Survey of Modern Psychology

1
Survey of Modern Psychology

• Anxiety Disorders

2
The Anxiety Disorders

• Panic Attack
• Agoraphobia
• Panic Disorder Without Agoraphobia
• Panic Disorder With Agoraphobia
• Specific Phobia
• Obsessive Compulsive Disorder
• Post Traumatic Stress Disorder
• Generalized Anxiety Disorder

3
Panic Attack

• A discrete period of intense fear or discomfort,
  in which four (or more) of the following symptoms
  developed abruptly and reached a peak within 10
  minutes
• Palpitations, pounding heart, or accelerated
  heart rate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath or smothering
• Feeling of choking
• Chest pain or discomfort

4
Panic Attack (4 or more)

1. Nausea or abdominal distress
2. Feeling dizzy, unsteady, lightheaded, or faint
3. Derealization (feelings of unreality) or
   depersonalization (being detached from oneself)
4. Fear of losing control or going crazy
5. Fear of dying
6. Paresthesias (numbness or tingling sensations)
7. Chills or hot flushes

5
Panic Attack

• Not a disorder by itself
• Can occur in Anxiety Disorders or other disorders
• i.e., Mood Disorders, Substance Related, general
  medical conditions
• Different from generalized anxiety because it
  happens within a discrete period of time
• There is no real danger present

6
Panic Attacks

• Uncued/Unexpected
• The individual does not associate onset with a
  particular internal or external situational
  trigger
• Seems to occur spontaneously
• Cued/Situationally Bound
• Almost invariably occur immediately upon exposure
  to, or in anticipation of, the situational cue or
  trigger
• Situationally Predisposed
• Similar to situationally bound but there are
  times that the person is exposed to the stimulus
  and does not have a Panic Attack

7
Agoraphobia

• The essential feature is a fear of being in
  places or situations from which escape might be
  difficult (or embarrassing) or impossible, or in
  which help would not be available in the event of
  a Panic Attack
• The individual avoids feared situations and may
  not be able to work or carry out responsibilities
• Agoraphobia by itself is not a codable disorder
• However, a diagnosis of Agoraphobia Without
  History of Panic Disorder is possible

8
Agoraphobia

• Anxiety about being in places or situations from
  which escape might be difficult (or embarrassing)
  or in which help may not be available in the
  event of having an unexpected or situationally
  predisposed Panic Attack or panic-like symptoms.
  Agoraphobic fears typically involve
  characteristic clusters of situations that
  include being outside the home alone being in a
  crowd or standing in a line being on a bridge
  and traveling in a bus, train, or automobile
• Note Consider the diagnosis of Specific Phobia
  if the avoidance is limited to one or only a few
  specific situations, or Social Phobia if the
  avoidance is limited to social situations

9
Agoraphobia

1. The situations are avoided (e.g., travel is
   restricted) or else are endured with marked
   distress or anxiety about having a Panic Attack
   or panic-like symptoms, or require the presence
   of a companion
2. The anxiety or phobic avoidance is not better
   accounted for by another mental disorder, such as
   Social Phobia (e.g., avoidance limited to social
   situations because of fear of embarrassment),
   Specific Phobia (e.g., avoidance limited to a
   single situation like elevators),
   Obsessive-Compulsive Disorder (e.g., avoidance of
   dirt in someone with an obsession about
   contamination), Posttraumatic Stress Disorder
   (e.g., avoidance of stimuli associated with a
   severe stressor), or Separation Anxiety Disorder
   (e.g., avoidance of leaving home or relatives)

10
Panic Disorder Without Agoraphobia

• Both (1) and (2)
• Recurrent unexpected Panic Attacks
• At least one of the attacks has been followed by
  1 month (or more) of one (or more) of the
  following
• Persistent concern about having additional
  attacks
• Worry about the implications of the attack or its
  consequences (e.g., losing control, having a
  heart attack, going crazy)
• A significant change in behavior related to the
  attacks
• Absence of of Agoraphobia

11
Panic Disorder Without Agoraphobia

1. The Panic Attacks are not due to the direct
   physiological effects of a substance (e.g., a
   drug of abuse, a medication) or a general medical
   condition (e.g., hyperthyroidism)
2. The Panic Attacks are not better accounted for by
   another mental disorder, such as Social Phobia
   (e.g., occurring on exposure to feared social
   situations), Specific Phobia (e.g., on exposure
   to a specific phobic situation),
   Obsessive-Compulsive Disorder (e.g., on exposure
   to dirt in someone with an obsession about
   contamination), Posttraumatic Stress Disorder
   (e.g., in response to stimuli associated with a
   severe stressor), or Separation Anxiety Disorder
   (e.g., in response to being away from home or
   close relatives)

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Panic Disorder With Agoraphobia

• Both (1) and (2)
• Recurrent unexpected Panic Attacks
• At least one of the attacks has been followed by
  1 month (or more) of one (or more) of the
  following
• Persistent concern about having additional
  attacks
• Worry about the implications of the attack or its
  consequences (e.g., losing control, having a
  heart attack, going crazy)
• A significant change in behavior related to the
  attacks
• The presence of Agoraphobia

13
Panic Disorder With Agoraphobia

1. The Panic Attacks are not due to the direct
   physiological effects of a substance (e.g., a
   drug of abuse, a medication) or a general medical
   condition (e.g., hyperthyroidism)
2. The Panic Attacks are not better accounted for by
   another mental disorder, such as Social Phobia
   (e.g., occurring on exposure to feared social
   situations), Specific Phobia (e.g., on exposure
   to a specific phobic situation),
   Obsessive-Compulsive Disorder (e.g., on exposure
   to dirt in someone with an obsession about
   contamination), Posttraumatic Stress Disorder
   (e.g., in response to stimuli associated with a
   severe stressor), or Separation Anxiety Disorder
   (e.g., in response to being away from home or
   close relatives)

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Panic Disorder Notes

• Tend to have more anxiety overall
• Often are less tolerant of medication side
  effects and need continued reassurance when
  taking a medication
• If the Panic Disorder was initially misdiagnosed
  or not treated, the person may believe that they
  have an undetected life-threatening condition
• May be exacerbated by disruptions in
  interpersonal relationships

15
Panic Disorder Notes

• Mixed reports on high comorbidity with Major
  Depressive Disorder
• Rates are reported as anywhere from 10 to 65
• In 1/3 of these cases, the Depression precedes
  the Panic Disorder
• In the other 2/3, they occur together
• Some may develop a substance abuse problem by
  trying to treat the anxiety with alcohol or other
  drugs
• Separation Anxiety Disorder in childhood is
  strongly associated with a later diagnosis of
  Panic Disorder
• Often comorbid with Hypochondriasis

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Panic Disorder Notes

• Panic Disorder is more common in women
• Lifetime prevalence is 1 - 2
• Point prevalence is .5 - 1.5
• Age of onset is bimodal
• Late adolescence
• Mid 30s
• Some cases begin in childhood, and can occur
  later in life
• First degree relatives are more likely to have
  Panic Disorder
• The risk is higher if it began before age 20
• Twin studies indicate a genetic component

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Specific Phobia

• Rarely severe enough to require treatment
• Marked and persistent fear that is excessive or
  unreasonable, cued by the presence or
  anticipation of a specific object or situation
  (e.g., flying, heights, animals, receiving an
  injection, seeing blood)
• Exposure to the phobic stimulus almost invariably
  provokes an immediate anxiety response, which may
  take the form of a situationally bound or
  situationally predisposed Panic Attack. Note In
  children, the anxiety may be expressed by crying,
  tantrums, freezing, or clinging

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Specific Phobia

1. The person recognizes that the fear is excessive
   or unreasonable. Note In children, this feature
   may be absent
2. The phobic situation(s) is avoided or else is
   endured with intense anxiety or distress
3. The avoidance, anxious anticipation, or distress
   in the feared situation's) interferes
   significantly with the persons normal routine,
   occupational (or academic) functioning, or social
   activities or relationships, or there is marked
   distress about having the phobia
4. In individuals under age 18 years, the duration
   is at least 6 months

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Specific Phobia

1. The anxiety, Panic Attacks, or phobic avoidance
   associated with the specific object or situation
   are not better accounted for by another mental
   disorder, such as Obsessive-Compulsive Disorder
   (e.g., fear of dirt in someone with an obsession
   about contamination), Posttraumatic Stress
   Disorder (e.g., avoidance of stimuli associated
   with a severe stressor), Separation Anxiety
   Disorder (e.g., avoidance of school), Social
   Phobia (e.g., avoidance of social situations
   because of fear of embarrassment), Panic Disorder
   With Agoraphobia, or Agoraphobia Without History
   of Panic Disorder

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Specific Phobia

• Specify type
• Animal Type
• Natural Environment Type (e.g., heights, storms,
  water)
• Blood-Injection-Injury Type
• Situational Type (e.g., airplanes, elevators,
  enclosed spaces)
• Other Type (e.g., fear of choking, vomiting, or
  contracting an illness in children, fear of loud
  sounds or costumes characters)

21
Social Phobia (Social Anxiety Disorder)

1. A marked and persistent fear of one or more
   social or performance situations in which the
   person is exposed to unfamiliar people or to
   possible scrutiny by others. The individual fears
   that he or she will act in a way (or show anxiety
   symptoms) that will be humiliating or
   embarrassing. Note In children, there must be
   evidence of the capacity for age-appropriate
   social relationships with familiar people and the
   anxiety must occur in peer settings, not just in
   interactions with adults

22
Social Phobia (Social Anxiety Disorder)

1. Exposure to the feared social situation almost
   invariably provokes anxiety, which may take the
   form of a situationally bound or situationally
   predisposed Panic Attack. Note In children, the
   anxiety may be expressed by crying, tantrums,
   freezing, or shrinking from social situations
   with unfamiliar people
2. The person recognizes that the fear is excessive
   or unreasonable Note In children, this feature
   may be absent
3. The feared social or performance situations are
   avoided or else are endured with intense anxiety
   or distress
4. The avoidance, anxious anticipation, or distress
   in the feared social or performance situation(s)
   interferes significantly with the persons normal
   routine, occupational (academic) functioning, or
   social activities or relationships, or there is
   marked distress about having the phobia

23
Social Phobia (Social Anxiety Disorder)

• In individuals under age 18 years, the duration
  is at least 6 months
• The fear or avoidance is not due to the direct
  physiological effects of a substance (e.g., a
  drug of abuse, a medication) or a general medical
  condition and is not better accounted fro by
  other mental disorder (e.g., Panic Disorder With
  or Without Agoraphobia, Separation Anxiety
  Disorder, Body Dysmorphic Disorder, a Pervasive
  Developmental Disorder, or Schizoid Personality
  Disorder)
• If a general medical condition or another mental
  disorder is present, the fear in Criterion A is
  unrelated to it, e.g., the fear is not of
  Stuttering, trembling in Parkinsons disease, or
  exhibiting abnormal eating behavior in Anorexia
  Nervosa or Bulimia Nervosa.
• Specify if
• Generalized if the fears include most social
  situations (also consider the additional
  diagnosis of Avoidant Personality Disorder)

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Social Phobia Specifiers

• Generalized
• The fears are related to most social situations
• Fear of public performance and social
  interaction
• This is as opposed to a more specific fear of
  certain types of social situations

25
Social Phobia Notes

• Social Phobia should only be diagnosed if the
  fear or avoidance interferes with the persons
  normal routine or causes distress
• For example, a person who is afraid of public
  speaking would not be diagnosed if he or she does
  not routinely encounter public speaking at
  work/school and is not distressed about it
• In general, a fear of being embarrassed in social
  situations is common, but it usually does not
  cause impairment
• Transient social anxiety or avoidance is common
  in childhood and adolescence

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Social Phobia Notes

• Associated features
• Hypersensitivity to criticism, negative
  evaluation, or rejection
• Difficulty being assertive
• Low self esteem
• Feelings of inferiority
• May manifest poor social skills
• May underachieve in school due to test anxiety or
  avoiding participation
• Smaller social support network
• Less likely to marry

27
Social Phobia Notes

• High comorbidity
• Other Anxiety Disorders
• Mood Disorders
• Substance Related Disorders
• Bulimia
• Most of these disorders are preceded by Social
  Phobia

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Social Phobia Notes

• Presentation may differ across groups and social
  demands
• i.e., might fear offending others rather than
  embarrassing oneself
• Young children might be selectively mute
• In children
• Must be evidence of a capacity for relationships
  with familiar people
• Impairment tends to show in failure to make
  expected achievements rather than a decline in
  functioning

29
Social Phobia Notes

• Lifetime prevalence reports range from 3 to 13
• Depends on the threshold used to determine
  distress or impairment and the number of
  situations specifically asked about
• In one study, 20 of people reported an
  excessive fear of public speaking, but only 2
  reported enough impairment to warrant a diagnosis
• Rarely a primary cause for seeking treatment
• Community based studies suggest that its more
  common among females in clinical samples, its
  equally common among males and females or more
  common among males
• There is strong genetic evidence for Generalized
  Social Phobia

30
Obsessive Compulsive Disorder

• Either obsessions or compulsions
• Obsessions as defined by (1), (2), (3), and (4)
• Recurrent and persistent thoughts, impulses, or
  images that are experienced, at some time during
  the disturbance, as intrusive and inappropriate
  and that cause marked anxiety or distress
• The thoughts, impulses, or images are not simply
  excessive worries about real-life problems
• The person attempts to ignore or suppress such
  thoughts, impulses, or images, or to neutralize
  them with some other thought or action
• The person recognizes that the obsessional
  thoughts, impulses, or images are a product of
  his or her own mind (not imposed from without as
  in thought insertion)

31
Obsessive Compulsive Disorder

• Compulsions as defined by (1) and (2)
• Repetitive behaviors (e.g., hand washing,
  ordering, checking) or mental acts (e.g., prying,
  counting, repeating words silently) that the
  person feels driven to perform in response to an
  obsession, or according to rules that must be
  applied rigidly
• The behaviors or mental acts are aimed at
  preventing or reducing distress or preventing
  some dreaded event or situation however, these
  behaviors or mental acts either are not connected
  in a realistic way with what they are designed to
  neutralize or prevent or are clearly excessive

32
Obsessive Compulsive Disorder

• At some point during the course of the disorder,
  the person has recognized that the obsessions or
  compulsions are excessive or unreasonable. Note
  this does not apply to children.
• The obsessions or compulsions cause marked
  distress, are time consuming (take more than 1
  hour a day), or significantly interfere with the
  persons normal routine, occupational (or
  academic) functioning, or usual social activities
  or relationships

33
Obsessive Compulsive Disorder

• If another Axis I disorder is present, the
  content of the obsessions or compulsions is not
  restricted to it (e.g., preoccupation with food
  in the presence of an Eating Disorder hair
  pulling in the presence of Trichotillomania
  concern with appearance in the presence of Body
  Dysmorphic Disorder preoccupation with drugs in
  the presence of a Substance Abuse Disorder
  preoccupation with having a serious illness in
  the presence of Hypochondriasis preoccupation
  with sexual urges or fantasies in the presence of
  a Paraphilia or guilty ruminations in the
  presence of Major Depressive Disorder)
• The disturbance is not due to the direct
  physiological effects of a substance (e.g., a
  drug of abuse, a medication) or a general medical
  condition
• Specify if
• With Poor Insight if, for most of the time
  during the current episode, the person does not
  recognize that the obsessions and compulsions are
  excessive or unreasonable

34
Obsessive-Compulsive Disorder Notes

• Example http//www.youtube.com/watch?v--sM3h6nnu
  s
• From the movie As Good As It Gets

35
Obsessive-Compulsive Disorder Notes

• Situations that trigger obsessions or compulsions
  are frequently avoided
• In laboratory settings, people with OCD show
  increased autonomic activity when faced with
  triggering stimuli the physiological reactivity
  decreases after the compulsion is performed
• Cultural or religious beliefs may influence the
  themes of obsessions and compulsions
• In general, people are more likely to engage in
  ritual behavior at home rather than in front of
  strangers

36
Obsessive-Compulsive Disorder Notes

• High comorbidity with
• Major Depressive Disorder
• Other Anxiety Disorders
• Eating Disorders
• Some Personality Disorders
• Learning Disabilities
• Disruptive Behavior Disorders
• High incidence in children and adults with
  Tourettes Disorder
• 35 - 50 of people with Tourettes have OCD
• 5 - 7 of people with OCD have Tourette's
• 20 - 30 of people with OCD have reported
  current or past tics

37
Obsessive-Compulsive Disorder Notes

• In some cases, OCD may be associated with Group A
  beta hemolytic streptococcal infection
• This is characterized by
• Onset prior to puberty
• Neurological abnormalities (Choreiform movements
  involuntary, rapid, jerky movements and Motoric
  hyperactivity)
• Abrupt onset
• Exacerbated during times of streptococcal
  infection

38
Obsessive-Compulsive Disorder Notes

• Common behaviors in children
• Washing
• Checking
• Ordering
• Common behaviors in adults
• Obsessions with morality
• Washing

39
Obsessive-Compulsive Disorder Notes

• In adults, OCD is equally common in males and
  females
• In children, OCD is more common in males than
  females
• Lifetime prevalence 1 - 2.3
• Point prevalence .7
• Prevalence is similar across cultures
  internationally
• Usually begins in adolescence or early adulthood
• Males between age 6 15 years
• Females between 20 29 years

40
Obsessive-Compulsive Disorder Notes

• Symptoms are usually exacerbated by stress
• Symptoms tend to be chronic wax and wane over the
  lifetime
• About 15 of people with OCD show a progressive
  deterioration in functioning
• 5 have an episodic course, with little to no
  symptoms between episodes
• Strong genetic component

41
Obsessive-Compulsive Disorder Hoarding

• A common symptom of OCD is hoarding
• Acquisition of, and inability to discard,
  meaningless objects
• Cluttered living spaces that limit their use
• Significant distress and/or interference in
  functioning

42
Obsessive-Compulsive Disorder Hoarding
43
Generalized Anxiety Disorder

1. Excessive anxiety and worry (apprehensive
   expectation), occurring more days than not for at
   least 6 months, about a number of events or
   activities (such as work or school performance)
2. The person finds it difficult to control the
   worry
3. The anxiety and worry are associated with three
   (or more) of the following six symptoms (with at
   least some symptoms present for more days than
   not for the past 6 months.) Note Only one item
   is required in children.

44
Generalized Anxiety Disorder(3 or more)

1. Restlessness or feeling keyed up or on edge
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle tension
6. Sleep disturbance (difficulty falling or staying
   asleep, or restless unsatisfying sleep)

45
Generalized Anxiety Disorder

1. The focus of the anxiety and worry is not
   confined to features of an Axis I disorder, e.g.,
   the anxiety or worry is not about having a Panic
   Attack (as in Panic Disorder), being embarrassed
   in public (as in Social Phobia), being
   contaminated (as in Obsessive-Compulsive
   Disorder), being away from home or close
   relatives (as in Separation Anxiety Disorder),
   gaining weight (as in Anorexia Nervosa), having
   multiple physical complaints (as in Somatization
   Disorder), or having a serious illness (as in
   Hypochondriasis), and the anxiety and worry do
   not occur exclusively during Posttraumatic Stress
   Disorder
2. The anxiety, worry, or physical symptoms cause
   clinically significant distress or impairment in
   social, occupational, or other important areas of
   functioning
3. The disturbance is not due to the direct
   physiological effects of a substance (e.g., a
   drug of abuse, a medication) or a general medical
   condition (e.g., hyperthyroidism) and does not
   occur exclusively during a Mood Disorder, a
   Psychotic Disorder, or a Pervasive Developmental
   Disorder

46
Generalized Anxiety Disorder Notes

• The intensity, duration, and frequency of the
  anxiety and worry are out of proportion to the
  actual likelihood or impact of the feared event
• During the course of GAD, the focus of worry may
  shift from one concern to another
• There may be trembling, twitching, feeling shaky,
  muscle aches or soreness associated with muscle
  tension from the anxiety
• May also have sweating, gastrointestinal
  problems, and an exaggerated startle response
• Symptoms that are prominent in other Anxiety
  Disorders, such as accelerated heart rate,
  shortness of breath, and dizziness are less
  common in GAD

47
Generalized Anxiety Disorder Notes

• High comorbidity with
• Mood Disorders
• Other Anxiety Disorders
• Substance abuse
• Medical conditions that are associated with
  stress

48
Generalized Anxiety Disorder Notes

• Expressions of anxiety tend to vary across
  cultures
• Somatic vs. cognitive symptoms
• Common focuses of worry for children tend to be
• Quality of performance or competence (even when
  they are not being evaluated)
• Excessive concerns about punctuality
• Catastrophes that are unlikely to happen
• Overly conforming
• Perfectionistism
• Tendency to redo tasks because of excessive
  dissatisfaction with an imperfect performance
• Overzealous in seeking approval
• Require excessive reassurance

49
Generalized Anxiety Disorder Notes

• More common in women
• In clinical settings, 55 - 60 of GAD cases are
  female
• In anxiety disorder clinics, up to 25 of clients
  have GAD as a presenting or comorbid diagnosis
• Usually begins in childhood or adolescence
• Strong genetic component which may be related to
  the same genetic factors as those for Major
  Depressive Disorder

50
Anxiety Disorders Treatment

• Cognitive Behavioral Therapy is extremely
  effective
• Particularly exposure techniques
• Medication
• Medication is most effective when combined with
  therapy
• Medications used often act on serotonin, other
  times tranquilizers are used
• Occasionally, antipsychotic medications are used
• Blood pressure medication may also be used to
  treat the physiological signs of anxiety

51
Anxiety Disorders Treatment

• Beta Blockers
• Inderal
• Selective Serotonin Reuptake Inhibitors
  (antidepressants)
• Celexa
• Luvox
• Paxil
• Prozac
• Zoloft

52
Anxiety Disorders Treatment

• Benzodiazepines (act on GABA)
• Side effects include

Ativan Klonopin Librium
Serax Tranxene Valium
Xanax
Short term Sedation Impaired physical coordination Memory loss Over an extended period Cognitive impairment Depression Brain shrinkage Daily use for a month or more Withdrawal symptoms upon cessation addiction
53
Posttraumatic Stress Disorder (PTSD)

• The person has been exposed to a traumatic even
  in which both of the following were present
• The person experienced, witnessed, or was
  confronted with an event or events that involved
  actual or threatened death or serious injury, or
  a threat to the physical integrity of self or
  others
• The person's response involved intense fear,
  helplessness, or horror. Note In children, this
  may be expressed instead by disorganized or
  agitated behavior

54
Posttraumatic Stress Disorder (PTSD)

• The traumatic even is persistently reexperienced
  in one (or more) of the following ways
• Recurrent and intrusive distressing recollections
  of the event, including images, thoughts, or
  perceptions. Note in young children, repetitive
  play may occur in which themes or aspects of the
  trauma are expressed
• Recurrent distressing dreams of the event. Note
  in children, there may be frightening dreams
  without recognizable content
• Acting or feeling as if the traumatic event were
  recurring (includes a sense of reliving the
  experience, illusions, hallucinations, and
  dissociative flashback episodes, including those
  that occur on awakening or when intoxicated.)
  Note in young children, trauma-specific
  reenactment may occur
• Intense psychological distress at exposure to
  internal or external cues that symbolize or
  resemble an aspect of the traumatic event
• Physiological reactivity on exposure to internal
  or external cues that symbolize or resemble an
  aspect of the traumatic event

55
Posttraumatic Stress Disorder (PTSD)

• Persistent avoidance of stimuli associated with
  the trauma and numbing of general responsiveness
  (not present before the trauma), as indicated by
  three (or more) of the following
• Efforts to avoid thoughts, feelings, or
  conversations associated with the trauma
• Efforts to avoid activities, places, or people
  that arouse recollections of the trauma
• Inability to recall an important aspect of the
  trauma
• Markedly diminished interest or participation in
  significant activities
• Feeling of detachment or estrangement from others
• Restricted range of affect (e.g., unable to have
  loving feelings(
• Sense of a foreshortened future (e.g., does not
  expect to have a career, marriage, children, or a
  normal life span)

56
Posttraumatic Stress Disorder (PTSD)

• Persistent symptoms of increased arousal (not
  present before the trauma), as indicated by two
  (or more) of the following
• Difficulty falling or staying asleep
• Irritability or outbursts of anger
• Difficulty concentrating
• Hypervigilance
• Exaggerated startle response

57
Posttraumatic Stress Disorder (PTSD)

• Duration of the disturbance (symptoms in Criteria
  B, C, and D) is more than 1 month
• The disturbance causes clinically significant
  distress or impairment in social, occupational,
  or other important areas of functioning
• Specify if
• Acute if duration of symptoms is less than 3
  months
• Chronic if duration of symptoms is 3 months or
  more
• Specify if
• With Delayed Onset if onset of symptoms is at
  least 6 months after the stressor

58
PTSD Notes

• PTSD is more common among people who have
  recently emigrated from areas of social unrest
  and conflict
• They may be less likely to discuss the problem or
  seek therapy because of immigration status
• Young children are less likely to experience
  flashbacks and more likely to show symptoms
  through their play
• Reports from parents and/or teachers are
  important to monitor changes in functioning
• Children are more likely to report physical
  symptoms

59
PTSD Notes

• Can begin at any age
• Usually starts within three months of the trauma
• Severity, duration, and proximity of an
  individuals exposure to the trauma are the most
  important factors that affect the likelihood of
  the person developing PTSD
• More likely to develop in people with preexisting
  mental illnesses, but it can develop in anyone if
  the trauma is extreme
• More common among people who are first degree
  relatives to someone with a history of Depression

60
PTSD Treatment

• Talk therapy and medication (depending on
  symptoms)
• Eye Movement Desensitization Reprocessing
• The client focuses on the memory of the traumatic
  event while looking at a moving visual target
• The theory is that the eye movement replicates
  the movement in the REM phase of sleep and helps
  the brain process the memory
• There is question as to whether or not it
  actually works, or may be harmful
• Debriefing
• The client repeats the memory until it loses its
  full emotion effect