PTSD Causes
- Extraordinary events (e.g. traffic accidents, terror attacks)
- > traumatic events: 7% will be exposed and develop PTSD
- women at greater risk
- symptoms can range from mild to moderate
- > normal functioning possible
- can also be: immobilizing, cause deterioration in work family and social life
Diagnosis
Requires presence of:
- repeated reexperiencing of a traumatic event
- persistent avoidance of stimuli associated with the trauma + emotional numbing
- hypervigilance & chronic arousal
PTSD DSM
A. Exposure to traumatic event
B. persistent reexperiencing of traumatic event
C. avoidance of stimuli associated with trauma, numbing of general responsiveness
D. Increased Arousal
E. duration of B,C, and D symptoms of more than 1 month
F. disturbances cause clinically significant distress or impairment in: social, job, or other important areas
DSM-5 additions
Traumatice event has to be personally experienced or witnessed happening to others, close relative or friend experienced it, or be requently exposed to aversive details of event
->
Common traumas leading to PTSD
Natural Disasters
Human-made disasters
Physical abuse: e.g. domestic violence
Sexual abuse: e.g. rape -> 95% of rape survivors experience PTSD symptoms in first 2 weeks, 50% qualifiy 3 months after
Environmental & Social Factors in PTSD vulnerability
- severity and duration of proximity to trauma
- availability of social support
Psychological Factors in PTSSD vulnerability
- higher PTSD risk for those already experiencing anxiety or depression
- coping style: self-destructive, avoidant or dissociation/detachment strategies more at risk
Gender & Cross-Cultural Differences in PTSD
- Women more likely to develop PTSD
- tendency to dissociate more likely in Latinos
- sex roles influence sex differences in PTSD symptoms (Mexican vs. US)
Biological Factors in PTSD Vulnerability
- amygdala more active
- smaller hippocampal volume
- lower resting cortisol levels
- Elevated heart rate & increased secreation of neurotransmitters (norepinephrine & epinephrine)
- overexposure of brain to neurochemicals (overconsolidation of memories)
- exposure to trauma might alter children’s biological stress resposne
Genetics & PTSD vulnerability
Heritability suggested: e.g. adult children of Holocaust survivors with PTSD more than 3x more likely to also develop it
-> abnormally low levels of cortisol
PTSD Treatment
Cognitive Behavioral Therapy
Stress Management
Biological Therapies
Cognitive Behavioral Therapy
- proven effective in children and adults
- major element: systematic desensitization
- monitoring for maladaptive thinking patterns and challenign them (e.g. survivor’s guilt)
- imagining and describing feared events in safety of therapy environment repeatedly
- -> habituation to anxiety, distinction between memory and present reality
- > significantly decreases symptoms and helps prevent relapse
Stress management
For patient not able to tolerate exposure to traumatic memories
-therapist teaches skills for overcoming problems in lives increasing stress , which may result from PTSD (e.g. marital problems)
Biological Therapies
SSRis (selective serotonin reuptake inhibiotrs)
-> antidepressants
Benzodiazepines
-> sedative
-> useful in treating PTSD symptoms
-> side effects: sleep problems, nightmares, irritability
Article: Engelhard et al. - ER and IR reasoning
ER: emotion-based reasoning: interpreting anxiety responses themselves as evidence that threat is impending
IR: intrusion-based reasoning: danger inferred from presence of intrusions (something is acutally happening)
-> reasoning may promote persistence, amplify distress, motivate PTSD patients to search for danger-confirming information)
-> chronic PTSD relates to intrusion-based reasoning (IR)
Article: Engelhard et al. -
Acute and chronci PTSD symptoms highly prevalent among those directly exposed to train crash (after 3.5 months: 24% met PTSD criteria)
- presence of intrusions often not good predictor of PTSD
- strong relationship suggested between IR and chronic PTSD symptoms
Dissociative amnesia
patients suffer loss of autobiographical memory for certain past experiences
Dissociative Fugue
Amnesia covers whole or at least large part of patient’s life
-> loss of personal identity and physical relocation
Dissociative idenditiy disorder (DID)
Single patient appears to possess and manifest two or more distinct identities that alternate in control over conscious experience, thought, and action
-> separated by amnesia
Dissociative idenditiy disorder (DID)
Single patient appears to possess and manifest two or more distinct identities that alternate in control over conscious experience, thought, and action
- > separated by amnesia
- > interpersonality amnesia generally confirmed: alter egos are unaware of each other
- implicit memories can travel between personalities
- explicit memories don’t transfer
Trauma-memory argument
Trauma victims as deploying psychological defneses like repression or dissociation to block awareness of the trauma
-> might be cause for dissociative disorders
Treatment of Dissociative Disorders
DID: therapeutic: based on notion that it is caused by childhood trauma
- > therapy usually psychodynamic and insight-oriented
- > uncovering and working through trauma and other issues presumed to underlie disorder
- > goal: get patient to abandon dissociative defences
- > success rate: 9-22%
Fugue states
Amnesia is retrograde, not anterograde
-> memory for premorbid events replaced by one covering the fugue itself
Fugue states
Amnesia is retrograde, not anterograde
-> memory for premorbid events replaced by one covering the fugue itself
