PTSD can be related to are depression, substance abuse,
problems of member and cognition, and other physical and
mental disorders. This is why diagnoses of PTSD can be hard.
 PTSD is associated with a persons inability to function in daily
life from family life such as divorce, parenting difficulties, and
job problems
 Some other common symptoms include:
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 Affective: Anhedonia- loss of the ability of feel pleasure, emotional
numbering
 Hyper vigilance- enhanced sensibility to the senses, Passivity,
Nightmares, Flashbacks, Exaggerated startle response (behavioral)
 Intrusive memories, inability to concentrate, hyper arousal- nervous
system is in constant state of alert (cognitive).
 Lower back pain, headaches, stomach ache and digestion
problems, regression in some children- maturity, insomnia, losing
skills the person already has- speech and toilet training (Somatic).
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(Etiologies- the cause or the origin of the disease. )
Twin Research has shown a possible genetic predisposition for
PTSD (Hauff and Vaglum 1994)
It is shown in studies that people who have developed PTSD
have an increased level of noradrenaline.
Noradrenaline is a neurotransmitter that plays a role in
emotional arousal.
The high level of noradrenaline causes a person to express
more emotions on a certain situation or topic more than a
normal person, this was found by Geracioti(2001).
The high levels of Noradrenaline often lead to people having
flash back and panic attacks.
Bremner 1998
 There is evidence for increased sensitivity of
noradrenaline receptors in patients with PTSD
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Researchers took a look into how the person perceives the
traumatic situation. If the person tries to blame themselves
and takes responsibility for the situation then they will suffer
significantly.
When the person feels this way they also beginning to feel
they have a lack of control over their surroundings and the
world.
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Development of PTSD is associated with a tendency to
take personal responsibility for failures and to cope with
stress by focusing on the emotion, rather than the
problem.
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People who have been diagnosed with PTSD often develop
something called intrusive memories. These memories come
to mind randomly and are triggered by sounds, sight, and
smells that the person associates with the event.
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Sutker et al. (1995)
› Found that Gulf War veterans who had a sense of purpose
and commitment to the military had less of a chance of
suffering from PTSD than other veterans.
› Cognitive theorists have also found that victims of child
abuse who are able to see that the abuse was not their
fault, but a problem with the perpetrator, are able to
overcome the symptoms of PTSD.
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Links to schema processing and attribution.
Suedfeld (2003)
Examined attributional patterns in Holocaust survivors.
Suedfeld found that the attributional style of Holocaust
survivors tends to be much more external (Fate, God,
Luck, etc.) When asked why someone survived the
Holocaust, survivors were more likely than a Jewish
control group to mention help from others- including
help from Gentiles. Although help from others was
prominent in the study, survivors nevertheless have low
trust in others and demonstrate a skeptical view of the
world.
This study shows that a specific attribution may be
linked to Holocaust survivors. However, it is relevant
to ask if this attributional style was the result of the
Holocaust or particular to the Jewish community,
which could perhaps be more about sociocultural
factors than cognitive ones.
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The majority of research on PTSD focuses on sociocultural
explanations. Research suggests that experiences with racism
and oppression are predisposing factors for PTSD.
Dyregrov
› Research on PTSD in Rwandan children.
› Argued that death was the factor evidencing the
strongest influence on intrusive thoughts and avoidance of
behavior, which simply means avoiding situations can
trigger anxiety and panic.
› This appears to have support in Bosnia, where in 1998 close
to 73 % of girls and 35% of boys in Sarajevo suffered from
symptoms of PTSD.
Research has found that there is a significant gender
difference in the prevalence of PTSD
 Breslau et al. (1991) did a longitudinal study of 1007
young adults who had been exposed to community
violence and found a prevalence rate of 11.3% in
woman and 6% in men.
 Horowitz et al. (1995) reviewed a number of studies and
found that woman have a risk up to 5 times greater
than males to develop PTSD after a violent or traumatic
event.
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According to DSM, somatic symptoms of PTSD are atypical.
Kleinmen (1987) argues that it is irrational and ethnocentric to
assume that non-western forms of this disorder are atypicalthe form commonly seen in the West being assumed to be
the norm.
Non-western survivors exhibit what is called body memory
symptoms
› Ex. The dizziness experienced by a woman which was
found to be a body memory of her repeated experience
of being forced to drink large amounts of alcohol and
then being raped (Hanscom 2001)
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Pros of Treatment
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Educating people with PTSD about the
disorder
may help them cope with having the
disorder.
Exposure therapy can work at helping
the survivor
of a traumatic experience get over
their anxiety
developed from it.
Giving a per suffering from PTSD the
correct medicines
may help cure them. (e.g.
Antipsychotics, Antidepressants or Antianxiety medications)
Individual treatment can allow the
doctor to gain one
on one personal relationships with the
patient allowing
them to be more open to sharing what
they are thinking.
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Cons of Treatment
Some people may deny they have the
disorder
and resist treatment more.
Using exposure on a person suffering
from PTSD
may cause them to freak out and
forget about the
coping mechanisms they learned, do
to panic.
If a person suffering from PTSD is
prescribed
too many different medicines they
may become
addicted or dependent on the drugs.
You may not know how well the
treatment worked
until how the patient reacts around
more than one
person.
Contemporary abnormal psychology
adopts a number of different approaches
to treatment depending on the disorder
(such as biomedical, individual and group
therapy).
 It’s believed that multifaceted treatment is
the best treatment and this is called the
biopsychosocial approach to treatment.
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› This may include drug treatment, individual
therapy and group therapy as well as handling
risk factors in the environment.
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People who suffer from PTSD often take
antidepressants and tranquillizers to help
cope with their disorder.
› Valium and Xanax are tranquillizers that
modulate the neurotransmitter GABA in
order to regulate anxiety levels.
› Antidepressants are often prescribed
because most people who suffer from PTSD
have depression; those will improve with
depression also will improve with PTSD
(Marshall, 1994).
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At a traumatic event psychiatrists come to help
survivors/witnesses and try to prevent them from
having PTSD. Mayou et. el (2000) claims that crisis
intervention may do more harm than good. The
argument is that psychiatrists lay down more
concrete memories of the event and make it more
difficult to forget.
Foa (1986) treats individuals suffering from PTSD by
having them talk about their experience. The four
goals of treating a person suffering from PTSD are:
1.
2.
3.
4.
Create a safe environment.
Show that remembering is not equivalent to experiencing
the event again.
Show anxiety is alleviated over time.
Acknowledge that experiencing PTSD symptoms does
not lead to loss of control.
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Friedman and Schnurr (1996) looked at the role of
group therapy on Vietnam War veterans. They had a
total of 325 war veterans as participants.
There was a group that held trauma-focused therapy
which had three components: exposure to traumatic
memories, cognitive restructuring, and coping skills
development. Compared to a controlled group who
only talked about current life issues, the group that
had trauma-focused therapy had a better
improvement rate.
› However, the trauma-focused group had a very high
attrition rate (participants dropping out).Attrition rate was
27 percent compared to 17 percent
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Antipsychotics. Are prescribed to relieve severe anxiety
and/or related problems.
Ex. difficulty sleeping or emotional outbursts.
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Antidepressants. Can be used to help symptoms of both
depression and anxiety. They can help improve sleeping
issues and improve concentration.
Medication related: selective serotonin reuptake inhibitor
(SSRI) medications sertraline (Zoloft) and paroxetine (Paxil)
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Anti-anxiety medications. Can improve feelings of anxiety
and stress.
Prazosin(Minipress) . For symptoms that include insomnia or
recurring nightmares. It is also used for the treatment of
hypertension and blocks the brain's response to adrenalinelike brain chemical called norepinephrine
Cognitive therapy.
 Vocal therapy lets the person recognize ways of thinking
or cognitive patterns that keep the patient stuck. This
method can be used along with behavioral therapy also
known as exposure therapy.
Ex. negative or inaccurate ways of perceiving normal situations.
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Exposure therapy.
Behavioral therapy safely lets the patient face the very thing
that is found frightening, and helps them learn to cope with it
effectively. Another way of doing this is by using "virtual
reality" programs that allow you to re-enter the setting in
which you experienced trauma
-Ex. a "Virtual Iraq" program.
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Eye movement desensitization and reprocessing (EMDR).
This combines exposure therapy with a series of guided eye
movements that can help process traumatic memories.
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Etiology: to find out why people suffer from a disorder; this
way is more difficult to establish for a psychological disorder,
than for physical illness in general.
Therapeutic: treating or curing of the disease.
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Therapy is the most effective approach to try to cure
PTSD.
Therapy will help one have a good relationship
between the person suffering from PTSD and the
therapist.
The goal of therapy is to provide a nonjudgmental
environment that allows the person suffering from
PTSD and the therapist to work together to achieve
certain goals.
The sooner one addresses the symptoms of PTSD, the
less likely that person will become worse with their
PTSD and will increase the risk of depression.
› Symptoms can vary depending on the sex of the patient.
Most men develop aggression, become irritable, and
violent while women are more prone to anxiety,
avoidance of social situations, and depression
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During therapy, the therapist and the patient work on
the triggers that make the PTSD more difficult.
The patient and therapist develop techniques to help
relieve the triggers that can cause an onset of PTSD
responses.
The therapeutic approach and the relationship with
etiology become more clear once the patient can
identify the triggers sooner and implement the
techniques to help relieve the symptoms of PTSD.
Some therapists recommend that the PTSD patient
work with a dog that is trained to know when the
patient is starting to feel the symptoms of PTSD.
› The patient can use the techniques developed faster
when they have a dog to help identify that symptoms are
starting.
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The patient usually suffers a traumatic experience
that leads the patient to suffer from PTSD.
› Some traumatic experiences include: fighting in a war and
having to kill someone, being involved in a car accident,
being raped, etc.
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Patients that suffer from PTSD learn with help from a
therapist what can trigger the symptoms of PTSD.
› Some triggers can include: a gun shot or a firecracker
going off, a person following too closely, or acting
aggressively towards a raped victim, etc.
› Another trigger is having nightmares about the traumatic
experience and feeling like the patient is reliving the
experience over and over again.
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Research for PTSD shows that gender plays a role in
symptoms.
Males are more likely to experience externalization symptoms
such as aggression and delinquency.
Females are more likely to experience symptoms internally
such as anxiety and depression.
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Criteria A: The person has
been exposed to a traumatic
event in which both of the
following were present:
› The
person
experience,
witnessed, or was confronted
with an event of events that
involved actual or threatened
death or serious injury, or a
threat to the physical integrity
of self or others
› The person’s response involved
intense fear, helplessness, or
horror. NOTE: In children, this
may be expressed instead by
disorganized
or
agitated
behavior.
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Criteria B: The traumatic event is
persistently reexperienced in one (or
more) of the following ways:
› Recurrent
and
instrusive
distressing
recollections of the event, including images,
thought, or perceptions. NOTE: In young
children, repetitive play may occur.
› Recurrent distressing dreams of the event.
NOTE:In children. There may be frightening
dreams without recognizable content.
Acting or feeling as if the traumatic event
were recurring (includes a sense of reliving
the experience, illusions, hallucination, and
associative flashback episodes, including
those that occur on wakening or when
intoxicated.
 Intense psychological distress at exposure
to internal or external cues that symbolize or
resemble an aspect of the traumatic event.
 Physiological reactivity on exposure to
internal or external cues that symbolize or
resemble an aspect of the traumatic event.
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Persistent avoidance of stimuli associated with the
trauma and numbering of general responsiveness
(not present before the trauma), as indicated by
three (or more) of the following:
› Efforts to avoid thoughts, feelings or conversations
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associated with the trauma
Efforts to avoid activities, places, or people that arouse
recollections of the trauma
Inability to recall an important aspect of the trauma
Markedly diminished interest or participation in significant
activities
Feeling of detachment of estragement from others
Restricted range of affect (e.g., does not expect to have
a career, marriage, children, or a normal life span)
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Persistent symptoms of increased arousal
(not present before the trauma), as
indicated by two (or more) of the
following:
› Difficulty falling or staying asleep
› Irritability or outbursts of anger
› Difficulty concentrating
› Hyper vigilance
› Exaggerated startle response
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Duration of the disturbance (symptoms in
Criteria B, C, and D) is more than 1
month.
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The disturbance causes clinically
significant distress or impairment in social,
occupational, or other important areas
of functioning.
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In the US, PTSD has a prevalence rate of
1-3 percent and an estimated lifetime
prevalence of 5 percent in men and 10
percent in women.
› Studies by Davidson (2007) and Breslau
(1998) estimate that PTSD affects 15-24
percent of individuals who are exposed to
traumatic events.
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Careful research and documentation of
PTSD began after the Vietnam War. The
National
Vietnam
Veterans
Readjustment Study estimated in 1988
that the prevalence of PTSD among
veterans was 15.2 percent at that time,
and that 30 percent had experienced
the disorder at some point since
returning from Vietnam
Study of the Survivors of the Rwandan
Genocide. (Occurred soon after the
genocide).
 1995 UNICEF conducted a survey of 3000
Rwandan children, aged 8—19 years of
these:
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› 95 percent had witnessed violence
› 80 percent had suffered a death in their
immediate family
› 62 percent had been threatened with death.
Des Forges (1999) argued that
eliminating Tutsi children was seen as a
critical dimension in eliminated the Tutsi
presence in Rwanda.
 According to a UNICEF survey (1999), 60
percent of children surveyed did not
care if they grew up.
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• Dyregrov (2000) argues that the extent of loss
and trauma which affected all levels of society
throughout Rwanda may have rendered the
traditional coping mechanisms and collective
support less viable, and the whole adult
community less receptive to children’s needs,
as adults coped with their own traumas and
grief.
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According UNICEF, in 1997 there were
650,000 families headed by children
aged 12 years or younger.
› Over 300,000 children were growing up in
households without adults.
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The children lived in the community in
which the atrocities occurred. This
community has a higher opportunity of
intrusive memories.
Twin research has shown a possible genetic predisposition for
PTSD (Hauff and Vaglum 1994), but most biological research
focal point is on the role of noradrenaline.
Noradrenaline- is a neurotransmitter which plays an important
part in emotional arousal
When people express emotions more openly than normal is
because they have higher levels of noradrenaline.
Geracioti (2001) found that PTSD patients have higher levels
of this neurotransmitter than a common person has.
In 70 percent of patients, stimulating the adrenal system in
PTSD patients causes a panic attack, and flashbacks in 40
percent of patients. These symptoms are not experience by
any of the control group members.
Bremner (1989), there is no proof found for increased
sensitivity of noradrenaline receptors in patients.
Can an individuals cognitions make a difference to people who
develop PTSD.
There may be differences in the way an individuals cognitive
process experiences and the other may be a difference in
attributional styles.
What cognitive therapists often note is that PTSD patients tend to
feel that that have very little control over their lives and that the
world is unpredictable.
Example: A survivor of a car accident or a victim of rape often
experience guilt regarding this trauma.
These intrusive memories that seem to come to consciousness at
random are often triggered by sight, sounds, and smells related to
the traumatic event.
Example: Flashbacks may be experience while watching a fireworks
display to a war veteran.
Brewin (1996) These flashbacks occur as a result of cue- dependent
memory, where stimuli similar to the original even may activate
sensory and emotional aspects of the memory, thus causing
extreme fright.
Albert Rizzo professor at the University in Southern California.
Rizzo was trying to develop a tool to treat PTSD patients by
using virtual reality.
In Virtual Iraq these traumatized soldiers can re- experience
these horrors of the war while therapist manipulated variables
that would be appropriate to each individual.
This was based on the concept of flooding. An example of
this is over- exposure to stressful events. When the stress
reaction finally fades is due to what is called habituation.
Rather than focusing on the problem, development of PTSD is
associated with a tendency to cope with stress by focusing
on the emotion and to take personal responsibility for failures
Sutker (1995) found that Gulf War veterans had a less chance
of suffering from PTSD than other veterans.
Cognitive Theorists have found that victims of child abuse
that see that the abuse was not their fault, tend to overcome
the symptoms of PTSD
A large amount of the research on PTSD focuses on
sociocultural explanations.
Some predisposing factors for PTSD are experiences with
racism and oppression.
Roysircar (2000) researched Vietnam War veterans. His results
were that 20.6 percent of black and 27.6 percent of Hispanic
veterans met the criteria for a diagnosis on PTSD and only 13
percent of white veterans met this criteria.
Dyregrov goes a step further, when it came to Rwandan
children, arguing that threat of death was the strongest
influence on intrusive thoughts and avoidance of behavior.
Research in Bosnia seemed to support this, because in 1998
close to 73 percent of girls and 35 percent of boys in Sarajevo
suffered from symptoms of PTSD.
Kaminer (2000) was credited to have the highest rate of PTSD
in fear of rape in girls.
A role in PTSD is social learning. Silvia (2000) studies indicated
that children may develop PTSD by observing domestic
violence.