Psychological theories of posttraumatic stress disorder.Brewin, C.R., & Holmes, E.A. (2003)Clinical Psychology Review, 23, 339-376 Memory and PTSDIn 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...
Predictors of Post-traumatic stress disorder - a summary of two meta-analysis
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 - a summary of an article by Brewin, Lanius, Novac, Schnyder and Galea (2009)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 more Testing a DSM-5 reformulation of posttraumatic stress disorder: Impact on prevalence and comorbidity among treatment-seeking civilian trauma survivors - summary of an article by Van Emmerik & Kamphuis (2011)Testing 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 - summary of an article by Morina et al. (2014)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 - summary of an article by Ehlers & Clark (2000)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 more Psychological theories of posttraumatic stress disorder - summary of an article by Brewin & Holmes (2003)Psychological 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 more Protocollaire behandeling van patiënten met een posttraumatische-stressstoornis: imaginaire exposure en exposure in vivo - samenvatting van hoofdstuk 6 uit Protocollaire behandelingen voor volwassenen met psychische klachten Protocollaire behandelingen voor volwassenen met psychische klachten
Hoofdstuk 6
Protocollaire behandeling van patiënten met een posttraumatische-stressstoornis: imaginaire exposure en exposure in vivo.
Een posttraumatische-stresstoornis (PTSS) kan ontstaan na het meemaken van een trauma. De belangrijkste symptomen zijn: 1) herbelevingen 2) vermijding van prikkels die geassocieerd zijn met het trauma 3) negatieve veranderingen in cognities en stemming 4) verhoogde arousal.
Als iemand naast de PTSS-symptomen ook symptomen heeft van derealisatie en/of depersonalisatie, wordt dit een dissociatief subtype genoemd.
Voor de behandeling van PTSS dis het van belang om de herinnering aan de traumatische gebeurtenis op te halen uit het geheugen en deze te bewerken. Het heeft als doel om pathologische elementen van het geheugen te corrigeren die ten grondslag liggen aan de angstsensaties. Hiervoor moet eerste het angstnetwerk in het geheugen geactiveerd worden. Ook moet nieuwe corrigerende informatie toegevoegd worden die incompatibel is met de bestaande pathologische informatie. Exposure is hiervoor geschikt.
Exposure is bewezen effectief.
Kenmerken van het trauma zelf hebben geen relatie met de behandelresultaten. Hetzelfde geld voor comorbiditeit.
Bij comorbiditeit is vaak de PTSS de centrale bron van de stoornissen. Hierbij hoeft de PTSS behandeling niet aangepast te worden.
Behandelingen waarin alleen imaginaire exposure werd toegepast zijn minder effectief dan behandelingen waarin exposure in vivo werd toegevoegd.
Factoren tijdens de behandeling zijn van invloed op het resultaat. Sociale steun en compliance aan de behandeling voorspellen het behandelresultaat. Groepsbehandelingen zijn minder effectief.
De diagnose PTSS wordt bij voorkeur gesteld aan de hand van een gestructureerd interview.
Imaginaire exposure en exposure in vivo staan centraal. De cliënt wordt herhaaldelijk en langdurig geconfronteerd met de angst oproepende herinneringen aan het trauma, door het opnieuw in gedachten te beleven. Ook wordt de cliënt blootgesteld aan triggers die de angst oproepen.
De behandeling bestaat uit tien sessies van negentig minuten.
De PTSS-klachtenschaal wordt voor elke sessie afgenomen en gescoord, en besproken. Het sessieplanningsforumulier wordt gebruikt om de sessies te plannen en de volgorde van de traumatische situaties te bepalen. De subective-units-of-distress-schaal wordt gebruikt om aan te geven hoeveel angst er op het moment wordt ervaren.
Op het formulier ‘Angstige verwachtingen’ kan de cliënt voorafgaand aan de exposure aangeven wat de gevreesde verwachting is als de exposure wordt uitgevoerd. Na de sessie kan worden aangegeven in hoeverre deze verwachtingen zijn uitgekomen.
Op
.....read more Cognitieve therapie bij posttraumatische stressstoornis - samenvatting van hoofdstuk 11 uit Cognitieve therapie: theorie en praktijk Cognitieve therapie: theorie en praktijk
Hoofdstuk 11
Cognitieve therapie bij posttraumatische stressstoornis
De cliënt met PTSS verkeert in een langdurige toestand van prikkelbaarheid en wordt geplaagd door herbelevingen en (soms) verwachting van herhaling van de gebeurtenis, fobische angst en vermijding. Ook leiden zij vaak aan gevoelens van schuld en schaamte, agressie, en verlies van eigenwaarde en vertrouwen in de wereld.
PTSS kan het best onderscheiden worden van specifieke fobie door de aan- of afwezigheid van herbelevingssymptomen en vermijdingssymptomen.
In cognitieve modellen staat de verwerking van een traumatische gebeurtenis centraal. Hiermee wordt bedoelt dat de traumatische gebeurtenis wordt opgenomen in bestaande cognitieve schema’s en/of dat nieuwe functionele schema’s worden ontwikkeld.
Traumatische gebeurtenissen zijn doorgaans complexe en overweldigende ervaringen die in strijd zijn met bestaande opvattingen van het slachtoffer over zichzelf en/of de wereld.
Een ervaring kan op verschillende manieren worden verwerkt en op verschillende manieren worden opgeslagen in het langetermijngeheugen. Hoe dit wordt opgeslagen wordt bepaald door de informatieverwerkingsprocessen die in gang worden gezet op het moment dat een individu geconfronteerd wordt met een traumatische ervaring. De nieuwe informatie komt binnen via de zintuigen. Dit kan op twee manieren worden verwerkt: 1) Data-driven processing, vooral fysieke informatie 2) Conceptually-driven processing, in verband gebracht met bestaande kennis. Hierdoor kan een ervaring worden ingepast in bestaande schema’s of opvattingen.
Hoe meer conceptually-driven verwerking, hoe minder data-driven en vice versa. Als er betekenis is gegeven aan de ervaring en deze wordt opgehaald uit het geheugen wordt de persoon niet langer overspoeld door zintuigelijke indrukken van die ervaring.
Bij cliënten met PTSS is het verwerkingsproces vastgelopen en blijft het traumatisch geheugen actief. Dit dringt zich op in de vorm van herbelevingen en trauma. Intrusies waren fragmentisch van aard. Ook lijken ze in het hier en nu plaats te vinden.
Het verwerken wordt niet alleen de angst voor de traumatische herinneringen minder, maar worden de sensorische, gefragmenteerde herinneringen ook omgezet naar een betekenisvol coherent ‘verhaal’.
Volgens sommigen zijn herbelevingen van het trauma nodig voor verwerking. Activatie van sensorische geheugen is nodig om het te kunnen transformeren in een meer abstract geheugen.
Volens Ehlers en Clark wordt de beleving van intrusies bepaald door de interpretaties die slachtoffers geven aan de aanwezigheid van intrusies. De mate waarin intrusies negatief geïnterpreteerd worden hangt samen met ervaren spanning tijdens intrusies, vermijdingsgedrag en het voorduren van PTSS-klachten. Het controleren en wegdrukken van intrusies staat gezonde verwerking in de weg, waardoor de betekenis onveranderd blijft.
Verwerking
.....read more Writing therapies for Post-Traumatic Stress and Post-Traumatic Stress Disorder - summary of an article by van Emmerik & Kamphuis (2015)Writing therapies for Post-Traumatic Stress and Post-Traumatic Stress Disorder
Van Emmerik, A., & Kamphuis, J.H. (2015)
A review of procedures and outcomes
Writing is an effective psychological treatment of post-traumatic stress disorder. The model includes three phases: 1) focusing on imaginal exposure to traumatic memories 2) cognitive restructuring and coping 3) social sharing and closure.
Therapeutic model
The basic therapeutic model of writing therapy includes three phases, whose effects cannot be completely disentangled.
Imaginal exposure to traumatic memories
The goal of the first phase is to expose clients to their traumatic memories, in order to achieve habituation and extinction of the fearful and other negative emotional responses that reactivation of these memories evoke.
Clients are asked to write a detailed account of the traumatic event, focusing on the most painful facts and emotions associated with the event. Clients are instructed to write in the first person and in the present tense. They must pay attention to their sensory experiences and bodily sensations during the event and to facts and feelings they have avoided.
The clinician’s primary task is to read the client’s essay and to determine with the client 1) what are the most painful facts and feelings 2) explore if any facts or feelings have been avoided 3) instruct the client to focus on precisely these facts and feelings in subsequent writing assignments.
Cognitive restructuring and coping
Targets the maladaptive cognitions and coping behaviours that may underlie the symptoms.
Clients write their best possible advice to an imaginal close associate that has experienced the traumatic event. The advice should concern how best to deal with the event and its consequences, making use of the client’s personal experiences.
Possible elements of the advice include: 1) aspects of the event that the other person has overlooked and that may shed a more positive light on the situation 2) alternative interpretations of the event 3) adaptive ways of coping 4) reflections on the meaning that the event may acquire.
The clinicians role is to identify and challenge any dysfunctional aspects of the advice and to instruct clients to apply the advice to themselves in a subsequent assignment.
Social sharing and closure
The goals are: 1) foster or promote social support by inviting clients to share their experiences in a dignified letter to a (true) close associate. The letter should describe the most important aspects of the traumatic event and its impact on the client’s life. The letter should explicitly state its
.....read more
Year 3 of psychology at the uva
In this bundle, all summaries of year 3 at the uva are bundled
Predictors of Post-traumatic stress disorder - a summary of two meta-analysisMeta-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 - a summary of an article by Brewin, Lanius, Novac, Schnyder and Galea (2009)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 more Testing a DSM-5 reformulation of posttraumatic stress disorder: Impact on prevalence and comorbidity among treatment-seeking civilian trauma survivors - summary of an article by Van Emmerik & Kamphuis (2011)Testing 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 - summary of an article by Morina et al. (2014)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 - summary of an article by Ehlers & Clark (2000)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 more Psychological theories of posttraumatic stress disorder - summary of an article by Brewin & Holmes (2003)Psychological 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 more Psychological disorders 
In this bundle, you can find information about pyschiatrical disorders and clinical psychology.
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