PYC4802
A complete Summary of Theme 02 - 05 & ALL Exam
Questions (2018/2019)
THEME 02
Trauma and Stressor Related Disorders
1. Posttraumatic Stress Disorder (PTSD) – *Duration more than 1 month
2. Acute Stress Disorder (ASD) – *Duration 3 days up to 1 month (ASD
often develops into PTSD)
1. Discuss the AETIOLOGY (Causative Factors) of PTSD. Make a
brief reference to the DIAGNOSTIC CRITERIA of PTSD according to
the DSM 5 (25) *(in exam):
1. Intro:
- PTSD is a disorder characterized by flashbacks, hypervigilance and
avoidance symptoms that last for more than 1 month after exposure to
extreme trauma.
- PTSD is the one disorder where the aetiology is known: a traumatic
event is experienced.
- However, the development of PTSD involves a complex interaction
between bio-psycho-social factors.
2. DSM-5 diagnostic criteria for PTSD:
Note: The following criteria apply to adults, adolescents, and children
older than 6 years.
A. Exposure to actual or threatened death, serious injury, or sexual
violence in one (or more) of the following ways:
1.Directly experiencing the traumatic event(s).
2.Witnessing in person the event(s) as it occurred to others.
3.Learning that the traumatic event(s) occurred to a close family member
or close friend. In cases of actual or threatened death of a family member
or friend, the event(s) must have been violent or accidental.
4.Experiencing repeated or extreme exposure to aversive details of the
traumatic event(s) (e.g., first responders collecting human remains; police
officers repeatedly exposed to details of child abuse).
Note: Criterion A4 does not apply to exposure through electronic media,
television, movies, or pictures, unless this exposure is work related.
B. Presence of one (or more) of the following intrusion symptoms
associated with the traumatic event(s), beginning after the traumatic
event(s) occurred:
1.Recurrent, involuntary, and intrusive distressing memories of the
traumatic events.
Note: In children older than 6 years’ repetitive play may occur in which
themes or aspects of the traumatic event(s) are expressed
1
,2.Recurrent distressing dreams in which the content and/or effect of the
dream are related to the traumatic event(s).
Note: In children, there may be frightening dreams without recognizable
content.
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or
acts as if the traumatic event(s) were recurring. (Such reactions may
occur on a continuum, with the most extreme expression being a
complete loss of awareness of present surroundings.)
Note: In children, trauma-specific re-enactment may occur in play.
4.Intense or prolonged psychological distress at exposure to internal or
external cues that symbolize or resemble an aspect of the traumatic
event(s).
5. Marked physiological reactions to internal or external cues that
symbolize or resemble an aspect of the traumatic events.
C. Persistent avoidance of stimuli associated with the traumatic
event(s),beginning after the traumatic event(s) occurred, as evidenced by
one or both of the following:
1. Avoidance of or efforts to avoid distressing memories, thoughts, or
feelings about or closely associated with the traumatic event(s).
2. Avoidance of or efforts to avoid external reminders (people, places,
conversations, activities, objects, situations) that arouse distressing
memories, thoughts, or feelings about or closely associated with the
traumatic event(s).
D. Negative alterations in cognitions and mood associated with the
traumatic event(s), beginning or worsening after the traumatic event(s)
occurred, as evidenced by two (or more) of the following:
1. Inability to remember an important aspect of the traumatic event(s)
(typically due to dissociative amnesia and not to other factors such as
head injury, alcohol or drugs).
2. Persistent and exaggerated negative beliefs or expectations about
oneself, others, or the world (e.g., “I am bad,” “No one can be trusted”,
“The world is completely dangerous”, “My whole nervous system is
permanently ruined”).
3. Persistent, distorted cognitions about the cause or consequences of the
traumatic event(s) that lead the individual to blame himself/herself or
others.
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt or
shame).
5. Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions (e.g., inability to
experience happiness, satisfaction, or loving feelings).
E. Marked alterations in arousal and reactivity associated with the
traumatic event(s), beginning or worsening after the traumatic event(s)
occurred, as evidenced by two (or more) of the following:
1. Irritable behavior and angry outbursts (with little or no provocation)
2
,typically expressed as verbal or physical aggression toward people or
objects.
2. Reckless or self-destructive behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance (e.g., difficulty falling or staying asleep, or restless
sleep).
F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1
month.
G. The disturbance causes clinically significant distress or impairment
in social occupational, or other important areas of functioning.
H. The disturbance is not attributable to the physiological effects of
a substance (e.g., medication, alcohol) or another medical condition.
Specify whether:
With dissociative symptoms: The individual’s symptoms meet the
criteria for posttraumatic stress disorder, and in addition, in response to
the
stressor, the individual experiences persistent or recurrent symptoms of
either of the following:
1. Depersonalization: Persistent or recurrent experiences of feeling
detached from, as if one were an outside observer of, one’s mental
processes or body (e.g., feeling as though one were in a dream; feeling a
sense of unreality of self or body or of time moving slowly.)
2. Derealization: Persistent or recurrent experiences of unreality of
surroundings (e.g., the world around the individual is experienced as
unreal, dreamlike, distant, or distorted.)
Note: To use this subtype, the dissociative symptoms must not be
attributable to the physiological effects of a substance (e.g., blackouts,
behavior during alcohol intoxication) or another medical condition (e.g.,
complex partial seizures).
Specify if:
With delayed expression: If the full diagnostic criteria are not met until
at least 6 months after the event (although the onset and expression of
some symptoms may be immediate).”
3. AETIOLOGY of PTSD:
3.1 BIOLOGICAL:
3.1.1) Nervous system:
- Many individuals who develop PTSD have a nervous system that is
abnormally reactive to fear and stress.
3.1.2) Heightened Amygdala:
3
, - Neuroimaging studies of individuals with PTSD have shown heightened
amygdala reactivity in response to trauma.
3.1.3) Dysregulation of HPA axis:
- Stressors activate the HPA axis.
- Individuals with PTSD reflect dysregulation of the HPA axis to stressors.
3.1.4) Lack fear extinction:
- Fear extinction can be defined as the decline in fear responses
associated to trauma.
- Studies report that individuals with PTSD show minimal fear extinction.
3.1.5) SS Genotype:
- Genetic differences have an effect in vulnerability to PTSD.
- Research indicate that individuals with a SS genotype have increased
stress sensitivity and are more likely to develop PTSD.
3.1.6) Family history:
- A family history of anxiety suggests a generalized biological
vulnerability.
- In PTSD a history of neurotic illness may predispose an individual to
develop PTSD by lowering susceptibility thresholds.
3.2 PSYCHOLOGICAL:
3.2.1) Personality characteristics (partially heritable):
- Pre-existing anxiety/depression may predispose individuals to trauma.
- Studies report that pre-existing conditions such as anxiety, depression
and negative emotions such as: hostility and anger are risk factors for the
development of PTSD.
- The Reciprocal Gene-Environment states that existing vulnerabilities
may determine the kind of environment in which one lives and therefore
the type of disorder that a person may develop.
3.2.2) Cognitive style:
- Individuals with specific cognitive styles or dysfunctional thoughts about
themselves are more likely to develop PTSD.
3.2.3) Severity of trauma:
- The severity of the trauma may have an impact on whether the
individual develops PTSD.
- For example: Individuals who experience serious injuries or extremities
have increased risk of developing PTSD.
- Studies report that one third of individuals hospitalized with major burn
injuries developed PTSD.
3.2.4) Interpersonal trauma:
- Research suggests that interpersonal traumas such as rape and assault
are more likely to result in PTSD than any other type of trauma.
3.2.5) Vicarious trauma:
- A study showed that approximately 30% of individuals who witness a
traumatic event may develop PTSD and other forms of mental disorders
including depression.
- For example: children observing domestic violence may develop PTSD.
4
A complete Summary of Theme 02 - 05 & ALL Exam
Questions (2018/2019)
THEME 02
Trauma and Stressor Related Disorders
1. Posttraumatic Stress Disorder (PTSD) – *Duration more than 1 month
2. Acute Stress Disorder (ASD) – *Duration 3 days up to 1 month (ASD
often develops into PTSD)
1. Discuss the AETIOLOGY (Causative Factors) of PTSD. Make a
brief reference to the DIAGNOSTIC CRITERIA of PTSD according to
the DSM 5 (25) *(in exam):
1. Intro:
- PTSD is a disorder characterized by flashbacks, hypervigilance and
avoidance symptoms that last for more than 1 month after exposure to
extreme trauma.
- PTSD is the one disorder where the aetiology is known: a traumatic
event is experienced.
- However, the development of PTSD involves a complex interaction
between bio-psycho-social factors.
2. DSM-5 diagnostic criteria for PTSD:
Note: The following criteria apply to adults, adolescents, and children
older than 6 years.
A. Exposure to actual or threatened death, serious injury, or sexual
violence in one (or more) of the following ways:
1.Directly experiencing the traumatic event(s).
2.Witnessing in person the event(s) as it occurred to others.
3.Learning that the traumatic event(s) occurred to a close family member
or close friend. In cases of actual or threatened death of a family member
or friend, the event(s) must have been violent or accidental.
4.Experiencing repeated or extreme exposure to aversive details of the
traumatic event(s) (e.g., first responders collecting human remains; police
officers repeatedly exposed to details of child abuse).
Note: Criterion A4 does not apply to exposure through electronic media,
television, movies, or pictures, unless this exposure is work related.
B. Presence of one (or more) of the following intrusion symptoms
associated with the traumatic event(s), beginning after the traumatic
event(s) occurred:
1.Recurrent, involuntary, and intrusive distressing memories of the
traumatic events.
Note: In children older than 6 years’ repetitive play may occur in which
themes or aspects of the traumatic event(s) are expressed
1
,2.Recurrent distressing dreams in which the content and/or effect of the
dream are related to the traumatic event(s).
Note: In children, there may be frightening dreams without recognizable
content.
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or
acts as if the traumatic event(s) were recurring. (Such reactions may
occur on a continuum, with the most extreme expression being a
complete loss of awareness of present surroundings.)
Note: In children, trauma-specific re-enactment may occur in play.
4.Intense or prolonged psychological distress at exposure to internal or
external cues that symbolize or resemble an aspect of the traumatic
event(s).
5. Marked physiological reactions to internal or external cues that
symbolize or resemble an aspect of the traumatic events.
C. Persistent avoidance of stimuli associated with the traumatic
event(s),beginning after the traumatic event(s) occurred, as evidenced by
one or both of the following:
1. Avoidance of or efforts to avoid distressing memories, thoughts, or
feelings about or closely associated with the traumatic event(s).
2. Avoidance of or efforts to avoid external reminders (people, places,
conversations, activities, objects, situations) that arouse distressing
memories, thoughts, or feelings about or closely associated with the
traumatic event(s).
D. Negative alterations in cognitions and mood associated with the
traumatic event(s), beginning or worsening after the traumatic event(s)
occurred, as evidenced by two (or more) of the following:
1. Inability to remember an important aspect of the traumatic event(s)
(typically due to dissociative amnesia and not to other factors such as
head injury, alcohol or drugs).
2. Persistent and exaggerated negative beliefs or expectations about
oneself, others, or the world (e.g., “I am bad,” “No one can be trusted”,
“The world is completely dangerous”, “My whole nervous system is
permanently ruined”).
3. Persistent, distorted cognitions about the cause or consequences of the
traumatic event(s) that lead the individual to blame himself/herself or
others.
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt or
shame).
5. Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions (e.g., inability to
experience happiness, satisfaction, or loving feelings).
E. Marked alterations in arousal and reactivity associated with the
traumatic event(s), beginning or worsening after the traumatic event(s)
occurred, as evidenced by two (or more) of the following:
1. Irritable behavior and angry outbursts (with little or no provocation)
2
,typically expressed as verbal or physical aggression toward people or
objects.
2. Reckless or self-destructive behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance (e.g., difficulty falling or staying asleep, or restless
sleep).
F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1
month.
G. The disturbance causes clinically significant distress or impairment
in social occupational, or other important areas of functioning.
H. The disturbance is not attributable to the physiological effects of
a substance (e.g., medication, alcohol) or another medical condition.
Specify whether:
With dissociative symptoms: The individual’s symptoms meet the
criteria for posttraumatic stress disorder, and in addition, in response to
the
stressor, the individual experiences persistent or recurrent symptoms of
either of the following:
1. Depersonalization: Persistent or recurrent experiences of feeling
detached from, as if one were an outside observer of, one’s mental
processes or body (e.g., feeling as though one were in a dream; feeling a
sense of unreality of self or body or of time moving slowly.)
2. Derealization: Persistent or recurrent experiences of unreality of
surroundings (e.g., the world around the individual is experienced as
unreal, dreamlike, distant, or distorted.)
Note: To use this subtype, the dissociative symptoms must not be
attributable to the physiological effects of a substance (e.g., blackouts,
behavior during alcohol intoxication) or another medical condition (e.g.,
complex partial seizures).
Specify if:
With delayed expression: If the full diagnostic criteria are not met until
at least 6 months after the event (although the onset and expression of
some symptoms may be immediate).”
3. AETIOLOGY of PTSD:
3.1 BIOLOGICAL:
3.1.1) Nervous system:
- Many individuals who develop PTSD have a nervous system that is
abnormally reactive to fear and stress.
3.1.2) Heightened Amygdala:
3
, - Neuroimaging studies of individuals with PTSD have shown heightened
amygdala reactivity in response to trauma.
3.1.3) Dysregulation of HPA axis:
- Stressors activate the HPA axis.
- Individuals with PTSD reflect dysregulation of the HPA axis to stressors.
3.1.4) Lack fear extinction:
- Fear extinction can be defined as the decline in fear responses
associated to trauma.
- Studies report that individuals with PTSD show minimal fear extinction.
3.1.5) SS Genotype:
- Genetic differences have an effect in vulnerability to PTSD.
- Research indicate that individuals with a SS genotype have increased
stress sensitivity and are more likely to develop PTSD.
3.1.6) Family history:
- A family history of anxiety suggests a generalized biological
vulnerability.
- In PTSD a history of neurotic illness may predispose an individual to
develop PTSD by lowering susceptibility thresholds.
3.2 PSYCHOLOGICAL:
3.2.1) Personality characteristics (partially heritable):
- Pre-existing anxiety/depression may predispose individuals to trauma.
- Studies report that pre-existing conditions such as anxiety, depression
and negative emotions such as: hostility and anger are risk factors for the
development of PTSD.
- The Reciprocal Gene-Environment states that existing vulnerabilities
may determine the kind of environment in which one lives and therefore
the type of disorder that a person may develop.
3.2.2) Cognitive style:
- Individuals with specific cognitive styles or dysfunctional thoughts about
themselves are more likely to develop PTSD.
3.2.3) Severity of trauma:
- The severity of the trauma may have an impact on whether the
individual develops PTSD.
- For example: Individuals who experience serious injuries or extremities
have increased risk of developing PTSD.
- Studies report that one third of individuals hospitalized with major burn
injuries developed PTSD.
3.2.4) Interpersonal trauma:
- Research suggests that interpersonal traumas such as rape and assault
are more likely to result in PTSD than any other type of trauma.
3.2.5) Vicarious trauma:
- A study showed that approximately 30% of individuals who witness a
traumatic event may develop PTSD and other forms of mental disorders
including depression.
- For example: children observing domestic violence may develop PTSD.
4
