2009.

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Delayed expression PTSD

PTSD symptoms appear later, not immediately, even months after.

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Complex PTSD (CPTSD)

Prolonged trauma triggers this type of PTSD.

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CPTSD Trauma Types

Common CPTSD traumas include neglect, abuse (emotional, physical, sexual), domestic abuse, war zone experiences, human trafficking, and repeated serious illnesses/procedures.

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CPTSD Worldview Changes

CPTSD can lead to changes in a person's beliefs about life, religion, philosophy, relationships, and trust.

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CPTSD Revenge Fantasies

People with CPTSD may have recurring thoughts of getting revenge on their abusers.

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CPTSD vs. PTSD

CPTSD is a severe form of PTSD, characterized by lasting trauma from prolonged trauma.

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Exposure Therapy (PTSD)

A first-line treatment for PTSD using visualization of trauma-related cues, combined with relaxation, to reduce fear responses.

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CBT/CPT for PTSD

Cognitive methods to help change thoughts and interpretations of trauma (PTSD).

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EMDR for PTSD

Eye movement desensitization and reprocessing that aims to reduce trauma-related distress.

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Polyvagal Therapy (PTSD)

A treatment focusing on body awareness and anxiety reduction to manage trauma.

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Group Therapy/Self-Help PTSD

Support groups for PTSD where individuals can share experiences and gain support from others.

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Stress Management (PTSD)

Methods to help manage stress and emotional difficulties.

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CPTSD Relationships

Reframing relationships (PTSD) means to reevaluate and change relationships with abusers.

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Meaning in Tragedy (PTSD)

People often search for meaning in tragic events, even relating to trauma.

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Critical Incident Stress Debriefing (CISD)

A debriefing process helping those during or after a traumatic event.

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Acute Stress Disorder (ASD)

A mental health condition triggered by a traumatic event, with symptoms lasting less than a month.

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Post-Traumatic Stress Disorder (PTSD)

A mental health condition resulting from a trauma, with symptoms lasting longer than a month.

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Earthquake Trauma (Girl)

10-year-old girl's experience of a major earthquake, causing physical and mental distress.

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Military Combat Trauma (Victor)

27-year-old man's struggles after two tours in Iraq.

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Intrusive Thoughts (ASD/PTSD)

Unwanted and recurring memories, images, or thoughts related to trauma.

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Sleep Disturbances (Combat)

Difficulties sleeping, characterized by nightmares or waking with one eye open.

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Trauma Exposure

Experiencing or witnessing a serious event like death, injury, or sexual violence; including witnessing it happen to others, or learning about it happening to loved ones, or chronic exposure to graphic details.

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Direct Trauma Exposure

Personally experiencing a traumatic event.

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Witnessing Trauma

Observing a traumatic event happening to someone else.

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Trauma Exposure to Loved Ones

Learning a loved one experienced trauma.

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Repeated Exposure to Trauma Details

Constant or extreme exposure to the graphic details of a traumatic event.

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Violent Death of a Loved One

The violent or accidental death of a close family member or friend.

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Acute Stress Disorder (ASD)

Severe anxiety lasting 2-4 weeks after a traumatic event.

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Post-Traumatic Stress Disorder (PTSD)

A disorder that develops after a traumatic event and lasts longer than 4 weeks.

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Intrusive Recollections

Unwanted, repeated memories of a trauma, appearing as flashbacks or nightmares.

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Chronic Hyperarousal

Heightened alertness and anxiety, with exaggerated startles, insomnia, vigilance, and restlessness.

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Dissociative Symptoms

Detachment from reality or one's body, common in stress disorders

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Study Notes

Introduction to Psychopathology

  • Course materials (lectures, discussions, handouts, exams, web materials) are protected by US Federal Copyright Law and California Civil Code.
  • Downloading for private student use is permitted, only if currently enrolled in UCSB Psych 183.
  • Reproduction, in whole or part, for profit without instructor permission is prohibited.
  • Violating UC regulations and the DMCA is prohibited.

Notice

  • All course materials are protected by US Federal Copyright Law and California Civil Code.
  • Recording lectures or distributing/selling course materials without instructor permission is prohibited.
  • Students are allowed to take notes solely for private educational use.
  • Exceptions for students with disabilities may be made with proper documentation.
  • Completing and selling study guides is forbidden.
  • Exposure to actual or threatened death, serious injury, or sexual violence (including inappropriate experiences in children) can cause disorders.
  • Exposure can be direct, witnessing, learning about it affecting a close family member, or extreme/repeated exposure to details.
  • Trauma exposure through electronic media (TV, movies, etc.) does not fall under this category unless work-related.

Reactions to Extreme Trauma

  • Intrusive recollections (flashbacks, nightmares, illusions).
  • Acute distress with trauma cues.
  • Dissociative symptoms (psychic numbing): presence in stress disorders indicates greater impairment.
  • Emotional detachment, "daze".
  • Avoiding trauma-related topics.
  • Intrusive recollections.
  • Avoidance of trauma-related topics.
  • Forgetfulness or "fogginess" related to trauma (often seen in combat veterans).
  • Time distortion during trauma.
  • Feeling detached from body (depersonalization).
  • Feeling the environment is "dreamlike" (derealization).
  • Chronic hyperarousal (exaggerated startle, insomnia, hypervigilance, and motor restlessness).
  • Irritability, unprovoked anger outbursts, and aggression (particularly in males).
  • Feelings of guilt or shame related to survival experiences.
  • Impulsive or reckless behaviors related to survival guilt or shame.
  • Acute stress disorder (ASD): Disability lasting 2 days to 1 month, can occur even without interpersonal trauma. Extreme anxiety interfering with daily life is a symptom (sleep problems, energy levels, concentration, withdrawal, etc.).
  • Post-traumatic stress disorder (PTSD): Disability lasting a month or longer after the trauma. Prevalences depend on the type and severity of trauma and pre-existing risk factors.
  • Complex PTSD (CPTSD): Prolonged exposure to trauma. Not formally part of DSM-5-TR but identified as a concern.
  • Delayed expression of PTSD: Symptoms not prominent in acute phase, show gradual increase over months. Can develop into PTSD.

Case Studies

  • Case studies of acute stress disorder and post-traumatic stress disorder are presented, including specifics about individuals' experiences and reactions.

Acute and Post-Traumatic Stress Disorders (Specific Examples)

  • U.S. Airways Flight 1549: Case study of acute and post traumatic responses regarding a forced water landing. Case study of a passenger. Case studies of crew members.

9/11/2001

  • Historical event and example of potential trauma response.

Post-Traumatic Stress Disorder

  • Prevalence: Lifetime prevalence is ~7% worldwide, among adolescents it is 5-8%. Female-to-male ratio is 2:1.
  • Symptom onset: ~90% of ASD sufferers develop PTSD within 3 months; among those without diagnosable ASD, 10% show delayed symptom expression.
  • Gender differences: Males may display irritability and alcohol abuse. Females may experience more avoidance and anxiety.
  • Developmental impacts: Children can show regression in language and toileting skills, increased aggression, social isolation, and distressing dreams.
  • Complicating factors: Existing diagnoses of people with PTSD may be hampered by the development of avoidant lifestyles or anxiety disorders, in addition to alcohol or drug use. Somatic symptoms (e.g., dizziness, short of breath, heat sensations) may be more common in non-Western cultures.
  • Sexual violence: Includes attempted or completed rape and sexual assault, with significant gender disparities in prevalence.
  • Military combat: High rates of PTSD amongst veterans, including combat veterans and POWs.
  • Physical/emotional abuse: Includes childhood sexual/physical abuse, domestic violence, and workplace abuse.
  • Human calamities: Deliberate violence, such as bombings, torture, and terrorism; accidental events, such as accidents, fires, and natural disasters.
  • Other: Physical trauma (surgery, illness, disfigurement) and climate-related disasters are also listed as types of stressor-related problems.
  • Trauma severity and duration.
  • Family history of depression or anxiety.
  • Family history of PTSD.
  • Racial/ethnic minority status potentially due to discrimination, adversity, and limited access to quality treatment or social support.
  • Poor coping habits (e.g., smoking, drinking).
  • Intergenerational trauma: cultures with horrific histories have learned to not trust others or the external world.
  • Poor social support, particularly in combat veterans and victims of other serious trauma.

Complex PTSD (CPTSD)

  • Special case of PTSD resulting from repeated or continuous trauma over months or years.
  • Symptoms are more extreme and persistent than in "simple" PTSD.

Psychotherapy for PTSD

  • 1st-line treatment is exposure therapy (visualization of trauma).
  • Cognitive-behavioral therapy (CBT), including Cognitive Processing Therapy (CPT).
  • EMDR (Eye movement desensitization and reprocessing) - neurologically dubious; generic supportive therapy is a better choice.
  • Polyvagal therapy.
  • Group therapy/support groups.
  • Stress management training.
  • Finding meaning to help with reworking relationships with abusers.

Group Management for Acute Stress: Critical Incident Stress Debriefing

  • Steps in debriefing sessions.

Medication Treatment of ASD and PTSD

  • Medications for anxiety, panic attacks, depression, sleep disorders, and other symptoms; includes anxiolytics, antidepressants, antipsychotics, and sleep medications.
  • Special mention for antihypertensive drug prazosin (Minipress) for anxiety, flashbacks, nightmares.
  • Experimental post-stressor propanolol (Inderal) as a problematic memory-dulling medication.
  • Psychedelic administration as a topic of potential research but needs further study to determine effectiveness.

Mental Health Law and Regulations

  • Laws regarding confidentiality, including duty to warn, protect, and reporting child/elder abuse.
  • Laws on involuntary commitment (5150/5250 holds).
  • Laws on conservatorships.
  • Laws on assisted outpatient treatment (AOT)
  • California's Lanterman, Petris, and Short (LPS) Act

Additional Considerations and Concerns

  • Crisis of placement: mental illness individuals more likely involved with police than medical help due to behaviors resulting in unnecessary jailing.
  • Chilling reports/case studies presented to illustrate consequences of trauma and/or stressor-related disorders.

Other

  • Legal aspects.
  • Case studies.
  • Statistics.

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