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Posttraumatic Stress Disorder

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Posttraumatic Stress Disorder Criterion F: Psychosocial Criteria Clinically significant distress or impairment in social, occupational, or other important areas of ... – PowerPoint PPT presentation

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Title: Posttraumatic Stress Disorder


1
Posttraumatic Stress Disorder
2
Epidemiology of PTSD
  • Kessler et al. (1995) Posttraumatic Stress
    Disorder in the National Comorbidity Study
  • Representative National Sample
  • N 5877 AGE 15-54 Years old
  • Lifetime prevalence of PTSD is 7.8
  • More than 1/3 of people with an initial episode
    of PTSD fail to recover after 10 years

3
Kessler National Comorbidity
  • Women Most Common Experiences
  • Rape
  • Sexual Molestation
  • 50 had experienced a trauma that met DSM-IV
    stressor criterion
  • Men Most Common Experiences
  • Combat
  • Witnessing death or severe injury
  • 60 had experienced an event that would meet
    DSM-IV stressor criterion

4
Kilpatrick et al (1992)
  • Nationally representative sample
  • 4008 women
  • 13 reported a completed rape
  • Of those who were raped
  • Lifetime PTSD 32
  • Current PTSD 12

5
Prevalence of PTSD
  • 5th Most Common Psychiatric Condition
  • Behind
  • Major Depression
  • Attention-deficit/hyperactivity disorder
  • Specific phobia
  • Social phobia

6
Comorbidity
  • PTSD/Depression Nearly 50 Comorbid
  • Specific phobia, social phobia, and dysthymic
    disorder also prevalent
  • Male PTSD/Alcohol Abuse (52)

7
Criterion A Exposure Criteria
  • Experienced or Witnessed an Event that involved
    actual or threatened death or serious injury or a
    threat to physical integrity
  • Persons response involved fear, helplessness, or
    horror or in children agitated behavior

8
Criterion B Re-experiencing Criteria
  • Recurrent and Intrusive distressing recollections
    of the event (images, thoughts, or repetitions)
  • Recurrent distressing dreams of the event
  • Acting or feeling as if the traumatic event were
    recurring

9
Criterion B continued
  • 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

10
Criterion C1 Persistent Avoidance Criteria
  • 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

11
Criterion C2 Numbing of Gen. Responsiveness
Criteria
  • Markedly diminished interest or participation in
    significant activities
  • Feeling of detachment or estrangement from others
  • Restricted range of affect
  • Sense of foreshortened future

12
Criterion D Increased Arousal Criteria
  • Difficulty falling or staying asleep
  • Irritability or outbursts of anger
  • Difficulty concentrating
  • Hypervigilance
  • Exaggerated startle response

13
Criterion E
  • Symptoms in criteria B, C, and D are more than 1
    month

14
Criterion F
  • The disturbance causes significant distress or
    impairment in social, occupational, or other
    important areas of functioning

15
Specifications
  • Acute if duration of symptoms is less than 3
    months
  • Chronic if duration of symptoms is 3 months or
    more
  • With delayed onset if onset of symptoms is at
    least 6 months after the stressor

16
Greens Generic Dimensions to Stressors
  • Threat to ones life
  • Threat to bodily integrity
  • Severe physical harm/injury
  • Exposure to grotesque
  • Witnessing/learning of violence or severe harm to
    others
  • Learning of exposure to a noxious agent
  • Causing death or severe harm to another

17
Dohrenwend
  • National Veterans Readjustment Study
  • Congressional Mandate in 1983
  • Representative sample of 1632 US Vietnam Theater
    Veterans and matched sample of 716 Vietnam era
    veterans and 668 civilian comparison
  • NVVRS rates for Male VTV 30.9 lifetime
  • And 15.2 current
  • CDC rates reported 14.7 lifetime and 2.2
    current all 11 to 12 years after the Vietnam war
    ended

18
Dohrenwend contd.
  • National Veterans Readjustment Study
  • Perplexing in these relatively high rates of PTSD
    was the relatively low rates of combat
  • Used data from archival sources to develop a
    record based military historical measure for
    exposure
  • Impairment wasnt formerly a part of the criteria
  • Adjusted Rates for impairment and verification
    are
  • 18.7 lifetime and 9.1 current
  • Dose response relationship between combat and
    exposure

19
Cultural Factors and PTSD
  • Hispanic veterans report significantly higher
    rates of PTSD than AA or Caucasian veterans.
    Hypotheses include
  • Greater exposure to war zone stressors
  • Greater prewar vulnerability
  • Culturally driven differences in reporting
    symptoms
  • Different post war stressful events
  • Greater experiences with racial/ethnic prejudice
    and discrimination

20
Sample
  • Subsample NVVRS
  • 94 Majority White
  • 70 African American
  • 84 Hispanic (Mostly Mexican American (63),
    Puerto Rican (15), Latin American (6)
  • War Zone stressor severity measured
  • Peri- and Post-War Discrimination
  • Vulnerability Factors Measured
  • Younger age at entry to Vietnam
  • Lower Armed Forces Qualification Tests
  • Disciplinary Actions
  • Pre-Vietnam educational level
  • Pre war psychiatric disorder

21
Results
  • Both Blacks and Hispanics had higher rates of
    war-related first onsets of PTSD (current PTSD
    10-11 years after the war)
  • PTSD course was more chronic for Hispanics than
    Blacks
  • Hispanics experiences more war-zone stressors
    compared with Caucasians
  • Controlling war zone exposure did not account for
    the greater rates of PTSD in Hispanics
  • Prewar vulnerability factors emerged as
    important younger age, less education, lower
    AFQT scores

22
9/11
  • Explored stressor exposure and PTSD symptoms in
    11,037 adults who live south of Canal Street in
    NYC on 9/11 (lower Manhattan)
  • PTSD Checklist Civilian Version
  • Within disaster exposure, e.g., residential
    proximity, direct exposure intensity (caught in
    the dust cloud from the tower collapse, an
    occupant of the north or south tower, sustaining
    an injury, witnessed horror, seeing people fall
    or jump from the buildings)

23
9/11 Results
  • 43.6 reported reexperiencing, 20.4 reported
    avoidance, 38.6 reported hyperarousal
  • Most common symptoms were hypervigilance, being
    upset by reminders, and insomnia
  • Current PTSD prevalence 12.6

24
9/11 Results Bivariate results
  • Increased risk was reported for African
    Americans, Hispanics, and other nonAsian
    minorities (Asian race was protective)
  • Increased risk for women
  • Lower education and lower income was associated
    with increased risk
  • Older age and female gender was assoc with
    increased risk
  • Being divorced, separated or separated was
    associated with increased risk
  • Within disaster risk factors were sustained
    injury, witnessed horror exposure to dust cloud,
    being in a building that was damaged or destroyed
    (except WTC towers), living less than 1000 feet
    from the towers
  • Post disaster risk was associated with evacuation
    from ones home and involvement in
    rescue/recovery efforts.

25
9/11 Results Multivariate results
  • Risk for PTSD increased for all age groups
    relative to the younger groups (greatest risk for
    adults 45-64 years)
  • Increased risk for women
  • Risk for PTSD higher among Hispanics, African
    American, and other ethnicities
  • Divorced, widowed or separated continued to
    increase risk
  • Lower education and income was associated with
    increased risk
  • Exposure intensity remained as a significant risk
    factor
  • Evacuation and involvement in rescue recovery
    efforts remained

26
Confluence of Factors
  • Discuss findings in terms of the diathesis,
    personality, stress model

27
Acute Stress Disorder
28
(No Transcript)
29
Criterion A Exposure Criteria
  • Experienced or Witnessed an Event that involved
    actual or threatened death or serious injury or a
    threat to physical integrity
  • Persons response involved fear, helplessness, or
    horror or in children agitated behavior

30
Criterion B Dissociative Criteria
  • Subjective sense of numbing, detachment, or
    absence of emotional responsiveness
  • Reduction in awareness of ones surroundings
    (e.g., being in a daze)
  • Derealization
  • Depersonalization
  • Dissociative amnesia

31
Criterion C Re-experiencing Criteria
  • Recurrent images
  • Thoughts, dreams, illusions
  • Flashback episodes, or a sense of reliving the
    experience
  • Distress on exposure to reminders of the
    traumatic event

32
Criterion D Avoidance Criterion
  • Marked avoidance of stimuli that arouse
    recollections of the trauma (e.g., thoughts,
    feelings, conversations, activities, places,
    people)

33
Criterion E Physiological Criteria
  • Marked symptoms of anxiety or increased arousal
    (e.g., difficulty sleeping, irritability, poor
    concentration, hypervigilance, exaggerated
    startle response, motor restlessness)

34
Criterion F Psychosocial Criteria
  • Clinically significant distress or impairment in
    social, occupational, or other important areas of
    functioning
  • Impaired ability to pursue some necessary task,
    such as obtaining personal assistance or
    mobilizing personal resources

35
Criterion G Time Criteria
  • Minimum of 2 days
  • Maximum of 4 weeks
  • Occurs within 4 weeks of the traumatic event

36
Inter-relationship between ASD and PTSD
Event
ASD
PTSD
4 weeks and on
2 days 4 weeks
37
How does someone develop PTSD?
Classical Conditioning
Unconditioned Stimulus
Unconditioned Response
CR
CS
Thoughts Feelings Behaviors
Car Jacking
38
Classical Conditioning
Triple vulnerability
39
Model for PTSD
  • PTSD develops through the process of classical
    conditioning
  • When cues are encountered, anxiety and other
    emotional reactions increase. Over time,
    habituation would occur.
  • Avoidance maintains PTSD because habituation can
    never occur.
  • Negative Reinforcement
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