Comprehensive summary of ALL literature concerning Task 2 (PTSD and OCD), summarized per article. Written in English, with Dutch clarifications. All tasks of this course are also available as a bundle! GGZ2024 - Anxiety Disorders
Part 1 – PTSD
Learning goals:
1. What is PTSD? (DSM.5 criteria, features, epidemiology)
Bovin, M. J., Wells, S. Y., Rasmusson, A. M., Hayes, J. P. and Resick, P. A. (2014)
Posttraumatic Stress Disorder, in The Wiley Handbook of Anxiety Disorders
Since the DSM 5, PTSD is no longer listed with the anxiety disorders. Currently,
PTSD is classified within the new category of trauma and stressor-related
disorders and has seven criteria (DSM 5) (want angst is niet altijd maar wel soms
een symptoom) it’s a internalizing disorder (so no aggression etc.):
A. The person was exposed to: death, threatened death, actual or threatened
serious injury, or actual or threatened sexual violence, as follows: (one
required)
a. 1. Direct exposure.
b. 2. Witnessing, in person.
c. 3. Indirectly, by learning that a close relative or close friend was
exposed to trauma. If the event involved actual or threatened death, it
must have been violent or accidental.
d. 4. Repeated or extreme indirect exposure to aversive details of the
event(s), usually in the course of professional duties
B. The traumatic event is persistently re-experienced in the following way(s):
(one required)
a. 1. Recurrent, involuntary, and intrusive memories, traumatic
nightmares.
b. 2. Dissociative reactions (e.g., flashbacks) which may occur on a
continuum from brief episodes to complete loss of consciousness.
c. 3. Intense or prolonged distress after exposure to traumatic reminders.
d. 4. Marked physiologic reactivity after exposure to trauma-related
stimuli
C. Persistent effortful avoidance of distressing trauma-related stimuli after the
event: (one required)
a. 1. Trauma-related thoughts or feelings.
b. 2. Trauma-related external reminders (e.g., people, places,
conversations, activities, objects, or situations).
D. Negative alterations in cognitions and mood that began or worsened after the
traumatic event: (two required)
a. 1. Inability to recall key features of the traumatic event (usually
dissociative amnesia; not due to head injury, alcohol, or drugs).
b. 2. Persistent (and often distorted) negative beliefs and expectations
about oneself or the world (e.g., "I am bad," "The world is completely
dangerous").
c. 3. Persistent distorted blame of self or others for causing the traumatic
event or for resulting consequences.
d. 4. Persistent negative trauma-related emotions (e.g., fear, horror,
anger, guilt, or shame).
e. 5. Markedly diminished interest in (pre-traumatic) significant activities.
f. 6. Feeling alienated from others (e.g., detachment or estrangement).
g. 7. Constricted affect: persistent inability to experience positive
emotions.
E. Trauma-related alterations in arousal and reactivity that began or worsened
after the traumatic event: (two required)
, a. 1. Irritable or aggressive behavior
b. 2. Hyper-vigilance
c. 3. Self-destructive or reckless behavior
d. 4. Exaggerated startle response
e. 5. Problems in concentration
f. 6. Sleep disturbance
F. Persistence of symptoms (in Criteria B, C, D, and E) for more than one
month.
G. Significant symptom-related distress or functional impairment (e.g., social,
occupational).
H. Disturbance is not due to medication, substance use, or other illness.
Specify if:
- Presence of dissociative symptoms (depersonalization/derealisation).
- Delayed onset of expression.
Trauma definition
o Bv. Scheiding of werk verliezen is géén trauma, maar een stressvol
event.
Natural history
Different individuals might experience varied symptom trajectories after trauma
exposure:
Resilience – the ability to maintain equilibrium after a trauma. Few (or
none) symptoms after a traumatic event and maintain their low symptom
levels over time.
Recovery – experience moderate disruptions in normal functioning after a
traumatic event. This decreases steadily over time.
Chronic – experience severe disruptions in functioning immediately after
the traumatic event and maintain these high symptom levels over time.
Delayed – individuals who initially demonstrate moderate disruptions in
functioning, and whose symptoms steadily increased to severe levels over
time.
Epidemiology
Although many people experience potentially traumatic events (PTE) over the
course of their lifetimes, PTSD can only be diagnosed following a traumatic event;
the event cannot just be a stressful life experience such as the loss of a job.
Therefore, before estimating the prevalence of PTSD, it is important to
understand the prevalence of exposure to traumatic events as the starting point
for potential PTSD diagnosis.
Exposure to potentially traumatic events:
o Majority of adults will experience at least one PTE during their
lifetime, with the majority more than one.
o 61% of men and 51% of women had experienced a traumatic event
during their lifetime (USA).
o Lifetime prevalence of trauma exposure was 39%.
Studies that have examined trauma exposure have
consistently found that these rates differ by gender:
A number of studies have found that men are exposed
to more traumatic events during their lifetime than
women.
Additionally, men and women experience different
types of traumatic events.
, o Men – war-zone and combat trauma’s, physical
assaults and accidents.
o Women – child sexual abuse, molestation, rape
and intimate partner violence.
Overall prevalence of PTSD:
Immediately following a trauma, most people experience an increase in
psychological distress. For the majority of these individuals, these symptoms
will quickly remit. However, a substantial minority of people that have
experienced a traumatic event will later be diagnosed with PTSD.
o Lifetime prevalence is approximately 8% among the general
population.
o Women’s lifetime prevalence (10%) were twice as high as men’s
(5%).
o Of those exposed to a traumatic event, 23.6% met the criteria of
PTSD over the course of their lifetimes.
o PTSD prevalence estimated may be higher in non-western than
western nations: TSD prevalence estimates may be higher in these
countries than in Western nations. Developing and poor countries
are often war-torn, experience political violence, have inadequate
shelter and food, and lack resources, these factors may increase the
risk of developing PTSD.
Research suggests that although a large percentage of individuals will be
exposed to traumatic events during their lifetimes, the majority of these
people will recover naturally. However, a substantial minority of individuals
will be diagnosed with PTSD after trauma exposure.
Impairment allemaal resultaten uit verschillende onderzoeken.
The diagnosis of PTSD is associated with impairments across a variety of
domains, including occupational and academic functioning, marital and family
functioning, parenting, friendships, and socializing. In addition, the disorder is
associated with reductions in global levels of quality of life.
Occupational and academic functioning:
o Occupational functioning:
Increased work loss and work cutback days.
Accomplishing less at work, limitations in the type of work
they are performing and more difficulty performing work.
o Academic impairment:
40% elevated odds (vehoogde kans) of high school and
college failure
Marital and family functioning:
o Greater marital dissatisfaction and higher rates of marital separation
and divorce.
o PTSD symptoms may affect relationships in that difficulties with
effective trauma combined with poor conflict resolution skills may
lead to poor communication.
Parenting: strong association between PTSD and parenting difficulties.
o Parental PTSD is associated with both elevated offspring
internalizing problems (bij de kinderen) and parental physical
aggression toward children.
o Impaired attachment to children, child behaviour problems and
decreased parenting satisfaction.
o To conclude – parental PTSD affects not just the behaviour of the
parent, but also the behaviour of the children.
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