Posttraumatic Stress Posttraumatic Stress Disorder (PTSD): What is Disorder (PTSD): What is

it and what causes it?it and what causes it?

World War IWorld War I•“Thousand-yard Stare” •“Shell Shock”

World War IIWorld War II•Combat Stress Reaction

Vietnam War VeteransVietnam War Veterans•Insurance Benefits

More than just warMore than just war

Rape victimsSevere physical abuseNatural disastersViolent crime victims

DSM-III - 1980DSM-III - 1980

PTSD first appears as a formal psychological disorder

Reaction to experiences “outside the range of normal human experience”

DSM-IV - 1994DSM-IV - 1994

(A1) 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

(A2) the person's response involved intense fear, helplessness, or horror.

Core Symptoms of PTSDCore Symptoms of PTSD

Re-experiencing through intrusive thoughts, nightmares

AvoidanceArousalDuration > 1 monthClinically significant distress or impairment

in everyday functioning

PTSD PrevalencePTSD Prevalence

~ 50% of people experience a traumatic eventMost people recover within 2 months (Bonanno, 2004)PTSD prevalence: 7-8%10-18% of OEF/OIF veterans

PTSDPTSDAssociated with:– Depression– Anxiety disorders– Low life satisfaction– Poor physical health– Poor sleep quality– Cognitive impairments– Anger management– Substance abuse– Marital problems– Distress and suicide ideation in partners

PTSDPTSDPre-Trauma Risk Factors:

– Female– Prior history of mental problems– Prior history of traumas– Neuroticism– Low IQ– Alcohol/Drug Abuse– Small hippocampi

PTSDPTSDPeri-Trauma Risk Factors:

– Severity of Event– Dissociation

PTSDPTSDPost-Trauma Risk Factors:

– Perceived Social Support– Event Centrality (Trauma as Identity)

PTSDPTSDClassical Conditioning

Treatment of PTSDTreatment of PTSDExposure Therapy

Barriers to TherapyBarriers to Therapy78% of Iraq war veterans acknowledged a mental health problem, yet only 26% sought treatment (Hoge et al.,

2004)“I would be seen as weak” “I don’t trust mental health professionals”

Posttraumatic GrowthPosttraumatic Growth“What Doesn’t Kill You “What Doesn’t Kill You Makes You Stronger”Makes You Stronger”

Greater Appreciation of LifePersonal StrengthSpiritual GrowthNew PossibilitiesRelating to Others