POST TRAUMATIC STRESS
What is trauma?
A fundamental rift
Severe psychological response to a major event such as war, rape, serious RTA, fire, flood, life threatening
diagnosis, sudden unexpected death of loved one etc
Recently, severe stress has been added as a possible trigger (not loss of a loved one/life threatening) –
created controversy as it makes it easier to fake (for financial benefit) & because it confuses PTSD with
merely experiencing stress
Symptoms can include
- Traumatic memories, substance abuse, inability to deal with everyday life, anxiety, depression,
dissociation, PTSD
Historical perspective:
Not a response to trauma in all cultures - culturally relevant construct
PTSD different now to in WWI - didn’t really exist then
What is it that goes on in the brain that is the same in all times and cultures and what makes it different?
A lot of guilt - why did I survive?
Achilles
Marathon
French Revolutionary wars - if soldiers broke down, blamed it on nostalgia of missing families - not
trauma of battle
WWI : when they broke down, blamed it on “shell shock” physical cause - little bits of shell get embedded
in the brain
WWII: after Freud talked about psychological traumatic breakdown - during WWII - psychiatrist Sergeant
notices it and gave soldiers psychiatric help
Vietnam
PTSD introduced into DSM in 1980, but much longer history
One of the few DSM concepts which requires an external stimuli - traumatic incident
MYTHS OF TRAUMA:
Most people become traumatised after a major event
- PILOTS database, 25,000 papers on PTSD
- Most people get upset but don’t get PTSD
If you do not experience problems there is something wrong with you
Traumatic events are rare
Individual differences:
, Early research looked at event - looked for relationship between severity of event and response - but too many
individual differences
It is not the event that is the problem, but the individuals response to the event
- Coping styles: avoidant, cognitive processing
- Social Support: family, friends. Probably the best predictor of PTSD. Not necessarily the number of
people, but how great you perceive your social network to be
- Personality
- Intelligence
Vulnerability factors:
Tendency to take personal responsibility for event
Early separation from parents / unstable family life in childhood
Family history of PTSD
High anxiety / a pre existing psychological disorder
What happens:
Traumatic memories are not normal memories
Disruption of personal schemata regarding the world - e.g. world is safe, people are pleasant, it cannot
happen to me
Need for resolution - coping through development of narrative - treatment, thinking, talking, writing
No resolution - coping through avoidance
Range of symptoms :PTSD, depression, substance abuse,
PTSD Criteria:
1. The person has been exposed to a traumatic event in which both of the following were present:
a) . The person experienced, witnessed, or was confronted with an event that involved actual or
threatened death or serious injury, or a threat to the physical integrity of self or others
b) The person’s response involved intense fear, helplessness or horror
c) In children: may be disorganised behaviour
2. Persistent re-experiencing in one or more of:
- Recurrent and distressing recollections
- Recurrent and distressing dreams
- Hallucinations or flashbacks
- Intense distress at cues/reminders
- Physiological reactivity on exposure to cues
3. Persistent avoidance and numbing of general responsiveness (3+)
- Avoid thoughts, feelings or conversations
- Avoid activities, places or people
- Inability to recall important aspects
- Markedly diminished interest in significant activities
- Feeling of detachment/estrangement
- Restricted affect
- Sense of foreshortened future
4. Persistent symptoms of increased arousal (2+)
- Sleeping difficulties
What is trauma?
A fundamental rift
Severe psychological response to a major event such as war, rape, serious RTA, fire, flood, life threatening
diagnosis, sudden unexpected death of loved one etc
Recently, severe stress has been added as a possible trigger (not loss of a loved one/life threatening) –
created controversy as it makes it easier to fake (for financial benefit) & because it confuses PTSD with
merely experiencing stress
Symptoms can include
- Traumatic memories, substance abuse, inability to deal with everyday life, anxiety, depression,
dissociation, PTSD
Historical perspective:
Not a response to trauma in all cultures - culturally relevant construct
PTSD different now to in WWI - didn’t really exist then
What is it that goes on in the brain that is the same in all times and cultures and what makes it different?
A lot of guilt - why did I survive?
Achilles
Marathon
French Revolutionary wars - if soldiers broke down, blamed it on nostalgia of missing families - not
trauma of battle
WWI : when they broke down, blamed it on “shell shock” physical cause - little bits of shell get embedded
in the brain
WWII: after Freud talked about psychological traumatic breakdown - during WWII - psychiatrist Sergeant
notices it and gave soldiers psychiatric help
Vietnam
PTSD introduced into DSM in 1980, but much longer history
One of the few DSM concepts which requires an external stimuli - traumatic incident
MYTHS OF TRAUMA:
Most people become traumatised after a major event
- PILOTS database, 25,000 papers on PTSD
- Most people get upset but don’t get PTSD
If you do not experience problems there is something wrong with you
Traumatic events are rare
Individual differences:
, Early research looked at event - looked for relationship between severity of event and response - but too many
individual differences
It is not the event that is the problem, but the individuals response to the event
- Coping styles: avoidant, cognitive processing
- Social Support: family, friends. Probably the best predictor of PTSD. Not necessarily the number of
people, but how great you perceive your social network to be
- Personality
- Intelligence
Vulnerability factors:
Tendency to take personal responsibility for event
Early separation from parents / unstable family life in childhood
Family history of PTSD
High anxiety / a pre existing psychological disorder
What happens:
Traumatic memories are not normal memories
Disruption of personal schemata regarding the world - e.g. world is safe, people are pleasant, it cannot
happen to me
Need for resolution - coping through development of narrative - treatment, thinking, talking, writing
No resolution - coping through avoidance
Range of symptoms :PTSD, depression, substance abuse,
PTSD Criteria:
1. The person has been exposed to a traumatic event in which both of the following were present:
a) . The person experienced, witnessed, or was confronted with an event that involved actual or
threatened death or serious injury, or a threat to the physical integrity of self or others
b) The person’s response involved intense fear, helplessness or horror
c) In children: may be disorganised behaviour
2. Persistent re-experiencing in one or more of:
- Recurrent and distressing recollections
- Recurrent and distressing dreams
- Hallucinations or flashbacks
- Intense distress at cues/reminders
- Physiological reactivity on exposure to cues
3. Persistent avoidance and numbing of general responsiveness (3+)
- Avoid thoughts, feelings or conversations
- Avoid activities, places or people
- Inability to recall important aspects
- Markedly diminished interest in significant activities
- Feeling of detachment/estrangement
- Restricted affect
- Sense of foreshortened future
4. Persistent symptoms of increased arousal (2+)
- Sleeping difficulties
