1. Prevalence, Symptomolgy and Etiology of PTSD

2. Symptoms of PTSD At least 30 days of the following symptoms:
Affective: anhedonia, emotional numbing and withdrawal, depression
Behavioral: hypervigilance, passivity, nightmares, impulsivity, substance abuse, inability to work, marital problems
Cognitive: intrusive memories, inability to concentrate, hyperarousal, flashbacks/nightmares
Somatic: headaches, body aches, insomnia, digestion issues, loss of developmental skills (in kids)

3. PTSD: Prevalence 1-3% of all Americans
5% chance of PTSD in lifetime in men
10% chance of PTSD in lifetime in women
Symptoms have been observed around the world
Davidson (2007) and Breslau (1998)
Estimate 15-24% of people who experience traumatic events will have PTSD

4. Factors influencing Prevalence
Type of Trauma
3% physical attack
20% wounded in combat
1988: est. 15.2% of all Vietnam Vets had PTSD, and 30% had had it at sometime after the war
33% loss of a loved one
50% rape victims
Community exposure to trauma
NY after 9-11 showed elevated rates of PTSD related to proximity to ground zero
See also: Rwanda, Northern Ireland

5. Biological Causes
Role of Noradrenalin: increased levels = more open expression of emotion
Geracioti (2001): PTSD subjects had higher NorAd levels than non-PTSD subjects; adrenal stimulation = panic attacks (70%) and flashbacks (40%) vs. 0% in both controls
Bremner (1998): PTSD subjects had increased sensitivity of Norad receptors

6. As cortisol levels decrease, norepinephrine levels increase resulting in an inability to regulate and recover from fight/flight responses

7. Brain Areas Affected by PTSD

8. Genetic Implications
Kolassa (2010): Val158Met polymorphism, gene for encoding the enzyme catechol-O-methyltransferase (COMT) levels affect Norad and Dopamine release during stress
Helps explain how two people can experience the same trauma and not both show symptoms of PTSD

10. Cognitive causes
Thoughts of “lack of control” suggest external locus of control and survivor guilt
Intrusive/pervasive thoughts come from “cue dependent memory” (Berwin et al 1996)
Rizzo: flooding therapy, “virtual Iraq” aided coping, recovery and “Habituation” (gradual fading of stress reactions)

15. Internal locus of control reduces PTSD; External LOC increases PTSD
Sutker et al (1995): soldiers with purpose/commitment to military/mission have lower rates of PTSD (Internal)
Can be linked to attributional style and Beck’s “cognitive schema” ideas on depression (Internal)
Suedfeld (2003): Holocaust survivors with external LOC more likely than controls to experience PTSD and also show low trust and a skeptical world view

16. Sociocultural causes
Suggests racism/prejudice/oppression are predisposing factors
Roysircar (2000): meta analysis showed ethnic differences in PTSD rates for Vietnam vets; black 20.6%, Hispanic 27.6%, white 13%
Dyregov: Rwandan kids: threatened with death #1 cause of intrusive thoughts and withdrawal behavior
Bosnian research 1998: 73% of girls (higher due to additional threat of rape, Kaminer et al 2000), 35% of boys from Sarajevo showed PTSD

17. Somatic symptoms of PTSD commonly treated across all cultures
Body Memory Symptoms: non-western, physical ailments solely from psychological causes (see Somatoform disorders)

19. Gender Considerations
Horowitz et al (1995): risk is 5x greater for women than men
Breslau et al (1991): 1007 kids exposed to violence PTSD rates: 11.3% in girls, 6% in boys
Different symptoms: Men show irritability, impulsiveness and aggression, substance abuse (external symptoms); women show numbing, withdrawal and avoidance/anxiety (internal symptoms)