Chapter 6: PTSD & Panic Disorders

Basics Close to anxiety d/o Linked to outside stressors Stress Stressor – thing or event – generates a stress reaction/response Single event or ongoing Individual differences Response is complex > body + emotions + cognitive activity

Major disorders PTSD (Post-traumatic Stress d/o) Psychophysical d/o > psychological factors affect medical conditions What about stress ? Flight or fight Person swimming > shark > hypothalamus releases hormones > endocrine glands & autonomic nervous system > sympathetic nervous system for emergencies (parasympathetic for normal times)

Stress Endocrine system – hypothalamus > pituitary gland > adrenal glands > epinephrine (adrenaline), norepinephrine (noradrenaline), cortisol, etc Trait anxiety – pt’s usual State anxiety – situation PTSD & Acute Stress d/o caused by serious life events – death, injury, sexual assault, etc

Acute Stress d/o “milder” form of PTSD Sx same Sx start w/in 1 month Last less than 1 month PTSD long-term ; sx may not show up for years Acute stress d/o likely to become PTSD

Symptoms of PTSD 1. Intrusive thoughts – pt never leaves the trauma 2. Nightmares 3. Flashbacks – some trigger & respond 4. Avoidance > disturbed by anything that reminds them & yet drawn to it > people, gatherings 5. Isolation > difficult to respond to others, esp family > shut down, no enjoyment, derealization 6. Increased arousal > hypervigilance – too alert

Sx of PTSD > startle response > sleep issues 7. Concentration difficulties – remembering, learning, distracted 8. Negative emotions – anger, guilt Trauma is common 4% of Americans yearly 65% get tx – often after years of problems Can show any time – children, elderly Women & poor more vulnerable

PTSD

PTSD

The Boston Strangler

Trauma Man-made the worst Combat experience Known since ancient times Limited attn in World War I d/o defined in DSM after Vietnam War (which ended in 1975) Vietnam-era Vets 30% PTSD 20+% NOS 10% still have serious issues

Trauma War on Terror 20% still serving report PTSD sx ½ were injured; others saw buddies, civilians hurt Risks incr w multiple tours Also disasters (natural or human) Sexual Assault Rape – penetration – force/underage (statutory) 1/6 American women raped 60% under 18

Trauma Sexual Assault 70% know their assailant ½ Caucasian 1/3 African American 1/3 Hispanic Devastating Immediately-2 weeks > sx dev Some improve w/in 3-4 mos (w/ help) PTSD, insomnia, anxiety, trust, self-esteem, self-blame, sexual issues Health issues Domestic abuse

Trauma Terrorism In US Anxiety Torture US has 400,000 immigrants who experienced Rates of use vary worldwide Govt oppression Can be psychological Can be thru deprivation

Why Some Develop PTSD Biological POV Trauma triggers cortisol, norepinephrine NE > certain circuits > hippocampus, amygdala – these in limbic system > memory processing > permanent changes Traumatized women > babies w incr cortisol Genetic – identical twins – significant likelihood Personality POV Positive individuals v anxious people who become more anxious > incr chance of PTSD

Why Some Childhood experiences Family violence – divorce – poverty – traumatic events Social Support Strong family & friends help Issue for Vets Multicultural Factors Latinos more at risk Latino Vets more at risk - family social support damaged - fatalism

Why Some What was the trauma More severe Intentional How close was the pt

Treatment Pts may show improvement w/in 6 mos Veterans – use combination therapies – group – drug – cognitive-behavioral therapy (CBT) w exposure – insight therapy Many on antidepressants & antianxiety meds Relaxation techs EMDR – Eye Movement Desensitization Reprocessing – controversial – teach eye mvmts & exposure Work w families Some self-help groups (all Vets, no therapists)

Treatment Debriefing as Relief – Critical Incident Stress Debriefing Immediate In the field Often less formal 1980s-90s Controversy > many still dev sx later; too much emphasis on the now & not moving forward

Psychophysiological Stress d/o Mind & body interact Physical illnesses aggravated my mental causes Similar to psychosomatic d/o DSM-5 > psychological factors affecting other medical conditions Ulcers – gastric (stomach) or duodenal (intestine) > most bacterial – H. pylori Asthma – often allergy, environment Insomnia – 25% Americans

Psychophys Muscle tension & backaches Headaches – tension or migraine Hypertension – high blood pressure > may lead to CAD, kidney issues, stroke – 75 m Americans Heart dz (CAD) – 18 m – heart attack is myocardial infarction Cancer ??? Immune system Diet, etoh, smoking, lifestyle Social issues Personality style - OCEAN