Understanding PTSD

1. Posttraumatic Stress
Disorder
Sandra Clamon

2. Overview
• DSM-IV definition of PTSD
• Causes
• Risk Factors
• Symptoms
• Screening
• Treatment
• References

3. Definition“Posttraumatic Stress
Disorder is a type of
anxiety disorder that
occurs after one sees
or experiences a
traumatic event that
involves the threat of
injury, death or other
physical integrity.”

Involved in/with event

Witness event

Learning or hearing about event

Person responds with intense
fear, horror, helplessness,
disorganized or agitated
behavior.

Symptoms must be present for
more than 1 month

Disturbance causes clinically
significant distress or impairment
in important areas of
functioning.

4. Specifiers

Acute

Symptoms last less than 3
months

Chronic

Symptoms last more than
3 months

Delayed Onset

At least 6 months have
passed between traumatic
event and onset of
symptoms

5. Differential Diagnosis

Adjustment Disorder

Stressor can be of any severity.

Situation in which symptoms occur are not extreme (e.g. being
fired, spouse leaving).

Acute Stress Disorder

Symptoms are similar to PTSD, but occur within 4 weeks and
resolve within the same 4 week period.

Obsessive-Compulsive Disorder

Recurrent intrusive thoughts not related to traumatic event.

Thoughts are experienced as inappropriate.

6. Causes
• Natural disasters
• Mass murder
• Combat Exposure
• Rape/Sexual Molestation
• Childhood Neglect
• Physical abuse/attack
• Other traumatic events

7. Risk Factors
• Female Middle-aged (40 to 60 years old)
• No experience coping with traumatic events
• Ethnic minority
• Lower socioeconomic status
• Children
• Spouse or partner with PTSD
• Pre existing psychiatric condition
• Primary exposure to the trauma
• Living in traumatized community

8. Symptoms
• Sleep problems
• Irritability,
• Difficulty concentrating,
• Jumpiness,
• Feeling constantly “on
guard”
are associated with anger
and
hostility (hyper alertness)
• Hostility
• Fear and anxiety

9. Symptoms cont'd
• Nightmares and flashbacks
• Sight, sound, and smell recollection
• Avoidance of recall situations
• Anger and irritability
• Guilt
• Depression
• Increased substance abuse
• Negative world view
• Decreased sexual activity

10. Screening for PTSD
• Posttraumatic Stress Disorder Checklist
• the only screening tool for PTSD
• 17-item checklist
• tested in primary care settings.
• Sensitivity is low (11)
• SPAN(Startle, Physiological arousal, Anger,
Numbness).
• only screens for four symptoms
• correlates with more extensive measures of PTSD

11. Screening for Trauma
(non-PTSD) Michigan Critical Events Perception Scale
 five-item questionnaire
 positive scores are 3X more likely to develop PTSD
 Acute Stress Disorder Scale
 19-item self report
 psychometric properties(reliability, validity),
 not tested in trauma or primary care setting.
 Suicide evaluation
 Very important for any trauma victim

12. PCL: PTSD Checklist
Examples
• Have you been jumpy or easily
startled lately?
• Have you been irritable or had
outbursts of anger?
• Have you found yourself trying
to avoid situations that remind
you of it?
• Have you had nightmares about
it or thought about it when you
did not want to?

The PCL is self administered

Responses range from 1 being
the lowest to 5 being the highest

The higher the score, the more
symptoms a patient may have.

Used for military personnel.

13. SPAN

Span is administered by clinician

Answers are evaluated by verbal
answer and body language.

If client answers “NO” to 2 or
more questions, PTSD is very
unlikely
“In your life have you ever had any
experience that was so
frightening, horrible, or upsetting
that in the past month you: “
Startle: “Have you had nightmares
or thought about it when you did
not want to”
Physiological arousal: “Tried hard
to avoid it or not think about it?”
Anger: where constantly on guard
or easily startled?
Numbness: “felt numb or
detached?”

14. Treatment
Trauma-focused cognitive-behavioral therapy. Cognitive-behavioral therapy for PTSD and trauma involves carefully
and gradually “exposing” yourself to thoughts, feelings, and situations that remind you of the trauma. Therapy also
involves identifying upsetting thoughts about the traumatic event–particularly thoughts that are distorted and
irrational—and replacing them with more balanced picture.
Family therapy. Since PTSD affects both you and those close to you, family therapy can be especially productive.
Family therapy can help your loved ones understand what you’re going through. It can also help everyone in the
family communicate better and work through relationship problems.
Medication. Medication is sometimes prescribed to people with PTSD to relieve secondary symptoms of depression or
anxiety. Antidepressants such as Prozac and Zoloft are the medications most commonly used for PTSD. While
antidepressants may help you feel less sad, worried, or on edge, they do not treat the causes of PTSD.
EMDR (Eye Movement Desensitization and Reprocessing). EMDR incorporates elements of cognitive-behavioral
therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. Eye
movements and other bilateral forms of stimulation are thought to work by “unfreezing” the brain’s information
processing system, which is interrupted in times of extreme stress, leaving only frozen emotional fragments which
retain their original intensity. Once EMDR frees these fragments of the trauma, they can be integrated into a
cohesive memory and processed.

15. Medication
• Selective serotonin reuptake inhibitors
• Celexa, Lexapro, Paxil and Prozac
• Reduce avoidance, numbing, hyper arousal, and intrusive thoughts.
• Side effects are general nausea, restlessness, and loss of libido.
• Heterocyclic antidepressants
• Elavil, Tofranil, and Pamelor
• Inhibit nerve cells' ability to reuptake serotonin and norepinehrine
• Reduce intrusive thoughts, hyper arousal, numbing, and insomnia
• Side effects include weight gain, sedation, constipation, dry mouth,
dizziness, blurred vision, EKG changes, Orthostasis. Can be harmful if
suddenly stopped.

16. Alternative Prevention
• Reach out to others for support
• Avoid alcohol and drugs
• Challenge your sense of helplessness
• http://www.youtube.com/watch?v=eHmXYhS4HQI
Positive ways of coping with PTSD:
• Learn about trauma and PTSD.
• Join a PTSD support group
• Practice relaxation techniques
• Confide in a person you trust
• Spend time with positive people
• Avoid alcohol and drugs

17. Complications
• Early treatment is better.
• PTSD symptoms can change family life.
• PTSD can be related to other health problems.
• Previous traumatic experiences, especially in early life.
• Family history of PTSD or depression.
• History of physical or sexual abuse.
• History of substance abuse.
• History of depression, anxiety, or another mental illness.
• High level of stress in everyday life.
• Lack of support after the trauma.
• Lack of coping skills.

18. PTSD Self-Test
Are you troubled by the following?
Yes No
You have experienced or witnessed a life-threatening event that caused intense fear, helplessness, or horror.
Do you re-experience the event in at least one of the following ways?
Yes No
Repeated, distressing memories, or dreams
Yes No
Acting or feeling as if the event were happening again (flashbacks or a sense of reliving it)
Yes No
Intense physical and/or emotional distress when you are exposed to things that remind you of the event
Do reminders of the event affect you in at least three of the following ways?
Yes No
Avoiding thoughts, feelings, or conversations about it
Yes No
Reference:
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994.

19. References
Hathaway, L. M., Boals, A., & Banks, J. B. (2010). PTSD symptoms and dominant
emotional response to a traumatic event: an examination of DSM-IV Criterion
A2.Anxiety, Stress & Coping, 23(1), 119-126. doi:10.1080/10615800902818771
Marshall, G. N., Schell, T. L., & Miles, J. V. (2010). All PTSD symptoms are highly
associated with general distress: Ramifications for the dysphoria symptom
cluster. Journal of Abnormal Psychology, 119(1), 126-135.
doi:10.1037/a0018477
Park, C. L., Mills, M., & Edmondson, D. (2010). Ptsd as meaning violation: Testing a
cognitive worldview perspective. Psychological Trauma: Theory, Research,
Practice, and Policy, doi:10.1037/a0018792
Postdeployment Anger and Aggressiveness in Veterans of Iraq and Afghanistan Wars.
(2010). The American Journal of Psychiatry, (), . Retrieved from
http://www.psych.org/MainMenu/Newsroom/NewsReleases/2010-News-
Releases/Anger-and-Aggressiveness-in-Veterans-.aspx

20. References cont'd
Drug treatment for posttraumatic stress disorder retrieved though
http://pier.axponline.org/physicians on February 5, 2011
DHCC Clinicians Helpline. (2003). PCL Primer. Retrieved from
http://www.pdhealth.mil/guidelines/downloads/PCL_Primer.pdf
http://www.adaa.org/living-with-anxiety/ask-and-learn/screenings/screening-
posttraumatic-stress-disorder-ptsd