How do we define STRESS? Incongruity between the demands placed on the organism and the adaptive capacities of the organism

DSM-IV Criteria for PTSD A. Stressor Criterion The person has been exposed to a traumatic event in which both of the following have been present: The person has experienced, witnessed, or been confronted with an event or events that involve 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, it may be expressed instead by disorganized or agitated behavior.

PREVALENCE OF PTSD FOLLOWING DISASTER Natural Disasters Buffalo Creek Disaster Lifetime PTSD 59% at 14 yr follow-up 25% in children 37% Mt. St. Helens Volcanic Eruption PTSD in exposed sample 3.6%, PTSD among non-exposed 2.6% Tornado PTSD 2-21%., Post- traumatic Stress Impairment 59% Earthquake Post-traumatic Stress Impairment 32-60%, PTSD in children 26-95% Human-Made Disasters Technological Disaster PTSD 7- 50%, Post-traumatic Impairment % Major Fire Post-traumatic Stress Impairment 54-66% PTSD in burned survivors 100% Transportation Disasters PTSD % PTSD in children 40-47% Terrorist Kidnapping and Torture PTSD 54% Mass Shooting 5% children 5-47% Rescue Workers pts Reactions 24%

DISASTER EXPERIENCES ASSOCIATED WITH CHRONIC PTSD Survivors/witnesses of mass destruction or death Unresolved bereavement Loss of home or community Survivors with histories of prior exposure to trauma Survivors who experience major life stressors Survivors of toxic contamination disasters

OTHER FACTORS ASSOCIATED WITH CHRONIC PTSD Low levels of emotional/social support or high levels of social demand Coping via avoidance, self-blame, or rumination ( However: maladaptive patterns of coping may be the result rather than cause of post-traumatic stress impairment ) Coping via substance abuse Serving as an emergency worker Children whose parents are persistently psychologically impaired. Children whose parents experience significant peritraumatic distress.

DSM-IV Criteria for PTSD B. Intrusive Recollection Criterion The traumatic event is persistently re-experienced in one (or more) of the following ways: recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in young children, repetitive play may occur in which themes or aspects of the trauma are expressed 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, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: in young children, trauma-specific reenactment may occur intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event physiological reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

DSM-IV Criteria for PTSD C. Avoidant / Numbing Criterion Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following: efforts to avoid thoughts, feelings, or conversations 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 or estrangement from others restricted range of affect (e.g., unable to have loving feelings) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

DSM-IV Criteria for PTSD D. Hyperarousal Criterion 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  hypervigilance  exaggerated startle response

Associated Features of PTSD Survivor Guilt Impaired relationships Impaired capacity to regulate feelings Self destructiveness, impulsive behavior Dissociation Somatization Personality change Change in world view, beliefs Shame, despair, hostility Social withdrawal Survivor Guilt Impaired relationships Impaired capacity to regulate feelings Self destructiveness, impulsive behavior Dissociation Somatization Personality change Change in world view, beliefs Shame, despair, hostility Social withdrawal

Comorbid Diagnosis in PTSD Depression Dysthymia Anxiety Disorders Substance Abuse Personality Disorderes

Differential Diagnosis of PTSD Acute Stress Disorder Adjustment Disorder Bereavement Affective Disorder Phobia Anxiety Dis. Obsessive Compulsive Dis. Organic Brain Dis. Dissociative Dis. Substance Abuse Dis. Antisocial/ Borderline Personality D. Malingering