Posttraumatic Stress Disorder

Diagnostic Criteria
A. The person has been exposed to a traumatic event in which both of the following were present:


 * (1) 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


 * (2) the person's response involved intense fear, helplessness, or horror.

B. The traumatic event is persistently reexpriencd in one (or more) of the following ways:


 * (1) recurrent & intrusive distressing recollections of the event, including images, thoughts, or perceptions.


 * (2) recurrent distressing dreams of the event


 * (3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, & dissociative flashback episodes, including those that occur on awakening or when intoxicated).


 * (4) Intense psychological distress at exposure to internal or external cues that symbolize or resemble as aspect of the traumatic event.


 * (5) Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma & numbing of general responsiveness (not present before the trauma) as indictated by three (or more) of the following:


 * (1) efforts to avoid thoughts, feelings, or conversations associated with the trauma


 * (2) efforts to avoid activities, places, or people that arouse recollections of the trauma


 * (3) inability to recall an important aspect of the trauma


 * (4) markedly diminished interest or participation in significant activities


 * (5) feeling of detachment or estrangement from others


 * (6) restricted range of affect (e.g. unable to have loving feelings)


 * (7) sense of foreshortened future (e.g. does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma) as indicated by two (or more) of the following:


 * (1) difficulty falling or staying asleep


 * (2) irritability or outbursts of anger


 * (3) difficulty concentrating


 * (4) hypervigilance


 * (5) exaggerated startle response

E. Duration of the disturbance (symptoms of Criteria B, C, & D) is more than one month.

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas or functioning.

Specifiers:

Acute: if duration of symptoms is less than three months.

Chronic: if duration of symptoms is three months or more.

With Delayed Onset: if onset of symptoms is at least six months after the stressor

Prevalence

 * The estimated lifetime prevalence of PTSD among adult Americans is 9 to 15%, with women (10-12%) twice as likely as ment (5-6%) to have PTSe at some point in their lives.
 * Historically, men's trauma was usually combat experience, and women't trauma was most commonly assault or rape.
 * The disorder is most likely to occur in those who are single, divorced, widowed, socially withdrawn, or of low socioeconomic level.

Treatment Issues
Cognitive Behavioral Therapy Prolonged Exposure (PE) Cognitive Processing Therapy (CPT) Eye Movement Desensitization & Reprocessing (EMDR)
 * The goal is to help people learn healthier ways of coping with distressing thoughts, as well as reducing avoidance or ther problematic behaviors.
 * The idea is that if someone can change how they evaluate his/her environment or thoughts and feelings, anxiety and avoidance may be reduced, improving a person's mood, and overall quality of life.
 * The goal of PE is to decrease distress about the trauma. This therapy works by helping people approach trauma-related thoughts, feelings, and situations that they have been avoiding due to the distress they cause.
 * Repeated exposure to these thoughts, feelings, and situations helps reduce the power they have to cause distress.
 * PE has four main parts:
 * 1) Education
 * 2) Breathing
 * 3) Real World Practice
 * 4) Talking through the trauma.
 * The main premise of CPT is they way people think and look at things directly affects how they feel and act.
 * CPT helps clients by giving them new coping skills to handle distressing thoughts and to gain an understanding of traumatic events.
 * CPT helps clients learn how going through a trauma changed the way they perceive the world, themselves, and others.
 * CPT has four main parts:
 * 1) Education
 * 2) Becoming aware of thoughts and feelings
 * 3) Learning skills
 * 4) Understanding changes in beliefs
 * EMDR is an information processing therapy and uses an eight phase approach. It attends to the past experiences that have set the groundwork for pathology, the current situations that trigger dysfunctional emotions, beliefs, and sensations, and the positive experience needed to enhance future adaptive behaviors and mental health.
 * Therapists often use eye movement, auditory tones, tapping, or other types of tactile stimulation.
 * EMDR has eight phases:
 * 1) History taking
 * 2) Stabilization and resource building
 * 3) Target identification for reprocessing
 * 4) Negative cognition identification
 * 5) Bilateral stimulation (eye movement, tapping, auditory tones)
 * 6) Positive cognition instillation
 * 7) Processing body sensations
 * 8) Closure

Articles
VA disability policies for PTSD.pdf‎

Sertraline or prolonged exposure in community ptsd tx.pdf‎

Media Links
http://www.youtube.com/watch?v=qIOnqgSjg9k (EMDR video)

http://www.youtube.com/watch?v=zBtqWrs2-K0&p=524A1FA69C51141F&playnext=1&index=1 (PTSD with brain imaging)

http://www.emdr.com/index.htm (EMDR Institute Website)

http://www.ptsd.va.gov/index.asp (Highly recommend this site for scholarly articles, descriptions of treatment, etc.)

new category for PTSD-joke

Resources for Referral Information

 * American Psychiatric Association. (2000). Anxiety disorders. Diagnostic and statistical manual of mental disorders: DMV-IV – 4th edition, text revision, (463-468). Arlington, VA: American Psychiatric Association.


 * EMDR Institute, Inc. (2004). A brief description of EMDR. Retrieved from http://www.emdr.com/briefdes.htm•Feeny,


 * N., Zoellner, L., Mavissakalian, M. & Roy-Byrne, P. (2009). What would you choose? Sertaline or prolonged exposure in community and PTSD treatment seeking women. Depression and Anxiety, 26, 724-732. doi:10.1002/da.20588


 * Frueh, C., Grubaugh, A., Elhai, J., & Buckley, T. (2007, December). US Department of Veterans Affairs disability policies for posttraumatic stress disorder: Administrative trends and implications for treatment, rehabilitation, and research. American Journal of Public Health, 97, 2143-2145. doi:10.2105/AJPH.2007.115436


 * Gingrich, H. (2009). Complex traumatic stress disorders in adults. Journal of Psychology and Christianity, 28(3), 269-274.


 * Kelly, K., Rizvi, S., Monson, C. & Resick, P. (2009). The impact of sudden gains in cognitive behavioral therapy for posttraumatic stress disorder. Journal of Traumatic Stress, 22(4), 287-293. doi: 10.1002/jts.20427


 * Marotta, S. (2000). Best practices for counselor who treat posttraumatic stress disorder. Journal of Counseling & Development, 78, 492-495.


 * Sadock, B. & Sadock, V. (2007) Anxiety disorders. In J. Grebb, C. Pataki, N. Sussman, C. Mitchell, J. Murphy, & K. Millet (Eds.), Kaplan & Sadock’s synopsis of psychiatry: behavioral sciences/clinical psychiatry 10th edition, (613-621). New York, NY: Lippincott Williams & Wilkins, a Wolters Kluwer Business


 * .United States Department of Veterans Affairs. (2009). National center for PTSD: treatment. Retrieved from http://www.ptsd.va.gov/public/pages/gen-treatment.asp

Questions and Answers
1. Everyone experiences the disorder after a traumatic event. (True or false)


 * Answer: False


 * Justification: The stressor alone does not suffice to cause the disorder. The response to the traumatic event must involve intense fear or horror.

2. PTSD with duration of symptoms that is three months or more is:


 * a. Delayed on-set


 * b. Acute


 * c. Complex


 * d. Chronic


 * Answer: d. chronic