Post-traumatic stress disorder (PTSD)
Refer to the consequences of experiencing extreme stressors as a result of a traumatic event
ex.: feeling numb, detached, chronically aroused
The presence of 3 types of symptoms are required to diagnose PTSD.
Name them.
- Repeated re-experiencing of the traumatic event
- Emotional numbing
- -> persistent avoidance of stimuli associated with the trauma - Chronic arousal
- -> being on guard for the traumatic event to recur
Acute stress disorder
Occurs in response to traumas similar to those involved in PTSD, occur within a month
–> BUT: short-term response to trauma, only lasting for appr. 1 month
Which symptoms are common in acute stress disorder ?
Dissociative symptoms, which arise within a month of the experience of the stressor
–> numbing, detachment, reduced awareness of surroundings
Adjustment disorder
Consists of emotional + behavioral symptoms
–> stressors leading to this disorder can be of any severity
BUT: stressors for acute disorder or PTSD have to be severe
Children may manifest different symptoms in PTSD than adults.
How do they show ?
May express their recollections in their play
ex.: child witnessed someone being shot, may repeatedly have one doll kill another
What are possible traumas leading to PTSD ?
- Human made disasters
ex. : wars, terrorist attacks, torture - Natural disasters
ex. : floods, tsunamis, earthquakes - Abuse (sexual), physical violence
- -> increased risk (46%) - Interpersonal disasters
ex. : accidents
What are strong predictors of how people will react to trauma/whether they will develop some form of PTSD ?
(Social + environmental factors)
- Severity
- Duration
- Proximity to it
- Available social support
What are psychological factors that will indicate that a person is more likely to develop PTSD ?
- Already experiencing increased symptoms of anxiety/depression before the trauma occurs
- Coping styles, meaning self- destructive or avoidant coping strategies
ex. : drinking, self isolation - Dissociation
- -> feeling like one is in someone else body, not the self
What are the gender differences in developing PTSD ?
Women are more likely to be diagnosed with it, as they may be more likely to experience some of the triggers
ex.: sexual abuse
What are the biological responses to PTSD ?
- Smaller hippocampus
- -> due to overexposure to neurotransmitters + hormones that were released in the stress response - Over-activation of Amygdala+ less activity in the MPFC
- -> responding more actively to emotional stimuli - Low levels of cortisol
- -> leads to prolonged activity of the SNS, thus more easily developing conditioned fear - Increased secretion of epinephrine + norepinephrine
- -> memories are over consolidated/planted more firmly in memory
Is PTSD heritable ?
Yes,
abnormally low cortisol levels may be a heritable risk factor for PTSD
What are possible treatment options for PTSD ?
- Trauma-focused psychotherapies (TFPs)
a) Cognitive behavioral therapy
- -> involves systematic desensitization
b) Eye movement desensitization and reprocessing (EMDR)
- Selective reuptake inhibitors (SSRI)
- Stress-incoulation therapy
- -> when people can’t be exposed to the trauma
Systematic desensitization
Patient has to vividly imagine + describe the feared events in the safety of the therapists office
–> allows to habituate to the anxiety + distinguishing memory from present reality
Emotion-based reasoning (ER)
Interpreting an anxiety response as evidence that threat is impending
Intrusion-based reasoning (IR)
Interpreting the presence of intrusions as evidence that threat is impending
–> intrusions refer to similar trauma experiences that are triggers
Are ER and IR involved in chronic PTSD ?
Which role does IR play in PTSD
- People with PTSD typically engage in both ER + IR
- IR is strongly related to
a) acute + chronic symptoms
b) onset + maintenance of PTSD symptoms
- -> IR is a cause of PTSD
Why is it said that Dissociation will have a negative impact on a possible successful PTSD treatment ?
- Could hinder fear activation
- -> key mechanism to a successful PTSD treatment - Increased activation of the anterior cingulate cortex + MPFC
–> leads to prevention of emotional engagement of trauma related matters
Does Dissociation really have a negative impact on the outcome of a trauma focused treatment program ?
No,
the results suggested differently
Eye movement desensitization and reprocessing
EMDR
Involves recalling traumatic memories while simultaneously making horizontal eye movements + accepting ones memories + thoughts
How does EMDR work, respectively why ?/
What is the correct hypothesis ?
By taxing WM during recall
–> as the WM is then busy with two tasks, the memory is reconsolidated less vividly, thus any other dual task has the same effect
Mindfulness-based cognitive therapy
Works similar to EMDR
–> uses mindfulness breathing instead of eye movements
Dissociative symptoms
- Depersonalization
–> detachment from town mental processes or body
- Derealization
–> detachment from the outside world
BUT: either one is required to be diagnosed
Delayed expression
Full criteria for PTSD have NOT been met before in the past, but for the past 6 months MORE of the symptoms are shown to fully meet the DSM 5 criteria
–> opposite to Partial remission (ADHD)
