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disorders
2018
DSM5
Reactive attachment Disorder (child)
Disinhibited Social Engagement
Disorder(child)
Acute stress Disorder
PTSD
Adjustments Disorders
Anxiety and Memory disorder
PTSD
Pathophysiology of PTSD
Depersonalization
Detachment
Feeling of sense of unreality of self
Time moving slowly
Derealization
World is unreal, dreamlike, distorted
Specifier : Delayed expression
Full diagnostic criteria are not met until at
least 6 months after the event although
onset and some symptoms may be
immediate.
Comorbidities
PTSD patients are 80% more likely to meet criteria for
at least one other mental disorder.
Suicidality
Psychosis
Substance abuse
Family dysfunction
Homelessness
CVD
Premature aging
Type II DM
……
Risk and Protective Factors for PTSD
WWI Trenches (Shell Shock)
The experience of War
Approximately 30% of men and women who have spent time in a war zone
experience PTSD.
Pre-traumatic Factors
Temperamental: childhood trauma , anxiety or
externalizing
Severity of trauma
Trauma perpetrated by a caregiver
For military personnel : being a perpetrator,
witnessing atrocities
Dissociation during the trauma
Post-traumatic factors
Temperamental:
Negative appraisals, poor coping
Environmental :
Exposure to repeated upsetting reminders,
subsequent adverse life events, financial and
other trauma- related losses.
Atypical Antipsychotics
EMDR can help even if the patient and therapist do not have a
trusting relationship
EMDR in Trauma: Eye Movement
Desensitization and Reprocessing
A stressor
An individual
An outcome
Characteristics of the Stressor
Severity
Duration and repetitiveness
Nature of the stressor
Symbolic meaning of the stressor
Personal Characteristics
Past history, current circumstances, future expectations
Personality Pattern
Coping strategies
Conscious, intentional, adaptive
Defense Mechanisms
Unconscious, unintentional, potentially maladaptive
Resilience
Prevalence of Childhood Adversity
2 fundamental questions:
Recovery: how well people bounce back and recover from a
challenge
Sustainability: how well do people sustain health and physical
wellbeing in a dynamic and challenging environment
Adjustment disorder
Special Considerations:
Following a trauma of the type that causes ASD and PTSD a
patient may develop symptoms of AD- diagnose AD
When no identifiable traumatic event has occurred but the patient
presents with symptoms of ASD or PTSD –diagnose AD.
The internal experience of
Adjustment Disorders
Affective states
An overriding affective feature is a vague
uneasiness resulting from the new event:
uncertainty, apprehensiveness..
Cognitive patterns
Focus on the situation or avoid it
Focus on the emotional state or on the
problem
Somatic conditions
A general state of tension and apprehension
Relationship patterns
Increased expressions of dependency
Distancing from relationships (
shame/neediness)
The crucial questions