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TRAUMA AND STRESSOR-RELATED DISORDERS

Trauma and Stressor-Related Disorders involve exposure to a traumatic or stressful event.

Neurobiology of PTSD refers to changes in their brain and body that develop, as a protective response, after a frightening or dangerous event. Other symptoms include intrusive or negative thoughts, avoidance behaviors, becoming easily startled or irritable, feeling like one’s surroundings or oneself is unreal, and problems with sleep. Most people who experience a trauma naturally recover. Those who experience prolonged psychological and physiological symptoms may require treatment.

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Acute Stress Disorder diagnosis includes a major stress disturbance which lasts from three days to one month. Many people who meet the criteria for Acute Stress Disorder, do not develop PTSD.

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Adjustment Disorder is a persistent emotional or behavioral response, within several months of a stressful life event, that is causing significant distress and impacting day to day functioning. Other symptoms that might be present are anxiety, depressed mood, or behavioral problems.

 

Post-Traumatic Stress Disorder is complex and requires the presence of multiple symptoms and a duration of disturbance for one month or more in order to make a diagnosis. The following criteria need to be met:

 

Criterion A: Stressor (at least 1)

The person was exposed to one of the following: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence.

 

Criterion B: Intrusion Symptoms (at least 1):

The traumatic event is persistently re-experienced in one or more of the following ways:

  • Recurrent, involuntary, and intrusive memories. Children older than six may express this symptom through repetitive play in which aspects of the trauma are expressed.

  • Traumatic nightmares or upsetting dreams with content related to the event. Children may have frightening dreams without content related to the trauma.

  • Dissociative reactions, such as flashbacks, in which it feels like the experience is happening again. These may occur on a continuum ranging from brief episodes to complete loss of consciousness. Children may re-enact the events in play.

  • Intense or prolonged distress after exposure to traumatic reminders.

  • Marked physiological reactivity, such as increased heart rate, after exposure to traumatic reminders.

 

Criterion C: Avoidance (1 or both)

Persistent effortful avoidance of distressing trauma-related reminders after the event as evidenced by one or both of the following:

  • Avoidance of trauma-related thoughts or feelings.

  • Avoidance of trauma-related external reminders, such as people, places, conversations, activities, objects, or situations

 

Criterion D: Negative Alterations in Mood (at least 2):

  • Negative alterations in cognition and mood that began or worsened after the traumatic.

  • Inability to recall key features of the traumatic event. This is usually dissociative amnesia, not due to head injury, alcohol, or drugs.

  • Persistent, and often distorted negative beliefs and expectations about oneself or the world, such as "I am bad," or "The world is completely dangerous."

  • Persistent distorted blame of self or others for causing the traumatic event or for the resulting consequences.

  • Persistent negative emotions, including fear, horror, anger, guilt, or shame.

  • Markedly diminished interest in activities that used to be enjoyable.

  • Feeling alienated, detached or estranged from others.

  • Persistent inability to experience positive emotions, such as happiness, love, and joy.

 

Criterion E: Alterations in Arousal and Reactivity (at least 2)

Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event, including two or more of the following:

  • Irritable or aggressive behavior

  • Self-destructive or reckless behavior

  • Feeling constantly "on guard" or like danger is lurking around every corner (hyper-vigilance)

  • Exaggerated startle response

  • Problems in concentration

  • Sleep disturbance

 

Those who meet the criteria for PTSD experience significant distress and difficulties functioning in their day to day lives, and they may also develop co-occurring disorders such as substance use disorders and depression (APA, 2013).

Dr. John Krystal Interview

Dr. John Krystal is the Robert L. McNeil, Jr. Professor of Translational Research, Psychiatry and Neuroscience at Yale School of Medicine, the Chair in the Department of Psychiatry at Yale-New Haven Hospital and the Director of the Clinical Neuroscience Division at the Department of Veterans Affairs’ National Center for PTSD.  He is a leading expert in the areas of alcoholism, schizophrenia, depression and the Neurobiology of Post-Traumatic Stress Disorder which is the topic we will discuss today. Dr. Krystal’s work is interdisciplinary and links psychopharmacology, neuroimaging, molecular genetics, and computational neuroscience to study the neurobiology and treatment of these disorders. He is best known for leading the discovery of the rapid antidepressant effects of ketamine in depressed patients.

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