Acute and Post Traumatic Stress Disorders

Traumatic stress disorders are defined in the DSM-IV-TR as an event that involves actual or threatened death or serious injury to self or others and creates intense feelings of fear, helplessness, or horror. Acute stress disorder (ASD) occurs within four weeks after exposure to a traumatic stress and characterized by dissociative symptoms as well as: Re-experiencing, avoidance of reminders, and marked anxiety or arousal. Post-traumatic stress disorder (PTSD) is defined by symptoms of re-experiencing, avoidance, and arousal, but PTSD is either longer lasting or has a delayed onset.

Dissociative symptoms are common in the immediate aftermath of a trauma, but must be present for the diagnosis of ASD, but not PTSD. An individual with dissociative symptoms is described as dazed and acts “spaced out”. The seem to lose touch with themselves and reality.

Re-experiencing are repeated, distressing images or thoughts; intrusive flashbacks; and horrifying dreams.

Avoidance is an attempt of avoid thoughts, feelings related to the event. An individual might avoid people, places, or activities that remind them of the event. Over time, an individual’s responsiveness becomes numbed.

An individual exhibiting anxiety or arousal might have a harder time moving past the disorder. Such an individual is usually hypervigilant. He or she is restless, agitated, and irritable. When started, the individual responds in an exaggerated manner.

Maladaptive reactions to trauma have long been an interest to the military. “Shell shock” or “combat neurosis are terms you may have heard of. Vietnam War prompted much interest in PTSD due to delayed reactions to combat being very common.

To understand ASD and PTSD, we need to have a good understanding of what trauma is. The DSM-IV-TR defines traumaas: the experience of an event involving actual or threatened death or serious injury to self or others. An individual experiencing trauma responds with emotions of intense fear, helplessness, or horror in the reaction to the event. Different traumas also have unique psychological consequences. The effect of exposure to disasters is a particular concern due to large numbers impacted.

Wouldn’t you imagine emergency workers would have a high rate of ASD or PTSD? This is not the case however. They are less than half as likely to develop PTSD as a victim. There training and exposure to difficult situations at work seems to give them a buffer against trauma’s effects.

ASD and PTSD have a high rate of comorbidity with depression, other anxiety disorders, and substance abuse. Individuals with ASD and PTSD generally have anger issues. When they do, there is a higher risk for suicide.

Prevalence of PTSD (NCS)

8% (10% women, 5% of men) of people living in the United States

Rape and assault victims are at especially high risk for PTSD.

Minorities are more likely to experience PTSD.

Social Factors in ASD and PTSD

Victims of trauma are more likely to develop PTSD when the trauma is more intense. This seems rather obvious. You are more likely to feel anything that is more intense. If I slap you across the face lightly, you will probably brush it aside pretty easily. But if I really lay into it, chances are you will feel it for a while afterwards. That’s how it is with PTSD. With less severe stressors, social support after a trauma can play a crucial role in alleviating long-term psychological damage.

Biological Factors in ASD and PTSD

There is evidence for some genetic influence on whether someone will experience PTSD.

Psychological Factors

two-factor theory is used to explain PTSD development.

The first factor is when classical conditioning creates fear when the terror of trauma is paired with the cues associated with it. Let me try and put it into laymen’s terms. You are in a car accident. A red car hits you and you are trapped inside. Before, you loved red cars or at least they didn’t bother you. After you have a wreck with one, however, and you have to amputate a leg, every time you see a red car you experience the same emotions that you experienced when trapped in your car. This is merely an example. Trauma could be anything.

The second factor is when operant conditioning maintains avoidance by reducing fear (negative reinforcement). Avoidance prevents the extinction of anxiety through exposure. So using the example above, you avoid going out because you might see a red car, and the thought alone makes you anxious. By not going out, you are not anxious. You are safe from any red cars. You maintain your control over the situation.

The risk for PTSD depends on cognitive factors: preparedness, purpose and blame.

The role of dissociation is debated. May not be adaptive- may be related to more PTSD.

Edna Foa is known for developing emotional processing. Emotional processing is where an individual engages emotionally with trauma. Emotional processing involves ­articulation and organization of the chaotic experience. Once an individual emotionally processes the trauma, he or she has a cognitive shift where they no longer see the world as a bad place.

Emergency Help for Trauma Victims

Immediate support to trauma victims is a common goal of all early interventions.

There is no evidence that CISD prevents future PTSD, and it’s possibly harmful.

Three principles for combat soldiers that can be applied to civilian disasters: (1) Immediate treatment (2) in the proximity of the battlefield with the (3) expectation to return to the front lines upon recovery.

Cognitive behavioral therapy is often used for PTSD. The most effective treatment for PTSD is re-exposure to trauma.

CBT helps the client through prolonged exposure to trauma. This is obviously done by the client going back in his or her mind and experiencing the trauma over again in his or her head. This is often referred to as imagery rehearsal therapy. The goal with this technique is cognitive restructuring.

Francine Sharpiro developed a technique called Eye Movement Desensitization and Reprocessing that includes rapid back-and-forth eye movements. Prolonged exposure appears to be the “active ingredient”.

Antidepressants and therapeutic re-exposure are first-line therapies for PTSD. Effectiveness of SSRIs is likely at least partially due to the high comorbidity between PTSD and depression. Traditional antianxiety medications are not effective in treating PTSD.

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