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POST TRAUMATIC STRESS DISORDER

POST TRAUMATIC STRESS DISORDER. Paul Bisbee, PhD May 2, 2013. PTSD. What is it? Where does it come from? What are we going to do about it?. Trauma as the Precipitant. In the headlines: Iraq/Afghanistan World Trade Center Boston Marathon Newtown, CT.

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POST TRAUMATIC STRESS DISORDER

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  1. POST TRAUMATICSTRESS DISORDER Paul Bisbee, PhD May 2, 2013

  2. PTSD What is it? Where does it come from? What are we going to do about it?

  3. Trauma as the Precipitant In the headlines: Iraq/Afghanistan World Trade Center Boston Marathon Newtown, CT. Hurricane Sandy/Katrina Jodi Arias

  4. Trauma as the Precipitant • NOT in the headlines: • Child abuse • Domestic abuse • Bullying • Malnutrition • Sudden death • Rape

  5. History of the PTSD Diagnosis • “Traumatic Neurosis” • “Shell Shock” • “Combat Fatigue” • DSM-I & DSM-II • DSM-III (1980)

  6. ANXIETY DISORDERS • Specific Phobia • Social Phobia • Panic Disorder (with or without agoraphobia) • Generalized Anxiety Disorder • Obsessive-Compulsive Disorder • Acute Stress Disorder • Posttraumatic Stress Disorder

  7. Diagnostic Criteria for PTSDDSM-IV-TR • A. The person has been exposed to a traumatic event in which both of the following were present: 1. The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. 2. The person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.

  8. Criteria for PTSD (cont’d) • The traumatic event is persistently reexperienced in one (or more) of the following ways: 1. Recurrent and 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. 2. Recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content. 3. Acting or feeling as if the traumatic event were recurring. Note: in young children, trauma-specific reenactment may occur.

  9. Criteriafor PTSD (cont’d) • B. 4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. 5. Psychological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

  10. Criteria for PTSD (cont’d) • C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness as indicated by three (or more) of the following: 1. Efforts to avoid thoughts, feelings, or conversations associated with the trauma. 2. Efforts to avoid activities, places, or people that arouse recollections of the trauma. 3. Inability to recall an important aspect of the trauma. 4. Marked diminished interest or participation in significant activities.

  11. Criteria for PTSD (cont’d) • C. 5. Feelings of detachment or estrangement from others. 6. Restricted range of affect (eg., unable to have loving feelings) 7. Sense of a foreshortened future (eg., does not expect to have a career, marriage, children, or a normal life span)

  12. Criteria for PTSD (cont’d) • Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: 1. Difficulty falling or staying asleep. 2. Irritability or outbursts of anger. 3. Difficulty concentrating. 4. Hypervigilance. 5. Exaggerated startle reponse.

  13. Criteria for PTSD (cont’d) • E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month. • F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  14. Clinical Description (Recap) • Recurrent reexperiencing of the traumatic event through nightmares or intrusive memories. • Avoidance of stimuli associated with the trauma and emotional numbing. • Increased arousal, which may involve insomnia, the inability to tolerate noise, and excessive response when startled.

  15. Prevalence of PTSDin the General Population • Lifetime prevalence rate in U.S. is 6.8%. - In women, 9.7% - In men, 3.6% - Higher rates in women despite findings that men are more likely to be exposed to traumatic events.

  16. Rates of PTSD After Exposureto Specific Stressors • Prisoner of war, concentration camp, and torture experience are all recognized traumas that can lead to PTSD. As well as rape and assault. • Traumas caused by human intent are more likely to cause PTSD than accidents or natural disasters. • Military combat can be especially traumatic • Creation of the PTSD diagnostic category was stimulated by combat experience.

  17. Causal Factors in PTSD • Not everyone exposed to a trauma will develop PTSD • Diathesis-Stress Model • Causal factors may include: • The nature of the trauma • Individual risk factors • Sociocultural risk factors

  18. Individual Risk Factors • Certain occupations • Being female • Low levels of social support • Preexisting anxiety or depression • Family history of anxiety or depression • Substance abuse • Biological factors

  19. Sociocultural Factors • Unsupportive environment • Stigma • Educational level • Identification with combat unit & goals

  20. Long-Term Effects of PTSD • PTSD symptoms can appear after a delay, such as when a soldier returns home. • Survivors guilt • Delayed reaction rare in civilian life.

  21. “Little” Traumatic Stressors • Not resulting in symptoms severe enough to meet PTSD criteria but could affect other diagnoses and treatment. • May involve events happening to others (eg., JFK, 9/11, tornados) or yourself. • Everyday life examples: • Minor car wreck • Robbery • Injury of family member • Trip to the dentist

  22. Prevention and Treatment ofStress Disorders • Prevention • Attempts to prepare a person in advance of a stressor has met with some success in the military • This approach is now being used with people facing events such as major surgery or the breakup of a relationship

  23. Treatment • Telephone Hot Lines • Distraction • Crisis Intervention • Psychological Debriefing • Cognitive-Behavioral • Medication • Trauma-Informed Care

  24. Psychological Debriefing • Allow people involved in disaster to discuss their experiences shortly after trauma has subsided • Critical Incident Stress Debriefing is a specific type of psychological debriefing • Examples: Katrina; Tornados

  25. Cognitive-Behavioral Treatment • Prolonged exposure strategy • Virtual reality exposure treatment • Cognitive therapy • Anxiety-reduction exercises • Cognitive restructuring

  26. Trauma Informed Care • Trauma informed approach (SAMHSA) • Key Principles • Trauma Specific Interventions

  27. Trauma and Physical Health • Substance Abuse • Chronic Pain • Obesity, Diabetes, and the Metabolic Syndrome • Cardiovascular Disease • Suicide

  28. PTSD and DSM-5 • Growing discontent • Probably will be listed under: Trauma- and Stressor-Related Disorders • New: Posttraumatic Stress Disorder in Pre-School Children

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