PTSD Triggers and Symptoms Quiz

Introduction to Psychopathology

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Traumatic and Stressor-Related Disorders

• Disorders can result from exposure to actual or threatened death, serious injury, or sexual violence.
• This exposure can occur directly experiencing the event, witnessing it, learning of it happening to a family member/friend, or experiencing repeated/extreme exposure to aversive details.
• Examples of aversive details include first responders collecting human remains.

Reactions to Extreme Trauma

• Intrusive recollections (flashbacks, nightmares, illusions) and acute distress (upon trauma cues).
• Dissociative symptoms (psychic numbing, emotional detachment, daze, dropping out of activities, avoidance of trauma-related topics, forgetting aspects of trauma).
• Dissociative amnesia (common in combat vets). Time distortion (slow motion).
• Feelings of detachment from one's body (depersonalization).
• Feeling detached from the surroundings (derealization).
• Chronic hyperarousal (exaggerated startle, sleep problems, vigilance, motor restlessness).
• Irritability, outbursts, aggression (esp. males).
• Survival guilt/shame (believing one doesn't deserve to live, feeling marginalized).
• Reckless, impulsive behaviors.

Major Trauma and Stressor-Related Disorders (DSM-5-TR)

• Acute stress disorder: Disability from 2 days to 1 month. Occurs in 20% of cases (not involving interpersonal assault), and in 20-50% of cases following interpersonal assault (e.g., accidents.) High anxiety, interference with sleep, energy, concentration, withdrawal, work absenteeism, reduced self-care, and inability to parent.
• Post-traumatic stress disorder (PTSD): Disability for over 1 month, with PTSD episodes or series of episodes. Prevalences rely on past trauma and pre-existing risk factors.
• Complex PTSD (CPTSD): From prolonged trauma. Approximately 10% of people with PTSD show delayed expression of symptoms.
• Note: Complex PTSD is a research topic, not in DSM-5-TR.

Case Studies

• Acute Stress Disorder: A 10-year-old girl, following a major earthquake, experienced symptoms like weakness, decreased food intake, speech problems, and incontinence. She displayed significant fear triggered by reminders of the earthquake. Her pre-morbid personality was playful, interactive, obedient, extroverted, and studious.
• Post-Traumatic Stress Disorder: A 27-year-old veteran reported significant sleep difficulties, nightmares, and avoidance of experiences from his time in Iraq. He displayed irritability, difficulty sleeping, and avoidance of certain situations and people.

Acute and Post-Traumatic Stress Disorders: U.S. Airways Flight 1549 (e.g., "Miracle on the Hudson")

• Captain "Sully" Sullenberger was forced to ditch his disabled plane on the Hudson River, saving 155 lives.
• Accounts from passengers and crew describe intense fear and near-drowning experiences.

9/11/2001

• A major traumatic event.

Post-Traumatic Stress Disorder Prevalence

• General US population: 2-3% prevalence, lifetime prevalence ~7%, and ~4% worldwide.
• Adolescents: 5-8% lifetime prevalence.
• 90% of acute stress disorder sufferers develop PTSD.
• Symptom differences: PTSD in females involves higher chances of numbing/anxiety avoidance and prolonged symptoms; PTSD in males is linked to irritability and increased alcohol use.
• Children can show regression, aggression, social isolation, and distressing dreams.

Common Precipitants of Trauma and Stressor-Related Disorders

• Sexual violence (attempted or completed rape, sexual assault): >300,000 cases per year in USA. Females 16-19 and college females (18–24) are disproportionately vulnerable.
• Military combat: PTSD is common in veterans (18% of combat veterans and 70% of POWs).
• Physical/emotional abuse: Includes childhood sexual/physical abuse, domestic violence, and workplace abuse.
• Human calamities: Deliberate acts (bombings, torture), accidents (motor vehicle, plane crashes), physical trauma (surgery, disease), climate-related events (floods, earthquakes).

Risk Factors for Developing Trauma and Stressor-Related Disorders

• Severity and duration of trauma.
• Family history of depression/anxiety or PTSD.
• Racial/ethnic minority status (discrimination), coping mechanisms (smoking/drinking), and lack of social support can increase risk.
• Intergenerational trauma can negatively affect coping mechanisms for trauma.
• Limited social support.
• Poor coping habits/preexisting substance abuse.

Complex PTSD (CPTSD)

• A special case of PTSD caused by repeated or continuous trauma (months or years). Symptoms are usually more severe and lasting than traditional PTSD.
• Trauma types: emotional/physical/sexual abuse, growing up in a violent home, being a POW/warzone resident, human trafficking, and repeated medical procedures/surgeries.
• Associated features include altered worldview, loss of faith, and difficulty trusting, plus typical PTSD symptoms.
• The primary debate is determining if CPTSD is just a severe form of PTSD.

Psychotherapy for PTSD

• First-line treatment is exposure therapy and relaxation techniques to neutralize trauma-related cues.
• Cognitive-behavioral therapies (CBT/CPT) help change thoughts/reactions to trauma.
• Eye Movement Desensitization and Reprocessing (EMDR) is a controversial technique.
• Polyvagal therapy focuses on anxiety reduction by improving bodily awareness.
• Group/self-help (rap) therapy focuses on support and catharsis.
• Stress management training assists in managing day-to-day stressors.

Group Management for Acute Stress: Critical Incident Stress Debriefing

• Method of helping victims deal with stress after a critical event (e.g. disaster).
• Stages include fact, reaction, symptom, teaching, and reentry phases.
• Note: Debriefing's effectiveness is questionable.

Medication Treatment of ASD and PTSD

• Symptomatic care: Anxiolytics (short-term anxiety), antidepressants (severe depression), antipsychotics (for severe reactions), and sleep medications.
• Experimental: Post-stressor Propranolol (reduces memory consolidation after stress), psychedelic administration (MDMA, Psilocybin, LSD, Ketamine, DMT).

Mental Health Law and Regulations

• California laws related to mental health are listed in publications from the California Hospital Association.
• Confidentiality of patient information requires patient consent unless there are exceptions.
• Involuntary commitment ("5150 hold") can be imposed when a patient poses imminent danger to themselves/others or is seriously disabled, due to a chronic illness, or to the failure to enter a facility voluntarily.

Involuntary Commitment

• "5150 hold" describes the 72-hour emergency evaluation period which can be implemented when an imminent danger exists to the patient or to others.
• The 14-day "5250 hold" is used initially after the 72-hour hold to permit in-depth treatment; it can be extended by court order for an additional period not exceeding 180 days.

A Crisis of Placement

• People with mental illnesses face a significant risk of being jailed rather than receiving proper medical assistance.
• Many individuals with ailments don't get proper care within the system, and their issues often worsen.

Involuntary Long-Term Custodial Care ("Conservatorship")

• Patients may be placed under a conservator for a mental health condition (30-day temporary or unspecified long-term) when seriously disabled.
• The court appoints a licensed conservator to manage the care, treatment, and living arrangements of the affected individual.

Assisted Outpatient Treatment (AOT)

• A court-ordered treatment regime for people with mental disorders.
• A transitional period for those discharged from inpatient care but still need assistance/support.
• Requires public/personal legal representation.

Mental Health Law Touches UCSB

• The report details the planning and execution of the Elliot Rodger killings in 2014.

CA Law AB 1014 – Temporary Gun Seizure

• The law allows a court to temporarily seize firearms from individuals who are judged to be a danger to themselves or others.
• The seizure occurs without prior notice to the involved party.