Coping styles in post-traumatic stress disorder (PTSD) patients (original) (raw)
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Chapter 7 Posttraumatic Stress Disorder
Posttraumatic stress disorder (PTSD) and acute stress disorder are the only disorders in our current classification system that require an identifiable external event as a precursor to the disorder's existence. Thus far, all research studies that are the basis of this chapter were conducted under earlier versions of the DSM. The DSM-5 was unveiled in May 2013, and undoubtedly a great deal of research will follow, comparing the old and new criteria for PTSD. This is the first time since the DSM-III-R that the items themselves have been modified. Furthermore, the biggest change may be the move of PTSD out of the anxiety disorders section and into a chapter on stress and trauma disorders. This move could change the focus of mechanisms research from considering PTSD from a fear circuitry model to including top-down cognitive models and greater focus on other emotions such as guilt, anger, shame, and sadness.
Psychological theories of posttraumatic stress disorder
Clinical psychology review, 2003
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The Prevalence and Longitudinal Course of PTSD
Annals of the New York Academy of Sciences, 1997
Posttraumatic stress disorder (PTSD) cannot just be looked at from a cross-sectional perspective. It progresses and changes with the passage of time.'.2 This suggests that the neurobiology should be viewed as being in a progressive state of modification in the different stages of the disorder. This issue needs to be considered against the background of a series of observations that have emerged which were not anticipated two decades ago.3 First, PSTD is the exception rather than the rule following exposure to trauma. The disorder is not a normal response to an abnormal experience, because many studies have shown the existence of risk factors other than trauma as predictors of PTSD. The biological data suggest the atypical rather than normative nature of
Posttraumatic Stress Disorder, 2015
Although most people will encounter a traumatic stressor at least once, and often several times, in their lives, most people who experience a traumatic stressor do not develop PTSD (Breslau, 2002; Kessler et al., 2005; Kessler, Sonnega, Bromet, & Hughes, 1995). Therefore, the question of what causes PTSD cannot simply be answered by referring to its definition: a disorder whose symptoms occur following exposure to a traumatic stressor. In fact, there is controversy as to whether PTSD symptoms really are caused by exposure to traumatic stressors, because all of the symptoms, except for memories, flashbacks, and nightmares of traumatic events, could occur regardless of whether a person has experienced a traumatic stressor. The PTSD symptoms that are not by definition tied to a traumatic stressor-even the two symptoms that are defined as psychological or physical distress due to reminders of past stressful events-actually are also symptoms of other psychiatric disorders as well as of PTSD. Thus, it is important to scientifically examine the assumption that PTSD is caused by exposure to traumatic stressors (Box 3.1). Scientific evidence indicating that PTSD is most likely to occur not just when a traumatic stressor has occurred-but when the objective severity of exposure to traumatic danger or harm is more extreme-provides important (albeit not definitive) support for the view that exposure to a traumatic stressor plays a key role in PTSD, as is discussed later in this chapter (see section on the Impact of Stressor Exposure). In this chapter, a more nuanced view of the causes of PTSD is presented than the commonsense version that PTSD is "caused" simply by exposure to a traumatic stressor. Research demonstrates that PTSD is a "multicausal" phenomenon, meaning that it is the product of a combination of a number of potential causes. Rather than describing the factors that contribute to the development of PTSD as "causes," it is clearer and more factual to describe them as "risk factors" and "protective factors"that is, things that increase a person's risk of developing PTSD and things that reduce (or protect against) the risk of developing PTSD. As you will see, risk factors include not only exposure to a traumatic stressor but also biological, psychological, and social factors that influence whether PTSD will occur and that can protect against (but not necessarily prevent) the development of PTSD (Box 3.2).
Chronic stress, 2017
Background: Although childhood endangerment often precedes adult posttraumatic stress disorder (PTSD), the mechanism from danger to disorder is unclear. We proposed a developmental process in which unprotected and uncomforted danger in childhood would be associated with ''shortcuts'' in information processing that, in adulthood, could result in PTSD if the adult experienced additional exposure to danger. Information processing was defined as the basic associative, dissociative, and integrative processes used by all humans. Individual differences in parents' (or primary caregivers') protective and comforting behavior were expected to force unprotected children to use psychological shortcuts that linked early trauma to later vulnerability for PTSD. Method: We compared 22 adults with chronic PTSD to (a) 22 adults with other psychiatric diagnoses and (b) 22 normative adults without any diagnosis, in terms of information processing around childhood danger. The Adult Attachment Interview was used to derive information processing variables, including self-protective strategies, childhood traumas, and depression. Results: The two patient groups differed from the normative group on all variables. Adults with chronic PTSD differed from other psychiatric patients in having more childhood traumas and using more transformations of associative and dissociative processes. Within the PTSD group, there were three psychologically different subgroups. Conclusion: Our findings suggest that (1) prediction of risk for adult PTSD may be possible, (2) treatment might be facilitated by provision of a protective and supportive therapist, (3) who included a focus on correction of information processing errors and use of more adaptive strategies, and (4) subgroups of adults with PTSD may require different forms of treatment.
2009
According to the National Comorbidity Study, approximately 60% of men and 51% of women have been exposed to one or more traumatic events during their lifetime. Similar rates of traumatic events have been found in college students (Bernat, Ronfeldt, Calhoun, & Arias, 1998). In the aftermath of a traumatic event, it is typical for an individual to experience a myriad of symptoms such as intrusive thoughts about the trauma, avoidance of trauma stimuli, hyperarousal, and/or general numbing (APA, 2000). For most individuals, these symptoms remit within one month. However, a small percentage of trauma victims continue to experience symptoms beyond one month, which can lead to a diagnosis of PTSD. Approximately 7.8% of the population experiences PTSD at some point in their lives, with rates for females (10.4%) being considerably higher than that for males (5.0%) (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). Recently, Gold, Marx, Soler-Baillo, and Sloan (2005) questioned whether only traumatic events, as defined by the DSM, are capable of causing PTSD symptoms. According to the DSM-IV-TR (APA, 2000, p. 463), a trauma is defined as having both an A1 component: ''the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others'' and an A2 component: ''the person's response involved intense fear, helplessness, or horror.'' Using the Posttraumatic Stress Diagnostic Scale (Foa, 1996), participants were screened for whether they had experienced a traumatic event. Each traumatic event was then coded by the researchers as either meeting A1 criterion (traumatic) or failing to meet A1 criterion (non-traumatic). Events such as rapes and natural disasters were coded as traumatic, whereas events such as divorce of parents and romantic relationship breakups were coded as non-traumatic. The A2 criterion was not assessed. Participants also completed the Brief Symptom Inventory (Derogatis, 1993) to measure related PTSD symptoms. Using this methodology, somewhat counterintuitive results were obtained. Participants in the traumatic group reported significantly higher levels of PTSD symptoms than participants in the non-traumatic group. Similar results have been obtained by Long et al. (in press) who also found higher PTSD symptoms were associated with stressful events that failed to meet A1 criterion in comparison to events that did meet A1 criterion. The unexpected finding led Gold et al. (2005) to question the DSM definition of a trauma. For instance, they suggested the DSM definition of trauma be altered to include many of the nontraumatic events, such as death of a loved one. A similar argument was made by Ziksook, Chentsova-Dutton, and Shuchter (1998) who found that bereaved widows and widowers exhibited significant levels of PTSD symptoms two months after their spouse's death. Fueling concerns surrounding A1 criterion, Bodkin,
Posttraumatic Stress Disorder: An Overview
Posttraumatic stress disorder (PTSD) is a very pervasive disorder that may result from an individual's exposure to a traumatic event. Even though the diagnostic criteria in the DSM-IV-TR establish that a traumatic event must exist in order for the disorder to develop, the etiology can be explained by different models of abnormality. Definition, diagnostic criteria, features of the disorder, treatment, historical and cultural contexts, and prognosis are also discussed.
Evidence for a unique PTSD construct represented by PTSD's D1–D3 symptoms
Journal of Anxiety Disorders, 2011
Two models of posttraumatic stress disorder (PTSD) have received the most empirical support in confirmatory factor analytic studies: King, Leskin, King, and Weathers' (1998) Emotional Numbing model of reexperiencing, avoidance, emotional numbing and hyperarousal; and Simms, Watson, and Doebbeling's (2002) Dysphoria model of reexperiencing, avoidance, dysphoria and hyperarousal. These models only differ in placement of three PTSD symptoms: sleep problems (D1), irritability (D2), and concentration problems (D3). In the present study, we recruited 252 women victims of domestic violence and tested whether there is empirical support to separate these three PTSD symptoms into a fifth factor, while retaining the Emotional Numbing and Dysphoria models' remaining four factors. Confirmatory factor analytic findings demonstrated that separating the three symptoms into a separate factor significantly enhanced model fit for the Emotional Numbing and Dysphoria models. These three symptoms may represent a unique latent construct. Implications are discussed.
As the Pendulum Swings: The Etiology of PTSD, Complex PTSD, and Revictimization
Traumatology, 2000
During the 19th century, a picture was painted of trauma in which the focus was on pathologies of the victims, including notions of inherited "moral degeneracy," with little cognizance of the greater contextual factors, such as the traumatic events themselves, that contributed to the symptom picture. The role of trauma in the etiology of posttraumatic symptoms was incorporated into the DSM-III in 1980 and the PTSD category was initially viewed as an improvement over earlier categorizations of trauma, as it acknowledged that some experiences are so overwhelming that few people would escape unscathed. However, recent findings that not all persons who have suffered traumatic events develop PTSD have led some writers to discussion of a genetic component to PTSD. This article looks at this conclusion and the role of individual and contextual factors in relation to PTSD, Complex PTSD, and revictimization. *Note: Some of the material in this article may be disturbing to some readers.