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1. Trauma and stressor related disorder
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Learning objectives
By the end of this session the students will be able
to:
oDefine PTSD
oIdentify the epidemiology of PTSD
oList the etiology of PTSD
oDescribe the clinical features of PTSD
oList the Diagnostic criteria of PTSD
oDescribe the DDx of PTSD
oList the Diagnostic method of PTSD
oDescribe the treatment of PTSD

3. Anxiety disorder…
POST-TRAUMATIC STRESS DISORDER
Definition
 Posttraumatic stress disorder (PTSD) is a condition
marked by the development of symptoms after
exposure to traumatic life events.
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4. PTSD …
Epidemiology
 The lifetime incidence 9 to 15%
 The lifetime prevalence 8% of the general population
 The disorder is most likely to occur in those who are:
Single, divorced, widowed
Socially withdrawn
Low socioeconomic level
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5. PTSD …
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oEvents that can cause or trigger PTSD include:
Military combat,
Violent personal attack,
Natural disasters, and tragedies (e.g., plane crash)
Physical or sexual abuse or
Witnessing another person’s serious injury.

6. PTSD …
Etiology
oA stressor is the prime causative factor in the development of PTSD.
oHowever, not everyone experiences the disorder after a traumatic
event.
oThe stressor alone does not suffice to cause the disorder.
oThe response to the traumatic event must involve intense fear or horror
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7. PTSD …
Clinical features
 The trauma is being reexperienced
 Avoidance of certain situations, places, people, and/or conversations
that remind patients of the trauma
 difficulties in remembering all the details and aspects of the trauma
 Irritability, tension and almost constant hypervigilance, and negative
expectations
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8. PTSD …
Diagnostic criteria
Symptoms occurs after a
traumatic stressor and
occurs in individuals who
have survived a severe or
terrifying physical or
emotional events
re-experiencing Sym. at
least 1
distressing recollections
Dreams
Flashbacks
psychological trigger
reactions
physiological trigger
reactions
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9. PTSD …
Diagnostic criteria…
Avoidance Sym. at least1
Avoid thoughts, feelings or memories
Avoidance of or efforts to avoid external reminders
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10. At least two Negative alterations in cognitions
Inability to remember an important aspect of the
traumatic event
Persistent and exaggerated negative beliefs or
expectations about oneself, others, or the world
Persistent, distorted cognitions about the cause or
consequences of the traumatic event
Persistent negative emotional state
Markedly diminished interest or participation in
significant activities.
 Feelings of detachment or estrangement from others
Persistent inability to experience positive emotions
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11. PTSD …
Diagnostic criteria…
Hyper arousal
Symptoms at least 2
Sleep disturbance
Irritability
Difficulty of
concentration
Startle response
hypervigilence
Cause impairment in
functioning
Duration
symptoms beyond 4
weeks
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12. PTSD …
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DDx
 Alcohol-use disorders
 Panic disorder
 GAD
 MDD

13. PTSD …
Diagnostic methods
 History
 Physical examination
 Mental status examination
 Laboratory investigation
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14. PTSD …
Treatment
 Antidepressants or
 Anxiolytics(Benzodiazepine)
 Psychotherapy
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15. DSM-V Diagnostic Criteria for Acute Stress Disorder
• Exposure to actual or threatened death, serious injury,
or sexual violation in one (or more) of the following
ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to
others.
3. Learning that the event(s) occurred to a close family
member or close friend.
4. Experiencing repeated or extreme exposure to aversive
details of the traumatic event(s).
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16. • Presence of nine (or more) of the following
symptoms from any of the five categories of
intrusion, negative mood, dissociation,
avoidance, and arousal, beginning or worsening
after the traumatic event(s) occurred:
• Intrusion Symptoms
1. Recurrent, involuntary, and intrusive
distressing memories of the traumatic event(s).
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17. • Recurrent distressing dreams in which the content and/or affect of
the dream are related to the event(s).
3. Dissociative reactions (e.g., flashbacks) in which the individual
feels or acts as if the traumatic event(s) were recurring. Note: In
children, trauma-specific re-enactment may occur in play.
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18. • 4. Intense or prolonged psychological distress or marked
physiological reactions in response
• to internal or external cues that symbolize or resemble an aspect
of the traumatic event(s).
• Negative Mood
• 5. Persistent inability to experience positive Dissociative
Symptoms
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19. 6. An altered sense of the reality of one’s
surroundings or oneself
7. Inability to remember an important aspect of the
traumatic event(s).
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20. Avoidance Symptoms
8. Efforts to avoid distressing memories, thoughts, or feelings
about or closely associated with the traumatic event(s).
9. Efforts to avoid external reminders that arouse distressing
memories, thoughts, or feelings about or closely associated with
the traumatic event(s).
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21. Arousal Symptoms
10. Sleep disturbance (e.g., difficulty falling or staying asleep, restless
sleep).
11. Irritable behavior and angry outbursts (with little or no
provocation), typically expressed as verbal or physical aggression
toward people or objects.
12. Hypervigilance.
13. Problems with concentration.
14. Exaggerated startle response.
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22. C. Duration of the disturbance (symptoms in Criterion
B) is 3 days to 1 month after trauma exposure.
D. The disturbance causes clinically significant distress
or impairment.
E. The disturbance is not attributable to the
physiological effects of a substance or another
medical condition and is not better explained by brief
psychotic disorder
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