1. Chapter 6: PTSD & Panic Disorders

2. 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

3. 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)

4. 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

5. 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

6. 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

7. 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

8. PTSD

9. PTSD

10. The Boston Strangler

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

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

18. 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)

19. 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

20. 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

21. 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