PTSD

Question 1

Pre-DSM3 Diagnosis

Answer 1

-obeservations of treatment of soldiers returning from war
-was called shellshock, war neurosis before 1980s
-DSM 1 and 2 stressors were seen as triggers of pre-existing diathesis
-forms of dysfunction we now call PTSD were classified in other categories accordinf to presenting symptomatology

Question 2

Discovery

Answer 2

-it was around the vietnam war where PTSD started to come to the forefront of research
-high rates of disorder in soldiers and similar patterns in survivors of rape and natural disasters

Question 3

Contreversy

Answer 3

what constitutes trauma and what constitutes dysfunction in this way?

Question 4

Criteria A

Answer 4

must have exposure to a traumatic event
-violent or accidental event that happens to you whether literally to you or through witness
-in the dsm4 it was sufficient to witness a traumatic event on TV to recieve a diagnosis, no longer the case

Question 5

DSM4 vs DSM5

Answer 5

-in the dsm4 it was sufficient to witness a traumatic event on TV to recieve a diagnosis, no longer the case

Question 6

Criteria B

Answer 6

re-experiencing of the event in some way (dreams, intrusive thoughts, flashbacks)

Question 7

Criteria C

Answer 7

avoidance (behavioural or cognitive) can be avoiding things or places that are reminders are avoiding thinking about it

Question 8

Criteria D

Answer 8

negative alterations of cognitions and mood (feelign unable to feel connections or only numbness or deep anger or restricted emotions)

Question 9

Criteria E

Answer 9

marked alterations in arousal and reactivity assc w/the traumatic event

Question 10

Criteria F

Answer 10

-duration of the disturbance is more than 1 month
-must experience symptoms within 6months following event, bc its unlikely for someone to be symptom free during this time and then develop symptoms

Question 11

Prevelance

Answer 11

-DSM3: PTSD thought to be rare 3%
-now: 7-8%

Question 12

Gender Differences

Answer 12

2F:1M
-rates of exposure to traumas are higher than rates of PTSD
-60% men, 51% women report traumas that meet 1st criterion
-why exposure higher than rates of diagnosis? Why similar rates of traumas in men and women but 2x as many women diagnosed? Look into predispositions and why ppl get diagnosed
-overall, following trauma, 9% develop PTSD
-women 2x as likely as men, 13% vs 6%
-highest risk associated with assault or violence
kidnapping/torturing: 54%
-rape: 49%
-only ~50% of ppl experiencing trauma exhibit PTSD

Question 13

Cultural Influence

Answer 13

-rates of PTSD much higher in developing non-western countries
-many of these studies done following periods of turmoil and war, may be getting elevated rates
-symptoms vary in different cultures

Question 14

Cultural Influence Example

Answer 14

-ex after thtsunami in sri lanka, rates of PTSD were higher but the primary symptoms was disturbances in roles and social group, inability to feel connected to ppl in community
-in afghanistan, after one of the wars the symptoms was extreme internal pressure
-in el salvador, after a civil war, main symptom was intense body heat

Question 15

Predictors of PTSD

Answer 15

1. gender
2. Family
3. Prexisting conditions
4. traits
5. exposure
6. education
7. nature of trauma

Question 16

Gender Predictors

Answer 16

women more likely to experience PTSD

Question 17

Family Predictors

Answer 17

-familial psychopathology predicts PTSD not specific

Question 18

Prexisting conditions predictor

Answer 18

-prexisiting psychopathology esp depression
-internalizing symptoms in early childhood
-childhood traumas/history of earlier traumas

Question 19

Education predictor

Answer 19

-ppl with lower IQ at greater risk for PTSD, bc they are at greater risk for trauma but this studies not tightly controlled

Question 20

Proximity predictor

Answer 20

(you or someone else, if you higher risk)

Question 21

Duration Predictor

Answer 21

longer is more likely

Question 22

Level of Risk Predictor

Answer 22

the more u believe ur gonna die the more likely, can be somewhat attributed to actual threat not really subjective fear

Question 23

Intention Predictor

Answer 23

the more deliberate the harm more likely

Question 24

Psychological processes Predictor

Answer 24

psychological processes during and after trauma, dissociation explains most variance

Question 25

Dissociation

Answer 25

feeling outside of their body or outside of reality, can be protective

Question 26

Social Support Predictor

Answer 26

-less support means more likely) -can be troublesome, bc of mood-state bias, ppl who are doing less psychologically well before the trauma are going to report feeling less fulfilled by relationships

Question 27

What Consittutes a Trauma?

Answer 27

-is PTSD a normal response to an abnormal event -or an abnormal response to a normal if stressful event? -if we expand the barries of what constitues trauma we can not form accurate and precise treatment -in DSM3 event had to be outside the range of usual human experience -therfore extreme response is understandable -but what events are outside the range of normal human experience? -rape/murder/torture can be common in some places but not in others -can PTSD result from events w/i normal range -ex car accident -DSM4 got rid of normal human experience concept

Question 28

Stressful Life Events vs Trauma

Answer 28

recent studies have looked at rates of PTSD following traumas compared to rates of PTSD following stressful life events (not necessarily traumatic) -rates of PTSD symptoms were higher after life stressors than for traumas -is the diathesis more important than the stressor? -maybe the vulnerability to life events -depression is as likely an outcome following a trauma as PTSD

Question 29

Vietnam Twin Study

Answer 29

-Vietnam twin registry -controlling for combat exposure, 33% of variance due to A -even w/o combat exposure, some vulnerability to PTSD -Same registry:identical twins, one served in Vietnam, the other didnt -twins who served in vietnam much more likely to have PTSD than those who did not -evidence for genetic factors as well as etiological events

Question 30

Hippocampus

Answer 30

involved in explicit memory processes and encoding of context during fear conditioning

Question 31

Amygdala Abnormalities

Answer 31

-interacts critically with the amygdala during encoding of fear memories -reduced volumes -reduced neuronal integrity -reduced functional integrity

Question 32

Small Hippocampal Volume

Answer 32

-verbal memory deficits, combat exposure severity -dissociative symptom severity, depression severity, PTSD symptom severity

Question 33

Hippocampal Animal Models

Answer 33

-ample evidence from animal research that severe stress can damage the hippocampus -eurotoxic effects of cortisol, can cause atrophy and cell death of hippocampal neurons

Question 34

Human Models

Answer 34

-but correlation does not equal causation, not everyone who experiences even severe acute stressors go on to develop PTSD, majority dont -Evidence that hippocampal volume is heritable, smaller sizes can alter neuroendocrine responses to stress

Question 35

Possible Explanations for Abnormality

Answer 35

1. may be an antecedent risk factor exposure to atraumatic event that could then cause PTSD 2. abnormality may be an antecedent vulnerability factor for developin PTSD upon exposure to traumatic event 3. abnormaility may be the consequence of exposure to the traumatic event alone 4. abnormality may be a manifestation or product of the PTSD 5. abnormality may be the product of a sequel or complication of PTSD

Question 36

Prospective Study Aim

Answer 36

measure biological factor in individuals prior to traumatic event and then again afterwards

Question 37

Prospective Study Results

Answer 37

-hippocampal reductions are assc with exposed and unexposed twins, it is a vulnerability -effect of diagnosis of twin pairs, not of the individual, see in twin pairs where one has PTSD and not in twin pairs where neither has PTSD -specific volume reduction in hippocampal volumes -twins hippocampal volumes predicts the other twins vulnerability to the disorder

Question 38

Conclusions

Answer 38

-smaller hippocampal volumes in trauma-exposed individuals diagnosed with severe, unremitting PTSD -non-combat exposed co-twins show comparable hippocampal volumes -suggest smaller hippocampi in PTSD represent a pre-exisiting familial vulnerability, not the result of neurotoxic events -combat-exposed vets showed higher rates of major depression, and more severe alcohol histories -but combat unexposed twin brothers didnt

Question 39

Reduced Hippocampal Volume and Fear

Answer 39

-hippocampal morphology implicated in conditioning and extinction of fear responses in animals, may be involved in the contextual processing of fear -rodents with hippocampal lesions show stronger conditioned fear, downregulating fear response as it is formed -smaller hippocampal volumes also associated with diminished neuroendocrine regulation of the HPA axis -smaller inherited hippocampal volumes may therefore predispose individuals when exposed to a traumatic event to: -acquire stronger/more persistent conditioned emotional (fear) response, easier to acquire to fear memory, harder to get rid of it -stonger hormonal stress responses

Question 40

PTSD MDD Comorbidity

Answer 40

-predict one another -similar characteristics