Trauma-
Related
Disorders
Definition of Trauma
• The DSM-5 definition of trauma
requires “actual or threatened death,
serious injury, or sexual violence”
• Stressful events not involving an
immediate threat to life or physical
injury such as psychosocial stressors
(e.g., divorce or job loss) are not
considered trauma in this definition.
• Acute (single incident) / Chronic
(prolonged incidents)
• Complex Trauma: Exposure to varied
and multiple traumatic events
• Natural disasters / traumatic events
caused by people
Psychologica
l Responses
to a Disaster
• 55% of people report at least one lifetime
serious trauma
• Out of these people, almost 70%
recover from it, while 30% develop
PTSD and other psychological disorders
• «Normal reactions to abnormal events»
• !! Be careful for suicidal thoughts,
prolonged shock and dissociative
responses, substance abuse, relapse of
previous illnesses
• Post-traumatic growth
Posttraumatic Stress
Disorder (PTSD)
• Symptoms may develop soon after the
trauma
• Sometimes symptoms do not develop
for years
• Symptoms can be chronic
• Unemployment and suicidality are
common
• High rates of medical illness
• Prolonged exposure to trauma may lead
to a broader range of symptoms
• Complex PTSD
DSM-5 Criteria: PTSD
• Exposure to a serious trauma
• At least 1 month after the event
• Symptoms in the following four categories:
• Intrusion (≥ 1)
• E.g., recurrent and intrusive memories,
dreams, flashbacks, nighmares
• Avoidance (≥ 1)
• Internal (emotions, thoughts, etc.) and
external (people, places, etc.) reminders
• Negative alterations in cognitions and mood (≥ 2)
• E.g., persistent negative beliefs and negative
emotional states (intense guilt, shame, fear,
anger, lack of positive emotions, feelings of
isolation and detachment)
• Arousal and reactivity (≥ 2)
• E.g., aggressiveness, hypervigilance,
exaggerated startle response
PTSD Epidemiology
• Usually comorbid with other conditions
• Anxiety disorders, depression, substance use,
conduct disorder, personality disorders
• 1.5 to 2 times more likely in women
• Consistent with gender ratio in other anxiety
disorders
• May be related to different life circumstances of
women
• Culture may shape risk of PTSD
• Exposure to trauma
• Types of symptoms observed
Acute Stress Disorder (ASD)
• Symptoms similar to PTSD
• At least 9 symptoms
• Shorter duration of symptoms
• 3 days to 1 month after trauma
• ASD may stigmatize reactions to serious trauma
• 90% of women report significant symptoms 1
month after a rape
• ASD is not very predictive of who develops PTSD
• Less than half develop PTSD within 2 years
Etiology of PTSD: Commonalties with
Other Anxiety Disorders
• Genetic risk
• Greater amygdala activation
• Diminished activation of regions of medial
prefrontal cortex
• Childhood exposure to trauma
• Greater reactivity to signals of threat
• Mowrer’s two-factor model of conditioning
Etiology of PTSD: Unique
Factors
• Severity and type of trauma
• Directly witnessing violence (vs. indirect
exposure)
• Trauma caused by human (vs. natural disasters)
• Neurobiology: The hippocampus
• Central role in autobiographical memories
• Greater activation in PTSD
• Dissociation
• A form of avoidance, keeping a person from
confronting memories
• 15% of people with PTSD
• Protective factors
• Cognitive abilities and social support
Dual Representation Theory of PTSD
(Brewin, Dalgleish, & Joseph, 1996)
• Situationally Accessible Memories (SAM)
• Unconscious processing, conditioned responses, not open
to voluntary access
• Triggered by internal and external stimuli
• Amygdala activation
• Hypothalamus glucocorticoid hormone inhibits the
information processing in the cortex (no time to think!)
• Verbally Accessible Memories (VAM)
• Accessible at the conscious level
• Can be re-processed and changed (e.g., re-evaluating the
traumatic event, changing the attributions and the
meanings attached)
• Involves the activity of hippocampus
Treatment of
PTSD
• Medications (SSRIs and SNRIs)
• Relapse common if medication
is stopped
• Exposure treatment
• Focus on memories and
reminders of trauma
• Exposure hierarchy
• Direct (in vivo), Imaginal, or
virtual reality
• 8 to 15 90-minute sessions
• Goals: extinguish fear response
and challenge belief that the
person cannot cope
Treatment of PTSD
• Cognitive therapy
• e.g., cognitive processing therapy
• Goal: Reduce overly negative interpretations
about trauma and its meaning
• EMDR (Eye Movement Desensitization and
Remonitoring)
• Short-term treatment of ASD may prevent PTSD
• Benefits lasts for years after the traumatic event
• Exposure treatment appears more effective than
cognitive restructuring in preventing the
development of PTSD
Case Examples
• Read and apply what you have
learned to the following cases:
• Posttraumatic Stress Disorder:
Rape Trauma (Oltmanns & Martin,
2019)
