Chapter 4 (Trauma Disorders)
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Questions and Answers

What type of behaviors indicate avoidance associated with PTSD?

  • Engaging in conversations about the traumatic event
  • Avoiding external reminders of distressing memories (correct)
  • Participating in activities that trigger strong emotions
  • Seeking out places that remind one of the trauma

Which of the following is NOT a symptom of negative alterations in cognitions and mood following a traumatic event?

  • Inability to remember an important aspect of the event
  • Excessive trust in others despite trauma (correct)
  • Persistent negative emotions such as fear or guilt
  • Diminished interest in significant activities

What age group does the PTSD: Preschool subtype specifically apply to?

  • Children aged 6 to 12 years
  • Children younger than 6 years old (correct)
  • Adolescents aged 13 to 17 years
  • Adults over 18 years old

Which cognitive change may occur due to PTSD after a traumatic event?

<p>Blaming oneself or others for the trauma (A)</p> Signup and view all the answers

What characterizes PTSD with prominent dissociative symptoms?

<p>Persistent experiences of depersonalisation or derealisation (B)</p> Signup and view all the answers

What is the defining period for PTSD with delayed expression?

<p>Full criteria not met until 6 or more months after trauma (A)</p> Signup and view all the answers

What is one possible emotional state associated with PTSD?

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

Which of the following best describes 'dissociative amnesia' in the context of PTSD?

<p>Loss of memory for key aspects of the traumatic event (D)</p> Signup and view all the answers

Which of the following is NOT a criterion for Acute Stress Disorder (ASD)?

<p>Presence of fewer than nine symptoms from five categories (D)</p> Signup and view all the answers

Which symptom category is NOT included in the diagnostic criteria for Acute Stress Disorder?

<p>Cognitive symptoms (B)</p> Signup and view all the answers

What does a 'persistent inability to experience positive emotions' refer to in PTSD?

<p>Inability to experience satisfaction or loving feelings (C)</p> Signup and view all the answers

What could be a common negative belief held by someone with PTSD?

<p>The world is unsafe and can harm me (D)</p> Signup and view all the answers

What is the duration of symptoms necessary to diagnose Acute Stress Disorder?

<p>3 days to 1 month (C)</p> Signup and view all the answers

Which statement best describes the nature of symptoms in Acute Stress Disorder compared to PTSD?

<p>ASD symptoms tend to be short-term reactions following trauma (D)</p> Signup and view all the answers

Which of the following is an example of feelings of detachment or estrangement in PTSD?

<p>Avoiding social situations entirely (A)</p> Signup and view all the answers

How many symptom categories are considered in diagnosing Acute Stress Disorder?

<p>Five categories (A)</p> Signup and view all the answers

Which symptom is NOT associated with Acute Stress Disorder?

<p>Compulsive behavior related to daily routines (C)</p> Signup and view all the answers

What is a characteristic of dissociative symptoms in Acute Stress Disorder?

<p>Inability to remember an important aspect of the traumatic events (B)</p> Signup and view all the answers

Which symptom can manifest as flashbacks in individuals with Acute Stress Disorder?

<p>Intense physiological reactions to distressing cues (D)</p> Signup and view all the answers

Which statement best describes an intrusion symptom of Acute Stress Disorder?

<p>Recurrent, involuntary, and intrusive memories of the traumatic event (D)</p> Signup and view all the answers

What is the estimated percentage of men who have experienced at least one trauma in their lifetime?

<p>60.7% (C)</p> Signup and view all the answers

What distinguishes an altered sense of reality in Acute Stress Disorder?

<p>Seeing oneself from another's perspective (B)</p> Signup and view all the answers

Which of the following indicates a negative mood in someone with Acute Stress Disorder?

<p>Inability to experience happiness (A)</p> Signup and view all the answers

Which trauma-related issue is women reported to experience more than men?

<p>Rape (A), Physical abuse (D)</p> Signup and view all the answers

What type of reactions might an individual experience in response to reminders of a traumatic event?

<p>Intense or prolonged psychological distress (C)</p> Signup and view all the answers

What percentage of the population is estimated to experience a motor vehicle accident at least once in their lifetime?

<p>23% (A)</p> Signup and view all the answers

What is the estimated incidence rate of PTSD from motor vehicle accidents?

<p>12% (C)</p> Signup and view all the answers

What is a key aspect that distinguishes Acute Stress Disorder from other disorders?

<p>Symptoms are not due to substance use (B)</p> Signup and view all the answers

Which of the following traumas are men more likely to report compared to women?

<p>Physical attack (D)</p> Signup and view all the answers

Which demographic is more likely to report experiencing trauma related to accidents?

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

Which is a primary focus examined in trauma- and stressor-related disorders?

<p>Diagnostic criteria (A)</p> Signup and view all the answers

What causes are considered for trauma- and stressor-related disorders?

<p>Traumatic experiences (D)</p> Signup and view all the answers

What is a psychological risk factor associated with PTSD?

<p>Negative Beliefs (A), Perception of control (B)</p> Signup and view all the answers

Which of the following is a known biological factor linked to PTSD?

<p>Disruption of verbal memory (A), Genetic predisposition (C)</p> Signup and view all the answers

Which type of trauma increases the risk of developing PTSD?

<p>All types of trauma (B)</p> Signup and view all the answers

What behavioral model is related to the understanding of PTSD?

<p>Mowrer’s Two-factor model (D)</p> Signup and view all the answers

What impact does social support have on PTSD outcomes?

<p>Negative support can hinder recovery (C)</p> Signup and view all the answers

Which factor does NOT contribute to the aetiology of PTSD?

<p>Higher intelligence (B)</p> Signup and view all the answers

What is the association between traumatic events and PTSD severity?

<p>More severe trauma increases PTSD risk (D)</p> Signup and view all the answers

Which of the following can predict a slower recovery from PTSD?

<p>Anger (D)</p> Signup and view all the answers

What is a common avoidance symptom associated with Acute Stress Disorder?

<p>Efforts to avoid distressing memories (D)</p> Signup and view all the answers

How long after an identifiable stressor do emotional or behavioral symptoms occur for Adjustment Disorders to be classified?

<p>3 months (D)</p> Signup and view all the answers

Which of the following is NOT one of the possible specifications for Adjustment Disorders?

<p>With psychotic features (A)</p> Signup and view all the answers

What duration cannot exceed for symptoms of Adjustment Disorders unless there is an enduring stressor?

<p>6 months (C)</p> Signup and view all the answers

Which of the following is considered a symptom of arousal in Acute Stress Disorder?

<p>Problems with concentration (A)</p> Signup and view all the answers

Which characteristic of Adjustment Disorders makes it probably the least stigmatized?

<p>It is often self-limiting (D)</p> Signup and view all the answers

In Acute Stress Disorder, what is exaggerated startle response classified under?

<p>Arousal symptoms (B)</p> Signup and view all the answers

Which of the following accurately describes the timeline for an Adjustment Disorder diagnosis?

<p>Symptoms must start within 3 months of stressor (B)</p> Signup and view all the answers

Flashcards

Avoidance (PTSD)

Avoiding reminders of the traumatic event, like people, places, or situations.

Dissociative Amnesia (PTSD)

Inability to remember important parts of a traumatic event, often not caused by physical factors like injury or substance use.

Negative Beliefs (PTSD)

Having overly negative thoughts about yourself, others, or the world after a trauma.

Negative Thoughts (PTSD)

Distorted thoughts about the cause or effects of the traumatic event.

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Negative Emotions (PTSD)

Feeling fear, horror, anger, guilt, or shame persistently after a trauma.

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Decreased Interest (PTSD)

Loss of enjoyment in activities once found pleasurable.

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Emotional Detachment (PTSD)

Feeling disconnected or estranged from others.

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Inability to Experience Positive Emotions (PTSD)

Difficulty feeling happiness, satisfaction, or love after a trauma.

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PTSD: Preschool Subtype

A specific type of PTSD for children under 6 years old, recognizing their unique symptoms and experiences.

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PTSD with Prominent Dissociative Symptoms

PTSD with added symptoms of depersonalization (feeling detached from oneself) or derealization (feeling detached from reality).

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PTSD Specifier - With Delayed Expression

PTSD diagnosed when symptoms appear more than 6 months after the traumatic event.

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Acute Stress Disorder (ASD)

Similar to PTSD but with a shorter time frame - symptoms last between 3 days and 1 month after a traumatic event.

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ASD Duration

ASD symptoms must last between 3 days and 1 month after trauma.

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ASD Diagnostic Criteria

ASD criteria are less specific than PTSD, allowing for a broader range of symptoms.

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ASD Exposure Criteria

ASD shares the same exposure criteria as PTSD - exposure to actual or threatened death, serious injury, or sexual violence.

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ASD Symptom Categories

ASD includes 9 or more symptoms across 5 categories: intrusion, negative mood, dissociation, avoidance, and arousal.

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Acute Stress Disorder

A mental health condition that develops after a traumatic event, causing significant stress and emotional distress within a month of the event. Symptoms include intrusive memories, nightmares, flashbacks, avoidance, negative thinking, and emotional numbness.

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Intrusive Memories

Unwanted, recurring memories of the traumatic event that intrude into your thoughts.

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Dissociative Reactions

Experiences of feeling detached from reality, like feeling as if the traumatic event is happening again (flashbacks).

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Trauma-specific Reenactment

In children, playing out the traumatic event through actions or play, even if they don't fully understand the meaning of their play.

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Negative Mood

Difficulty experiencing positive emotions, feeling hopeless or unable to find joy.

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Dissociative Amnesia

A gap in memory related to the traumatic event, typically due to dissociation and not to other factors.

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Altered Sense of Reality

Feeling detached from your surroundings or yourself, like feeling in a daze or time slowing down.

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Inability to Remember Traumatic Event

Trouble recalling important details about the trauma, but not because of factors like head injury or substance use.

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Avoidance Symptoms (Acute Stress Disorder)

Avoiding thoughts, feelings, or reminders (people, places, activities) related to the traumatic event.

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Arousal Symptoms (Acute Stress Disorder)

Increased alertness, irritability, sleep problems, and exaggerated startle responses.

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Adjustment Disorders

Emotional or behavioral changes occurring within 3 months of an identifiable stressor, lasting less than 6 months (unless the stressor is long-lasting).

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Types of Adjustment Disorders

Adjustment disorders can present with: depressed mood, anxiety, mixed anxiety and depressed mood, disturbance of conduct, or unspecified.

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Distinguishing Adjustment Disorders

Adjustment disorders are not a more severe form of stress reaction; they are distinct from other mental disorders.

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Stigma of Adjustment Disorders

Adjustment disorders are usually considered less stigmatized compared to other mental health conditions.

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Impact of Adjustment Disorders

Adjustment disorders can significantly impact daily life, including work, relationships, and overall well-being.

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Trauma Prevalence

A large study found that over half of the population experiences at least one trauma in their lifetime.

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Gender Differences in Trauma

Men are more likely to experience physical attacks and accidents, while women are more likely to experience sexual violence and abuse.

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MVA and PTSD

About 23% of people experience a car accident, and 12% of those develop PTSD.

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PTSD: Intrusion Symptoms

Recurring, unwanted memories, dreams, or flashbacks of the traumatic event.

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PTSD: Avoidance Symptoms

Avoiding people, places, or situations that remind them of the trauma.

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PTSD: Negative Thoughts & Mood

Difficulty feeling positive emotions, negative beliefs about oneself or the world.

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PTSD: Arousal & Reactivity

Increased alertness, difficulty concentrating, exaggerated startle response.

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PTSD: Dissociation Symptoms

Feeling detached from oneself or reality, amnesia for parts of the traumatic event.

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Comorbidity

The presence of two or more disorders in the same person at the same time.

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Mowrer's Two-factor Model

Explains PTSD development by combining classical conditioning (fear learned through trauma) with operant conditioning (avoidance behaviors reinforced by reducing anxiety).

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Smaller Hippocampal Volume

People with PTSD often have a smaller hippocampus, the brain region involved in memory.

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Supersensitivity to Cortisol

People with PTSD may have an overactive stress response, making them more sensitive to stress hormones like cortisol.

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Peritraumatic Dissociation

Experiencing detachment from oneself or reality during a trauma.

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Cognitive Avoidance

Trying to avoid thinking about the traumatic event, which can actually worsen PTSD symptoms.

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Negative Beliefs

Distorted thoughts about oneself, others, or the world after a trauma.

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Social Support (Lack of or Negative)

Lack of support or negative support from others can increase PTSD risk.

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Study Notes

  • This material has been reproduced and communicated by the University of South Australia.
  • It is subject to copyright under the Copyright Act 1968 (Act).
  • Further reproduction or communication is also subject to copyright protection.

Chapter 4: Trauma- and Stressor-Related Disorders

  • Includes: Reactive Attachment Disorder, Disinhibited Social Engagement Disorder, Posttraumatic Stress Disorder, Acute Stress Disorder, Adjustment Disorders, Prolonged Grief Disorder, Other Specified Trauma- and Stressor-Related Disorder, Unspecified Trauma- and Stressor-Related Disorder

Diagnoses of Anxiety Disorders

  • DSM IV-TR anxiety disorders categorized in three chapters in the proposed DSM-5: anxiety disorders, obsessive-compulsive, and trauma- and stressor- related disorders.
  • Agoraphobia transitioned from a subtype of panic disorder to a separate diagnosis.

Trauma- and Stressor-Related Disorders (summary)

  • Reactive Attachment Disorder
  • Disinhibited Social Engagement Disorder
  • Posttraumatic Stress Disorder
  • Acute Stress Disorder
  • Adjustment Disorders
  • Prolonged Grief Disorder
  • Other Specified Trauma- and Stressor-Related Disorder
  • Unspecified Trauma- and Stressor-Related Disorder

Learning Objectives

  • Describe current diagnostic criteria for PTSD
  • Identify PTSD prevalence and course of posttraumatic stress responses
  • Compare models accounting for PTSD development
  • Understand components of effective PTSD treatments and current challenges

Trauma- and Stressor-Related Disorders (Detailed)

  • PTSD contrasts with other disorders, it's a disorder of non-recovery.
  • Strong emotions, reactions, thoughts and behaviors occur during and after the traumatic event.
  • Recovery stalls for PTSD, instead of escalating over time.

The Diagnosis of Posttraumatic Stress Disorder (PTSD)

  • Exposure to a traumatic event

  • Re-experiencing symptoms (flashbacks)

  • Avoidance symptoms (avoiding reminders)

  • Negative changes in cognitions and mood (emotional numbing)

  • Marked alterations in arousal (hypervigilance)

  • DSM-5 Diagnostic Criteria: Exposure to actual or threatened death, serious injury or sexual violence. This includes: direct experience, witnessing, learning of experience, or repeated exposure to details (like first responders).

DSM-5 Diagnostic Criteria - PTSD (cont.)

  • Intrusion symptoms (involving memories, dreams, or dissociative reactions)

  • Avoidance symptoms (avoiding reminders)

  • Negative alterations in cognitions and mood (such as negative beliefs about oneself)

  • Marked alterations in arousal and reactivity (such as irritability, exaggerated startle response)

  • Duration of symptoms (more than one month)

  • Disturbance impairs social, occupational or other areas of functioning.

  • The disturbance is not directly attributable to the physiological effects of a substance or another medical condition.

DSM-5 PTSD Subtypes/Specifiers

  • Preschool subtype (children under 6)
  • Prominent dissociative symptoms
  • Delayed expression (full criteria not met until 6+ months)

Acute Stress Disorder (ASD)

  • Symptoms similar to PTSD but shorter duration
  • Symptoms occur between 3 days and 1 month after trauma
  • Diagnostic criteria less specific than for PTSD

Adjustment Disorders

  • Emotional or behavioral symptoms within 3 months of a stressor
  • Doesn't persist for more than six months after the stressor, unless the stressor is enduring.
  • Categorized by various symptom types (e.g. with depressed mood, with anxiety)
  • Can't involve the criteria for another disorder

Prolonged Grief Disorder

  • Death of a close person (at least 12 months prior)
  • Intense yearning, preoccupation with thoughts, avoidance, intense emotional pain
  • Disturbance impairing social functioning (e.g. reintegration difficulty)
  • Grief response exceeding social norms
  • Symptoms are not due to another disorder
  • Symptoms are not due to another medical or drug condition

Trauma and PTSD: Prevalence and Epidemiological Factors

  • Approximately 60.7% of men and 51.2% of women have experienced at least one trauma

  • Men reported physical attacks, threats, accidents or witnessing traumas more frequently than women.

  • Women reported rape, molestation, neglect or abuse.

  • Less than 7% of the population develop PTSD over their lives.

  • Individuals exposed to higher trauma rates are more likely to develop PTSD (e.g. war veterans).

Comorbidity and PTSD

  • High comorbidity with major depression, dysthymia, bipolar disorder, generalised anxiety, panic, social phobia and obsessive-compulsive disorders, alcohol and drug use disorders.

Aetiology of PTSD

  • Genetics, severity and type of trauma.
  • Neurobiological factors (e.g., smaller hippocampal volume, disrupted verbal vs. non verbal memory, effect of cortisol).
  • Behavioral factors (e.g. Mowrer's two-factor model)
  • Psychological factors (coping mechanisms, perception of control, avoidance, dissociation).

Risk factors for PTSD

  • Gender (women more affected)
  • Type of traumatic event (e.g., sexual assault, physical abuse)
  • Peritraumatic dissociation
  • Prior trauma (greater risk when experiencing multiple previous traumas).
  • Negative beliefs, cognitive avoidance
  • Lack of social support

Types of Traumatic Events and PTSD

  • Relationships as well as traumas from accidents, physical/sexual abuse or threats are factors.

The Treatment of PTSD

  • Medication (e.g., SSRIs)

  • Cognitive-Behavioral Therapy (CBT) – psychoeducation, anxiety management, cognitive restructuring, imaginal exposure, in vivo exposure, relapse prevention

  • Psychological Treatment of PTSD

  • Exposure therapy to memories; either in vivo (direct exposure) or imaginal exposure, more effective than meds or support therapy.

  • Eye-movement desensitization and reprocessing (EMDR).

  • Cognitive therapy (enhancing coping abilities).

Prevention of PTSD

  • Difficult to assess effectiveness of early interventions.
  • Early intervention may involve CBT approaches.

Current Challenges in Treatment

  • High rates of treatment drop-out
  • Helping patients tolerate distress from exposure therapy
  • Enhancing extinction learning.
  • Developing community-based treatments

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