PTSD Diagnosis based on DSM-5

PTSD Diagnosis (DSM-5)

• Exposure to actual/threatened death, serious injury, or sexual violence required
• Exposure can be direct, as a witness, learning of it happening to a close person, or repeated exposure to aversive details
• One or more intrusion symptom related to the event must be present
• Intrusion symptoms may include recurrent memories (repetitive play in children), recurrent dreams, dissociative reactions, and intense distress at cues
• Avoidance of traumatic event stimuli must be present, including efforts to avoid distressing memories or external reminders
• Negative alterations include cognitions/mood associated with the trauma
• Alterations evidenced by two or more present conditions, including inability to remember trauma aspects, exaggerated negative beliefs, and distorted cognitions
• Persistent negative emotional state, diminished interest, detachment, and inability to experience positive emotions are also included
• Arousal/reactivity alterations associated with the traumatic event must be present
• Alterations evidenced by two or more conditions, including irritable behavior, reckless behavior, hypervigilance, exaggerated startle, concentration/sleep problems
• Disturbance duration (criteria B, C, and D) exceeds one month
• The disturbance causes clinically significant distress and is not attributable to other conditions
• Specify subtype with dissociative symptoms, like depersonalization or derealization
• Specify if there is delayed expression, with criteria not met until six months post-event

PTSD in Children (Under 6)

• Requires fewer symptoms
• Behavioral indications, not verbal expressions
• Memories may be reenacted in play
• Some categories grouped
• Avoidance and cognitive/mood alterations
• Manifests differently (play/family settings)
• Difficulties verbally relating to trauma

PTSD Symptom Clusters

• At least one re-experiencing symptom
• At least one avoidance symptom
• At least two arousal and reactivity symptoms
• At least two cognition and mood symptoms

PTSD Etiology & Risk Factors

• Pre-existing vulnerabilities
• Severity/type of trauma
• Lack of social support
• Biological predispositions (genetic/neurobiological)
• Female gender
• Early life adversity
• Negative coping/ongoing stressors
• Repeated exposure

PTSD Protective Factors

• Strong social support
• Effective coping (not self-harm)
• Early intervention

PTSD Epidemiology

• 8% in the US, lower in Europe
• Varies based on population
• Military vs civilian
• Men vs women
• War country vs non-war
• Higher in populations with repeated exposure
• Rates differ with context and exposure to collective trauma
• Symptom expression differences and comorbidities affected by sociocultural factors

PTSD Treatment

• Involves psychosocial and pharmacological interventions
• Involves behavioral principles
• Addresses trauma-related stimuli while avoiding fear

Evidence-Based PTSD Psychotherapies

• Trauma-focused CBT
  • Includes exposure therapy and cognitive restructuring
  • Often used in children/adolescents
• Cognitive processing therapy (CPT)
  • Targets maladaptive thoughts
  • Emphasizes interpretations maintaining PTSD
  • Starts with psychoeducation
  • Creates a trauma impact statement
• Eye movement desensitization and reprocessing (EMDR)
  • Views PTSD as incomplete trauma memory processing
  • Memories stored in distorted state
  • Lists traumas, distorted/desired beliefs
  • Reprocessing has visualisations, sensation focus, and eye movements
• Prolonged exposure (PE) therapy
  • Reduces PTSD symptoms
  • Relaxation training and psychoeducation
  • Imaginal exposure (reliving trauma)
  • In vivo exposure (confronting situations)

PTSD Pharmacological Treatments

• SSRIs (e.g., sertraline, paroxetine)
  • First-line medications
  • Improve all symptoms and quality of life
  • Discontinuation leads to relapse
• Prazosin targets nightmares
  • but is not FDA-approved

Additional PTSD Considerations

• Medications and therapy are beneficial, but psychotherapy preferred
• Traditional models focus on individual pathology
• A social-interpersonal model expands social affect, support, and societal response

Trauma 3 Core Aspects

• Social affects including guilt, shame, anger
• Close relationships buffer
• Culture and society impacts

Clinical Applications of Trauma Model

• Incorporate family, peer, and community support

Differential Diagnosis and Comorbidities

• Adjustment disorders have stressors of any type/severity
• Acute stress disorder lasts three days to one month post trauma
• Anxiety disorders are not tied to a specific trauma
• OCD involves intrusive thoughts unrelated to trauma
• MDD lacks intrusion/avoidance or negative cognition/mood/arousal
• Personality disorders have interpersonal problems both before and after trauma, unlike PTSD
• Dissociative disorders may or may not be preceded by trauma
• Psychotic disorders: PTSD flashbacks distinguish from psychosis
• Traumatic brain injury can lead to PTSD and TBI, re-experiencing/avoidance is for PTSD, disorientation/confusion is for TBI

Comorbidity

• Rates are high and requires care when assessing
• May include depression, anxiety, or substance abuse

PTSD vs C-PTSD

• Complex PTSD (C-PTSD) is not in DSM-5, but is in ICD-11
• PTSD focuses on trauma, C-PTSD has dysregulation/self-concept/interpersonal issues
• C-PTSD is often linked to chronic trauma
• PTSD can result from a single traumatic event
• C-PTSD overlaps with borderline PD

PTSD Main Takeaways

• Complex disorder with individual/psychosocial dimensions
• Treatment needs therapy, medicine, and social support
• Socio-interpersonal model emphasizes social relations and societal response

Theme 2: Obsessive-Compulsive Disorder (OCD) Diagnosis (DSM-5)

• Involves obsessions, compulsions, or both
• Obsessions are recurrent, persistent thoughts/urges/images that are intrusive and unwanted, causing marked anxiety/distress
• The individual attempts to ignore/suppress these with another thought/action
• Compulsions have repetitive behaviors/mental acts the individual feels driven to perform in response to an obsession, according to rigid rules
• Behaviors/mental acts aim to prevent/reduce anxiety/distress or prevent a dreaded event, without realistic connection or are clearly excessive
• The obsessions/compulsions are time-consuming (more than 1 hour per day) and causes distress/impairment
• OC symptoms are not due to substance use or another medical condition
• Symptoms are not better explained by another mental disorder
• Specify insight: good/fair (recognizes beliefs may not be true), poor (thinks beliefs are probably true), absent/delusional (convinced beliefs are true)
• Specify if tic-related

OCD Compulsions

• Provide temporary relief
• Reinforce an anxiety cycle

OCD Dimensions

• Contamination: concern about dirt, germs, washing, showering, cleaning
• Harm-related: concern about harm, checking
• Unacceptability: aggressive, sexual, religious thoughts, praying
• Symmetry: symmetry concerns, ordering, straightening, repeating, counting
• Hoarding: hoarding concerns, hoarding behaviours

Related Conditions

• Anxiety disorders are more realistic and not compulsive
• MDD ruminations are not intrusive/triggering
• Body Dysmorphic appearance concerns
• Trichotillomania hair pulling
• Hoarding possessions
• Excoriation skin picking
• Eating Disorders are not limited to food
• Tics and stereotyped less complex/anxiety reducing
• Psychotic has poor insight, but lacks psychosis
• OC personality inflexible without intrusions/compulsions

OCD Comorbidity

• High with anxiety/mood/impulse control/substance use disorders
• OCPD with OCD
• Tic disorder
• Sometimes ADHD

OCD Etiology

• Dysregulation in CSTC brain circuits
• Family genetics
• Neurotransmitter abnormalities
• Cognitive dysfunction
• Obsessions lead to compulsions
• Failures to stop fear cycle
• Altered thought
• Poor life

OCD Traits

• Stress
• Trauma
• Overestimate threat
• Overthink
• Needy

OCD Epidemiology

• Onset childhood
• Slight female overlap
• Comobid with anxiety, tics, depression

Categories of OCD traits

• Overthinking
• Hyperfocus
• Fear

Characteristics of Traits

• Harm
• Loss
• Guilt

Treatment

• ERP
• Meds

OCD Memory

• Hyper self-conscientious
• Poor recall with intrusive

Treatment Goal

• Calmin the feedback look
• Change the pattern
• Address triggers

Steps with ERP

• Therapist shows non reaciton
• Then shows patient
• Then has patient do it
• Slowly

Schizophrenia Diagnoses

• Delusions
• Hallucinations
• Speech issues
• Negative issues

Sczhizpphrenia details

• Must interfer with work if more then 6 months
• ASD is not linked
• Hallucination are not real

Schiphrenia traits

• derailment
• Clanging
• Word salad