,1. THEME 2: Trauma and stressor related disorders
When is a trauma- or stressor-related response abnormal?
- The definition of a trauma is in many ways defined by the individual's
sociocultural background, both directly, and indirectly through the beliefs and
attitudes he/she has acquired and internalized.
- If it leads to negative consequences (e.g. poor job-performance, social
withdrawal, anhedonia – loss of experiencing pleasure.
- 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.
- Acute stress disorder (ASD) and PTSD are the 2 disorders that have special
relevance to South Africa with its high rates of violence and crime.
- These disorders are extreme psychological reactions to an intensely traumatic
or violent event such as assault, sexual assault, natural disasters, and
wartime trauma.
- The risk of developing either ASD or PTSD depends on a number of variable,
including the type of trauma and degree of perceived threat, the magnitude of
the event, the extent of exposure to the stressor, and risk and protective
factors specific to the individual.
- The trauma may be so overwhelming that the person finds it difficult to
process or make sense of the event.
- Indirect exposure could also lead to ASD and PTSD.
- A diagnosis of ASD and PTSD requires direct or indirect exposure to the
traumatic event, as well as symptoms from these major symptom clusters:
o Intrusion symptoms
o Avoidance
o Negative alterations in mood or cognition
o Arousal and changes in reactivity
o Recurrent symptoms of depersonalisation – feeling detached from
one’s own body or thoughts
o Or derealisation – a persistent sense of unreality
- ASD – present of at least 9 symptoms from any of these clusters.
- PTSD – present at least 1 or 2 symptoms from each individual cluster.
- If someone with ASD experiences distressing symptoms for more than 30
days, diagnosis may be changed to PTSD.
- Person has to be exposed to either – death, threatened death, actual or
threatened serious injury, or actual or threatened sexual violence to be
diagnosed with either ASD or PTSD.
, Causative factors (Aetiology/Etiology)
- Fear and anxiety involve behavioural, autonomic, and endocrine changes
aimed at increasing an organism’s chance of survival. Our senses take
information from our environment, which guides our behaviour.
- Severe physical injuries or more personalised trauma are more likely to result
in PTSD.
- Factors such as a person’s cognitive style, childhood history, genetic
vulnerability, and availability pf social support also moderate the impact of a
traumatic event.
Neurochemistry
- Multiple neurotransmitters have been found to play a role in fear and anxiety
behaviour. Neurotransmitters implicated in anxiety disorders include
serotonin, glutamate, GABA (gamma-amino butyric acid), and norepinephrine
(noradrenaline).
- Serotonin – enhances fear and anxiety, and its anxiety-enhancing
(anxiogenic) effects respond to selective serotonin reuptake inhibitors (SSRI),
selective serotonin-norepinephrine reuptake inhibitors (SNRI), and other
classes of pharmacological drugs.
- Norepinephrine neurons are projected to different areas of the brain by a
structure called the locus coeruleus – these neurons regulate mood,
cognition, and sleep.
Brain structure and functioning
- The amygdala and insula have been identified as 2 structures that seem to be
overtly responsive in the brains of people with high levels of anxiety.
- Amygdala – Associated with the storage of emotional memories, processing
fear and other aspects of emotional and social behaviour. It is central in
investigating anxiety responses. This structure plays a critical role in
mediating emotions, such as anxiety.
- Limbic system – A critical function of it is mediating autonomic, emotional, and
behavioural responses to threat, and it also plays a significant function in the
storage of emotional memories. Some of these limbic structures are
suggested to be hyperresponsive in anxiety-prone individuals.
Genetics
- Genetics play a role in anxiety disorders – however, the specificity of the
genetic predisposition is unclear.
- The heritability estimates of anxiety disorders suggest a moderate level of
clustering of certain traits within a family, which may result in a temperament
that later increases one’s risk of developing an anxiety disorder – heritability
estimates suggest that anxious traits and anxiety disorders share a moderate
heritability.
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