PTSD Diagnostic Criteria and Prevalence

PTSD Diagnostic Criteria and Prevalence

• Post-traumatic stress disorder (PTSD) is a persistent anxiety disorder triggered by a traumatic event (actual/threatened death, serious injury, or sexual violence).
• It's classified as a trauma-and-stressor-related disorder, distinguishing it from other anxiety or dissociative disorders. The traumatic experience is a defining factor in the diagnosis.
• PTSD symptoms fall into four categories: intrusive symptoms (re-experiencing the trauma), avoidance, negative alterations in mood and cognition, and hyperarousal/hypervigilance.

Trauma and Stress-Related Disorders

• PTSD symptoms can develop even if the stressor is not life-threatening, such as witnessing a stressful event.
• Lifetime prevalence of PTSD is estimated at 1-3% of the general population, but is higher for groups with a higher risk of experiencing severe trauma (e.g., 12-33% for civilians in war zones, 10% for rescue workers).

Gender Differences in PTSD

• Women are significantly more likely than men to develop PTSD after a traumatic experience (2.4 times more).
• Possible contributing factors include differences in the nature of experienced trauma (e.g., sexual abuse vs war) and the associated stigma surrounding different types of trauma.
• Cultural factors and socioeconomic status can also contribute to differing rates of help-seeking among different demographic groups.

Acute Stress Disorder (ASD)

• ASD is a short-term psychological and physical response to severe trauma.
• Symptoms are similar to PTSD, but last no longer than 4 weeks, arising within 1 month of the trauma.
• Individuals with ASD have a high risk of developing PTSD symptoms in the subsequent months.

Avoidance and Dissociation

• Avoidance coping strategies after trauma often do not improve psychological health and can increase PTSD risk.
• Dissociation is a coping mechanism for detaching from trauma, which is a risk factor for developing PTSD.
• Dissociation may be an avoidant strategy for managing painful memories.
• People who dissociate during or just before a traumatic experience are more likely to develop PTSD.

Conditioning Theory

• Classical conditioning can explain PTSD symptoms. Trauma (unconditioned stimulus) becomes associated with the place and time of the trauma (conditioned stimulus), eliciting conditioned fear responses. Avoidance behavior reinforces this association.

Emotional Processing Theory

• Severe trauma leads to unique memory representations and associations, overriding previous positive associations related to a cue.
• Severe trauma can significantly change an individual's beliefs about themselves and the world.

Mental Defeat

• Mental defeat involves a victim mentality, negative processing of trauma, and a perceived lack of control over the outcome.
• Negative beliefs about self and the world resulting from trauma can maintain the disorder.

PTSD Treatment

• Exposure therapies (e.g., imaginal flooding, VR) aim to extinguish trauma-related fear by confronting trauma-related cues.
• Cognitive restructuring therapies assist patients with challenging and replacing dysfunctional thoughts and beliefs about the world.
• EMDR (eye movement desensitization and reprocessing) is an exposure-based therapy that has been controversial but has shown efficacy in some studies.
• Psychological debriefing is a structured intervention that aims to prevent PTSD in the immediate aftermath of trauma, but its efficacy is debated.

Biological Factors

• Elevated cortisol levels, hippocampus size, and amygdala activity are sometimes observed in PTSD patients.
• Genetic factors, and environmental factors and social factors can increase risk of PTSD.

Psychological Vulnerability Factors

• Factors that can increase vulnerability to PTSD include pre-existing anxiety, depression, or psychological disorders, low intelligence, and a tendency toward personal responsibility for events or misfortunes of others around them.
• Early childhood experiences, particularly separation from parents, or unstable family life contribute to greater risk and can change biological response to stress.

Treatments of Dissociative Disorders

• Treating dissociative disorders often involves psychodynamic and insight-oriented therapies focused on uncovering, releasing, and working through past trauma.
• These therapies aim to integrate different personality fragments/identities/states into a single coherent self and to resolve dissociative defenses.
• Standardized treatment protocols for dissociative disorders are not common, leading to difficulty in assessing therapy effectiveness.

Dissociative Disorders

• Dissociative disorders include a variety of syndromes that alter consciousness and impact memory and identity.
• Conditions include amnesia, fugue, dissociative identity disorder, and depersonalization/derealization disorder.
• Dissociative Disorders are not always triggered or caused by trauma, but they can be associated with it. These conditions can be difficult to diagnose accurately and the criteria for diagnosis can be subjective.