PTSD

PTSD Trauma- and Stressor-Related Disorders

• Acute Stress Disorder: mild PTSD, lasting about 1 month
• Adjustment Disorders: non-physical threats
• Posttraumatic Stress Disorder (PTSD)

Posttraumatic Stress Disorder (PTSD)

• Exposure to actual or threatened death, serious or sexual violence in which the sense of personal safety is threatened
• Direct experiencing of traumatic event(s)
• Witnessed in person the events as it occurred to others
• Learning that the traumatic events occurred to person close to them
• Experiencing repeated or extreme exposure to aversive details of trauma
• Presence of 1+ intrusive symptoms after the event:
  • Recurrent, involuntary and intrusive memories of event (reliving the event)
  • Flashback triggered by stimulus (usually related to the trauma)
  • Recurrent trauma-related nightmares
  • Dissociative reactions
  • Intense physiologic distress at cue exposure
  • Makes physiological reactivity at cue exposure
• Body enters perpetual fight-or-flight
• Can cause different neurological disorders because of hyperarousal
• Complex PTSD: if chronic sexual trauma as a child leads to perpetual fight-or-flight (most likely for life)

PTSD Symptoms

• Persistent avoidance by 1 or both:
  • Avoidance of distressing memories, thoughts or feelings of the event(s)
  • Avoidance of external reminders of that arouse memories of event(s) e.g. people, places, activities
• PTSD CHANGES IN COGNITIONS AND MOOD:
  • Inability to remember an important aspect of the traumatic event(s)
  • Persistent distorted cognitions about cause or consequence of event that lead to blame of self - or others
  • Persistent negative emotional state
  • Marked diminished interest
  • Feeling detached from others
  • Persistent inability to experience positive emotions
• PTSD CHANGES IN AROUSAL AND REACTIVITY:
  • Irritable behavior and and angry outbursts
  • Reckless or self-destructive behavior
  • Hypervigilance
  • Exaggerated startle response
  • Problems with concentration
  • Sleep disturbance
• Due to constant arousal

PTSD Epidemiology

• 7-9% of general population
• 60-80% of trauma victims
• 30% of combat veterans
• 50-80% of sexual assault victims
• Increased risk in women, younger people (because they are more vulnerable in society; no biological, psychological reasons)
• Risk increases with “dose” of trauma, lack of social support, pre-existing psychiatric disorder

PTSD Comorbidities

• Depression
• Other anxiety disorders
• Substance use disorders
• Somatization
• Dissociative disorders

PTSD Risk Factors

• PRE TRAUMA:
  • Genetic Predisposition
  • Neurological Vulnerabilities:
    • Low cortisol levels = abnormal stress response
    • Amygdala hyperactivation with PTSD (constantly turning on without calming down)
    • Smaller hippocampal volume as a vulnerability factor for developing PTSD symptoms
  • Developmental Factors:
    • Stress sensitization: childhood adversity
    • Attachment style: Secure vs Insecure
    • History of psychiatric illness: family & personal
• PERSONALITY FACTORS:
  • Neuroticism: more intense reactions to stress
  • Impulsivity: increased likelihood of experiencing trauma
• PSYCHOPATHOLOGY:
  • Resilience: Self-efficacy, problem-solving, coping abilities (decreased likelihood of PTSD)
  • Optimism (decreased likelihood of PTSD)

During Trauma

• Peritraumatic Disassociation:
  • Dissociation of the brain from the body for self-protection
  • Altered Sense of Self
  • Cause Unclear
• Cognitive Appraisal:
  • Evaluation of the Situation
  • Altered Assumptions

Post Trauma

• Maladaptive Coping:

  • Anger, shame
  • Negative appraisals of event, self, others, and world
  • Avoidance/attempts to suppress thoughts

• Social Support### PTSD Symptoms

• Changes in Cognitions and Mood: inability to remember important aspects of traumatic events, persistent distorted cognitions about cause or consequence of event, leading to blame of self or others, and persistent negative emotional state

• Changes in Arousal and Reactivity: irritable behavior, angry outbursts, reckless or self-destructive behavior, hypervigilance, exaggerated startle response, problems with concentration, and sleep disturbance

Epidemiology

• 7-9% of general population, 60-80% of trauma victims, 30% of combat veterans, and 50-80% of sexual assault victims are affected by PTSD
• Increased risk in women, younger people, those with lack of social support, and those with pre-existing psychiatric disorders
• Comorbidities include depression, other anxiety disorders, substance use disorders, somatization, and dissociative disorders

PTSD Risk Factors

• Genetic Predisposition: heritability of .40 in twin study of Vietnam veterans
• Neurological Vulnerabilities: low cortisol levels, amygdala hyperactivation, and smaller hippocampal volume
• Developmental Factors: stress sensitization, childhood adversity, insecure attachment style, and history of psychiatric illness
• Personality Factors: neuroticism, impulsivity, and psychopathology
• Resilience: self-efficacy, problem-solving, coping abilities, optimism, and social support
• Psychological Vulnerabilities: lack of social support, external locus of control, negative attributional style, rumination, and looming cognitive style
• Cognitive Vulnerabilities: negative appraisals of event, self, others, and world, and avoidance or suppression of thoughts

Peritraumatic Factors

• Dissociation: dissociation of the brain from the body for self-protection, unclear causes, and affects PTSD development
• Cognitive Appraisal: evaluation of the situation, altered assumptions, and maladaptive coping
• Social Support: perception, availability, satisfaction, and external locus of control