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PTSD & Trauma-Related Disorders (PTSD: The Diagnosis (Associated…
PTSD & Trauma-Related Disorders
PTSD: The Diagnosis
Typical Symptoms
Cluster A
Exposure to life threatening event, death, serious injury or sexual violence, in one or more ways.
Cluster B
Intrusive symptoms
Cluster C
Active avoidance
Cluster E
Increased arousal and reactivity
Cluster D
Negative changes in mood/cognition
Epidemiology
Relatively few people develop PTSD.
Woman twice the risk to get PTSD, even though men are twice as exposed to traumatic events.
More serious trauma lead to a more severe PTSD.
Interpersonal violence lead more often to PTSD than other types of trauma.
Comorbidity
High level of comorbidity
Depression
Anxiety
Personality disorders
Traumatic brain injury
Classification
PTSD is not the only disorder that may develop after a trauma. Others may be
depression, anxiety,
and
substance abuse disorder
.
Development
Most people adapt after a traumatic event, and they don't develop PTSD.
Delayed onset PTSD
Associated clinical features
Unemployement
Marital problems
Increased cardiovascular reactivity
Increased HPA activity
Increased substance use
Smoking
Sleep problems
Violence
Depression
Sexual dysfunction
Increased risk of suicide
Evolving Diagnostic Criteria
The DSM-5 includes "PTSD with dissociative symptoms".
Dissociation is conceptualized as a non-effortful avoidance strategy which can disconnect the person from negative feelings.
Accurate assessment is required to consider whether or not the patient has this subtype of PTDS.
In DSM-5, PTSD is included in the category
"Trauma- and stressor-related disorders"
.
Assessment
Assessment of traumatic events
Identifying the trauma in the patient's life.
Structured diagnostic interview
Gold standard:
CAPS (Blake et al., 1995)
Self-report instruments
Psychometric Properties of the PTSD Check-list for DSM-5 in Veterans
Excellent psychometric properties.
The newest version consists of 20 items related to the 20 symptoms in DSM-5.
Total score 80. Cut-off 33.
Free to use.
The International Trauma Questionnaire
PTSD and Complex PTSD
ICD-11
ICD provides a narrative description of PTSD, rather than a defined list of symptoms like in DSM-5.
Psychophysiological assessment
Treatment
Other Variables
Sex and ethnicity
Secondary trauma
Resistance
Patients with repeated trauma
Group therapy
Trauma-focused psychotherapy is the most common type of treatment.
Trauma-focused CBT
Psychoeducation
Exposure techniques
Imaginary
In vivo
Systematic desensitization
Prolonged exposure (PE)
Cognitive restructuring
EMDR
Eye Movement Desensitization and Reprocessing
Often combined with relaxation techniques and positive visualizations.
Focus on traumatic memories followed by restructuring of the memory, all while directing attention toward the therapist's finger,
Cognitive processing therapy
SIT
Stress inoculation training
Aim: Provide the patient with coping skills and a feeling of mastery.
Phase 1: Psychoeducation and treatment preparation.
Phase 2: Coping skills training
Socratic dialogue
CISD
Critical incident stress debriefing
Models/Etiology
Risk factors
Previous mental illness
Family history of mental illness
Childhood abuse
Being female
Level of trauma exposure
Responses during the trauma
Symptom severity the first weeks after the trauma
Genetic vulnerability
Low intelligence
Femininity
Hippocampal volume
Low social support
Biological models
Fear conditioning
Hypersensitive amygdala
Lack of top-down inhibition in prefrontal cortex
Cognitive models
Mowrer's Two-Factor
Classical
and
operant conditioning
Information-processing theory
Fear network develops, leading to avoidance and escape.
Dual-representation theory
Verbally available memories
Situationally available memories
Processing of emotions
Processing of situationally available memories.
The conscious attempt to find meaning.
SPAARS
Four mental representation systems
Schematic
Propositional
Analog
Associativ
Cognitive models suggest two processes in the development of PTSD:
maladaptive appraisals of the trauma
and
autobiographical memory disturbances
.
Attention bias
to threat stimuli.
"Completion tendency"
Ehler's & Clark's
Inability to consider the trauma as time limited.
Poor integration of the memory.
Acute Stress Disorder
Describes acute stress reactions that appear the first month after the trauma.
Need to have at least 9/14 symptoms in these categories
Negative mood
Dissociation
Intrusive symptoms
Activation
Avoidance
And at least 3 of the following symptoms
Subjective feeling of numbness
Derealization
Reduced attention
Depersonalization
Dissociative memory loss
Research suggests that dissociation following the trauma hinders processing of reactions, and thus, leads to PTSD.