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49 Cards in this Set

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DSM PTSD
A
Been exposed to traumatic event in which:
Objective
1) Experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury or a threat to physical integrity of eslf or others (rape)

Subjective
2) Response involved intense fear, helplessness, or horror. In children this may be expressed instead by disorganized or agitated behavior
DSM PTSD
B
The traumatic event is persistently reexperienced in 1 or more of the following ways (pathognomonic)
1) Recurrent and intrusive distressing recollections of the event including images, thoughts, or perceptions. Children may be repetitive play expressing themes of the trauma
2) Recurring distressing dreams of event
3) Acting or feeling as if traumatic event were happening again. Children trauma specific reenactment
4) Extreme psychological distress at exposure to internal/external cues that symbolize or resemble aspects of the trauma
5) Physiological reactivity on exposure to internal/external cues that symbolize or resemble aspects of the trauma
DSM PTSD
C
Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before trauma) as indicated by 3 or more of the following:
1) Efforts to avoid thoughts, feelings, conversations associated with trauma
2) Avoid activities, places, people that arouse recollections of the trauma
3) Inabilitiy to recall important aspects of the trauma
4) Markedly diminshed interest and participation in activities
5) Feelings of detachment or estrangement from others
6) Restricted range of affect
7) Sense of foreshortened future
DSM PTSD
D
Persistent symptoms of increased arousal (not present before trauma) as indicated by 2 or more of the following:
1) Difficulty falling/staying asleep
2) Irritability or outbursts of anger
3) Difficulty concentrating
4) Hypervigilance
5) Exaggerated startle response
DSM PTSD
E
Duration of the disturbance (above symptoms) is greater than 1 month
DSM PTSD
F
The disturbances causes clinically significant impairment in social, occupational, or other important areas of functioning
"Normal" response to "abnormal" situation
-Based on 2 assumptions
1) Incident causing PTSD is abnormal
2) Reactions seen are within normal response to such a stressor and would be expected to be seen in majority of people experiencing the trauma
-This view is not consistent with New Data
1) PTSD symptoms have occurred after normal/ordinary events
2) Even with extraordinary events, only 15-30% of exposed individuals tend to respond with PTSD (some variability with regard to trauma)
Effects of Trauma
After trauma exposure, most people become preoccupied with the event
-Involuntary recollections represent a normal respones to trauma
--This replaying of trauma seems to serve the function of modifying emotions surrounding trauma, creating tolerance, in mose people
-Most people exposed to trauma are able to go on with their life without being continually haunted
--Some get Caught on the trauma with intrusive memories that resist integration
Without PTSD:
-Accomodation-learn from experience
-Assimilation-accept whats happened, adjust expectations
Versus With PTSD:
-Sensitization-increased distress with recollections of trauma
Information Processing and PTSD
1) Intrusions - sensory memories, flashbacks, intense emotions, somatic sensations, nightmares, reenactments, ruminations
- new events cue memories of previous trauma
2) Compulsive Reexposure to Trauma
a. Harm to Others
- high % of violent criminals were abused (not vice versa)
- sexual acting out in children is linked to abuse
b. Self Destructiveness
- suicide, cutting, most self-mutilators were abused
3) Avoiding and Numbing
- Restricting acitivities, alcohol and drug use
- Numbness of responsivenss particularly positive emotions
4) Inability to Modulate Arousal
- Hypervigilance, exaggerated startle response, restlessness
- generalized arousal response - intense negative emotions to wide range of minor stimuli
- generalization of threat response - trivial innoccuous cues are experienced as potential threats
- due to chronic hyperarousal, bodily sensations can no longer be trusted as warning system for threat or guide for action
- narrowing of attention onto sources of potential threat
Information Processing and PTSD
Continued
5) Attention, distractibility, and stimulus discrimination
- problems with problem solving, focusing attention
- difficulty discriminating relevant stimuli for lives, as lives become organized around not reexperiencing trauma
- avoidant coping prevents active engaging to improve life
6) Sense of Personal Identity
- trauma challenges basic beliefs about self, world-self no longer invulnerable or intrinsicably worthwhile, world no longer safe or just
- interpretation of trauma affected by history (bank account model)
3 Cognition Types Associated with PTSD
1) Negative thoughts about the world

2) Negative thoughts about the self

3) Self-Blame
Predictors of PTSD
1
1) Pretrauma Vulnerability
- family hx of mentall illness, alcoholism
- female gender
- biological stress response variables-lower resting cortisol levels
- genetic factors
- neuroticism
- introversion
- history of mental illness
- prior trauma exposure
- negative parenting behavior, early seperation from parents, parental poverty, lower education
Predictors of PTSD
2
2) Stressor Characteristics
- trauma intensity and duration
- dangerousness - extent of injury
Green-7 dimensions linked to posttrauma response
1. Legitimate threat to life and physical integrity
2. Severe physical harm or injury
3. Injury/harm in intentional or inflicted
4. Exposure to grotesque imagery
5. Witnessing or learning of violence to loved ones
6. Learning of exposure to noxious agents
7. Causing death or severe harm to another
Predictors of PTSD
3
3) Preperation of the Event
- Adequate preperation for an event can reduce risk
-reduces uncertainty
-increases sense of control
-teaches automatic responses which are more resilient during stress (when its difficult to problem solve)
Predictors of PTSD
4
4) Immediate Responses
- extreme anxiety arousal
- peritraumatic dissociation
- breakdown of normal functioning in information processing (dissociation)
Predictors of PTSD
5
5) Posttrauma
- presence of PTSD symptoms immediately after trauma linked with later PTSD
- social support after trauma linked with positive outcome (Not Significant)
- Negative social support (blaming) linked with negative outcome (Significant)
PTSD as Biopsychosocial Trap
PTSD as complex diagnosis distinguished by occurence
1) Permanent alteration of neurobiological processes, resulting in hyperarousal & disrupted stimulus discrimination
2) Acquisition of conditioned fear responses to trauma-related stimuli
3) Altered cogntive schemata & social apprehension, resulting from profound dissonance between the traumatic experience and ones previous knowledge of the world
Epidemiology
1) Branch of medical science that deals with incidence, distribution, and control of disease in a population
2) Sum of factors controlling the presence or absence of a disease or pathogen
Incorporates:
1. Incidence
2. Prevalence
3. Contributing Factors
Incidence
Frequency of occurrence - number of new cases of a disorder for a specified time
Prevalence
Distribution - how widespread a disorder is at a given time - overall frequency
Causes of PTSD
Stressor Types
1) Acute Events
- time limited
- victim unpreparedness
- high intensity
- accident, disaster, rape
2) Sequential Stressors
- can have cumulative effect
- emergency service workers
3) Long lasting Exposure to Danger
- helplessness
-combat
- repeated intrafamilial abuse
Course of PTSD
Acute Stress
|
Chronic Stress Response
|
Adaptation to chronic PTSD symptoms
Factors that incluence course of PTSD
- ability to tolerate suffering
- neurobiology of stress response
- capacity for self modulation
- ability to tolerate fear and threat
- ability to cope with losses
- vulnerability factors
- resilience factors
Resilience
- Resolution of trauma - how it ends
- Individuals emotional reaction at time of trauma
- Training or level of preparedness for trauma
- Might there be cogntive/lifestyle factors
Vulnerability
- Intrusive memories following trauma seem to be a normal part of adaptation and are Not good predictors of later PTSD
-Distrubances of arousal/affect Are good predictors of PTSD
--Enduring exaggerated startle, hypervigilance, irritability, sleep and memory problems
-Vulnerability factors mediate progression from distress to severe symptoms
--past or family hx of mental illness
--trait neuroticism
--social mediators
--additional traumatic life events following intial trauma
Adaptation to Chronic Symptoms
-How do people react to their symptoms
-What coping mechanisms
Affected By:
-personal meaning assigned to trauma
-attributions
-interction with personal values, beliefs
-environmental support/validation (or lack therefore) of experiences
-resources available to person
Trauma and Human Development
-development of affect regulation and dysregulation
-secure attachments promote appropriate affect regulation
-abusive or unresponsive parents may promote chronic hyperarousal (infants respond to absence with arousal)
-traumatized children not able to manage their own arousal/affect, not know approriate way to cope
Manifestations of Self-Regulation Deficit
-Inability to distinguish between harmless stimuli and real threats
-Emotional reactivity can lead to quick reacitivty (acting out) without assessment of situation meaning (thinking 1st)
Abuse - Secure Attachments
Compex Effects of Ongoing Trauma
- Interaction of trauma process with developmental trajectory
Secure Attachments -Defense vs. Trauma
-parents teach children to modulate their arousal appropriately
-modelling of appropriate reactions
-teach coping skills-self soothing
-teach how to use social resources-elicit caring/support from environment
DSM for Borderline Personality Disorder
Pervasive pattern of instability of interpersonal relationships, self image, and affects, and markedly impulsivity beginning by early adulthood and present in a variety of settings of contexts as indicated by 5 or more of the following:
1) Franitc efforts to avoid real or imagined abandonment
2) Pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3) Identity disturbance; markedly and persistently unstable self-image/sense of self
4) Impulsivity in at least 2 areas that are potentially self damaging
5) Recurrent suicidal behavior, gestures, threats, self mutilation
6) Affective instability due to marked reactivity of mood
7) Chronic feelings of emptiness
8) Inappropriate, intense anger of difficulty controlling anger-frequent displays of temper, constant agner, physical fights
9) Transient, stress related paranoid ideation or severe dissociation symptoms
Biosocial Theory of BPD Development
Linehan
Emotion Dysregulation
1) High Emotional Vulnerability - biological in nature
2) Inability to regulate emotions - behavioral
Biosocial Theory of BPD Development
Linehan
Emotional Vulnerability
- High sensitivity to emotional stimuli
--quick emotional reactions, low threshold for emotional reactions
- Intense emotional reactions/experience
--reactions are dramatic and extreme
- Slow return to baseline
Biosocial Theory of BPD Development
Linehan
Emotional Regulation
1) Individual must learn to experience and label discrete emotions
--hard wired into neurophysiological behavior
2) Individual must thenlearn to reduce emotionally relevant stimuli that serve either to reactivate and augment ongoing negative emotions or to set off secondary dysfunctional emotional responses
Emotion Modulation Strategies
Abilities To:
1) Inhibit inappropriate behavior related to strong negative or positive affect
2) Self regulate physiological arousal associated with affect
3) Refocus attention in the presence of strong affect
4) Organize oneself for coordinated action in the service of an external non-mood-dependent goal
Invalidating Environment
-Heavily implicated in development of BPD
-Describes both the environment in overtly abusive homes as well as other family types
Characterized by:
- Communication of private experiences is met be erratic, inappropriate, and extreme responses
- Expression of private experiences is not validated, but is punished and or trivialized
- Experience of painful emotions is disregarded
- Individuals interpretation of own behavior is dismissed
Characteristics of Invalidation
1) Tells individual that she is wrong in both her description and her anlayses of her own experience, particularly in her views of what is causing her own emotions, beliefs, and actions
2) Attributes her experiences to socially unacceptable characteristics of personality traits
- may insist that she feels what she says she does not
- may insist she likes or prefers what she says she doe not
Consequences of Invalidating Environment
1) Fails to validate emotional expressions
- fails to teach child to label private experiences, including emotions, in a manner normative in her larger societal community
- child not taught to modulate emotions
2) Oversimplifies the ease of solving lifes problems
- failt to teach distress tolerance
- failt to teach forming of realistic goals and expectations
3) Shapes extreme emotional displays/problems
- necessary to provoke helpful environmental response
4) Fails to teach child to trust her own emotional and cognitive responses
- child learns not to trust herself
Psychobiology of PTSD
1) Brainstem & Hypothalamus
- regulation of internal functions
- maintenance of bodily homeostasis
2) Limbic System
- maintaining balance between internal world and external reality
- highly involved in emotions
- internal reacions to perceptions
3) Neocortex
- analyzing and interacting with external world
- conscious thought
Psychobiology of PTSD
Brain Systems Control Regulatory Functions:
1) Internal Vegetative Functions
- rest/sleep activity cycles
- feeding
- reproductive cycles
2) Monitor Relations With Outside World
- take in & categorize new info
- integrate new info with previously stored knowledge
- discriminate between relevant and irrelevant info
- weigh consequences of alternate
3) Engage in routine tasks without being distracted by irrelevant stimuli
- focus on relevant stimuli
- learn from experience
4) Form complex social relationships
- recognize and respond to social rules
Psychophysiological Effects of Trauma
- Extreme autonomic responses to trauma cues

- Hyperarousal of neutral stimuli
--nonhabituation of acoustic startle response
--generalization of threat response
Neurochemicals: Stress Response
1) Corticotropin Releasing Factor CRF
-neurotransmitter in Limbic System
-stimulates anterior pituitary gland to release ACTH which stimulates adrenal cortex to release steroid hormones (corisol)
-abnormal cortisol levels in PTSD
2) Norepinephrine (NA)
-involved in arousal system
-increased blood flow & pressure, respiratory rate
-increased attention, vigilance
-enhancement of memory recall
-subjective experience of stress
In PTSD We See:
-increased HR & BP
-more urinary NA levels
-increased plasma NA levels in respones to traumatic reminders
-down regulation of NA receptors
Neurochemicals: Stress Response
Continued
3) Serotonin 5HT
-decreased serotonin acitivty in traumatized animals
-stress response involves increased metabolism of serotonin
-decreases in serotonin associated with stress-induced behavioral deficits (learned helplessness)
-injection of serotonin in frontal cortex after stress reverses behavioral deficits
-SSRI's are best med for PTSD
Functions of Limbic System
Hippocampus
- categorizing and organizing experience
- creation of spatial map
- storage of simple memory
- explicit/declarative memory

Amygdala
- conditioned fear response
- Attachments of affect to neutral stimuli
- Establishment of associations between different senses
- Development of anxiety disorders
Effects of Lesions
Hippocampus
- Declarative memory loss
- Intact skill based & immediate memory

Amygdala
- Loss of fear response
- Meaningful social interaction lost
- Declarative memory intact
Amygdala
- evaluating and assigning emotional meaning to incoming information
- conditioned fear response
Hippocampus
- role in categorization and storage of info into memory
--declarative/explicit memory-facts
- Animals-high levels of stimulation of the amygdala interferes with hippocampal functioning
--implies that intense emotion may inhibit proper memory function
--thinking of trauma memories in PTSD
Memory Systems
1) Declarative/Explicit Memory
- conscious awareness of facts or events
- seriously affected by lesions of hippocampus and frontal lboes
2) Nondeclarative/Implicit Memory
- memories of skills, habits, emotional responses, reflexive actions, and classically conditioned responses
Memory Disruption in PTSD
1) Altered nature of trauma memories
-flashbulb memories
- trauma remembered in terms of images, sounds, smells-which are associated with strong emotions
-difficulty forming narrative descriptions of their events
2) PTSD survivors show attention and memory biases for trauma related info
-stroop finding-PTSD
-enhanced recall for trauma related info on word stem completion
3) Dissociation and PTSD
- current & peritraumatic dissociation linked with PTSD
-dissociative amnesia
4) Short-Term Verbal Memory Deficits
-STM deficits with chronic PTSD
- reduction in hippocampal volume for PTSD patients--STM deficits
Dissociation
Disruption in the usually integrated functioning of consciousness, memory, identity, or perception of the environment