PTSD PDF

Tuesday, March 26, 2024 PTSD Trauma- and Stressor-Related Disorders 1. Acute Stress Disorder (mild PTSD, lasting about 1 month) 2. Adjustment Disorders (non-physical threats) 3. Posttraumatic Stress Disorder Video: The Vietnam was was the first war where soldiers came back home and were met with hos...

Tuesday, March 26, 2024 PTSD Trauma- and Stressor-Related Disorders 1. Acute Stress Disorder (mild PTSD, lasting about 1 month) 2. Adjustment Disorders (non-physical threats) 3. Posttraumatic Stress Disorder Video: The Vietnam was was the first war where soldiers came back home and were met with hostility from society - lack of social support is one of the main factors of PTSD 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 Introduced after 9/11; firefighters and relatives were more likely to get PTSD - Learning that the traumatic events occurred to person close to them You don’t need to be the person who has been victimized i.e. mothers of children with terminal illness - Experiencing repeated or extreme exposure to aversive details of trauma Presence of 1+ intrusive symptoms after the event: - Recurrent, involuntary and intrusive memories of event (reliving the event) Flashback triggered by stimulus (usually related to the trauma) - Recurrent trauma-related nightmares - Dissociative reactions - Intense physiologic distress at cue exposure - Makes physiological reactivity at cue exposure Body enters perpetual fight-or-fight Body is always aroused Can cause different neurological disorders because of hyperarousal Complex PTSD: if chronic sexual trauma as a child leads to perpetual fight-or-flight (most likely for life) 1 Tuesday, March 26, 2024 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 Because always under stress - Reckless or self-destructive behavior Lots of drug abuse alcoholism linked to PTSD as ways to escape - Hypervigilance - Exaggerated startle response - Problems with concentration - Sleep disturbance Due to constant arousal 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 (because they are more vulnerable in society; no biological, psychological reasons) Risk increases with “dose” of trauma, lack of social support, pre-existing psychiatric disorder COMORBIDITIES - 2 Depression Other anxiety disorders Substance use disorders Somatization Dissociative disorders Tuesday, March 26, 2024 ACUTE STRESS DISORDER (PTSD-LIKE) - Similar but less severity and doesn’t last as long If not treated, can develop into PTSD - Similar exposure as in PTSD - Duration of disturbance is 3 days to 1 month after trauma - Causes significant impairment CRITICS OF THE PTSD DEFINITION - Only diagnosis in DSM where disorder is premised by a traumatic event BUT not all individuals will develop PTSD - Looks at the event, and not at the individual himself PTSD Risk Factors PRE TRAUMA Genetic Predisposition ✓ Twin study of Vietnam veterans: heritability of.40 (not very high) Neurological Vulnerabilities ✓ Low cortisol levels = abnormal stress response ✓ Amygdala hyperactivation with PTSD (constantly turning on without calming down) ✓ Smaller hippocampal volume as a vulnerability factor for developing PTSD symptoms However not sure if of the causal relationship (does this lead to PTSD, or does trauma lead to this) Developmental Factors - Stress sensitization: childhood adversity Having experienced a traumatic event makes you more vulnerable to other traumatic events and have reduced ability to cope - Attachement style: Secure vs Insecure The belief that parents are there: world is safe and traumatic event is “bad luck” Insecure: world is not safe and is “waiting” for something bad to happen - History of psychiatric illness: family & personal Personality Factors - Neuroticism: more intense reactions to stress Increased anxiety before the event - Impulsivity: increased likelihood of experiencing trauma Psychopathology - Resilience: Self-efficacy, problem-solving, coping abilities (decreased likelihood of PTSD) - Optimism (decreased likelihood of PTSD) 3 Tuesday, March 26, 2024 Psychological Vulnerabilities - Lack of Social support: perception availability satisfaction - External Locus of control : less able to endure stressful events attribution of responsibility : Role of responsibility and self-blame Cognitive Vulnerabilities - Negative attributional style - Problem vs Emotion Focused Coping Problem focused is better to deal with PTSD - Rumination - Looming cognitive style (overestimation of the intensity of the threat) Hyper vigilance for threatening events When an event does occur, it just validates their worry - Cognitive schemas about self, world and future DURING TRAUMA Peritraumatic Disassociation - Dissociation of the brain from the body for self-protection - Altered Sense of Self - Cause Unclear But it does affect whether one gets PTSD Dissociation = avoidance = not coping Cognitive Appraisal - Evaluation of the Situation - Altered Assumptions POST TRAUMA Maladaptive Coping - Anger, shame - Negative appraisals of event, self, others, and world - Avoidance/attempts to suppress thoughts - Anger, shame - Negative appraisals of event, self, others, and world - Avoidance/attempts to suppress thoughts Social Support 4 Tuesday, March 26, 2024 Conclusions - Exposure to trauma is a necessary but insufficient condition for the development of PTSD - Retrospective vs. prospective Not certain which factors causes PTSD, and what is a consequence of it - Most consistent risk factors: Neuroticism History of psychiatric illness Perceived threat Social support 5