PTSD

I HOPE SO YOU WILL FIND IT INFORMATIVE......:)

1. POST-
TRAUMATIC
STRESS
DISORDER

2. LEARNING
OUTCOMES
1.What is PTSD???
2.Who is at risk for PTSD???
3.When does PTSD start???& How
long does it last???
4.Symptoms
5.Consequences
Physiological outcomes
Psychological outcomes
Self-destructive behaviors
1.Treatment
Psychotherapy
Pharmacotherapy

3. INTRODUCTION
Disorder driven by pathogenic memories of past
danger.
Symptoms must last for more than a month
Acute stress disorder, which occurs earlier than
PTSD

4. PTSD is an anxiety
disorder that develops in
response to a stressful
event or situation of
exceptionally threatening
or catastrophic nature
What is PTSD?

5. EPONYMS OF PTSD
Civil War-Irritable heart
World War I-shell shock
/Effort syndrome
World war II – combat stress
syndrome
Vietnam War- brought the
concept of PTSD.
Gulf war syndrome
PTSD entered the DSM-III in
1980

6. Traumatic events that may trigger
PTSD include:
violent personal assaults
Sexual assault
Physical attack
Abuse
Stabbing
natural disasters
Accidents
Military combat.
Traumatic events

7. COMMON FEATURE SHARED BY ALL
SYNDROMES
Fatigue, fainting
Shortness of breath,
Palpitations,
Headache, dizziness,
Excessive sweating,
Disturbed sleep,
Difficulty in
concentration
 Forgetfulness

8. EPIDEMIOLGY
Lifetime prevalence -8 percent in general population
5 to 15 percent -subclinical forms of the disorder.
Among high-risk groups -5 to 75 percent.
10 to 12 percent among women
5 to 6 percent among men.
Higher in women, single, divorced, widowed, socially
withdrawn, of low socioeconomic level

9. Sexual assault-higher impact
Sudden unexpected death of
a loved one

and road traffic
accidents
Men -more traumatic events
Women - higher impact
events.

10. COMORBIDITY
Depressive disorders
Substance-related disorders
Anxiety disorders
Bipolar disorders

11. WHO IS AT
RISK?
Every One!!!

12. People with military combat
experience or civilians who have been
harmed by war
People who have been raped, sexually
abused, or physically abused
People who have been involved in or
who have witnessed a life-threatening
event
People who have been involved in a
natural disaster, such as a tornado or
an earthquake
Who is at risk for PTSD??

13. RISK FACTORS FOR PTSD AMONG
THOSE EXPOSED TO TRAUMA
Female, neuroticism
Lower social support
Lower IQ
Pre-existing
psychiatric illness
Family history of
mood, anxiety, or
substance abuse
disorders
Neurological soft signs

14. PREDICTORS
Previous exposure to trauma
Peritraumatic responses
Negative interpretations of one's acute responses
Borderline, paranoid, dependent, or antisocial
personality disorder traits
Presence of childhood trauma
Inadequate family or peer support system
Recent stressful life changes
Recent excess alcohol intake

15. GENETICS
1/3rd of variance in
symptoms is genetic
Trauma exposure-little or
no effect on measures of IQ
&neurocognitive
functioning
Similarity in the test scores
between co-twins implies
genetic influence on
cognitive performance
Above average cognitive
ability -protect

16. PSYCHODYNAMIC FACTORS
Trauma has reactivated a previously quiescent, yet
unresolved psychological conflict
The subjective meaning of a stressor may determine its
traumatogenicity.
Traumatic events can resonate with childhood traumas.
Inability to regulate affect can result from trauma.
Somatization and alexithymia may be among the after
effects of trauma.
Common defenses -denial, minimization, splitting,
projective , dissociation, and guilt
Mode of object relatedness involves projection and
introjection

17. COGNITIVE FACTORS
Affected persons cannot process or rationalize the
trauma that precipitated the disorder.
They continue to experience the stress and attempt to
avoid experiencing it by avoidance techniques.
Less decline in vividness, emotional intensity, and
accuracy of traumatic memories.
Exhibit difficulty retrieving specific memories
Difficulties of attentional control

18. EMOTIONAL STROOP PARADIGM
Delayed naming of
the word's colour
Heightened stroop
interference for
trauma words in
PTSD

19. FEAR CONDITIONING
MOWRER'S TWO-FACTOR
CONDITIONING THEORY
Traumatic stimuli (UCS) fear&arousal
UCS+CS fear response stimulus
generalization variety of stimuli become triggers
avoidance of CS negative reinforcement by
operant conditioning prevents extinction of
conditioned fear responses maintains the problem.
 

20. NORADRENERGIC SYSTEM
Nervousness, increased blood
pressure and heart rate,
palpitations, sweating,
flushing, and tremors
-symptoms of adrenergic
drugs.
Increased 24-hour urine
epinephrine concentrations in
veterans

21. Increased urine
catecholamine concentrations
in sexually abused girls
Platelet alpha
2
- and
lymphocyte beta 2 adrenergic
receptors are downregulated

22. STRUCTURAL CHANGES
Lower average volume
in the hippocampal
region
Structural changes in
the amygdale

23. SYMPTO
MS

24. The symptoms of PTSD can start
after a delay of weeks, or even
months. They usually appear
within 3 months after the
traumatic event.
Some people get better within 6
months. Others may have the
illness for much longer.
When does PTSD start??
& How long does it last???

25. Re-experiencing the event through flashbacks or
nightmares
Avoiding people, places or thoughts that bring
back memories of the trauma
Feeling angry & unable to trust people
Social withdrawal
Numbness
Insomnia
Lack of concentration
Symptoms

26. CONSEQUEN
CES
1)Physiological outcomes
2)Psychological outcomes
3)Self-destructive behaviors

27. Neurobiological changes (alterations in
brainwave activity and in functioning of processes such
as memory and fear response)
Psychophysiological changes
Hyper-arousal of the sympathetic nervous system,
Sleep disturbances
Increased neurohormonal changes that result in
increased stress & depression
Headache
Stomach or digestive problems
Dizziness
1)Physiological outcomes

28. Depression
Other anxiety disorders (such as phobias,
panic, and social anxiety)
Splitting off from the present
Eating disorders
2)Psychological outcomes

29. Low self esteem
Alcohol and drug abuse
Suicidal attempts
Self-injury
Risky sexual behaviors
leading to unplanned
pregnancy or STDs, including
HIV
3)Self-destructive behaviors

30. TREATME
NT

31. PTSD is treated by a variety of forms of psychotherapy
(talk therapy) and pharmacotherapy (medication).
There is no single best treatment, but some treatments are
quite promising, especially cognitive behavioral therapy
(CBT).
Treatment

32. COGNITIVE BEHAVIORAL
THERAPY (CBT)
A Cognitive Behavioral Therapy (CBT) is a
psychotherapy based on modifying beliefs and
behaviors, with the aim of influencing disturbed
emotions.
CBT includes a number of
techniques such as:
I.Cognitive restructuring
II.Exposure therapy
III.Eye movement desensitization
and reprocessing (EMDR)

33. Cognitive restructuring aims at replacing
dysfunctional thoughts with more realistic &
helpful ones.
e.g.
“I’ll never be normal again..I am gonna die”
“I’ll get better..It will just take time”
Or “I feel scared..But I am safe”
I. Cognitive Restructuring

34. In exposure therapy your goal is to
have less fear about your
memories.
By talking about your trauma
repeatedly with your therapist,
you'll learn to get control of your
thoughts and feelings about the
trauma.
You'll learn that you do not have to
be afraid of your memories
anymore.
II. Exposure Therapy

35. EMDR is a new therapy for PTSD.
In EMDR, patients are instructed to focus on the
traumatic memory while they visually track something
that is moving from side to side (such as the therapist’s
finger).
Thus, the therapist supplies positive emotional beliefs
to replace the negative ones.
III. EMDR

36. MEDICATION
The use of medication in addition
to psychotherapy has been shown
to be beneficial in the treatment of
PTSD.
The most widely used drug
treatments for PTSD are the
selective serotonin reuptake
inhibitors (SSRIs), such as Prozac
& Zoloft
N.B. Drug trials for PTSD are still
at a very early stage