Introduction to PTSD
Option: Abnormal Pyschology
What do you already know about PTSD?
● the symptomology of PTSD.
● misconceptions about the disorder.
****Although you will never be asked a specific question asking them to describe
the symptoms of the disorder, this knowledge and understanding is essential
before starting the more in-depth study of how the different approaches explain
the etiology of the disorder.
What do you know about PTSD?
1. True. The term "posttraumatic stress disorder" came into use in the 1970s in large part due to the diagnoses of U.S.
military veterans of the Vietnam War. It was officially recognized by the American Psychiatric Association in 1980 in the third
edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).
2. False. The number one source of PTSD for women is sexual assault; the number one source of PTSD in men is car
accidents.
3. Possibly true. The research on adults seems to indicate that we cannot develop PTSD from watching the news.
However, there is some evidence that this may be true in children. See this report.
4. Possibly false. For too many people living with PTSD, it is not possible to work while struggling with its symptoms and
complications.
5. Possibly true. It is possible that the symptoms of PTSD go away on their own without treatment. However, it is common
for people to "re-experience" the trauma by triggers - such as a film, a news story, or an environmental trigger. Without
treatment, people who have experienced PTSD are not always able to cope with these triggers and may see a return of
symptoms.
6. Possibly false. Violence usually occurs because of other risk factors and not the disorder itself. Risk factors include
alcohol abuse, drug misuse, and other psychiatric disorders. For more information, see here.
7. Possible false. There is some evidence that biological markers - e.g. levels of certain neuropeptides or genetic
expression based on parental trauma - may increase one's vulnerability to PTSD.
What are the symptoms of PTSD?
Post your answers here:
Nightmares, aggressiveness, intense emotional or physical reactions
Anxiety, Depression, drug abuse, alcohol abuse, possible cardiac arrest,
Social difficulties,
Flashbacks, nightmares, difficulty sleeping, irritability, outbursts of rage, trouble concentrating,
addictions, alienation,
Having difficulty concentrating, violent behavior,
Numbness, alcoholism (or other addictions), dissociation
Potential lack of sleep (sleep deprivation, maybe insomnia caused by the stress induced
thoughts),
loss of appetite
hypervigilance
Psychological effects of war
Let’s update our list of symptoms + key points made in the video
Add your notes here:
PTSD is caused by stressors. There are so many stressors caused by circumstances of war, either physical or psychological.
TBI = Traumatic Brain Injury - way beyond a concussion, an impairment on the brain. / mTBI = mild Traumatic Brain Injury
Increased risk taking behaviour
Depression
Alcohol dependence
Reexperiencing trauma and avoidance
Numbing / Social isolation
Physiologic arousal
Social or occupational dysfunction
Symptoms continued
What are the DSM 5 criteria for PTSD?
In 2013, the American Psychiatric Association revised the PTSD diagnostic criteria
in the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders
(DSM-5)1.
PTSD is included in a new category in DSM-5, Trauma- and Stressor-Related
Disorders.
All of the conditions included in this classification require exposure to a traumatic
or stressful event as a diagnostic criterion.
All of the following criteria are required
for the diagnosis of PTSD
Criterion A: stressor (one required)
The person was exposed to: death, threatened death, actual or threatened serious
injury, or actual or threatened sexual violence, in the following way(s):
● Direct exposure
● Witnessing the trauma
● Learning that a relative or close friend was exposed to a trauma
● Indirect exposure to aversive details of the trauma, usually in the course of
professional duties (e.g., first responders, medics)
Criteria B & C
Criterion B: intrusion symptoms (one required)
The traumatic event is persistently re-experienced in the following way(s):
● Unwanted upsetting memories
● Nightmares
● Flashbacks
● Emotional distress after exposure to traumatic reminders
● Physical reactivity after exposure to traumatic reminders
Criterion C: avoidance (one required)
Avoidance of trauma-related stimuli after the trauma, in the following way(s):
● Trauma-related thoughts or feelings
● Trauma-related external reminders
Criteria D
Criterion D: negative alterations in cognitions and mood (two required)
Negative thoughts or feelings that began or worsened after the trauma, in the following
way(s):
● Inability to recall key features of the trauma
● Overly negative thoughts and assumptions about oneself or the world
● Exaggerated blame of self or others for causing the trauma
● Negative affect
● Decreased interest in activities
● Feeling isolated
● Difficulty experiencing positive affect
Criteria E & F
Criterion E: alterations in arousal and reactivity
Trauma-related arousal and reactivity that began or worsened after the trauma, in the
following way(s):
● Irritability or aggression
● Risky or destructive behavior
● Hypervigilance
● Heightened startle reaction
● Difficulty concentrating
● Difficulty sleeping
Criterion F: duration (required)
● Symptoms last for more than 1 month.
Criteria G & H
Criterion G: functional significance (required)
● Symptoms create distress or functional impairment (e.g., social,
occupational).
Criterion H: exclusion (required)
● Symptoms are not due to medication, substance use, or other illness.
Two Specifications: Dissociative & Delayed
Dissociative Specification In addition to meeting criteria for diagnosis, an
individual experiences high levels of either of the following in reaction to
trauma-related stimuli:
● Depersonalization. Experience of being an outside observer of or detached
from oneself (e.g., feeling as if "this is not happening to me" or one were in a
dream).
● Derealization. Experience of unreality, distance, or distortion (e.g., "things are
not real").
Delayed Specification. Full diagnostic criteria are not met until at least six
months after the trauma(s), although onset of symptoms may occur immediately.
Different types of symptoms: Affective, Behavioural, Cognitive, Somatic
Knowing the different types of symptoms is an important distinction because it
may be that different classifications of symptoms may have different origins.
Different types of symptoms
Affective
Emotional distress after exposure to traumatic reminders, negative affect, decreased interest in activities,
loneliness/isolation, difficulties experiencing positive affect
Behavioural
Avoidance of trauma-related stimuli, irritability or aggressive behavior, risky or destructive behavior,
Cognitive
Unwanted upsetting memories, flashbacks, trauma-related thoughts, inability to recall key features of the
trauma, overly negative thoughts, and assumptions about oneself or the world, exaggerated blame of self or
others for causing the trauma, hypervigilance, difficulty concentrating,
Somatic
Physical reactivity after exposure to traumatic reminders, insomnia.
Reflecting on the effects of PTSD
1. Watch the following videos.
2. Discuss with your neighbours, how each patient compares to the DSM
criteria.
3. Discuss what questions about PTSD arise from each of the the video clips.
A. “I can’t sleep without my gun” (2 min)
B. “One of my big triggers is driving” (2 min)
C. Teresa’s story (survivor’s guilt) (2 min)
D. The other PTSD (sexual abuse of women in the military) (4min)
Take 7 minutes and write a reflection on the effects of PTSD on an individual; On
their loved ones; On a community.
Cultural considerations & PTSD
Is PTSD is a universal disorder? (write your responses here)
Palestinian perspective on PTSD
Palestine's head of mental health services caused a stir in 2019 when she said
that PTSD is a Western disorder.
Sama Jabr says,
People in Palestine who face continual trauma are more susceptible to shifts in
personality and express a variety of symptoms where their emotional stress is
manifested in physical reactions. For example, she had a patient who suffered
from breathlessness and who was sent to a psychiatrist after physical
examinations could not find a cause. “A few months after he developed enough
trust, he told me that he developed these symptoms after he was attacked by
soldiers who forced him to use filthy words against his wife [and] his mother,” she
says. “He was so ashamed of the event, that he had to comply with the
instructions or soldiers…and his body expressed the suffering. We see that very
often.”
PTSD – Western vs non-Western culture
Based on what you know about Western vs non-Western culture, why do you think
Sama Jabr has made this argument? (add responses here)
PTSD – Western vs non-Western culture
How might the context of the situation make a difference in what would be
diagnosed as PTSD? (add responses here)
