PTSD_2016.pptx

PTSD Sydney B. Miller Trauma- and Stressor-Related Disorders    Acute Stress Disorder Adjustment Disorders Posttraumatic Stress Disorder  https://www.youtube.com/watch?v=JBUjL Xtedfc Posttraumatic Stress Disorder  Exposure to actual or threatened death, serious or sexual violence in...

PTSD Sydney B. Miller Trauma- and Stressor-Related Disorders    Acute Stress Disorder Adjustment Disorders Posttraumatic Stress Disorder  https://www.youtube.com/watch?v=JBUjL Xtedfc Posttraumatic Stress Disorder  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  PTSD continued PRESENCE OF 1 OR MORE INTRUSIVE SX AFTER THE EVENT      RECURRENT, INVOLUNTARY AND INTRUSIVE MEMORIES OF EVENT RECURRENT TRAUMARELATED NIGHTMARES DISSOCIATIVE REACTIONS INTENSE PHYSIOLOGIC DISTRESS AT CUE EXPOSURE MARKED PHYSIOLOGICAL REACTIVITY AT CUE EXPOSURE 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 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 Risk increases with “dose” of trauma, lack of social support, pre-existing psychiatric disorder Comorbidities      Depression Other anxiety disorders Substance use disorders Somatization Dissociative disorders Acute Stress Disorder     Similar exposure as in PTSD Presence of >9 of 5 categories of intrusion, negative mood, dissociation, avoidance, and arousal related to the trauma. Duration of disturbance is 3 days to 1 month after trauma Causes significant impairment Critics of the PTSD definition  PTSD as a homogenous response to trauma BUT not all individuals will develop PTSD.  Looks at the event, and not at the individual himself PTSD Risk Factors  Pre trauma       During Trauma     Genetic Predisposition Neurological Vulnerabilities Developmental Factors Psychological Vulnerabilities Cognitive Vulnerabilities Peritraumatic Dissociation Cognitive Appraisal Biological Reaction Post Trauma   Coping Social Support Genetic Predisposition Genetic factors  Twin study of Vietnam veterans: heritability of .40 (True et al., 1999, 1993) Neurological vulnerabilities  Low cortisol levels  Increased blood flow in left hippocampus (Shin & al., 2004)  Amygdala activation with PTSD  Smaller hippocampal volume as a vulnerability factor for developing PTSD symptoms. (Gilbertson and collegues, 2002) Developmental Risk Factors  Stress sensitization   Attachement styles   Childhood adversity Secure vs Insecure History of psychiatric illness  Family & personal Personality Factors  Neuroticism   More intense reactions to stress Impulsivity Likelihood of experiencing trauma  Psychopathology   Resilience   Self-efficacy, problem-solving, coping abilities Optimism Psychological vulnerabilities  Lack of Social support : perception  availability  satisfaction   External Locus of control : less able to endure stressfull events  attribution of responsability : Role of responsability and self-blame  Cognitive vulnerabilities      Negative attributional style Problem vs Emotion Focused Coping Rumination Looming cognitive style (overestimation of the intensity of the threat) Cognitive schemas about self, world and future Risk Factors During Trauma  Peritraumatic Disassociation Altered Sense of Self  Cause Unclear   Cognitive Appraisal Evaluation of the Situation  Altered Assumptions   Biological Reaction  “HPA Deregulation” Cognitive Appraisal “The World is a Safe Place” Traumatic Event Assumption Shattered Generate New Assumption / Integrate Event Difficulty PTSD HPA Axis Deregulation  Low Cortisol Levels  DST Test Yehuda et al., 1995  Vietnam Combat Veterans  No PTSD N = 14 PTSD N = 14 DST Test  Cortisol Hypersuppression Hippocampus Damage DST X Post Trauma Risk Factors  Lack of Social support  Maladaptive Coping Coping With the Event  Anger, shame  Rumination  Negative appraisals of event, self, others, and world  Attention bias for trauma-related stimuli  Avoidance/ attempts to suppress thoughts  Experiential Avoidance Experiential Avoidance eg. Marks & Sloan, 2005 Trauma Fire in the Metro Avoidance Affective Physiological Feeling Sad Feeling Warm Mourning Loss Burning Smells Behavioural Using the Metro Cognitive Thinking about the explosion People Involved Temporary Relief Reexperiencing / Poor Coping Conclusions  Exposure to trauma is a necessary but insufficient condition for the development of PTSD  Retrospective vs. prospective Conclusions  Most consistent risk factors: Neuroticism  History of psychiatric illness  Perceived threat  Social support  Implications  Treatment of PTSD requires a multimodal approach that considers biological predispositions  Personality/psychological factors  Social factors  Bibliography          American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th – Text Revision ed.) Washington, DC. Shin, L.M. & al. (2004). Hippocampal Function in Posstraumatic Stress Disorder. Hippocampus, 14 (3), 292-300. Meewisse, M., Reitsma, J., De Vries, G., Gersons, B.P.R., Olff, M. (2007). Cortisol and posttraumatic stress disroder in adults. British Journal of Psychiatry, 191, 387-392. Yehuda, R., Flory, J.D. (2007). Differentiating Biological Correlates of Risk, PTSD, and Resilience Following Trauma Exposure. Journal of Traumatic Stress, 20 (4), 435-447. Elswood, L.S., Hahn, K.S., Olatunji, B.O., Williams, N.L. (2009). Cognitive vulnerabilities to the development of PTSD: A Review of four vulnerabilities and the proposal of an integrative vulnerability model. Clinical Psychology Reviex, 29, 87- 100. Solomon, Z., Mikulincer, M. (1990). Life Events and Combat-Related Posttraumatic Stress Disorder: The Intervening Role of Locus of Control and Social support. Military Psychology, 2(4), 241-256. O’Connor, M., Elklit, A. (2008). Attachment styles, traumatic events, and PTSD: a crosssectional investigation of adult attachment and trauma. Attachment and Human Development, 10(1), 59-71. Declercq, F., Palmans, V. (2006). Two subjective factors as moderators between critical incidents and the occurrence of post traumatic stress disorders: ‘Adult attachment’ and ‘perception of social support’, Psychology and Psychotherapy: Theory, Research and Pratice, 79, 323-337. Voges, M., Romney, D.M. (2003). Risk and resiliency factors in posttrauamtic stress disorder. Annals of General Hospital Psychiatry, 2 (2), 1-9.