Stress Disorders and PTSD

Stress Disorders

Disorders common in a stressful and violent world.

Two Types of Stress Disorders

The Psychological Stress Disorders Acute Stress Disorder (ASD) Posttraumatic Stress Disorder (PTSD)

The Physiological Stress Disorders Medical problems having a stress component

Stress and Arousal

The state of stress has two components: The stressor

a stressful event that creates a demand/challenge for the individual to cope with.

The stress response The person’s reactions to the challenge or

demand created by the stressor.

The Stressor

Range of events can produce stress: Chronic daily stress Positive and negative life transitions Traumatic experiences

The Stress Response

A “package” of responses physiological emotional cognitive

Intensity depends upon the individual’s biological and psychological makeup

Stress and Arousal: The Fight-or-Flight Response

The features of arousal and fear are set in motion by the hypothalamus Two important systems are activated:

Autonomic nervous system (ANS) An extensive network of nerve fibers that connect the

central nervous system (the brain and spinal cord) to the body’s other organs

Contains two systems: sympathetic and parasympathetic Endocrine system

A network of glands throughout the body that release hormones


There are two pathways by which the ANS and the endocrine systems produce arousal and fear reactions:

Sympathetic nervous system

Hypothalamic-pituitary-adrenal pathway


When confronting a dangerous situation, the hypothalamus first activates the sympathetic nervous system, which stimulates key organs either directly or indirectly.

When the perceived danger passes, the parasympathetic nervous system helps return bodily systems to normal.

Stress and Arousal: The Fight-or- Flight Response

The second pathway is the hypothalamic-pituitary-adrenal (HPA) pathway When confronted by stressors, the hypothalamus

sends a message to the pituitary gland, which signals the adrenal cortex to release corticosteroids – the stress hormones – into the bloodstream.


The reactions displayed by these two pathways are referred to as the fight-or-flight response

People differ in their particular patterns of autonomic and endocrine functioning and therefore also in their particular ways of experiencing arousal and fear…

Definition of “Traumatic Stress”

An event involving actual or threatened serious injury to the person.

Witnessing the death or serious injury of another person.

The experience involves feeling extreme fear or terror.

Psychological Impact of Traumatic Stress

The precipitating event usually involves actual or threatened serious injury to self or others.

Follows an event which would be traumatic to anyone (unlike other anxiety disorders).

During and immediately after trauma, many people become highly anxious and depressed.

For some, feelings persist well after the trauma. These people may be experiencing a stress disorder.

Traumatic Stress Disorders:

Acute stress disorder (ASD) Symptoms begin within four weeks of event and

last for less than one month

Posttraumatic stress disorder (PTSD) Symptoms can begin at any time following the

event but must last for longer than one month May develop from acute stress disorder

Symptoms of PTSD

Reexperiencing the trauma Intrusive thoughts Flashbacks Nightmares

Symptoms of PTSD

Physiological Arousal Irritability Rageful outbursts Hypervigilance Exaggerated startle reaction Difficulty sleeping Difficulty concentrating

Symptoms of PTSD

Avoidance and numbing Persistent avoidance of triggers Isolation Feeling numb or detached Feelings of guilt Use of substances

PTSD and Other Disorders

PTSD is often accompanied by depression. Abuse of substances leading to dependence Heightened risk of suicide

Who Develops Psychological Stress Disorders?

Can occur at any age and affect all aspects of life ~4% of U.S. population affected each year ~7% of U.S. population affected sometime during

life Approximately 2/3 seek treatment at some point Ratio of women to men is 2:1

After trauma, 20% of women and 8% of men develop disorders

Some events – including combat, disasters, abuse, and victimization – are more likely to cause disorders than others

Who develops stress disorders?

Combat veterans It has long been recognized that soldiers

experience distress during combat Called “shell shock,” “combat fatigue” Post-Vietnam War clinicians discovered that

soldiers also experienced psychological distress after combat

~30% of Vietnam combat veterans suffered acute or posttraumatic stress disorders An additional 22% had some stress

symptoms 10% still experiencing problems


Victims of disasters Acute or posttraumatic stress disorders may

also follow natural and accidental disasters

Civilian traumas have been implicated in stress disorders at least 10 times as often as combat trauma

Types of disasters include traffic accidents, weather, earthquakes, and airplane crashes


Victims of crime and abuse People who have been abused, victimized,

or terrorized often experience lingering stress symptoms.

Sexual assault/rape ~1 in 7 women is raped at some time during her

life Psychological impact is immediate and may be

long-lasting. One study found that 94% of rape survivors

developed an acute stress disorder within 12 days after assault.


Emergency Workers Police Firemen Emergency Medical Personnel Disaster Relief Workers


Victims of family violence and abuse may also lead to acute or posttraumatic stress disorder.

Children as well as adults develop stress disorders. These may be misdiagnosed as other conditions.


Those living in a war zone.

Those who experience terrorism or the threat of terrorism -- this often leads to posttraumatic stress symptoms.

Why Do People Develop a Psychological Stress Disorder?

Clearly, extraordinary trauma can cause a stress disorder for anyone. However, the event alone may not be the entire

explanation. Why do only some develop PTSD?

Researchers have looked to the survivors’ biological processes, personalities, childhood experiences, and social support systems, and to the severity of the trauma itself

Biological and genetic factors

Traumatic events trigger physical changes in the brain and body that may lead to severe stress reactions, and stress disorders.

Some research suggests abnormal NT and hormone activity (especially norepinephrine and cortisol). There may be a biological/genetic predisposition to such

reactions.

Evidence suggests that other biological changes and damage may also occur as a stress disorder sets in.

Personality factors Some studies suggest that people with

certain personality profiles, attitudes, and coping styles are more likely to develop stress disorders Risk factors include:

Preexisting high anxiety A history of psychological problems Negative worldview

A set of positive attitudes (called resiliency or hardiness) is protective against developing stress disorders

Who is vulnerable?

Negative childhood experiences A wave of studies has found that certain childhood

experiences increase risk for later stress disorders

Risk factors include: An impoverished childhood Psychological disorders in the family The experience of assault, abuse, or catastrophe

at an early age Being younger than 10 years old

when parents separated or divorced

Risk factors for developing PTSD

History of previous trauma or abuse

Severity of the trauma The more severe the trauma and the more

direct one’s exposure to it, the greater the likelihood of developing a stress disorder Especially risky: mutilation and severe injury;

witnessing the injury or death of others

Social support a key factor People whose social support systems are weak are

more likely to develop a stress disorder after a negative event

How Do Clinicians Treat the Psychological Stress Disorders?

Symptoms have been found to last an average of 3 years with treatment and 5½ years without treatment General goals:

Help person regain a sense of safety End lingering stress reactions Gain perspective on traumatic experience Return to constructive living

Treatment for Stress Reactions

Drug therapy Exposure therapy Insight therapy Group therapy

Medications for PTSD

Anti-anxiety medications Xanax, Klonopin, Valium

Antidepressants

Exposure Therapy

Flooding EMDR – Eye Movement Desensitization and

Reprocessing Client recalls aspects of the trauma while moving

eyes back and forth. Clients report improvement Research inconclusive

Psychotherapy and group therapy

1-1 therapy to help clients: Become safe Express feelings Understand and better manage their symptoms Come to terms with the trauma and its impact on

their life

Group therapy Reduces isolation and shame Provides opportunities for feelings Promotes recovery through support and

relating to others

Minimizing Vulnerability?

Critical incident stress debriefing A form of crisis intervention. Victims are encouraged to talk extensively about

the trauma within 3 days. Disaster Response Network of the APA & Red

Cross. Research has not supported its effectiveness.

Stress Disorders and PTSD

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