Transcript DSM-IV Criteria for PTSD A. Stressor Criterion

How do we define
STRESS?
Incongruity between the demands
placed on the organism and the
adaptive capacities of the organism
DSM-IV Criteria for PTSD
A. Stressor Criterion
The person has been exposed to a traumatic event in
which both of the following have been present:
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The person has experienced, witnessed, or been
confronted with an event or events that involve actual
or threatened death or serious injury, or a threat
to the physical integrity of self or others
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The person’s response involved intense fear,
helplessness, or horror. Note: in children, it may be
expressed instead by disorganized or agitated behavior.
PREVALENCE OF PTSD FOLLOWING DISASTER
Natural Disasters
Human-Made Disasters
Buffalo Creek Disaster Lifetime
PTSD 59% at 14 yr follow-up 25%
in children 37%
Technological Disaster PTSD 750%, Post-traumatic Impairment 2243%
Mt. St. Helens Volcanic Eruption
PTSD in exposed sample 3.6%,
PTSD among non-exposed 2.6%
Major Fire Post-traumatic Stress
Impairment 54-66%
Tornado PTSD 2-21%., Posttraumatic Stress Impairment 59%
Earthquake Post-traumatic Stress
Impairment 32-60%, PTSD in
children 26-95%
PTSD in burned survivors 100%
Transportation Disasters PTSD 29100% PTSD in children 40-47%
Terrorist Kidnapping and Torture
PTSD 54%
Mass Shooting 5% children 5-47%
Rescue Workers pts Reactions 24%
DISASTER EXPERIENCES
ASSOCIATED WITH CHRONIC PTSD
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Survivors/witnesses of mass destruction or death
Unresolved bereavement
Loss of home or community
Survivors with histories of prior exposure to
trauma
• Survivors who experience major life stressors
• Survivors of toxic contamination disasters
OTHER FACTORS ASSOCIATED WITH
CHRONIC PTSD
• Low levels of emotional/social support or high levels of
social demand
• Coping via avoidance, self-blame, or rumination
(However: maladaptive patterns of coping may be the result rather than
cause of post-traumatic stress impairment )
• Coping via substance abuse
• Serving as an emergency worker
• Children whose parents are persistently psychologically
impaired.
• Children whose parents experience significant
peritraumatic distress.
DSM-IV Criteria for PTSD
B. Intrusive Recollection Criterion
The traumatic event is persistently re-experienced in one (or more) of the following
ways:
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recurrent and intrusive distressing recollections of the event, including
images, thoughts, or perceptions. Note: in young children, repetitive play may
occur in which themes or aspects of the trauma are expressed
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recurrent distressing dreams of the event. Note: in children, there may be
frightening dreams without recognizable content
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acting or feeling as if the traumatic event were recurring (includes a sense
of reliving the experience, illusions, hallucinations, and dissociative flashback
episodes, including those that occur upon awakening or when intoxicated).
Note: in young children, trauma-specific reenactment may occur
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intense psychological distress at exposure to internal or external cues that
symbolize or resemble an aspect of the traumatic event
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physiological reactivity upon exposure to internal or external cues that
symbolize or resemble an aspect of the traumatic event
DSM-IV Criteria for PTSD
C. Avoidant / Numbing Criterion
Persistent avoidance of stimuli associated with the trauma and
numbing of general responsiveness (not present before the
trauma), as indicated by three (or more) of the following:
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efforts to avoid thoughts, feelings, or conversations associated with
the trauma
efforts to avoid activities, places, or people that arouse recollections
of the trauma
inability to recall an important aspect of the trauma
markedly diminished interest or participation in significant activities
feeling of detachment or estrangement from others
restricted range of affect (e.g., unable to have loving feelings)
sense of a foreshortened future (e.g., does not expect to have a
career, marriage, children, or a normal life span)
DSM-IV Criteria for PTSD
D. Hyperarousal Criterion
Persistent symptoms of increased arousal (not
present before the trauma), as indicated by two (or
more) of the following:
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difficulty falling or staying asleep
irritability or outbursts of anger
difficulty concentrating
hypervigilance
exaggerated startle response
Associated Features of PTSD
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Survivor Guilt
Impaired relationships
Impaired capacity to regulate feelings
Self destructiveness, impulsive behavior
Dissociation
Somatization
Personality change
Change in world view, beliefs
Shame, despair, hostility
Social withdrawal
Comorbid Diagnosis in PTSD
• Depression
• Dysthymia
• Anxiety Disorders
• Substance Abuse
• Personality Disorderes
Differential Diagnosis of PTSD
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Acute Stress Disorder
Adjustment Disorder
Bereavement
Affective Disorder
Phobia
Anxiety Dis.
Obsessive Compulsive Dis.
Organic Brain Dis.
Dissociative Dis.
Substance Abuse Dis.
Antisocial/ Borderline Personality D.
Malingering