Trauma & Stress Disorders Overview

Trauma & Stressor-Related Disorders

• Trauma & Stressor-Related Disorders are caused by catastrophic or aversive life events.
• They cause more impairment than expected.
• Variability exists in how individuals respond to events.

Post-traumatic Stress Disorder (PTSD)

• PTSD is categorized by exposure to a traumatic event involving actual or threatened death or serious injury to self or others.
• Most common traumatic events are interpersonal, such as sexual assault, physical assault/abuse, combat, torture, and genocide.
• Less common sources of PTSD involve natural environmental events, such as floods and earthquakes.
• PTSD is associated with four symptom clusters: Intrusion symptoms, Avoidance of trauma-related stimuli, Negative alterations in cognitions & mood, and Marked alterations in arousal and reactivity.

Criterion A: Exposure to traumatic event

• Interpersonal trauma is the most common cause of PTSD.
• Individuals struggling with PTSD often have difficulty accepting the fact that others would hurt them.

Criterion B: Intrusion symptoms

• Intrusion symptoms include memories, images, dreams, and nightmares related to the event (not always the exact event) that often contain common themes.
• Flashbacks are common among combat victims.
• Images can involve dissociation.
• Intrusive symptoms are often cued by trauma stimuli.
• Physiological reactivity and physiological distress to trauma cues also occur.

Criterion C: Avoidance of trauma-related stimuli

• Avoidance occurs cognitively and environmentally.

Criterion D: Negative alterations in cognitions & mood

• Individuals may develop exaggerated beliefs about themselves and the world.
• Persistent negative emotions, detachment, and an inability to feel pleasure (emotional numbing) can occur.

Criterion E: Marked alterations in arousal and reactivity

• Symptoms include hypervigilance, startle response, concentration problems, sleep disturbance, irritability, and self-destructive actions.
• Individuals may try to protect themselves in ways that are not safe, such as driving fast after a car accident under the belief that they are a “less likely to hit a moving target”.

Treatment of PTSD

• Avoidance or attempts to avoid trauma-related stimuli is common.
• Biological treatments include SSRIs, such as Paroxetine, which may increase neurogenesis.
• Trauma-focused therapy is considered the gold standard for PTSD treatment.
• Prevalence rates of PTSD vary geographically, with the USA at 8.7% and Asia at 1%.
• Common events that lead to PTSD in civilians include rape, assault, emergency work, and motor vehicle accidents (MVA).
• Common events related to combat include captivity, torture, and genocide.
• PTSD can occur at any age, but is less common in older individuals.
• Females are more likely to be at risk for PTSD than males, possibly due to a higher incidence of traumatic events in women.
• Some argue that women are more likely to report their distress.
• Men may manifest trauma in different ways, such as through anger.
• The recovery rate for PTSD is 50% within 3 months, but declines after that time.
• The incidence rate of PTSD also falls off at a slow rate.
• After 2 years, the prognosis for recovery is guarded and individuals may continue to experience significant symptoms.

Controversies of PTSD

• The definition of a traumatic event has evolved over time, leading to a broad vs narrow definition debate.
• The broad definition of trauma exposure increased from 68% to 89%.
• The DSM-5 introduced a requirement for a threat to life or serious injury for events to qualify as trauma, with additional criteria for specific populations.
• The nonspecificity of PTSD symptoms creates an overlap with other disorders, such as depression.
• Legal issues related to PTSD include questionable/unsubstantiated claims, reliance on self-report, and the assumption that symptoms are caused by the event.
• The debate about whether "traumatic events" should be eliminated from the PTSD criteria is ongoing.
• Second-hand events, such as hearing about the death or severe injury of a close person, could constitute trauma.

Complex PTSD (C-PTSD)

• C-PTSD is not included in the DSM-5, but is listed in the ICD-11.
• C-PTSD involves prolonged or chronic exposure to trauma that shapes an individual’s sense of self and disrupts self-organization.
• Childhood abuse is the most common cause of C-PTSD.
• It has the highest levels of comorbidity with depression and anxiety.
• Individuals with C-PTSD demonstrate the lowest levels of psychological well-being.

Diagnosis Criteria of the ICD-11 for C-PTSD

• The criteria for C-PTSD include the PTSD criteria + 3 other symptom clusters:
• Affect dysregulation- Individuals often have difficulty expressing emotions due to limited exposure to emotional regulation strategies in childhood.
• Negative self-concept- Individuals may experience shame and self-hatred.
• Disturbances in relationships - Individuals may struggle with relationships due to their experiences with abuse.
• The intergenerational transmission of C-PTSD can occur when individuals who have experienced trauma are unable to provide love and support to their children.

Case Study: Residential School Trauma

• The cultural clash between Indigenous and Western cultures led to the harmful policies and practices of residential schools.
• Differences in cultural perspectives on human nature, relationship to the environment, and cultural practices contributed to the negative impact of residential schools on Indigenous communities.
• The impact of residential schools on Indigenous survivors include emotional suppression, numbness, lack of emotional awareness, difficulty expressing emotions verbally, difficulty modulating thoughts, emotions, and behaviors, impulsive violence, socio-cultural shame, and attraction to alcohol and drug use to numb pain.

PTSD vs C-PTSD

• While both PTSD and C-PTSD involve exposure to a traumatic event, C-PTSD presents with additional symptom clusters:

  • Affect dysregulation
  • Negative self-concept
  • Disturbances in relationships

• The intergenerational transmission of trauma is highly relevant when examining the impact of C-PTSD on Indigenous communities:

  • Individuals who are traumatized may be less able to care for their children, resulting in intergenerational cycles of trauma.
  • The normalization of abuse through generations can perpetuate harmful behaviors.

• Western approaches to trauma do not always consider cultural differences and differences in cultural practices and beliefs.

• Legal approaches to violence and abuse in Western society often focus on punishment and isolation, which can perpetuate trauma by creating a disconnect between individuals and their communities.

• The treatment philosophy for C-PTSD requires a nuanced understanding of cultural perspectives and the impact of trauma on individuals and communities.

Criterion F: Impairment or Distress

• Impairment is a significant factor in the diagnosis of PTSD.
• Initially, 50-60% of men who served in combat experienced PTSD, but only 17% are now substantially impaired by it.

Clinical Picture

• Prevalence rates of PTSD in the USA are 8.7%, with a point prevalence determined by questionnaires, while 3.5% meet the diagnostic criteria.
• The text does not mention prevalence rates for gender.
• The impact of trauma is complex and varies depending on individual susceptibility and the toxicity of the event.
• While a Criterion A1 event is necessary for a PTSD diagnosis, it is not a sufficient condition.