Trauma-and-Stress-Related Disorders

1. What is stress ?
1. external
2. internal
2. Forms of stress
1. acute stress
2. chronic stress
3. daily hassles
4. major life events
3. Key characteristics of stress
1. severity
2. chronicity
3. timing
4. degree of impact
5. level of expectation
6. controllability
4. Stress responses
1. Sympathetic-adrenomedullary (SAM) system (fight-or-flight response)
2. Hypothalamic-pituitary adrenocortical (HPA) (Hormonal system)
5. The trauma-and-stress-related disorders in DSM-5
1. Adjustment disorder
  1. impairment in social, occupational and academic function & emotional stress
  2. 3 months
  3. disappear when stressor ends or person adapts
  4. prevalence: very widely
  5. specific types of Adjustment Disorders
    1. Adjustment disorder with depressed mood
    2. Adjustment disorder with anxiety
    3. Adjustment disorder with mixed anxiety and depressed mood
    4. Adjustment disorder with disturbance of conduct
    5. Adjustment disorder with mixed disturbance of emotion and conduct
    6. Adjustment disorder unspecified
2. Acute/Posttraumatic stress disorder
  1. Trauma in DSM 5
    1. direct exposure
    2. witness
    3. learning (events occurred to a loved one)
    4. repeated exposure to details
  2. PTSD
    1. sympotoms
      1. Intrusive sympotoms ≥ 1
      2. Avoidance sympotoms ≥ 1
      3. Negative sympotoms ≥ 2
      4. Arousal sympotoms ≥ 2
      5. Dissociative sympotoms (as specifier)
    2. > 1 month
    3. may not develop until many months or even years after the traumatic event
    4. prevalence: US (6.8%) 女：9.7% 男：3.6% unexpected death of a loved one (most common)
  3. exposure to above traumatic experiences ≥ 1/4
  4. ASD
    1. symptoms : ≥ 9/14 in five categories
      1. Intrusive sympotoms
      2. Avoidance sympotoms
      3. Negative sympotoms
      4. Arousal sympotoms
      5. Dissociative sympotoms
    2. 3 days - 1 month
  5. marked personal disdress or significant impairment of functioning
  6. severity: NSESSS
6. Causal factors
1. PTSD
  1. Nature of trauma
  2. Individual risk factors
  3. Socialcultural risk factors
2. ASD & PTSD
  1. Biological factors
    1. Serotonin transporter gene (s/s alleles)
    2. Brain stuctures
      1. 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
      2. Reduction in intracranial and cerebral volume
      3. Increase in volumes of lateral ventricles
    3. SNS is aroused
    4. Overactive HPA axis: increase in cortisol
7. Treatment
1. Antidepressant Medication (e.g. SSRIs)
2. CBT: re-exposure

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Trauma-and-Stress-Related Disorders

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