Anxiety and mood disorders
This is a magazine about anxiety and mood disorders
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In this bundle, you can find information about pyschiatrical disorders and clinical psychology.
This is a magazine about anxiety and mood disorders
This is a magazine about addiction and compulsions.
Personality disorders are pervasive, persistent and pathological personality structures. In this magazine, information is given about the personality disorders, the current theories and a bit about how to treat a personality disorder.
What are the ten personality disorders?
How do personality disorders come to be and how do you treat them?
This is a bundle about Post-traumatic stress disorder. In this bundle, it is described how post-traumatic stress disorder is diagnosed and some theoretical background.
Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults.
Brewin, C.R., Andrews, B., & Valentine, J.D. (2000).
Journal of Consulting and Clinical Psychology, 68(5), 748-766.
Predictors of posttraumatic stress disorder and symptoms in adults: a meta-anlaysis
Ozer, Weiss & Lipsey 2003
Exposure to trauma may not always be sufficient to explain the development of PTSD, but when people are exposed to traumatic events, the risk of PTSD is enhanced reliably. Individual vulnerability factors have a role to play in understanding PTSD.
The strongest predictors of PTSD are factors occuring during of after the trauma.
Gender, age at trauma and race predict PTSD in some populations, but not others. Education, previous trauma and general childhood adversity predicts PTSD more consistently but to a varying extend. Psychiatric history, reported childhood abuse, and family psychiatric history have predictive effects.
By a relatively small extent, the risk of PTSD is enhanced by the effects of: female gender, greater social, educational and intellectual disadvantages, psychiatric history and various types of previous adversity
The risk of PTSD is enhanced by factors occurring during or after the trauma like: peritraumatic dissociation, preceived support, preceived life threat and peritraumatic emotions.
Reformulating PTSD for DSM-V: Life after Criterion
Brewin, C.R., Lanius, R.A., Novac, A., Schnyder, U., & Galea, S. (2009)
A. Journal of Traumatic Stress, 22, 366-373.
The diagnosis of posttraumatic stress disorder has been criticised on three main reasons, namely: 1) the alleged pathologizing of normal events 2) the inadequacy of criterion A 3) symptom overlap with other disorders.
PTSD has a multifactorial etiology.
Criticism 1: PTSD pathologizes normal distress
One criticism of PTSD is that it creates a medical condition out of normal distress.
Studies show that extreme stress sometimes leads to severe and long-lasting psychopathology, as well as to a variety of serious medical conditions.
A popular view currently is that PTSD reflects a failure of adaptation, whereby normal reactions to extreme stress do not correct themselves. What is pathological about PTSD is defined by the persistence of its symptoms.
Evidence supports a distinctive biological profile associated with PTSD.
Criticism 2: inadequacy of criterion A
Three fundamental issues with the A criterion are: 1) how broadly or narrowly should trauma be defined? 2) can trauma be measured reliably and validly? 3) what is the relationship between trauma and PTSD?
Trauma is not exclusively associated with PTSD.
Other disorders are linked to traumatic (criterion A) events
Trauma is associated with an increased prevalence of other disorders. If these can be diagnosed after a traumatic event, the question arises why the same could not be true of PTSD.
Trauma’s do not increase the risk for other disorders independently of the increased risk for PTSD. PTSD plays a central role in the psychological response to trauma.
Insufficient specificity of criterion A
The original conceptualization of PTSD was a response to an event ‘generally outside the range of usual human experience’. This was broadened, due to which there is a conceptual creep that is causing PTSD to be diagnosed in response to situations that are far removed from the original concept of trauma (according to critics).
There are few cases with PTSD after circumstances like divorce or money problems.
Trauma of lower intensity would be expected to provoke PTSD in vulnerable individuals with a limited capacity do dampen ther physiological response to stress. Such vulnerability may be genetic, interacting with lifetime exposure to trauma or epigenetic. It can also be related to greater levels of
.....read moreTesting a DSM-5 reformulation of posttraumatic stress disorder: Impact on prevalence and comorbidity among treatment-seeking civilian trauma survivors.
Van Emmerik, A.A.P., & Kamphuis, J.H. (2011).
Journal of Traumatic Stress, 24, 213-217.
The Brewin criteria for PTSD suggest abolishing criterion A, and retaining a subset of symptoms from criteria B to D, as well as the duration (criterion E) and impairment (criterion F) criteria. The symptom criteria Brewin proposes are: 1) distressing dreams 2) vivid daytie images or flashbacks 3) avoidance of internal trauma reminders 4) hypervigilance 5) exaggerated startle response.
The Brewin criteria do no appreciably affect overall PTSD prevalence or comorbidity. They do impact diagnostic status at the individual level. Approximately two-thirds of participants who lost the PTSD diagnosis qualified for treatment for a comorbid disorder. Reducing symptom overlap of PTSD with depression and anxiety disorders did not reduce comorbidity.
Criterion A is not essential to diagnosing PTSD.
Comparison of DSM-IV and proposed ICD-11 formulations of PTSD among civilian survivors of war and war veterans
Morina, N., Van Emmerik, A.A.P., Andrews, B., & Brewin, C.R. (2014).
Journal of Traumatic Stress, 27, 647-654
Proposals for the ICD-11 have included a reduction and simplification in the symptoms required for a PTSD diagnosis. An proposed innovation involves specifying core elements rather than typical features of PTSD. Core elements are those that on empirical or theoretical grounds most clearly distinguish PTSD from other disorders.
Core elements consist of: 1) re-experiencing the traumatic event(s) in the present, a evidenced by either flashbacks or nightmares, accompanied by fear or horror. Flashbacks are intrusive waking memories in which re-experiencing in the present can vary from a transient sensation to a complete disconnection from the current environment. 2) Avoidance of intrusions, evidenced by marked internal avoidance of thoughts and memories, or external avoidance of activities or situations 3) Excessive sense of current threat, evidenced by hypervigilane or exaggerated startle.
PTSD is defined in terms of the presence of at least one of the two symptoms of each of these core elements. In addition there must be impairment in functioning.
The new approach proposed for ICD-11 need not make a substantial difference to PTSD prevalence.
The 17 symptoms described in the DSM-IV are not all required to access PTSD.
More individuals meet the avoidance criterion in the ICD-11 system.
The reduced set of symptoms led to less comorbidity.
A cognitive model of posttraumatic stress disorder
Ehlers, A., & Clark, D.M. (2000)
Behaviour Research and Therapy, 38, 319-345.
PTSD becomes persistent when individuals process trauma in a way that leads to a sense of serous, current threat. This sense of threat arises as a consequence of: 1) excessively negative appraisals of the trauma and/or its sequelae 2) a disturbance of autobiographical memory. This is characterized by poor elaboration and contextualisation, strong associative memory and strong perceptual priming.
Change in the negative appraisals and trauma memory are prevented by a series of problematic behavioural and cognitive strategies.
Symptoms of posttraumatic stress disorder (PTSD) include: 1) repeated and unwanted re-experiencing of the event 2) hyperarousal 3) emotional numbing 4) avoidance of stimuli (including thoughts) which could serve as reminders for the event.
Overview
PTSD occurs only if individuals process the traumatic event and/or its sequealae in a way which produces a sense of serious current threat.
Two processes lead to a sense of current threat 1) individual differences in the appraisal of the trauma and/or its sequelae 2) individual differences in the nature of the memory for the event and its link to other autobiographical memories.
Once activated, the perception of current threat is accompanied by intrusions and other reexperiencing symptoms, symptoms of arousal, anxiety and other emotional responses.
The perceived threat motivates a series of behavioural and cognitive responses that are intended to reduce perceived threat and distress in the short-term, but have the consequence of preventing cognitive change and maintaining the disorder.
Appraisal of the trauma and/or its sequelae
Individuals with PTSD are unable to see the trauma as a time-limited event that does not have global negative implications for their future. These individuals are characterized by idiosyncratic negative appraisals of the traumatic event and/or its sequelae that have the common effect of creating a sense of serous current threat. This threat can be external or internal (for example: threat to one’s view of oneself as a capable person).
Appraisal of the traumatic event
Several types of appraisal can produce a sense of current threat: 1) individuals may overgeneralise from the event, as a consequence perceive a range of normal activities as more dangerous than they really are 2) exaggerate the probability of further catastrophic events as general, or think that they ‘attract disaster’.
Appraisals of the way one felt or behaved during the even can have long-term threatening
.....read morePsychological theories of posttraumatic stress disorder.
Brewin, C.R., & Holmes, E.A. (2003)
Clinical Psychology Review, 23, 339-376
Memory and PTSD
In PTSD, there are a number of changes in memory functioning that are comparable with depressed patients: 1) a bias toward enhanced recall of trauma-related material 2) difficulties in retrieving autobiographical memories of specific incidents.
Specific changes in memory of PTSD are: 1) a contradictory patterns of recall related to the traumatic material itself. High levels of emotions are in some studies associated with more vivid and long-lasting memories, but in others with vague memories, lacking in detail and error prone. PTSD is described as characterized by both high-frequency, distressing, intrusive memories and by amnesia for the details of the event. 2) the reliving of memories, or flashbacks to the trauma. Flashbacks are dominated by sensory detail. These images and sensations are typically disjointed and fragmentary. Reliving is reflected in a distortion in the sense of time, such that the traumatic event seems to be happening in the present rather than belonging in the past. Reliving episodes are triggered involuntarily by specific reminders that relate in some way to the circumstances of the trauma.
Flashbacks are a distinctive feature of PTSD.
Individual differences in working memory capacity appear to be related to the ability to prevent unwanted material from intruding and negatively affecting task performance.
Attention and PTSD
Research does not provide evidence that the effects of an attentional bias are unique to PTSD.
Dissociation and PTSD
Dissociation are any kind of temporary breakdown in what we think of as the relatively continuous, interrelated processes of perceiving the world around us, remembering the past, or having a single identify that links our past with our future.
Mild dissociative reactions are common under stress.
Dissociative symptoms most commonly encountered in trauma include: emotional numbing, derealisation, depersonalisation, out-of-body experiences. They are related to the severity of the trauma, fear of death, and feeling helpless.
It has been suggested that such reactions reflect a defensive response related to freezing in animals.
When these symptoms occur in the course of a traumatic experience, they are referred to as ‘peri-traumatic dissociation’.
The presence of dissociative symptoms occurring after rather than during trauma is not consistently associated with risk for later PTSD.
Cognitive-affective reactions and PTSD
A requirement of the PTSD diagnosis according to the DSM-IV, is to experience intense fear, helplessness, or horror at the time of the trauma.
There is a strong relationship between each of the
.....read moreIn this bundle, you can find information about pyschiatrical disorders and clinical psychology.
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