Psychopathology PYC4802
THEME 02
Trauma and Stressor Related Disorders
Acute and Posttraumatic Stress Disorders
• Anhedonia (loss of experiencing pleasure)
• Dysphoria (a state of feeling sad, unwell or unhappy),
• A trauma- or stressor-related response is considered to be abnormal if it leads to negative consequences (e.g.
poor job-performance, social withdrawal, anhedonia).
• In trauma- and stressor-related disorders exposure to a traumatic or stressful event is listed as the major
diagnostic criterion.
• Anxiety, dissociation, or obsessive- compulsive responses may also be part of the psychological distress response
to experiencing a traumatic event.
• The ICD-10 states that the stress disorders differ from other disorders in that they are identifiable on the basis
not only of symptoms and course, but also of the existence of a specified causative influence (an exceptionally
stressful life event producing an acute stress reaction).
• The DSM-5 states that this group of disorders are characterised by exposure to a traumatic or stressful event.
• Symptoms include fear or anxiety, anhedonic, dysphoric, aggressive or dissociative symptoms.
Post-traumatic Stress Disorder (PTSD)
,
,• The diagnosis of PTSD requires, primarily, that a person has been exposed to a traumatic event that led to a
response of intense fear, helplessness, or horror.
• A traumatic event could refer to direct or vicarious exposure to actual or threatened death, serious injury or
sexual violence.
• The diagnosis of PTSD further requires that a person presents with a set of symptoms following exposure to a
traumatic event.
• Categories of symptoms:
1. Re-experiencing the traumatic event
2. Avoiding associated stimuli, or emotional numbing and detachment
3. Hypervigilance and chronic arousal.
• Traumatic events:
1. Natural disasters (e.g. floods)
2. Human-made' traumas such as interpersonal aggression (e.g. rape)
, 3. Accidents (e.g. a mining disaster)
4. May be found both in very rare (e.g. being taken hostage) and more common events (e.g. motor vehicle
accidents).
5. Medical procedures
• Research reports significant rates of PTSD found in fathers during the acute stage following a child’s diagnosis
with a chronic disease or unintentional injury.
• Post-traumatic Stress Symptoms (PTSS)
• Schelling studied a population of patients who received ICU treatment along with the administration of stress
hormones such as cortisol, epinephrine, and norepinephrine for medical reasons. The majority of them reported
traumatic memories of their stay in ICU. The memories contained little factual detail but described respiratory
distress, pain, nightmares, and anxiety. Schelling found, however, that there was a complex, and at times
protective, interaction between the administration of certain stress hormones and PTSD development.
• In a sample of women who survived intimate partner violence (IPV), PTSD was found to be significantly
associated with their shame, guilt, distress, and guilt cognitions. HOPE, an effective CBT intervention for the
women victimised by IPV. The treatment was found to significantly lower the symptom severity of emotional
numbing, effortful avoidance, and arousal, as well as reduce the likelihood of re-abuse over a six month follow-
up period.
• Psychological factors that play a role in the development and maintenance of PTSD: guilt, shame, grief, anxiety,
dysfunctional or distorted cognitions, and various cognitive, affective, and behavioural avoidance mechanisms,
which may interfere with the emotional processing of the traumatic event.
• PTSD and Major Depressive Disorder (MDD) share many symptoms, suggesting that they are highly correlated
and that there may be a single, underlying PTSD-MDD symptom dimension.
• Most people who experience a traumatic event will not go on to develop PTSD.
• Edwards, Sakasa, and van Wyk examined the proportion of people who do develop PTSD relative to those who
do not. This study highlighted the variables associated with resilience, such as personality factors, developmental
factors, social support, and gender (believed to play a role in protection against pathology and recovery).
• Pietrzak et al. examined post-traumatic growth in a population of war veterans. Post-traumatic growth refers to
subjective definitions of positive change that can result from exposure to major life crises and trauma. 72% of the
veteran endorsed a significant degree of positive change, particularly in terms of changed life priorities as well as
being better able to appreciate each day and handle difficulties. Hierarchical regression analysis revealed that
greater unit member support and effort or perseverance were significantly associated with posttraumatic
growth, suggesting that appropriate interventions may help to promote it.
• Certain people present with some PTSD symptoms, but find that these are manageable or that they resolve
spontaneously and these people continue to function normally.
• PTSD was the most prevalent of the mental disorders in a group exposed to a disaster.
ICD-10 Diagnostic Criteria
THEME 02
Trauma and Stressor Related Disorders
Acute and Posttraumatic Stress Disorders
• Anhedonia (loss of experiencing pleasure)
• Dysphoria (a state of feeling sad, unwell or unhappy),
• A trauma- or stressor-related response is considered to be abnormal if it leads to negative consequences (e.g.
poor job-performance, social withdrawal, anhedonia).
• In trauma- and stressor-related disorders exposure to a traumatic or stressful event is listed as the major
diagnostic criterion.
• Anxiety, dissociation, or obsessive- compulsive responses may also be part of the psychological distress response
to experiencing a traumatic event.
• The ICD-10 states that the stress disorders differ from other disorders in that they are identifiable on the basis
not only of symptoms and course, but also of the existence of a specified causative influence (an exceptionally
stressful life event producing an acute stress reaction).
• The DSM-5 states that this group of disorders are characterised by exposure to a traumatic or stressful event.
• Symptoms include fear or anxiety, anhedonic, dysphoric, aggressive or dissociative symptoms.
Post-traumatic Stress Disorder (PTSD)
,
,• The diagnosis of PTSD requires, primarily, that a person has been exposed to a traumatic event that led to a
response of intense fear, helplessness, or horror.
• A traumatic event could refer to direct or vicarious exposure to actual or threatened death, serious injury or
sexual violence.
• The diagnosis of PTSD further requires that a person presents with a set of symptoms following exposure to a
traumatic event.
• Categories of symptoms:
1. Re-experiencing the traumatic event
2. Avoiding associated stimuli, or emotional numbing and detachment
3. Hypervigilance and chronic arousal.
• Traumatic events:
1. Natural disasters (e.g. floods)
2. Human-made' traumas such as interpersonal aggression (e.g. rape)
, 3. Accidents (e.g. a mining disaster)
4. May be found both in very rare (e.g. being taken hostage) and more common events (e.g. motor vehicle
accidents).
5. Medical procedures
• Research reports significant rates of PTSD found in fathers during the acute stage following a child’s diagnosis
with a chronic disease or unintentional injury.
• Post-traumatic Stress Symptoms (PTSS)
• Schelling studied a population of patients who received ICU treatment along with the administration of stress
hormones such as cortisol, epinephrine, and norepinephrine for medical reasons. The majority of them reported
traumatic memories of their stay in ICU. The memories contained little factual detail but described respiratory
distress, pain, nightmares, and anxiety. Schelling found, however, that there was a complex, and at times
protective, interaction between the administration of certain stress hormones and PTSD development.
• In a sample of women who survived intimate partner violence (IPV), PTSD was found to be significantly
associated with their shame, guilt, distress, and guilt cognitions. HOPE, an effective CBT intervention for the
women victimised by IPV. The treatment was found to significantly lower the symptom severity of emotional
numbing, effortful avoidance, and arousal, as well as reduce the likelihood of re-abuse over a six month follow-
up period.
• Psychological factors that play a role in the development and maintenance of PTSD: guilt, shame, grief, anxiety,
dysfunctional or distorted cognitions, and various cognitive, affective, and behavioural avoidance mechanisms,
which may interfere with the emotional processing of the traumatic event.
• PTSD and Major Depressive Disorder (MDD) share many symptoms, suggesting that they are highly correlated
and that there may be a single, underlying PTSD-MDD symptom dimension.
• Most people who experience a traumatic event will not go on to develop PTSD.
• Edwards, Sakasa, and van Wyk examined the proportion of people who do develop PTSD relative to those who
do not. This study highlighted the variables associated with resilience, such as personality factors, developmental
factors, social support, and gender (believed to play a role in protection against pathology and recovery).
• Pietrzak et al. examined post-traumatic growth in a population of war veterans. Post-traumatic growth refers to
subjective definitions of positive change that can result from exposure to major life crises and trauma. 72% of the
veteran endorsed a significant degree of positive change, particularly in terms of changed life priorities as well as
being better able to appreciate each day and handle difficulties. Hierarchical regression analysis revealed that
greater unit member support and effort or perseverance were significantly associated with posttraumatic
growth, suggesting that appropriate interventions may help to promote it.
• Certain people present with some PTSD symptoms, but find that these are manageable or that they resolve
spontaneously and these people continue to function normally.
• PTSD was the most prevalent of the mental disorders in a group exposed to a disaster.
ICD-10 Diagnostic Criteria
