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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 :

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how do we define stress

How do we defineSTRESS?

Incongruity between the demands placed on the organism and the adaptive capacities of the organism

dsm iv criteria for ptsd a stressor criterion
DSM-IV Criteria for PTSDA. 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 22-43%

Major Fire Post-traumatic Stress Impairment 54-66%

PTSD in burned survivors 100%

Transportation Disasters PTSD 29-100% PTSD in children 40-47%

Terrorist Kidnapping and Torture PTSD 54%

Mass Shooting 5% children 5-47%

Rescue Workers ptsReactions 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
DSM-IV Criteria for PTSDB. 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
DSM-IV Criteria for PTSDC. 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
DSM-IV Criteria for PTSDD. 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
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
comorbid diagnosis in ptsd
Comorbid Diagnosis in PTSD
  • Depression
  • Dysthymia
  • Anxiety Disorders
  • Substance Abuse
  • Personality Disorderes
differential diagnosis of ptsd
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