PSY240H1 Lecture Notes - Lecture 4: Acute Stress Reaction, Posttraumatic Stress Disorder, Autobiographical Memory

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26 Jul 2016
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PTSD Lecture 4
Trauma: Experiences or situations that are extremely emotionally painful and distressing and
that overwhelm a person’s ability to cope, leaving them feeling powerless
A lot of people that they are extreme circumstances – terrorism, war, car accidents
Can occur frequently and become a part of the common human experience
marginalized groups who are more likely to have violence and chaos and abuse
More subtle and insidious forms of trauma – discrimination, racism, oppression and
poverty which are pervasive and when chronic are life altering
oIntention violence, witnessing violence, sustained discrimination, poverty,
chaotic life which are related to chronic fear and anxiety with long term risks
Risk Factors
Children with emotional problems or diagnoses mental disorders by age 6 are at greater
risk of developing PTSD later in life
Female and younger are risk factors
Low SES, low education, prior exposure to trauma (during childhood), childhood
adversity, lower intelligence, minority racial/ethnic status and family psychiatric history
all increase risk
Trauma tends to have most significant impacts when it is
oInterpersonal
oRepeated
oUnpredictable
oMultifaceted
oSadistic
oExperienced in hood
oBy a caregiver
Dose response relationship of the severity of trauma to the likelihood of developing
PTSD
Dissociation during trauma, perceived threat to life and personal injury are risk factors s
Individual factors – negative appraisals of self or others/world, maladaptive coping,
development of acute stress disorders – for posttraumatic
oSymptoms start early and are continuous for PSD rather than acute stress
disorder
oSubsequent exposures to upsetting reminders, adverse life effects after and
trauma related losses are for post traumatic
DSM
1. Exposure to traumatic event  actual threatened death, serious injury or sexual violence
a. Directly experience
b. Witness in person
c. Learning that happened to close family member or friend
d. Experience repeated or extreme exposure to aversive details over time (police)
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e. For children under six b isn’t for media, and d isn’t for media unless work related
2. At least 1 or 5 of intrusion symptoms
a. Recurrent intrusive memories
b. Recurrent, distressing dreams in content or affect
c. Dissociative reactions in which the individual acts were recurring  flashback
d. Intense or prolonged psychological distress at exposure to internal or external
cues that symbolize events
e. Marked physiological reactions for cues that resemble the event
f. In children younger than 6, expressed by repetitive play or dreams with themes
associated with trauma
3. At least 1 of 2 avoidance symptoms
a. Avoidance of memories or objects
4. At least 2 of 7 cognition/mood symptoms
a. Cannot remember event
b. Exaggerated negative believes about themselves, others or world
c. Persisted distorted cognitions about consequences in blame
d. Negative emotional state
e. Diminished interest from activities
f. Feelings of detachment
g. Persistent inability to feel positive emotions
5. At least 2 of 6 hyperarousal symptoms
a. Irritable behavior and angry outbursts
b. Reckless or self-destructive behavior
c. Hypervigilance
d. Exaggerated startle response
e. Problems with concentration
f. Sleep disturbance
6. Symptoms last greater than a month
7. Symptoms cause clinically significant distress or impairment
8. Symptoms are not as a result of substance use or medical condition
Specifiers
1. Depersonalization – being detached from oneself
2. Derealization – being detached from environment
Delayed expression until 6 months after they event
Changes in 2 because the response does not involve fear, helplessness or horror
An additional cluster in 5  thought and mood symptoms, around cognition, arousal and
self-destructive behavior
oSeparate for children and adults
oSubtype of PTSD that has disassociation
New symptoms
oBlame of self
oPersistent negative trauma-related emotions
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oSelf-destructive or reckless behavior
Other symptoms revised to clarify symptom expression
Separate diagnostic criteria for preschool
New dissociative subtype for PTSD added
US lifetime rates at 8.7% - decreased to 3.5%
oHigher among Latino, Black and Aboriginals
PTSD events vary across cultures and higher rates among veterans and first responders
o18.5% of troops in Iraq/Afghanistan developed PTSD
Different events are perceived differently by different people
oMeaning that one makes of experience from beliefs and cultural symptoms and
context
Can be a spectrum disorder in which there are different expressions that are
symptomatic and even psychobiologically
oOptimal treatment from one phenotype might not be the best treatment for
another
Nauseous because digestive symptoms are shutting down which can upset stomach
oBlood moves to middle of body so if you lose a limb don’t lose as much died
oFight flight or freeze reaction mechanism combined with thoughts in order to
keep ourselves safe from threats
Triggered anxiety
Someone experiences a single traumatic event, cues related to trauma that can be
associated with danger
oSounds smells tastes, times of day, crowds or certain people
Following trauma, you have increased arousal so that we have a lot of potential threat
cues
High alter to respond to attack, fight flight remains active in sympathetic NS
Intrusion, unwanted thoughts for events
oMemories, vivid imagery, intrusive thoughts, upsetting nightmare and dreams
Overwhelms brain’s ability integrate this into our regular experience
oOverwhelms capacity to be a part of our autobiographical memory
This happens in the amygdala and the hippocampus which is our process of memory
Amygdala emotional responses, threat system if we are afraid and endanger trigger
fight or flight
oNot good at time and place, confuse memory with actual experience
Hippocampus is the brain’s librarian which helps us store and remember info and tag it
with where and when
oThreat system active it is not effective
oThreat based memories may not be tagged to a time or place, and we feel that
the threat is current
oPTSD memories may not have been tagged properly
Intrusion can be with the dual representation model – 2 systems organizing incoming
information with 2 different types of memories
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find more resources at oneclass.com