Trauma and Stress Disorders

• Trauma involves maladaptive reactions that follow exposure to emotionally disturbing or life-threatening incidents or repeated events.

Types of Trauma

• Acute trauma stems from a single event, such as a car accident.
• Chronic trauma results from repeated exposure, such as domestic violence or emotional and sexual abuse.
• Complex trauma involves multiple and varied events, often starting in childhood and are interpersonal, like abandonment and neglect.
• Secondary trauma is common among therapists and first responders.

Adjustment Disorder

• Reactions to the event are out of proportion.
• Symptoms develop within 3 months of the stressor's onset.
• Symptoms end within 6 months of experiencing the stressor(s).
• The stress response does not meet criteria for another mental disorder and is not an exacerbation of symptoms of another mental disorder.

Acute Stress Disorder

• Requires exposure to actual or threatened events relating to death, serious injury, or sexual abuse.
• Symptoms last from 3 days to 1 month.
• Requires at least 9 of the following symptoms:
  • Intrusive symptoms include recurrent distressing memories or dreams, dissociative reactions (flashbacks), and distress or physiological reactions to event-related cues.
  • Negative mood is characterized by the inability to experience positive emotions.
  • Dissociative symptoms involve altered reality of surroundings or self, and inability to remember aspects of the event.
  • Avoidance symptoms include avoiding memories, thoughts, or feelings related to the event and external reminders.
  • Arousal symptoms include sleep disturbance, irritability and anger, hypervigilance, concentration problems, and an exaggerated startle response.

Post-Traumatic Stress Disorder (PTSD)

• Symptoms last for more than 1 month.
• Requires one or more intrusive symptoms like recurrent distressing memories or dreams, dissociative reactions (flashbacks), intense distress, and physiological reactions to cues.
• Requires one or both avoidance symptoms, such as avoiding memories, thoughts, or feelings, and external reminders.
• Requires two or more negative experiences in cognitions and mood, including inability to remember aspects of the event, inability to experience positive emotions, persistent negative states, detachment, exaggerated negative beliefs, distorted cognitions leading to self-blame, and diminished interest in activities.
• Requires two or more arousal and reactivity symptoms such as sleep disturbance, irritability and anger, hypervigilance, concentration problems, exaggerated startle response, and reckless behavior.

Etiology of PTSD

Psychological Models

• Maladaptive appraisals involve negative self-evaluation.
• Classical conditioning leads to event triggers (CS) causing fear reactions (CR).

Biological Models

• Stress neurochemicals such as noradrenaline and adrenaline are released, strengthening fear conditioning and heightening awareness.

Social Model

• Social support builds resilience, while lack of support can exacerbate symptoms.

Neurobiology of PTSD

• Primarily involves the amygdala, hippocampus, and prefrontal cortex.

Amygdala

• The Amygdala processes emotions and is hyperactive during trauma.
• During fear conditioning neutral stimuli become associated with fear or trauma, leading to exaggerated fear responses.
• Emotional memory dysfunction can cause flashbacks.
• Heightened sensitivity to threat results in hypervigilance and threat perception.
• Neuroplasticity in the amygdala can help rebuild positive connections and heal from PTSD.
• Disrupts contextualization and regulation of emotional responses to traumatic memories through interaction with the Hippocampus.

Hippocampus

• The Hippocampus is responsible for memory formation and emotional regulation, and shrinks when trauma occurs
• Alterations in consolidating memories can disrupt the encoding and retrieval of memories related to traumatic experiences.
• Dysfunction in emotion regulation can lead to difficulties in differentiating past traumatic experiences from present reality, exacerbating emotional reactivity and arousal.
• Hippocampal alterations contribute to difficulties in contextualizing traumatic memories, leading to intrusive recollections and flashbacks detached from their original context.
• Stress and trauma exposure can hinder neurogenesis and dendritic branching, impacting its ability to adapt and recover from traumatic experiences.
• Reduced hippocampal volume and function disrupts interaction with the Amygdala and can exacerbate amygdala hyperactivity, contributing to symptom severity