Posttraumatic S tress Disorder

1. Posttraumatic Stress Disorder How experiencing trauma can haunt us long after the crisis has passed

2. PTSD in general • The rare disorder in which the cause (trauma) is a necessary part of the diagnosis • Basically when a severe trauma causes severe stress followed by avoidance, the re-experiencing of trauma, numbness, anxiety and heightened arousal • Around for millennia, finally merited recognition after Vietnam

3. Changes from DSMIV • No longer need to experience horror, grave fear, or helplessness at the time of the event • Many didn’t but later had necessary symptoms • Definition of requisite trauma is narrowed – no longer are media reports enough • Symptoms must commence after the event • Need avoidance but not numbness in DSM5

4. Arises from only BIG traumas • Must have experienced or witnessed an event that involved actual or near death, severe injury or sexual violation • Rape can bring it on • Most common precipitating event • 1/3 of the time, it does • Four categories of symptoms

5. Uncontrolled reexperiencing • Intrusive, repetitive memories or nightmares of event • Reminders of event cause heightened arousal • Dark alley, if similar to site of rape • Flat roof buildings if similar to site of sniper attack

6. Avoidance of Stimuli • Anything that recalls event is avoided • Afghan war vet avoids deserts • Survivor of train crash won’t get on again • Avoiding even thinking about event often backfires, causing reexperience instead

7. Mood and/or Cognitive changes • Inability to recall aspects of the event • Persistent negative mood/thoughts • Blaming self for event • Difficulty experiencing pleasure • Lack of interest in old activities • Estrangement from others

8. Increased Arousal • Easily angered and/or aggressive • Trouble with sleep • Hypervigilance • Reckless or self-endangering behavior • Trouble concentrating • Exaggerated startle response • All confirmed by objective physiological tests

9. Other aspects • Symptoms tend to be chronic • Increased risk of suicide, self hurt • Higher risk of early death due to medical, accidental causes • Women 2x more likely to receive diagnosis • Most likely because sex abuse predisposes • Ethnic considerations also can play a role

10. Acute Stress Disorder • For people who suffer similar symptoms 3 days to one month after event • Doesn’t last as long • High risk of PTSD in next 2 years. • Changed by DSM5 to be very similar to PTSD • But isn’t it natural to have a reaction shortly after a harrowing event? • Also, most who develop PTSD don’t get ASD.

11. Comorbidity • If at 26 you have PTSD, 90+% chance of another condition before 21 – 2/3s anxiety • Other common comorbid conditions include depression, substance abuse and conduct disorder

12. Etiology – just like anxiety • Marked similarity with anxiety disorders – explaining why they are grouped so closely in DSM • Genetic risk for one = risk for the other • Also, hyperactivity of fear circuit and amygdala • Too much attention to threat cues • Neuroticism predicts both both

13. Return to two-factor model • The two-factor model for Phobias explains PTSD • Bagdad vet was attacked (UCS) while walking through urban area with low rooftops (CS) • Now flat rooftops are so stressful he avoids them • The avoidance behavior is reinforcing (causes feelings of belief) so it is engaged in repetitively • With no exposure to CS, extinction never occurs

14. Unique causal agents – severity • More severe, higher chance • Fighting in Vietnam – 20% chance • POW in Nam – 50% • Assigned to collect body parts of dead – 65% • In WWII, incidence of PTSD correlated with casualties in battalions • Prediction – 98% after 60 days of combat • Similar findings after 911

15. Another factor – Who’s responsible? • Traumas caused by humans (war, rape, assault) are more likely to cause • Challenge our assumption that humans are good or fair? • Just world hypothesis flipped upside down?

16. The Brain’s role • Amygdala too revved up • Medial prefrontal ineffective – failure to corral the amygdala • Even more crucial may be the hippocampus, our “gateway to memory” • Those with PTSD have a smaller hippocampus which likely precedes the disorder

17. Coping with Trauma • How we cope with the trauma both during and after effects whether PTSD will follow • Avoiding thinking about the trauma backfires • Dissociation – event is split off from regular consciousness • Those who drift away from trauma often develop PTSD • Found true for rape victims and PTSD

18. Two things that help • Intelligence – those with higher intelligence develop PTSD less • Social Network – more high quality relationships to discuss and share experience, better chance of dodging PTSD • Amazingly, some have used horrible traumas as a catalyst for personal growth

19. Treatment of PTSD & ASD • Exposure – victims are encouraged and helped to face the memories and reminders of the original trauma to gain mastery • Can either go to the actual scene or intentionally remember it – imaginal exposure • Both work better than just meds or unstructured psychotherapy • These are difficult, painful and time-consuming but they work

20. Medications & PTSD • SSRIs have shown considerable effectiveness in helping overcome symptoms of PTSD in several controlled clinical trials • However, once the meds stop, the problems return

21. Cognitive therapies • Various cognitive strategies have helped victims overcome PTSD • Cognitive Processing Therapy has shown success in decreasing self-blame and guilt • But it is uncertain as to whether these provide benefits above and beyond exposure treatments

22. Treating ASD • Using short-term cognitive behavioral techniques seems to prevent ASD from turning into PTSD • Replicated 5 times • Risk drops from 58 to 32% • These gains can last for years