Outline

Introduction
Diagnostic criteria
Features
Etiology

Introduction
● Both posttraumatic stress disorder (PTSD) and acute stress disorder are marked by
increased stress and anxiety following exposure to a traumatic or stressful event.
● Traumatic or stressful events may include being a witness to or being involved in a
violent accident or crime, military combat, or assault, being kidnapped, being involved in
a natural disaster, being diagnosed with a life-threatening illness, or experiencing
systematic physical or sexual abuse.
● The person reacts to the experience with fear and helplessness, persistently relives the
event, and tries to avoid being reminded of it. The event may be relived in dreams and
waking thoughts (flashbacks).
● The stressors causing both acute stress disorder and PTSD are sufficiently overwhelming
to affect almost everyone. They can arise from experiences in war, torture (discussed in
detail below), natural catastrophes, assault, rape, and serious accidents, for example, in
cars and burning buildings.
● Persons reexperience the traumatic event in their dreams and their daily thoughts; they
are determined to avoid anything that brings the event to mind and they undergo a
numbing of responsiveness along with a state of hyperarousal. Other symptoms are
depression, anxiety, and cognitive difficulties such as poor concentration.

Diagnostic Criteria:

6B40 Post-traumatic stress disorder Post-traumatic stress disorder (PTSD) is a syndrome that
develops following exposure to an extremely threatening or horrific event or series of events that
is characterized by all of the following:
1)Re-experiencing the traumatic event or events in the present in the form of vivid intrusive
memories, flashbacks, or nightmares, which are typically
Accompanied by strong and overwhelming emotions such as fear or horror and strong
physical sensations, or feelings of being overwhelmed or immersed in the same intense emotions
that were experienced during the traumatic event;
2) Avoidance of thoughts and memories of the event or events, or avoidance of activities,
situations, or people reminiscent of the event or events; and
3) Persistent perceptions of heightened current threat, for example as indicated by hypervigilance
or an enhanced startle reaction to stimuli such as unexpected noises.
The symptoms must persist for at least several weeks and cause significant impairment in
personal, family, social, educational, occupational, or other important areas of functioning.
● Inclusions: Traumatic neurosis
● Exclusions: Acute stress reaction (QE84) Complex post-traumatic stress disorder (6B41)

6B41 Complex post-traumatic stress disorder Complex post-traumatic stress disorder (Complex
PTSD):
● It is a disorder that may develop following exposure to an event or series of events of an
extremely threatening or horrific nature, most commonly prolonged or repetitive events
from which escape is difficult or impossible
(e.g., torture, slavery, genocide campaigns, prolonged domestic violence, repeated
childhood sexual or physical abuse).
● The core symptoms of PTSD characterize the disorder; that is, all diagnostic
requirements for PTSD have been met at some point during the disorder. In addition,
Complex PTSD is characterized by
1. Severe and pervasive problems in affect regulation;
2. Persistent beliefs about oneself as diminished, defeated, or worthless, accompanied by
deep and pervasive feelings of shame, guilt, or failure related to the traumatic event;
and
3. Persistent difficulties in sustaining relationships and in feeling close to others. The
disturbance causes significant impairment in personal, family, social, educational,
occupational, or other important areas of functioning. Exclusions: Post-traumatic stress
disorder
Etiology:
Even when faced with overwhelming trauma, most persons do not experience PTSD symptoms.
The National Comorbidity Study found that 60 percent of males and 50 percent of females had
experienced some significant trauma, whereas the reported lifetime prevalence of PTSD, as
mentioned earlier, was only about 8 percent

Biological Factors:
● Acute stress response activates self-bodies of norepinephrine increasing cortical level
arousal, contributing to hypervigilance, preparedness for response, inhibitions of
consummate activities, and preceding sexual activities.
● Parallel inputs from serotogenic, and GABA.
● There is a registered decrease in serotonin, norepinephrine, dopamine, and GABA in the
brain.
● the changes may cause the organism to eventually seeds trying to register or escape and
show decreasing appetitive behaviors and grooming, the features of learned helplessness.
● Antidepressants may have a full-blown impact on the stress response.
● Preclinical models of learned helplessness, kindling, and sensitization in animals have led
to theories about norepinephrine, dopamine, endogenous opioids, benzodiazepine
receptors, and the hypothalamic-pituitary-adrenal (HPA) axis.
● The HPA axis is more sensitive
● Increased activity and responsiveness of the autonomic nervous system, as evidenced by
elevated heart rates and blood pressure readings and by abnormal sleep architecture-
fragmentary sleep and latency period Is changed.
1. Noradrenergic System: Soldiers with PTSD-like symptoms exhibit nervousness,
increased blood pressure and heart rate, palpitations, sweating, flushing, and tremors
symptoms associated with adrenergic drugs. Yohimbine -flashbacks.
2. Coricotropin releasing factor:
Course and Prognosis:
● PTSD usually develops sometime after the trauma. The delay can be as short as 1 week
or as long as 30 years
● Untreated:
○ 30 percent of patients recover completely
○ 40 percent continue to have mild symptoms
○ 20 percent continue to have moderate symptoms
○ 10 percent remain unchanged or become worse.
● A good prognosis is predicted by rapid onset of the symptoms, short duration of the
symptoms (less than 6 months), good premorbid functioning, strong social supports, and
the absence of other psychiatric, medical, or substance-related disorders or other risk
factors.
● In general, the very young and the very old have more difficulty with traumatic events
than do those in midlife.
 ● Young children may not yet have adequate coping mechanisms to deal with the physical
and emotional insults of the trauma.
● Older persons are likely to have more rigid coping mechanisms than younger adults and
to be less able to muster a flexible approach to dealing with the effects of trauma.

Differential Diagnosis:

● Head Injury
● Dissociation
● Borderline Personality Disorder

‘Therapeutic Window’

Psychodynamic Factors:

● The re-emergence of childhood trauma results in regression and the use of Defence
mechanisms such as denial, reaction formation, and undoing.
● The Ego relives and tries to master and reduce anxiety.

Treatment:
● Hypnosis
● Psychodynamic Psychotherapy

Cognitive Behavioral Model

The behavioral model of PTSD emphasizes two phases in its development.

1. The trauma (the unconditioned stimulus) that produces a fear response is paired, through
classic conditioning, with a conditioned stimulus (physical or mental reminders of the
trauma, such as sights, smells, or sounds).
2. Through instrumental learning, the conditioned stimuli elicit the fear response
independent of the original unconditioned stimulus, and persons develop a pattern of
avoiding both the conditioned stimulus and the unconditioned stimulus.
3. Other factors: Some persons also receive secondary gains from the external world,
commonly monetary compensation, increased attention or sympathy, and the satisfaction
of dependency needs. These gains reinforce the disorder and its persistence.

● Exposure therapy: The first is exposure therapy, in which the patient re-experiences the
traumatic event through imaging techniques or in vivo exposure.
● Implosive Therapy
● Systematic Desensitization
● EMDR: While clients briefly focus on the trauma memory and simultaneously experience
bilateral stimulation (BLS), the vividness and emotion of the memory are reduced.