THEME 2: TRAUMA AND STRESSOR RELATED DISORDERS
ARTICLES
AVERILL – POST TRAUMATIC STRESS DISORDER IN OLDER ADULTS: A CONCEPTUAL REVIEW
— This review – 1) Summarize and integrate the extant literature on PTSD in older adults; 2) To spotlight
special concerns that are involved in understanding PTSD in older adults; 3) To set the stage for future
research in the relatively neglected area.
— Initiated by exposure to extraordinarily stressful life events
— 3 categories of symptoms
a) Reexperiencing Symptoms
b) Avoidance and numbing symptoms
c) Increased physiological arousal
— DSM-5: Individual is exposed to trauma; trauma is persistently reexperiencing; pervasive avoidance of
cues associated with the trauma and numbing of general responsiveness; persistent symptoms of
hyperarousal; lasted at least 1 month and cause significant distress.
— People experience trauma young tend to ‘mask symptoms’ until later in life.
— As they aged PTSD symptoms exacerbation was common
— Sleep disturbances and memory impairment are seen commonly in OLDER adults in general and may
not be associated with trauma exposure per se.
— Among older veterans, the most salient PTSD symptoms were distress when exposed to trauma-
related events and diminished interest in usual activities.
— Suggesting, older adults with PTSD may be prone to symptom exacerbation/worsening when faced
with trauma-related triggers.
— Suggest PTSD like other anxiety disorders decline with advancing age
— Some older adults have a history of chronic PTSD, others indicated that symptomatology resurfaced
after a period of symptom-free functioning and yet others report the onset of combat-related PTSD in
later life
— Not much information on PTSD in older women, mostly men from war etc.
— Many combat soldiers experience symptoms 40-50years later
— Difficult to study prevalence on war soldiers and holocaust survivors as most are dead
— Scotland air disaster – elderly had similar rate of PTSD to younger participants; 84% and 100% of both
participants met criteria for PTSD
— Relationship between severity of trauma and age
— Delayed-onset could be due to as the person ages, physical and mental resilience over time decreases
— Normal stressors such as retirement and bereavement may precipitate delayed onset PTSD may not
have the psychological resources to cope
— Co-Morbid – likely to experience MAJOR DEPRESSIVE DISORDER, other anxiety disorders, somatic
conditions (feel extreme anxiety over physical symptoms SSD), cognitive disturbances and
ALCOHOLISM
— 53% reported cases alcoholism among veterans
— Alcohol is rationalized as a means of self-medication to reduce symptoms such as nightmares,
insomnia, and anxiety - a lot more research is needed
— Radiating effects of exposure to trauma on the elderly – Advancing age potentially represents a
differential vulnerability factor that moderates the impact of exposure to a stressor
— Presumably if older persons are more susceptible to the effects of a stressor, greater negative effects
of their psychosocial functioning could be expected, regardless of the type of trauma to which they
are exposed
— General Psychological Effects – depend heavily on the individual’s premorbid functioning, particularly
with regard to anxiety, depression and extant PTSD. Characteristics of the stressor and individual
differences in coping skills appeared significant in this report.
— Physical Effects – Older adults are more likely to manifest trauma-related symptoms somatically
— Coping Strategies – younger soldiers were more likely to experience stress reactions after combat
exposure, suggesting that emotional maturity may increase resilience in coping strategies
, — Much more research is needed – specific symptoms may differ in older adults. The potential
differences could lead to misdiagnosis
BROWN – SUBSTANCE ABUSE AND POST-TRAUMATIC STRESS DISORDER COMORBITY
, — Research suggests that there is a high rate of PTSD and substance abuse comorbidity
— PTSD is classified as an anxiety disorder – it is the MOST EXTREME reactions that individuals can have
to high magnitude life events and can result in severe and chronic impairment across the major life
areas
— Link between substance abuse appears to be particularly complex with cause-and-effect relationships
difficult to disentangle and determine
— Self-medication hypothesis – postulates that PTSD occurs first and chemical substances are used as a
means of achieving symptom relief
— PTSD patients report using alcohol and or drugs to overcome distress of trauma-related events and ‘to
forget’ intrusive, disturbing memories of trauma
— Little evidence of specificity of substance use – patients use a variety of substances with vastly
different pharmacological actions
— PTSD patients characterized primarily by avoidance may use central nervous system stimulants i.e.
amphetamines to boost sociability
— PTSD patients experiencing predominately sleep difficulties and irritability/agitation may prefer to use
sedatives i.e. alcohol
— PTSD patients with severe levels of re-experiencing, avoidance/numbing and hyperarousal a variety of
substances may be used to alleviate and manage
— Self-medication and tension-reduction models suggest substance abuse is second to PTSD however
the converse is too possible
— People who start substance abuse young, may not have the correct coping skills when faced with
trauma as they have constantly used substances to deal and combat stress
— A history of conduct disorder/antisocial personality disorder is a predisposing variable for the
development of both substance abuse disorders and PTSD
— This theory suggests that PTSD and substance abuse are not related but instead share a common
etiological pathway
— PTSD substance abusers have an earlier onset of relapse than non-PTSD substance abusers
— Research shows us that coping skills play an important role in the recovery process
— Increased drinking following treatment is associated with both skills deficits and the failure to use
alternative coping responses
— Differences exist in the coping styles of PTSD and non-PTSD substance abusers
— Without treatment focused on their trauma, PTSD substance abusers experience more difficulty in the
early stages of sobriety and may be more susceptible to relapse
— Marked reductions in alcohol abuse can be obtained by successful treatment of PTSD anxiety
symptoms
— More research needs to be done to look into the relationship between substance abuse and PTSD
DE SLIVA – POST-TRAUMATIC STRESS DISORDER: CROSS-CULTURAL ASPECTS
— It was only till after World War II that work on trauma-induced stress began to flourish.
ARTICLES
AVERILL – POST TRAUMATIC STRESS DISORDER IN OLDER ADULTS: A CONCEPTUAL REVIEW
— This review – 1) Summarize and integrate the extant literature on PTSD in older adults; 2) To spotlight
special concerns that are involved in understanding PTSD in older adults; 3) To set the stage for future
research in the relatively neglected area.
— Initiated by exposure to extraordinarily stressful life events
— 3 categories of symptoms
a) Reexperiencing Symptoms
b) Avoidance and numbing symptoms
c) Increased physiological arousal
— DSM-5: Individual is exposed to trauma; trauma is persistently reexperiencing; pervasive avoidance of
cues associated with the trauma and numbing of general responsiveness; persistent symptoms of
hyperarousal; lasted at least 1 month and cause significant distress.
— People experience trauma young tend to ‘mask symptoms’ until later in life.
— As they aged PTSD symptoms exacerbation was common
— Sleep disturbances and memory impairment are seen commonly in OLDER adults in general and may
not be associated with trauma exposure per se.
— Among older veterans, the most salient PTSD symptoms were distress when exposed to trauma-
related events and diminished interest in usual activities.
— Suggesting, older adults with PTSD may be prone to symptom exacerbation/worsening when faced
with trauma-related triggers.
— Suggest PTSD like other anxiety disorders decline with advancing age
— Some older adults have a history of chronic PTSD, others indicated that symptomatology resurfaced
after a period of symptom-free functioning and yet others report the onset of combat-related PTSD in
later life
— Not much information on PTSD in older women, mostly men from war etc.
— Many combat soldiers experience symptoms 40-50years later
— Difficult to study prevalence on war soldiers and holocaust survivors as most are dead
— Scotland air disaster – elderly had similar rate of PTSD to younger participants; 84% and 100% of both
participants met criteria for PTSD
— Relationship between severity of trauma and age
— Delayed-onset could be due to as the person ages, physical and mental resilience over time decreases
— Normal stressors such as retirement and bereavement may precipitate delayed onset PTSD may not
have the psychological resources to cope
— Co-Morbid – likely to experience MAJOR DEPRESSIVE DISORDER, other anxiety disorders, somatic
conditions (feel extreme anxiety over physical symptoms SSD), cognitive disturbances and
ALCOHOLISM
— 53% reported cases alcoholism among veterans
— Alcohol is rationalized as a means of self-medication to reduce symptoms such as nightmares,
insomnia, and anxiety - a lot more research is needed
— Radiating effects of exposure to trauma on the elderly – Advancing age potentially represents a
differential vulnerability factor that moderates the impact of exposure to a stressor
— Presumably if older persons are more susceptible to the effects of a stressor, greater negative effects
of their psychosocial functioning could be expected, regardless of the type of trauma to which they
are exposed
— General Psychological Effects – depend heavily on the individual’s premorbid functioning, particularly
with regard to anxiety, depression and extant PTSD. Characteristics of the stressor and individual
differences in coping skills appeared significant in this report.
— Physical Effects – Older adults are more likely to manifest trauma-related symptoms somatically
— Coping Strategies – younger soldiers were more likely to experience stress reactions after combat
exposure, suggesting that emotional maturity may increase resilience in coping strategies
, — Much more research is needed – specific symptoms may differ in older adults. The potential
differences could lead to misdiagnosis
BROWN – SUBSTANCE ABUSE AND POST-TRAUMATIC STRESS DISORDER COMORBITY
, — Research suggests that there is a high rate of PTSD and substance abuse comorbidity
— PTSD is classified as an anxiety disorder – it is the MOST EXTREME reactions that individuals can have
to high magnitude life events and can result in severe and chronic impairment across the major life
areas
— Link between substance abuse appears to be particularly complex with cause-and-effect relationships
difficult to disentangle and determine
— Self-medication hypothesis – postulates that PTSD occurs first and chemical substances are used as a
means of achieving symptom relief
— PTSD patients report using alcohol and or drugs to overcome distress of trauma-related events and ‘to
forget’ intrusive, disturbing memories of trauma
— Little evidence of specificity of substance use – patients use a variety of substances with vastly
different pharmacological actions
— PTSD patients characterized primarily by avoidance may use central nervous system stimulants i.e.
amphetamines to boost sociability
— PTSD patients experiencing predominately sleep difficulties and irritability/agitation may prefer to use
sedatives i.e. alcohol
— PTSD patients with severe levels of re-experiencing, avoidance/numbing and hyperarousal a variety of
substances may be used to alleviate and manage
— Self-medication and tension-reduction models suggest substance abuse is second to PTSD however
the converse is too possible
— People who start substance abuse young, may not have the correct coping skills when faced with
trauma as they have constantly used substances to deal and combat stress
— A history of conduct disorder/antisocial personality disorder is a predisposing variable for the
development of both substance abuse disorders and PTSD
— This theory suggests that PTSD and substance abuse are not related but instead share a common
etiological pathway
— PTSD substance abusers have an earlier onset of relapse than non-PTSD substance abusers
— Research shows us that coping skills play an important role in the recovery process
— Increased drinking following treatment is associated with both skills deficits and the failure to use
alternative coping responses
— Differences exist in the coping styles of PTSD and non-PTSD substance abusers
— Without treatment focused on their trauma, PTSD substance abusers experience more difficulty in the
early stages of sobriety and may be more susceptible to relapse
— Marked reductions in alcohol abuse can be obtained by successful treatment of PTSD anxiety
symptoms
— More research needs to be done to look into the relationship between substance abuse and PTSD
DE SLIVA – POST-TRAUMATIC STRESS DISORDER: CROSS-CULTURAL ASPECTS
— It was only till after World War II that work on trauma-induced stress began to flourish.
