300 likes | 426 Views
Historical Overview of Traumatic Reactions: late 19th century. Terms used in combat veterans populationsCardiovascular:Soldier's heartDa Costa's SyndromeNeurocirculatory astheniaPsychiatricNostalgiaShell shockCombat fatigueWar neurosisTerms used in civilian populationsRailway Spine. Late
E N D
1. Posttraumatic Stress Disorder
2. Historical Overview of Traumatic Reactions: late 19th century Terms used in combat veterans populations
Cardiovascular:
Soldier’s heart
Da Costa’s Syndrome
Neurocirculatory asthenia
Psychiatric
Nostalgia
Shell shock
Combat fatigue
War neurosis
Terms used in civilian populations
Railway Spine
3. Later Descriptions of Traumatic Reactions (1940s-1980s) Later descriptions of post-traumatic responses were labeled according to the type of trauma
Rape trauma syndrome
Survivor syndrome
War neurosis
Shell shock
4. PTSD: DSM-III (1980) PTSD becomes an established diagnosis
Traumatic event defined as “a recognizable stressor that would evoke significant symptoms of distress in almost anyone.”
Three symptom clusters (based on clinical experience): reexperiencing, numbing and detachment, and changes in personality
5. PTSD: DSM-III-R (1987) Definition of trauma was narrowed:
“An event outside the range of usual human experience and that would be markedly distressing to almost anyone”
Avoidance symptoms were added to numbing cluster
Symptoms expanded from 12 to 17
Duration and onset criteria added
Impairment in functioning and/or distress added.
Issues with definition:
Definition proved too restrictive as traumas more common than originally believed
Did not allow for individual differences
6. PTSD: DSM-IV (1994) Exposure to a traumatic event in which the person:
experienced, witnessed, or was confronted by death or serious injury to self or others AND
responded with intense fear, helplessness, or horror
Symptoms
appear in 3 symptom clusters: reexperiencing, avoidance/numbing, and hyperarousal
last for > 1 month
cause clinically significant distress or impairment in functioning
7. Acute Stress Disorder: DSM-IV (1994) Exposure to a traumatic event in which the person:
experienced, witnessed, or was confronted by death or serious injury to self or others AND
responded with intense fear, helplessness, or horror
> 3 dissociative symptoms
>1 reexperiencing symptoms
>1 anxiety/arousal symptoms
Onset: 2 days to 4 weeks
Clinically significant distress or impairment in functioning
8. Criterion A: Exposure Criteria Experienced or Witnessed an Event that involved actual or threatened death or serious injury or a threat to physical integrity
Person’s response involved fear, helplessness, or horror or in children agitated behavior
9. Criterion B: Re-experiencing Criteria Recurrent and Intrusive distressing recollections of the event (images, thoughts, or repetitions)
Recurrent distressing dreams of the event
Acting or feeling as if the traumatic event were recurring
10. Criterion B continued… Intense Psychological Distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
Physiological Reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
11. Criterion C1: Persistent Avoidance Criteria 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
12. Criterion C2: Numbing of Gen. Responsiveness Criteria Markedly diminished interest or participation in significant activities
Feeling of detachment or estrangement from others
Restricted range of affect
Sense of foreshortened future
13. Criterion D: Increased Arousal Criteria Difficulty falling or staying asleep
Irritability or outbursts of anger
Difficulty concentrating
Hypervigilance
Exaggerated startle response
14. Criterion E Symptoms in criteria B, C, and D are more than 1 month
15. Criterion F The disturbance causes significant distress or impairment in social, occupational, or other important areas of functioning
16. Specifications Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more
With delayed onset: if onset of symptoms is at least 6 months after the stressor
17. Acute Stress Disorder
18. Criterion A: Exposure Criteria Experienced or Witnessed an Event that involved actual or threatened death or serious injury or a threat to physical integrity
Person’s response involved fear, helplessness, or horror or in children agitated behavior
19. Criterion B: Dissociative Criteria Subjective sense of numbing, detachment, or absence of emotional responsiveness
Reduction in awareness of one’s surroundings (e.g., “being in a daze”)
Derealization
Depersonalization
Dissociative amnesia
20. Criterion C: Re-experiencing Criteria Recurrent images
Thoughts, dreams, illusions
Flashback episodes, or a sense of reliving the experience
Distress on exposure to reminders of the traumatic event
21. Criterion D: Avoidance Criterion Marked avoidance of stimuli that arouse recollections of the trauma (e.g., thoughts, feelings, conversations, activities, places, people)
22. Criterion E: Physiological Criteria Marked symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness)
23. Criterion F: Psychosocial Criteria Clinically significant distress or impairment in social, occupational, or other important areas of functioning
Impaired ability to pursue some necessary task, such as obtaining personal assistance or mobilizing personal resources
24. Criterion G: Time Criteria Minimum of 2 days
Maximum of 4 weeks
Occurs within 4 weeks of the traumatic event
25. Inter-relationship between ASD and PTSD
26. How does someone develop PTSD?
27. Validity is Well Established PTSD has proven to be a useful and valid diagnosis after 25 years of clinical use
Although there have been minor revisions to the diagnostic criteria the core concept has withstood the test of time
28. PTSD Prevalence in US Adults National Comorbidity Survey (1995); NCS-Replication (2005)
Large national probability samples (Ns > 5000)
Benchmark for prevalence of mental disorders in US
Lifetime PTSD prevalence = 6.8% (NCS-R)
9.7% women
3.6% men
Current PTSD prevalence = 3.6% (NCS-R)
5.2% women
1.8% men
29. The Burden of PTSD Individuals with PTSD have:
Elevated risk of mood, other anxiety, and substance abuse disorders
Elevated risk of suicide attempts
Greater functional impairment
Reduced quality of life
PTSD had the greatest impact of all anxiety disorders on economic burden to society (Greenberg et al., 1999)
30. PTSD and Functioning in the NCS In NCS, PTSD associated with:
40% elevated odds of academic failure
30% elevated odds of teenage parenthood
60% elevated odds of marital problems
150% elevated odds of current unemployment