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Posttraumatic Stress Disorder

Posttraumatic Stress Disorder. -Brief History. Coconut Grove Fire (1942) “Post Vietnam Syndrome” “shell shocked”, “war neurosis”, “combat fatigue” 1 st Appeared in DSM-III (1980). Posttraumatic Stress Disorder. -DSM Definition/Criteria A. Exposure to, witnessing of, learning about

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Posttraumatic Stress Disorder

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  1. Posttraumatic Stress Disorder -Brief History • Coconut Grove Fire (1942) • “Post Vietnam Syndrome” • “shell shocked”, “war neurosis”, “combat fatigue” • 1st Appeared in DSM-III (1980) (c) 2008 Jason M. Karampatsos

  2. Posttraumatic Stress Disorder -DSM Definition/Criteria A • Exposure to, witnessing of, learning about • Extreme traumatic stressor • Actual or threatened death or serious injury • Threat to one’s physical integrity • To self, family member or others • Response: fear, helplessness or horror • Disorganized or agitated behavior in Children (c) 2008 Jason M. Karampatsos

  3. Posttraumatic Stress Disorder -DSM Diagnostic Criteria B • Re-experienced in one (or more) • Distressing recollections, images, thoughts, etc • Distressing dreams • Acting or feeling as if event was recurring • Exposure related psychological distress • Exposure related physiological reactivity (c) 2008 Jason M. Karampatsos

  4. Posttraumatic Stress Disorder -DSM Diagnostic Criteria C • Avoidance three (or more) • Thoughts, feelings, conversations • Activities, places, people • Inability to recall • Diminished interest or participation • Feelings of detachment or estrangement • Restricted affect • Sense of foreshortened future (c) 2008 Jason M. Karampatsos

  5. Posttraumatic Stress Disorder -DSM Diagnostic Criteria D • Arousal two (or more) • Sleep disturbances • Irritability • Difficulty concentrating • Hypervigilance • Startle response (c) 2008 Jason M. Karampatsos

  6. Posttraumatic Stress Disorder -DSM Diagnostic Criteria E,F • Duration of disturbance > 1 Month • Sx in criteria B,C and D • (re-experiencing, avoidance, arousal) • Distress in social, occupational or other area (c) 2008 Jason M. Karampatsos

  7. Posttraumatic Stress Disorder -DSM Diagnostic Specifiers • Acute: if duration of Sx is < 3 months • Chronic: if duration of Sx is > 3 months • Delayed Onset: if onset of Sx is > 6 months (c) 2008 Jason M. Karampatsos

  8. Acute Stress Disorder -DSM Diagnostic Criteria • Three (or more) Dissociative Sx [Criterion B] • Numbing/detachment • of awareness (“being in a daze”) • Derealization • Depersonalization • Dissociative Amnesia • Dx Criteria A, C, D, E same as PTSD • Exposure, Reexperiencing, Avoidance, Arousal • Lasts minimum of 2 days, maximum of 4 weeks • Must occur within 4 weeks of traumatic event (c) 2008 Jason M. Karampatsos

  9. PTSD • Lifetime prevalence 8% (approx.) • At-risk groups can be as high as 33-50+% • Combat & Sexual Assault (most common trauma) • 50% recover within 3 months • Many other lasting > 12 months • Reminders, stressors, new trauma can be triggers • Trauma is Necessary, but not Sufficient (c) 2008 Jason M. Karampatsos

  10. PTSD • Only Disorder with a Clear Etiology • Biological & Psychological Vulnerability • Amount of Social support is a predictor • Increase in Suicides? • Experiences Uncontrollable & Unpredictable events • Severity, Duration, Unpredictability, & Proximity • Influences to likelihood of developing PTSD • Reaction to True Alarm (fear) • Contrasted with the anxiety in Panic Attacks (c) 2008 Jason M. Karampatsos

  11. Treatment of PTSD • Face the Original Trauma • Imaginal exposure (intentional and systematic) • Flooding • Arrange for Corrective Emotional Learning • Group or Individual Therapy • Tx for 1st Responders • CISM, CISD, Mitchell Model • Pharmacological Tx • Same as other anxiety disorders? • Disability and Compensation (c) 2008 Jason M. Karampatsos

  12. Differential Diagnosis of PTSD • Adjustment Disorder • If stressor is not “extreme” • If full criteria is not met • Acute Stress Disorder • If occurs within 4 weeks & resolves within 4 weeks • A Mood Disorder or another Anxiety Disorder • If Sx of avoidance, numbing, increased arousal were present before exposure to stressor • Flashbacks must be distinguished from illusions, hallucinations, & other perceptual disturbances (c) 2008 Jason M. Karampatsos

  13. Additional Reading Resources • Trauma and Recovery, Judith Herman • Effective Treatments for PTSD, Edna Foa, Terence Keane & Matthew Friedman • The Death of the Messiah, Raymond Brown • God, Where are You?: Evaluating a spiritually-integrated intervention for sexual abuse, Nichole Murray-Swank & Kenneth Pargament (c) 2008 Jason M. Karampatsos

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