Psyc 180 Lecture 10

Reactive Attachment Disorder Disinhibited Social Engagement Disorder PTSD Acute Stress Disorder Adjustment Disorders

Rape or sexual molestation Combat exposure Childhood neglect and physical abuse Physical attack Being threatened with a weapon Torture (immigrant populations) Natural disasters Severe automobile accidents

Repeated reexperiencing / Intrusions Avoidance Negative Cognitions and Mood Arousal and Reactivity

(A) Exposure to actual or threatened death, serious injury, or sexual violence: -directly experienced -witnessed in person -learning that it occurred to close family member or friend. In case of death, must have been violent or accidental - experiencing repeated or extreme exposure to aversive details of traumatic events (e.g. collecting human remains) not through media unless work related

(B) one or more of intrusion symptoms - recurrent, involuntary, intrusive distressing memories - recurrent distressing dreams - dissociative reactions such as flashbacks - intense distress when exposed to cues - marked physiological reactions to cues

(C) Persistent avoidance (one or both) - avoidance of memories, thoughts or feeligs - avoidance of external reminders

(D) Negative alterations in cognitions and mood (2 or more) - inability to remember important aspects of trauma - persistent negative beliefs or expectations about oneself, others or the world - persistent distorted cognitions about cause or consequence of trauma that lead to blame - persistent negative emotional state - marked diminshed interest or participation in significant activities - feelings of detachment and estrangement from others - persistent inability to experience positive emotions

(E) alterations in arousal and reactivity (two or more) - irritable behavior and angry outbursts - reckless or self-destructive behavior - hypervigilance - exaggerated startle response - problems with concentration - sleep disturbance

symptoms for more than 1 month Distress/impairment Not due to substance or medical condition Specifier: with dissociative symptoms/with delayed expression (6 months after event)

Symptoms similar to PTSD More emphasis on Dissociation Duration varies Short term reaction Symptoms occur between 3 days and 1 month after trauma As many as 90% of rape victims experience ASD More than 2/3 of those with ASD develop PTSD

Men are more likely to be exposed to traumatic events than women Women are far more likely than men to develop PTSD following a trauma Lifetime prevalence rate around 7-9% 5% for men and 10% for women 12-month incidence: 3-4% Higher for at risk individuals

Nature of trauma Highest risk for most severe trauma Neurobiological Smaller hippocampal volume linked to PTSD Increased receptor sensitivity to cortisol Behavioral Two factor model Psychological Perception of control Avoidance coping, dissociation, memory suppression

Nature of and proximity to stressor Gender Psychosocial factors Appraisal of stressor Unpredictability and uncontrollability Stress reaction sign of personal weakness Dissociation during trauma Personality severity or number of posttrauma symptoms from about 1 to 2 weeks after the event onward Cognitive ability Sociocultural factors Social support Stigma, readjustment Biological factors locus coeruleus/norepinephrine-sympathetic - system HPA - Hypothalamic-pituitary-adrenocortical - axis

Exposure to memories and reminders of the original trauma Either direct (in vivo) or imaginal Treatment may initially increase symptoms Enhance through medications (e.g. d-cylcoserine)? Cognitive Therapy Enhance beliefs about coping abilities Medications Benzodiazepins, SSRIs

Psychological debriefing is a brief crisis intervention usually administered within days of a traumatic event. A debriefing session, especially if done with a group of individuals (e.g., firefighters), usually lasts about three to four hours. By helping the trauma-exposed individual \"talk about his feelings and reactions to the critical incident,\" the debriefing facilitator aims \"to reduce the incidence, duration, and severity of, or impairment from, traumatic stress.\"

After conducting a meta-analysis of randomized, controlled trials (RCTs) on debriefing, Rose et al. (2001) concluded, There is no current evidence that ...psychological debriefing is a useful treatment for the prevention of post traumatic stress disorder after traumatic incidents. Compulsory debriefing of victims of trauma should cease.

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