Trauma &

Stressor Related
Disorders
Leann Barajas
Kendra Ostrovsky
Kasey Valencia
 Posttraumatic
Stress Disorder
(PTSD)
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1.
Diagnosis

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 DSM-5 Diagnostic Criteria
A. The person was exposed to: death, threatened C. Avoidance of trauma-related stimuli after the
death, actual or threatened serious injury, or trauma, in one the following way(s):
sexual violence, in one the following way(s): a. Trauma-related distressing memories,
a. Direct exposure thoughts or feelings
b. Witnessing the trauma b. Trauma-related external reminders
c. Learning that a relative or close friend was D. Negative thoughts or feelings that began or
exposed to a trauma
worsened after the trauma, in two of the
d. Indirect exposure to aversive details of the
following way(s):
trauma
B. The traumatic event is persistently a. Inability to recall key features of the trauma
re-experienced in one the following way(s): b. Overly negative thoughts and assumptions
a. Unwanted upsetting memories about oneself or the world
b. Nightmares c. Exaggerated blame of self or others for
c. Flashbacks causing the trauma
d. Emotional distress after exposure to d. Negative affect
traumatic reminders e. Decreased interest in activities
e. Physical reactivity after exposure to traumatic f. Feeling isolated
reminders g. Difficulty experiencing positive affect

4 APA (2013)
 DSM-5 Diagnostic Criteria
E. Trauma-related arousal and reactivity
H. Symptoms are not due to medication or
that began or worsened after the trauma, in
substance use.
two or more in the following way(s):
a.Irritability or aggression
Specify whether:
b.Risky or destructive behavior
c.Hypervigilance With dissociative symptoms:
d.Heightened startle reaction
1. Depersonalization: Experience of being an
e.Difficulty concentrating
outside observer of or detached from oneself
f.Difficulty sleeping
2. Derealization. Experience of unreality,
F. Symptoms last for more than 1 month. distance, or distortion
G. Symptoms create distress or impairment in Specify if:
social, occupational, or other important With delayed expression: Full diagnostic criteria are
areas of functioning not met until at least six months after the trauma(s),

5 APA (2013)
PTSD Symptoms
Behavioral Physical Cognitive/Emotional
⊳ Irritability ⊳ Sleep issues ⊳ Reliving the event
⊳ Hypervigilance ⊳ Angry outbursts memory
⊳ Avoidance ⊳ Physical reactivity ⊳ Feeling isolated
⊳ Aggression ⊳ Somatic symptoms ⊳ Intense fear or
⊳ Violence towards (ex. stomachaches and sadness
others or self headaches) ⊳ Low self worth
⊳ Tired/low energy ⊳ Difficulty breathing ⊳ Intrusive thoughts
⊳ ⊳ Anxiety
⊳ Distressing dreams

6 (Boelen et al., 2013; CDC, 2020; Zhang et al., 2015)

PTSD in Schools
Academics
⊳ Changes in school
performance
⊳ Lower GPA
⊳ Decreased reading ability
⊳ Decreased rates of high
school graduation
⊳ Poor concentration
⊳ School attendance
decrease
Behavior/Social Age Differences
⊳ Foreshortened future Young Children
⊳ Loss of interest ⊳ Distress manifests through
⊳ Poor relationship with disorganized behavior
peers ⊳ Reenacts event through play
⊳ Aggressive and
Adolescents
delinquent behavior
⊳ Substance abuse ⊳ Avoid talking about the
⊳ Anxiety and depression event
⊳ Not participating in activities
they once enjoyed
⊳ Engage in impulsive or
aggressive behaviors
7 (Boelen et al., 2013; Kataoka et al., 2012; Zhang et al., 2015)
2.
Epidemiology

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Epidemiology
⊳ Why does PTSD occur in different groups of
people and not others?
⊳ Causes and risk factors
⊳ Prevalence

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Causes
⊳ When trauma is experienced (first-hand or witnessed) or learned

○ Everyone experiences trauma differently

⊳ Underlying cause is a “Medical Mystery”

⊳ PTSD is not caused by one thing or another rather a collective of

factors

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Risk Factors
⊳ Longevity of the trauma
⊳ Previous trauma
⊳ Environment
○ SES, education/intellect
○ Exposure of triggers
⊳ Dissociation during the trauma
⊳ Cultural Characteristics
○ Meaning
○ Expression of symptoms
⊳ Career
⊳ Existing mental health problems
⊳ Lack of social support
⊳ Genetic predisposition
○ Genotype
⊳ Gender differences
○ Female
⊳ Developmental level
○ Younger at time of exposure
⊳ Type of traumatic event
○

(Mayo Clinic, 2018)

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 8 million people
Have PTSD during a given year

7-8%
Of the population will have PTSD at some point in their lives!

Almost 2x
About 10 of every 100 women (10%) develop PTSD sometime in their lives compared to 4
out of every 100 men (4%)

70%
of adults in the U.S. experience at least one traumatic event in their lifetime.

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PTSD: National Center for PTSD. (n.d.)
Prevalence
○ Differences in cultural groups
■ Higher rates in Latinos, African Americans, American
Indians
■ Lower rates in Asian Americans
○ Varies across age
■ Highest in 45 to 59 year olds
■ PTSD in adolescents was highest in females (13 to 18
years old)
■ Lower in older adults
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3.
Etiology

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Common PTSD-Related Events
● Combat exposure ● Mugging
● Childhood physical abuse ● Plane crash
● Sexual Violence (49%) ● Torture
● Physical Assault (32%) ● Kidnapping
● Being threatened with a ● Life-threatening medical
weapon diagnosis
● An accident (16.8%) ● Terrorist Attack
● Natural Disasters (3.8%) ● And more...

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Theories
Emotional Processing Theory (Foa & Kozak, 1986)
⊳ Complex fear structures, benign stimuli, beliefs connected to stimuli influencing existing
schemas, trauma stored as a “fragmented memory”
Dual Representation Theory (Brewin et al, 1996)
⊳ VAMs, SAMs, successful emotional processing is a conscious process that depends on
exposure to SAMs, conflicts between trauma-related information and pre-existing schemas
Cognitive Model Theory (Ehlers & Clark, 2006)
⊳ Negative thoughts about external threats, view the world as dangerous place regardless of
threat, viewing the self as “incapable,” misinterpretation, stimuli strongly associated with
particular responses
(Bison, 2009)

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4.
Treatment

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HEARTS
● Healthy Environments and Tier 1 : school-wide universal supports to change school
Response to Trauma in cultures into learning environments that are more safe,
Schools (HEARTS) supportive, and trauma-informed.
Program promotes school
success for Tier 2: capacity-building with school staff to facilitate the
trauma-impacted students incorporation of a trauma-informed lens into the
through a whole-school development of supports for at-risk students,
approach utilizing the school-wide concerns, and disciplinary procedures
Response to Intervention
multi-tiered framework. Tier 3 : intensive interventions for students suffering from
the impact of trauma

18 Dorado et al., 2016

CBITS Identify Students
● Screen from referral list
● Individual Screening
○ Individual meetings to screen
● Group Screening
○ I.e. class and grade level

Group and Individual

01 Counseling
Forming CBITS groups
● 10 group sessions
● From one group of 6-8 ● 1-3 individual sessions
participants ● 2 parent
● Do not screen more psychoeducational
youth than you can treat sessions
● If multiple groups 02 03 ● 1 teacher educational
consider age and gender
session

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 References
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5TM).
Washington, D.C.: American Psychiatric Press, Inc.
Bisson, J. I. (2009). Psychological and social theories of post-traumatic stress disorder. Psychiatry, 8(8), 290-292.
Boelen, P., & Spuij, M. (2013). Symptoms of Post-Traumatic Stress Disorder in Bereaved Children and Adolescents: Factor
Structure and Correlates. Journal of Abnormal Child Psychology, 41(7), 1097–1108.
https://doi-org.libproxy.chapman.edu/10.1007/s10802-013-9748-6
Dorado, J. S., Martinez, M., McArthur, L. E., & Leibovitz, T. (2016). Healthy Environments and Response to Trauma in Schools
(HEARTS): A Whole-School, Multi-level, Prevention and Intervention Program for Creating Trauma-Informed, Safe and
Supportive Schools. School Mental Health, 8(1), 163–176. https://doi.org/10.1007/s12310-016-9177-0
How Common is PTSD in Adults? - PTSD: National Center for PTSD. (n.d.). [General Information]. Retrieved October 29, 2020,
from https://www.ptsd.va.gov/understand/common/common_adults.asp
E., & Pecora, P. (2010). Toolkit for Adapting Cognitive Behavioral Intervention for Trauma in Schools (CBITS) or Supporting
Students Exposed to Trauma (SSET) for Implementation with Youth in Foster Care.
https://www.rand.org/pubs/technical_reports/TR772.html
Post-Traumatic Stress Disorder (PTSD). Mayo Clinic. (2018). Retrieved from:
https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967
Zhang, Y., Zhang, J., Zhu, S., Du, C., & Zhang, W. (2015). Prevalence and Predictors of Somatic Symptoms among Child and
Adolescents with Probable Posttraumatic Stress Disorder: A Cross-Sectional Study Conducted in 21 Primary and
Secondary Schools after an Earthquake. PLoS ONE, 10(9), 1–14.
https://doi-org.libproxy.chapman.edu/10.1371/journal.pone.0137101

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