PSYC 2490 Lecture Notes - Lecture 1: Insomnia, Dsm-5, Psychogenic Amnesia
19 Jun 2018
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THE DIAGNOSIS OF POSTTRAUMATIC STRESS DISORDER (PTSD)
Your readings for Unit 1 contain our first case study book chapter:
Case #4 – Posttraumatic Stress Disorder (PTSD)
This is a very interesting case of a stress reaction due to the trauma of a train accident.
The diagnostic category of PTSD also has an interesting history from which much can
be learned. Posttraumatic can be written as one word as it is in DSM, or as hyphenated
“post-traumatic” (as it is in ICD-10), or as a two-worded “post traumatic”. Mostly, we just
say PTSD.
PTSD gets an increasing amount of publicity, and deservedly so. There are many
experiences that might lead to PTSD: natural disasters such as an earthquake, motor
vehicle accidents, industrial accidents, witnessing a crime, or being a victim of a crime.
Acquiring PTSD is especially a possibility when a crime violates our core sense of self
and of safety, such as a home invasion or sexual assault.
PTSD is a reaction to a traumatic event, usually with the threat of death. Afterwards, the
traumatic event is re-experienced over and over again in vivid images and thoughts and
dreams, such that one might feel that the event is recurring. However, key aspects of the
traumatic event may be difficult to recall. There are many accompanying feelings of an
exaggerated startle response, irritability, disturbed sleep, and a feeling of detachment
from others.
PTSD IN ICD-10 AND DSM-5
Let’s start by comparing the two diagnostic systems:
In ICD-10, a PTSD disorder is described in one simple paragraph:
Post-traumatic stress disorder: Arises as a delayed or protracted response to a
stressful event or situation (of either brief or long duration) of an exceptionally
threatening or catastrophic nature, which is likely to cause pervasive distress in almost
anyone. Predisposing factors, such as personality traits (e.g. compulsive, asthenic) or
previous history of neurotic illness, may lower the threshold for the development of the
syndrome or aggravate its course, but they are neither necessary nor sufficient to
explain its occurrence. Typical features include episodes of repeated reliving of the
trauma in intrusive memories ("flashbacks"), dreams or nightmares, occurring against
the persisting background of a sense of "numbness" and emotional blunting, detachment
from other people, unresponsiveness to surroundings, anhedonia, and avoidance of
activities and situations reminiscent of the trauma. There is usually a state of autonomic
hyperarousal with hypervigilance, an enhanced startle reaction, and insomnia. Anxiety
and depression are commonly associated with the above symptoms and signs, and
suicidal ideation is not infrequent. The onset follows the trauma with a latency period that
may range from a few weeks to months. The course is fluctuating but recovery can be
expected in the majority of cases. In a small proportion of cases the condition may follow
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a chronic course over many years, with eventual transition to an enduring personality
change.
Now it should be noted that ICD also has a companion book that gives a little more
direction and guidelines to the diagnosis. This is referred to as the bluebook, and is also
freely available online at:
http://www.who.int/classifications/icd/en/bluebook.pdf (optional, not required). PTSD
guidelines are on p.120 (if you are curious).>
While offering more information, the ICD-10 bluebook guidelines remain very descriptive
and brief.
In DSM-5, we are given a very detailed long list of symptoms and criteria:
POSTTRAUMATIC STRESS DISORDER
A. Exposure to actual or threatened death, serious injury, or sexual violence
in one (or more) of the following ways:
A.1.Directly experiencing the traumatic event(s).
A.2.Witnessing, in person, the event(s) as it occurred to others.
A.3.Learning that the traumatic event(s) occurred to a close family
member or close friend. In cases of actual or threatened death of
family member or friend, the event(s) must have been violent or
accidental.
A.4.Experiencing repeated or extreme exposure to aversive details of
the traumatic event(s) (e.g., first responders collecting human
remains; police officers repeatedly exposed to details of child
abuse).
Note: Criterion A4 does not apply to exposure through electronic media, television,
movies, or pictures, unless this exposure is work related.
A. Presence of one (or more) of the following intrusion symptoms associated
with the traumatic event(s), beginning after the traumatic event(s)
occurred:
A.1.Recurrent, involuntary, and intrusive distressing memories of the
traumatic event(s).
A.2.Recurrent distressing dreams in which the content and/or affect of
the dream are related to the traumatic event(s).
A.3.Dissociative reactions (e.g., flashbacks) in which the individual
feels or acts as if the traumatic event(s) were recurring. (Such
reactions may occur on a continuum, with the most extreme
expression being a complete loss of awareness of present
surroundings.)
A.4.Intense or prolonged psychological distress at exposure to internal
or external cues that symbolize or resemble an aspect of the
traumatic event(s).
A.5.Marked psychological reactions to internal or external cues that
symbolize or resemble an aspect of the traumatic event(s).
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Your readings for unit 1 contain our first case study book chapter: This is a very interesting case of a stress reaction due to the trauma of a train accident. The diagnostic category of ptsd also has an interesting history from which much can be learned. Posttraumatic can be written as one word as it is in dsm, or as hyphenated. Post-traumatic (as it is in icd-10), or as a two-worded post traumatic . Ptsd gets an increasing amount of publicity, and deservedly so. There are many experiences that might lead to ptsd: natural disasters such as an earthquake, motor vehicle accidents, industrial accidents, witnessing a crime, or being a victim of a crime. Acquiring ptsd is especially a possibility when a crime violates our core sense of self and of safety, such as a home invasion or sexual assault. Ptsd is a reaction to a traumatic event, usually with the threat of death.
