Trauma-and-Stress-Related Disorders

Trauma-and-Stress-Related Disorders

1. 1. What is stress ?

   • external
   • internal

2. 2. Forms of stress

   • acute stress
   • chronic stress
   • daily hassles
   • major life events

3. 3. Key characteristics of stress

   • severity
   • chronicity
   • timing
   • degree of impact
   • level of expectation
   • controllability

4. 4. Stress responses

   • Sympathetic-adrenomedullary (SAM) system (fight-or-flight response)
   • Hypothalamic-pituitary adrenocortical (HPA) (Hormonal system)

5. 5. The trauma-and-stress-related disorders in DSM-5

   • Adjustment disorder
     • impairment in social, occupational and academic function & emotional stress
     • 3 months
     • disappear when stressor ends or person adapts
     • prevalence: very widely
     • specific types of Adjustment Disorders
       • Adjustment disorder with depressed mood
       • Adjustment disorder with anxiety
       • Adjustment disorder with mixed anxiety and depressed mood
       • Adjustment disorder with disturbance of conduct
       • Adjustment disorder with mixed disturbance of emotion and conduct
       • Adjustment disorder unspecified
   • Acute/Posttraumatic stress disorder
     • Trauma in DSM 5
       • direct exposure
       • witness
       • learning (events occurred to a loved one)
       • repeated exposure to details
     • PTSD
       • sympotoms
         • Intrusive sympotoms ≥ 1
         • Avoidance sympotoms ≥ 1
         • Negative sympotoms ≥ 2
         • Arousal sympotoms ≥ 2
         • Dissociative sympotoms (as specifier)
       • > 1 month
       • may not develop until many months or even years after the traumatic event
       • prevalence: US (6.8%) 女：9.7% 男：3.6% unexpected death of a loved one (most common)
     • exposure to above traumatic experiences ≥ 1/4
     • ASD
       • symptoms : ≥ 9/14 in five categories
         • Intrusive sympotoms
         • Avoidance sympotoms
         • Negative sympotoms
         • Arousal sympotoms
         • Dissociative sympotoms
       • 3 days - 1 month
     • marked personal disdress or significant impairment of functioning
     • severity: NSESSS

6. 6. Causal factors

   • PTSD
     • Nature of trauma
     • Individual risk factors
     • Socialcultural risk factors
   • ASD & PTSD
     • Biological factors
       • Serotonin transporter gene (s/s alleles)
       • Brain stuctures
         • The limbic system
           • Reduction in amygdala: emotional processiong
           • Hippocampus: memory
             • Smaller hippocampus
               • Smaller left hippocampus: more disssociative symptoms
               • Smaller right hippocampus: more PTSD symptoms
             • Malfunctioning hippocampus
         • Reduction in intracranial and cerebral volume
         • Increase in volumes of lateral ventricles
       • SNS is aroused
       • Overactive HPA axis: increase in cortisol

7. 7. Treatment

   • Antidepressant Medication (e.g. SSRIs)
   • CBT: re-exposure