Summary: Post-Traumatic Stress Disorder | 9780470688977

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• 1 PTSD and Related Disorders

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• PTSD is a disorder of ___ rather than a disorder of ____ 

  reactivity
  altered baseline state

• traumatic  stimuli activate the ____, which in turn produces outputs to the 

  Amygdala
   hippocampus, medial prefrontal cortex, locus coeruleus, thalamus, hypothalamus, insula and dorsal/ventral striatum. 

• alterations to DSM III PTSD criteria

  - number possible symptoms increased (12-17)
  - original three symptoms have been rearranged into present triad of reexperiencing, avoidance/numbing and hyperarousal). 
  - Criterion E (duration of symptoms must exceed one month) was included in DSM III-R in 1987 and Criterion F (symptoms must cause clinically significant distress or functional impairment) was added in DSM IV in 1994
  - Criterion A no longer characterized as exposure to traumatic event, as an event that 'is generally outside the range of usual human experience'

• Does traumatic exposure cause PTSD :

  Bearings on question:
  - people differ in their vulnerability and resilience (most people do not develop PTSD)
  - events differ with regard to conditional probability that PTSD will follow exposure 
  
  complex interaction between individual susceptibility and toxicity of a given stressful event
  
  Criterion A1 is necessary but not sufficient condition for subsequent development of PTSD. There is a debate over how narrow criterion A1 should be.

• prototypical major negative events be rated objectively along 6 dimensions (proposed by Dohrenwind)

  1) valence (negative)
  2) source (external, uncontrollable, 'fateful')
  3) unpredictable, central (life-threatening
  4) deprivation of basic needs and goals)
  5) magnitude (likelihood of causing great negative changes)
  6) likelihood to exhaust the individual

• suggested modifications for criterion A1 from DSM IV to DSM V

  - emphasizing temporal rather than anthological relationship between A1 and B-F symptoms
  - narrowing the criterion to eliminate second hand exposure
  - incorporating Dohrenwend's dimensional approach

• Criterion A in DSM V

  adress concerns:
  - reduce ambiguity surrounding what is and what is not a traumatic event (A1)
      -> key question is whether to A1 should be designed to maximize sensitivity                          or whether it should maximize specificity
  
  - increase utility criterion A2 in making PTSD diagnosis and whether  'fear, helplessness, or horror' should be expanded to include both peritraumatic dissociation and other intense peritraumatic emotions.  
  - elimination A2.

• 3 symptom clusters in DSM IV PTSD construct

  - B: reexperiencing
  - C: avoidance/numbing
  - D: hyperarousal

• proposal DSM V 4 symptom clusters

  reexperiencing
  avoidance
  arousal and reactivity
  negative alterations n cognitions and mood (replace DSM IV numbing cluster)

• people who meet ASD criteria are at ___ risk for developing PTSD. Majority of people who develop PTSD _____ ASD criteria

  higher
  have never met
  
  partially explained by the fact that the re-experiencing, avoidance, and arousal ASD clusters are very similar to same clusters in PTSD,  while most ASD dissociative symptoms are not found in PTSD