Midterm 2 Psych 300 Ch. 7 PDF

# Trauma & Stress-Related Disorders (Chapter 7) ## Learning Objectives * Be familiar with disorders included in this category. * Be familiar with diagnostic criteria for PTSD, ASD, Adjustment Disorder. * Be aware of controversies regarding PTSD as a diagnostic category. * Be familiar with predomin...

# Trauma & Stress-Related Disorders (Chapter 7) ## Learning Objectives * Be familiar with disorders included in this category. * Be familiar with diagnostic criteria for PTSD, ASD, Adjustment Disorder. * Be aware of controversies regarding PTSD as a diagnostic category. * Be familiar with predominant models of PTSD and the treatment strategies that flow from them. ## Trauma & Stressor-Related Disorders * Based on exposure to catastrophic or aversive life event. * Causes more impairment than it should ("than it should" is subjective and variable). * Variability in response to events. ## Distinct Events ### 1. Post-traumatic Stress Disorder (PTSD) #### Criterion A: Exposure to traumatic event * Actual or threatened death or serious injury to self or others. * **Interpersonal** * Most common events that lead to PTSD are interpersonal. * People have difficulty accepting the fact that other people would hurt them. * E.g. sexual assault, physical assault/abuse, combat, torture, genocide. * **Natural environment** * Less common sources of PTSD. * E.g. floods, earthquakes. #### 4 Symptom Clusters #### Criterion B: Intrusion symptoms (1) * Memories, images, dreams, nightmares related to the event but doesn't have to be about the exact event. * E.g. contains common themes). * Flashbacks are most common with combat victims. * Images can involve dissociation (alteration in consciousness). * Often cued by trauma stimuli. * Physiological reactivity to trauma cues. * Physiological distress to trauma cues. #### Criterion C: Avoidance of trauma-related stimuli (1) * Cognitive: * Environmental cues #### Criterion D: Negative alterations in cognitions & mood (2) * Exaggerated beliefs about self & world. * Persistent negative emotions. * Detachment, inability to feel pleasure. * Emotional numbing. #### Criterion E: Marked alterations in arousal and reactivity (2) * Hypervigilance. * Startle response. * Concentration problems. * Sleep disturbance. * Irritability. * Self-destructive actions. * Trying to protect themselves but the way they do it is not safe. * E.g. woman who was in car accident drives super fast because it is "less likely to hit a moving target #### Treatment of PTSD * Avoidance or attempts to avoid. * **Biological:** SSRIs - Paroxetine * May increase neurogenesis. * **Psychological** * Trauma-focused therapy: gold standard. * 1. **Exposure** * **In vivo** * **Imaginal** - prolonged imaginal exposure * Trying to retrieve the memory and sensory detail (e.g. what did you see/smell/taste etc). * When the memory is stored/coded again, it is less associated with fear, because it has been activated in a safe context. * This is repeated until it produces less fear. * Won't forget the trauma and still may experience intrusions, but not as severe. * Must be done professionally, otherwise it could be harmful. * 2. **Cognitive re-evaluation** * **Cognitive processing therapy** * Look at the beliefs they have developed because of the trauma, and consider if they are accurate or exaggerated. * E.g. blaming self instead of putting responsibility where it belongs. * **Prevention** * Critical incident stress debriefing. * Can be harmful and make people worse; i.e., desensitize them to the threat. * Effective alternative: preventive trauma-focused CBT * Look for dysfunctional sensory encoding, negative appraisals and safety behaviours, and address those before they become entrenched. * Staying in therapy is also effective. * 40% completely recover * Many people have some improvement. ### 2. Complex PTSD * Not in the DSM-5, but in the ICD-11. * Complex PTSD: prolonged or chronic exposure to trauma which shapes sense of self and disturbs self-organization. * Associated with childhood abuse. * Highest levels of comorbidity with depression and anxiety. * Lowest levels of psychological well-being. * **Diagnosis Criteria of the ICD-11** * PTSD criteria + 3 other symptom clusters: * Affects dysregulation * Negative self-concept (very low self-esteem) * Disturbances in relationships. #### Case Study: Residential School Trauma * **Reason for this**: culture clash * **Human nature** * Humans are fundamentally good vs born as sinner. * **Relationship of humans to the environment** * Western view: man should master the environment VS Indigenous view: reciprocity and part of spiritual whole. #### Criterion F: Impairment or Distress * Especially impairment. * Initially 50-60% of men who have been in military combat have PTSD. * But now, only 17% were substantially impaired by it. #### Clinical Picture * **Prevalence** * USA: 8.7% - point prevalence on some questionnaire, 3.5% are actually diagnosable. * Canada: 9.2% * Netherlands; 7.4% * Asia: 1% * **Events** * Civilians: rape, assault, emergency work, motor vehicle accidents (MVA). * Combat: captivity, torture, genocide. * **Onset** * Can occur at any age. * Less common as you get older as they are a bit more able to process negative things. * **Gender** * Females are at greater risk than men. * Women may be more likely to be at risk to traumatic events (e.g. assault). * Some say it's because women are more likely to report their distress. * Men manifest trauma in a different way - e.g. Anger. * **Course** * 50% recovery within 3 months. * Recovery rate then falls off. * Incidence rate of PTSD falls off at a slow rate. * After 2 years, prognosis is guarded and will continue to have significant symptoms. * PTSD results from a complex interaction - individual susceptibility + toxicity of event. * Criterion A1 event is necessary but not sufficient condition. #### Controversies of PTSD (1) * What is a traumatic event? * DSM III: outside of human experience. * DSM IV: broadened definition. * Almost anything could be considered a trauma. * Broad vs narrow definitions - trauma exposure increased from 68% to 89%. * DSM-5: threat to life or serious injury with some additional events in specific populations. * E.g. witness PTSD. * Should the "traumatic event" criterion be eliminated? * **Nonspecificity:** Most people who experience "traumatic" events do not develop PTSD, they can develop depression or panic disorder etc. * **Legal issues:** Increase in questionable/unsubstantiated claims, reliance on self-report, diagnosis assumes symptoms were caused by event. * Overlap with other disorders. * E.g. numbing, lack of pleasure - shared with depression. * But victims are aware of discontinuity in life. * They know their lives have fundamentally changed. * Avoidance and intrusions only make sense in light of traumatic event. * Eliminating Criterion A increases overlap with other disorders. * Are these events traumatic? * **Second-hand events:** Hearing about the death/ severe injury of a close person could constitute a trauma. * **Witnessed events** ## All things are related. * Spiritual relationship with the world. * Ethical responsibility towards all of creation. * Cognitive distinctions VS holistic thinking. * Linear vs spatial links. * Connections between events. * Communication differences. * Assertiveness VS deference and inclusiveness. * Gender roles. * Many Indigenous bands are matrilineal VS man as dominant in Western society. * Child rearing practices. * Social hierarchy VS cohesiveness. * Denigration of women and their roles - adhere to rules of patriarchal institutions of male dominance and female submission. * Children were separated from their parents. * Punished for speaking their own language. * Some schools only used numbers not names. * Abusive behaviour - verbal, physical and/or sexual. * Sense of denigrating the Indigenous culture - no sense of identity or belonging. * Lived in poverty, disease and death. * Schools poorly funded, lack of access to healthcare. * Result of residential schools on victims * Emotional suppression and numbness. * Lack of emotional awareness. * Unable to express verbally. * Unable to modulate thoughts, emotions & behaviours. * Impulsive violence. * Socio-cultural shame (of identity, self) * Attracted to alcohol and drugs to numb pain. ## PTSD VS C-PTSD * **PTSD** * **Criterion A: exposure to traumatic event** * Actual or threatened death or serious injury to self/others - interpersonal, genocide (destruction of a culture). * **Event risk factors:** trauma severity, low social support, lack of control. * **C-PTSD** - additional symptom clusters * Affect dysregulation: only taught emotion suppression. * Negative self-concept: shame and self-hatred. * Disturbances in relationships: physical and sexual abuse. * **Intergenerational transmission** * If you're not shown love and support, you can't show love and support to family and children. * If you're traumatised you're less able to care for your children. * Alcohol abuse leads to violence. * Physical and sexual abuse because those behaviours become normalised. * Western society punishes those who engage in violence & abuse which often perpetuates the problem. * Higher rates of C-PTSD in survivors of residential schools. * **Western approaches** * Don't always consider cultural differences. * The West focuses more on the individual and assertiveness towards others. * Legal offences result in punishment, prison and social isolation. * **Treatment philosophy**