Trauma and Stress Related

Disorder
Engida G. (MD)
 What is Trauma?

• Unbearable and intolerable attack perpetrated

towards the self (the body, the mind and the brain).
(Van der Kolk: The body Keeps the Score)

• Experience(s) that destroy the human kernel.

(Schauer et al: Narrative Exposure Therapy)
• Trauma is of various type; psychological,
sexual or physical
• A single blow or repetitive experiences
• Perceived vs Actual trauma
• Vulnerability vs Resilience
• Trauma and stressor related disorders
o Reactive attachment disorder
o Disinhibited social engagement disorder
o Posttraumatic disorder
o Acute stress disorder
o Adjustment disorders
o Other specified trauma and stressor related disorders
o Unspecified trauma and stressor related disorders
 Diagnostic Criteria

• DSM 5: Exposure to actual death, serious

injury or sexual violence and one of the
– 1) direct experience
– 2) witnessing
– 3) learning that the traumatic event occurred to
a close friend or family member
– 4) experiencing repeated or extreme exposure to
aversive details of the traumatic events.
 DSM 5

• Re-experiencing: one or more

– Memories
– Dreams
– Flashbacks
– Exposure distress
– Physiological reaction
 DSM-5

• Avoidance symptoms: one or both

– Internal reminders: thoughts, feelings, or
physical reactions
– External reminders: people, places, and objects
 DSM 5

• Two of the following negative symptoms:

– 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)
– Negative self image
– Blame
– Persistent negative emotional state (e.g., fear, horror, anger,
guilt, or shame)
 DSM 5

• 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
– Hyper-vigilance
– exaggerated startle response
– Reckless or self destructive behavior
 The dialectics of trauma

• Avoidance vs. Repetition compulsion

• Hyperarousal vs. Hypoarousal

• Intrusive memories vs. having no recollection

• To deny vs. to tell

TRAUMATIC MEMORY
 PTSD and Memory

• People are not fully aware that what they are

experiencing through flashback is active
memory arising from past experience.
• The memory of the traumatic event does not
seem to be fixed in the context of time and
space in which it actually occurred.
• Feel the experience, but prevented from
communicating coherently.
Schematic representation of Memory
Schematic representation of Memory

TRAUMATIC
MEMORY
 It sets up a
stream of
thoughts and
gives the event
personal
meaning.

It evaluates
the
emotional
significance.
It evaluates unrelated
events, compare it with
previously stored
information and
determines how they are
associated.
 It sets up a
stream of
thoughts and
gives the event
personal
meaning.

It evaluates
the
emotional
significance.
It evaluates unrelated
events, compare it with
previously stored
information and
determines how they are
associated.
 What determines how/where to save?

• Rational brain

• Emotional Brain

• Reptilian Brain
 Risk factors

• Presence of childhood trauma

• Borderline, paranoid, dependent, or antisocial
personality disorder traits
• Inadequate family or peer support system
• Being female
• Genetic vulnerability to psychiatric illness
• Recent stressful life changes
• Perception of an external locus of control, rather
than an internal one
• Recent excessive alcohol intake
 Protective factors

• High Sociability
• A thoughtful and active coping style
• Internal locus of control --- a strong
perception of their ability to control their
destiny.
Neurobiology
 MANAGEMENT

• Three phases of treatment

– Safety and Stabilization
– Working through remembering
– Re-integration
 Safety and stabilization

• Safety
• Relaxation
• Medications
• decrease the most prominent and disabling symptoms and
improving functioning.
• treatment of co-occurring psychiatric disorders.
• No clear guidelines when it is indicated. But the greater the
severity, the more likely to be treated with medications.
• SSRIs, TCAs and Benzodiazepines
 Working through remembering

• Exposure therapy
– Aimed at integrating the memory in to the
normal declarative memory schema.
– Narrative exposure therapy
 Reintegration/Reconnection

• Re-integrating the self

• Reconnecting with important relations and
social role
THANK YOU