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How do we define STRESS?

How do we define STRESS?. Incongruity between the demands placed on the organism and the adaptive capacities of the organism. DSM-IV Criteria for PTSD A. Stressor Criterion. The person has been exposed to a traumatic event in which both of the following have been present :

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How do we define STRESS?

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  1. How do we defineSTRESS? Incongruity between the demands placed on the organism and the adaptive capacities of the organism

  2. DSM-IV Criteria for PTSDA. Stressor Criterion The person has been exposed to a traumatic event in which both of the following have been present: • The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of self or others • The person’s response involved intense fear, helplessness, or horror. Note: in children, it may be expressed instead by disorganized or agitated behavior.

  3. Natural Disasters Buffalo Creek Disaster Lifetime PTSD 59% at 14 yr follow-up 25% in children 37% Mt. St. Helens Volcanic Eruption PTSD in exposed sample 3.6%, PTSD among non-exposed 2.6% Tornado PTSD 2-21%., Post-traumatic Stress Impairment 59% Earthquake Post-traumatic Stress Impairment 32-60%, PTSD in children 26-95% PREVALENCE OF PTSD FOLLOWING DISASTER Human-Made Disasters Technological Disaster PTSD 7-50%, Post-traumatic Impairment 22-43% Major Fire Post-traumatic Stress Impairment 54-66% PTSD in burned survivors 100% Transportation Disasters PTSD 29-100% PTSD in children 40-47% Terrorist Kidnapping and Torture PTSD 54% Mass Shooting 5% children 5-47% Rescue Workers ptsReactions 24%

  4. DISASTER EXPERIENCES ASSOCIATED WITH CHRONIC PTSD • Survivors/witnesses of mass destruction or death • Unresolved bereavement • Loss of home or community • Survivors with histories of prior exposure to trauma • Survivors who experience major life stressors • Survivors of toxic contamination disasters

  5. OTHER FACTORS ASSOCIATED WITH CHRONIC PTSD • Low levels of emotional/social support or high levels of social demand • Coping via avoidance, self-blame, or rumination (However: maladaptive patterns of coping may be the result rather than cause of post-traumatic stress impairment ) • Coping via substance abuse • Serving as an emergency worker • Children whose parents are persistently psychologically impaired. • Children whose parents experience significant peritraumatic distress.

  6. DSM-IV Criteria for PTSDB. Intrusive Recollection Criterion The traumatic event is persistently re-experienced in one (or more) of the following ways: • recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in young children, repetitive play may occur in which themes or aspects of the trauma are expressed • recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content • acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: in young children, trauma-specific reenactment may occur • intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event • physiological reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

  7. DSM-IV Criteria for PTSDC. Avoidant / Numbing Criterion Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following: • efforts to avoid thoughts, feelings, or conversations associated with the trauma • efforts to avoid activities, places, or people that arouse recollections of the trauma • inability to recall an important aspect of the trauma • markedly diminished interest or participation in significant activities • feeling of detachment or estrangement from others • restricted range of affect (e.g., unable to have loving feelings) • sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

  8. DSM-IV Criteria for PTSDD. Hyperarousal Criterion Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: • difficulty falling or staying asleep • irritability or outbursts of anger • difficulty concentrating • hypervigilance • exaggerated startle response

  9. Associated Features of PTSD • Survivor Guilt • Impaired relationships • Impaired capacity to regulate feelings • Self destructiveness, impulsive behavior • Dissociation • Somatization • Personality change • Change in world view, beliefs • Shame, despair, hostility • Social withdrawal

  10. Comorbid Diagnosis in PTSD • Depression • Dysthymia • Anxiety Disorders • Substance Abuse • Personality Disorderes

  11. Differential Diagnosis of PTSD • Acute Stress Disorder • Adjustment Disorder • Bereavement • Affective Disorder • Phobia • Anxiety Dis. • Obsessive Compulsive Dis. • Organic Brain Dis. • Dissociative Dis. • Substance Abuse Dis. • Antisocial/ Borderline Personality D. • Malingering

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