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Chapter 5

Ch. 5 - PTSD.pdf

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McMaster University
Richard B Day

 p. 162 - 180  Post-traumatic stressdisorder-PTSD  Symptoms o Re-experience trauma through thoughts or nightmares o Avoids stimuli associated with trauma o Chronic tension / irritability, with insomnia and intolerability to noise o Impaired concentration and memory o Unable to feel positive emotions  Epidemiology o Lifetime prevalence of PTSD = 7 - 12%  Occurs in a minority of traumatized people  67% of people are traumatized in their lives o Examples - wars  19% of Vietnam war veterans  10 - 20% of Canadian armed forces develop PTSD o Risk of trauma and PTSD is higher in people living in war-torn countries and those in dangerous jobs  Prostitutes - Vancouver  72% were classified as having PTSD  90% had been traumatized o Developing PTSD is more likely in women  Even though men are exposed to trauma more  Comorbidity o 16% have 1 other disorder o 54% have 3+ more diagnoses o 54% of substance abusers have PTSD  Acute stress disorder vs. PTSD o Stressor is unusually severe in both o ASD  Occurs within 4 weeks of traumatic event  Lasts 2 days - 4 weeks o PTSD  Lasts longer than 1 month Acute = lasts less than 3 months   Chronic = lasts more than 3 months  Delayed-onset = starts more than 6 months after trauma  Two forms:  No symptoms until PTSD starts  Increasing severity of symptoms - slowly developing PTSD  Most common  94 - 96% are immediate rather than delayed onset  Victimsinitial responsefollowing atraumahas3 stages: o Shock stage o Suggestible stage  Takes directions from rescue workers, passive o Recovery stage  Repeatedly describe catastrophic event  Where PTSD can develop  Rapeis mostfrequentcauseofPTSDin women o 39% of Canadian women have been sexually assaulted since age 16 o Different types of rape  Stranger rape = fear of harm and death  Acquaintance rape = guilt Young child rape = sexual scars and confusion   Young adult women = independence and separation issues  Married rape = unable to care for kids o Affects women in 5 areas of functioning  Physical disturbances, e.g., anxiousness Emotional problems, e.g., depression   Cognitive dysfunction, e.g., intrusive thoughts  Atypical behavioural acts, e.g., substance abuse  Interference with social relationships, e.g., intimacy issues o Long term effects  Depends on their past coping skills, resiliency in dealing with problems, and level of psychological functioning  Perception of if they can control future circumstances  Better if they think future assault is less likely o Counseling rape victims  Those who disclose the rape have more positive and fewer negative outcomes o Coping with rape  Coping begins before rape occurs and ends many months after the attack  4 phases  Anticipatory phase  Offender sets-up the rape… you know something dangerous is going to happen  Impact phase  I am going to be raped -> end of rape  Intense fear and immobility 3. Posttraumatic recoil phase  2 emotional styles: sobbing or calm facade 4. Reconstitution phase  After emergency room or crisis center -> months later  Self-protective activities, frightening nightmares and phobias  Theworldaroundus-Traumaofincredible proportions o Likelihood of developing PTSD increases with the proximity to the World Trade Center o Remote exposure  Trauma just by watching it on TV  Rarely causes PTSD, but can trigger some symptoms - nightmares and avoidance  Mild and short-lived symptoms  TraumaofMilitary combat o World War 1 Shell-shock   Thought to be because of brain hemorrhages  Realized barely any have physical injury o World War 2  Combat fatigue or combat exhaustion  10% of troops during WW2 o Korean war  % dropped  27% of discharges were forpsychiatric reasons o Vietnam war  Even less (1.5%) o Middle East war  15.6 - 17.1% had PTSD symptoms after duty  Versus 11.2 - 9.3% who had symptoms before duty o Rates of disorder increased with extent of combat and with being wounded in combat o Clinical PictureofPTSD  Simply being in a war-zone is insufficient to cause PTSD  Dose-response relationship  Risk of developing PTSD increases if the person has been in combat…  Risk is even higher if the person has witnessed atrocities, e.g., mutilated corpses  Laufer, Brett & Gallops  IV: Level of stress with DV: PTSD symptoms  Exposed to combat  Exposed to abusive violence in combat  Intrusive imagery, hyper arousal, numbing & cognitive disruptions  Participated in abusive violence in combat  More severe pathologies  Clinical picture of PTSD depends on severity of stressor Anger and anger control problems is a strong component of PTSD in combat  veterans Physically wounded soldiers show less anxiety /combat exhaustion symptoms   Except with permanent mutilation  It gives you a good reason to leave a stressful combat situation = removes anxiety source o Prisonersofwarandholocaustsurvivors  124 holocaust survivors  63% were detained  46% developed PTSD  Tattooed survivors had more severe PTSD symptoms  camp identification numbers - objective measure of trauma severity  Retrospective study of psychological maladjustment in POWs  1/2 report symptoms meeting PTSD 1 year following release  1/3 meet PTSD 40 - 50 years after release  Higher death rate after return to civilian life  Developmentinresearch:Unpredictableanduncontrollablestressors o 2 most important determinants of how an organism responds to stress is if the stressors are:  Unpredictable and uncontrollable  More stressed by unpredictable and uncontrollable stressors versus it's equal magnitude that is the opp. o PTSD symptoms parallel with animal symptoms in response to U and U stressors Animals - increase levels of norepinephrine   Give drug that increases this to PTSD patients and it increases flashback and bad thoughts  Stress-induced analgesia or diminished sensitivity to pain  Emotional numbing may be this in ptsd o What makes someone who experiences these stressors more likely to develop PTSD  Prior experience with uncontrollable stressor can sensitize you and make you more susceptible to the negative consequences experienced with uncontrollable trauma  Neuroticism  Severe threatstopersonalsafetyandsecurity o Adults who emigrate experience a high degree of stress and problems in psychological adjustment o More stress can happen in the children
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