Anxiety Disorder Post Traumatic Stress Disorder Ms Carmelitano

Anxiety Disorder: Post Traumatic Stress Disorder Ms. Carmelitano

Anxiety Disorders • Disorders that cause the sufferer to have irrational fear as the main disturbance ▫ ▫ PTSD OCD Social Anxiety Disorder Phobia

Post Traumatic Stress Disorder • Characterized by ▫ ▫ ▫ ▫ Intrusive memories of a past traumatic event Emotional withdrawal Heightened automatic arousal Insomnia Hyper-vigilance Loss of control over anger or aggression Anhedonia – an inability to feel positive emotions • Symptoms must last for more than 30 days • Symptoms occur after a person experiences a traumatic event and are triggered by certain stressors

Prevalence • Davidson et al (2007) and Breslau et al (1998) estimate PST affects 15 -24% of people who are exposed to traumatic events • Lifetime prevalence of 5% in men and 10% in women • People at risk: Those who experience traumatic events ▫ 50% of rape victims will develop PTSD ▫ 20% of those who experience war will develop PTSD ▫ 3% of people who suffer personal attack will develop PTSD ▫ 1/3 of all PTSD suffers have lost a love

Difficulty of Diagnosis • Other diseases frequently occur with it ▫ ▫ Depression Substance abuse Memory and cognitive difficulties Social impairment

Symptoms of PTSD • Affective: ▫ Ahedonia, emotional numbing • Behavioral: ▫ Hyper-vigilance, passivity, nightmares, flashbacks, exaggerated startle response • Cognitive: ▫ Intrusive memories, inability to concentrate, hyper vigilant • Somatic: ▫ Lower back pain, headaches, stomach aches, insomnia, regression, losing developmental skills

Question to answer • Why do only 25% of people who experience a traumatic event develop PTSD? ▫ The answer lies in the etiology! �Biological �Genetics, Brain defects, hormones, neurotransmitters �Cognitive �Schema processing, attribution style �Sociocultural �Social support after a traumatic event

Biological Etiology • Genetic predisposition ▫ Twin Research – Hauff and Vaglum 1994 ▫ Found that there was higher concordance rate of PTSD in identical twins that in fraternal twins �This supports the idea that people will be more prone to developing PTSD after a traumatic event if they have the genetic predisposition �However: this gene has not been discovered

Biological Etiology • The “flight or fight” response is the body’s way of defense in a high-stress situation ▫ The hormone adrenaline is released for a quick response ▫ After the situation, cortisol is released to shut down the stress response • A lack of cortisol results in the body’s stress response being active

Neurotransmitters • Noradrenaline (norepinephrine) – plays a role in arousal ▫ When a person is in a dangerous situation, they have an increase in levels of Noradrenaline. ▫ When these levels do not return to normal, a person may be more prone to develop PTSD • Geracioti (2001): Found that PTSD patients had a higher level of noradrenaline than average patients ▫ When these patient’s adrenal systems were stimulated (causing production of norepinephrine) � 40% had flashbacks and 70% had panic attacks � 0% of the control experienced these symptoms • Bremner 1998: Found evidence of increased sensitivity of noradrenaline receptors in patients

The Brain (Bremner 1997) • When a person experiences a dangers situation the brain switches from “learning mode” to “survival mode” • PET scans have shown that the amygdala (emotional memories) is more responsive in PTSD patients than control subjects ▫ In a PET scan, it produces a darker color image than a control • These patients have a less active prefrontal cortex (impulse control)

Cognitive Etiology • Theory that individual cognitions play a role in the formation of PTSD ▫ PTSD patients may cognitively process experiences differently than others (due to their schemas) ▫ PTSD patients may also have a faulty attribution style • PTSD patients often feel that they do not have control over their lives and the world is unpredictable ▫ A person with these schemas may be more likely to develop PTSD after a traumatic event ▫ The event reinforces the ideas they already have • Intrusive memories come randomly, triggered by sounds, smells, or sights related to a past traumatic event

Brewin et al (1996) • Dual Representation Theory ▫ There are two types of trauma-related memories �Situational accessible memories: Visual intrusions, flash-backs, nightmares - Involuntary recall 0 f non-verbal memories (visual, auditory, sensory) �Information is accompanied by a strong emotional response and bodily sensations �Perceived as ongoing here and now �Verbally accessible memories: Voluntary recall in a verbal or narrative memory �Experienced as a “bad memory” • Flashbacks occur as a result of cue-dependent memory • A stimuli similar to the original event triggers sensory and emotional aspects of the memory causing panic (flashbulb memories in the amygdala)

Sutker et al 1995 • Theorized that PTSD is associated with the tendency to take personal responsibility for failures and to cope with stress by focusing on emotion rather than the problem (attribution) ▫ Gulf War Veterans who had a sense of purpose and commitment to the military had less of a chance of suffering from PTSD • Victims of child abuse who see the abuse is not their fault, will be less likely to develop PTSD

Sutker et al (1995) • Participants: Troops assigned to Marines, Air Force, Navy, Army Reserve, and National Guard who were deployed to combat during the Persian Gulf War ▫ 484 participants. 88% Male and 12% female ▫ Control: 97 87% male and 13% female • Correlational study examining PTSD positive and PTSD negative veterans on personal and environmental resources available • Conclusions: PTST positive veterans reported less satisfaction with social support, less family cohesion and expressiveness, and more avoidant coping mechanisms. They had more self-blame and wishful thinking than the PTSD negative veterans

Suedfeld 2003 • Showed the role attribution style plays in PTSD • Examined attribution of Holocaust survivors ▫ Found that they attribute their survival to external factors (situational) – luck, God, fate, help from others ▫ While a control group of Jewish citizens attributed others survival to dispositional factors ▫ The result is higher chances for a person to develop PTSD because they feel that the situation was out of their control

Sociocultural Etiology • Most research on PTSD looks at the role situational experiences play • If a person has enough emotional support, they are less likely to develop PTSD after experiencing a traumatic event

Racism • Roysircar (2000) ▫ Conducted a meta-analysis of research on Vietnam War veterans • Found: ▫ 20. 6% of War veterans with PTSD were African American ▫ 26. 6% of War veterans with PTSD were Hispanic ▫ 13% of War veterans with PTSD were white • Roysircar argues that pervious racism and oppression predisposed these soldiers to develop PTSD later in life due to traumatic experiences

Dyregrov (2000) • Studied PTSD child survivors of the Rwandan Genocide • UNICEF conducted a survey of 3000 Rwandan children age 8 -19 ▫ 95% had witnessed violence ▫ 80% suffered death in their immediate family ▫ 62% had been threatened with death �These children still live in the same area and lack social support to cope with the events of the Genocide, having been orphaned ▫ Over 60% percent suffer PTSD because of their experience and lack of social support