Page 1

WHAT IS PTSD?

Emotions are encoded as information structures.

1. In particular, trauma memories are encoded as fear structures.
2. Information structures, including fear structures, can incorporate new information.
3. Sometimes fear structures do not accurately represent the real world.
   1. Example: a survivor of a dog mauling might become afraid of all dogs, even ones that are not dangerous.
   2. Other, unrelated stimuli that happened to be present during the trauma can also become encoded in the fear structure. In the above example, the survivor might become anxious when encountering dog houses or chew toys.
   3. Extreme fear reactions to objectively safe stimuli are called maladaptive or pathological fear reactions.
4. When a trauma survivor chronically avoids fear stimuli, new information is not incorporated.
   1. If fear stimuli are objectively safe, the trauma survivor never learns this.
   2. This can cause fear reactions to become maladaptive.
   3. Chronic avoidance can allow fear of one stimulus to generalize to other stimuli. For example, the survivor of a dog mauling who never learns that some dogs are friendly may become afraid of all dogs.
   4. It is believed that this kind of pathological fear structure can lead to PTSD.
5. Fear is not the only emotion that can precipitate PTSD. Intense guilt or shame can also cause chronic avoidance.

Avoidance is both a symptom and (researchers believe) a cause of PTSD.

1. Chronic avoidance of trauma reminders can obstruct emotional processing of the trauma memory. This can result in maladaptive fear structures and the development of PTSD.
2. Avoidance of trauma reminders is a reasonable, natural reaction; however, it can become cyclical.
   1. Trauma reminders lead to a sudden onset of anxiety and emotion.
   2. It is natural for some people to respond by escaping the situation.
   3. This causes a drop in anxiety, which feels good and reinforces the habit of avoidance.
3. Avoidance provides only temporary relief from anxiety.
   1. It does not treat the root of the problem - the "unfinished business" of the trauma memory.
   2. As such, the anxiety (and possibly other symptoms) will continue.
   3. The efficacy of avoidance may actually decrease over time, affording the trauma survivor less and less relief from anxiety.
   4. In the long run, continued avoidance may make overall anxiety worse and cause more severe symptoms (including chronic PTSD).
   5. Breaking the habit of avoidance via gradual exposure to trauma reminders is a major component of PE.

PTSD has three main symptom clusters: re-experiencing, avoidance/numbing, and hyper-arousal.

1. Re-experiencing cluster
   1. Recurrent and intrusive recollection of the trauma
   2. Recurrent nightmares related to the trauma
   3. "Flashbacks," illusions, or hallucinations
   4. Intense mental or physical reaction to trauma reminders
2. Avoidance/Numbing cluster
   1. Efforts to avoid trauma reminders, which can include people, places, objects, activities, topics, emotions, etc.
   2. Numbing of emotional responsiveness
   3. Sense of foreshortened future
   4. Loss of interest in enjoyable activities
3. Hyper-arousal cluster
   1. Exaggerated startle response
   2. Hyper-vigilance
   3. Trouble sleeping
   4. Chronic anger or irritability
   5. Difficulty concentrating

Prevalence of PTSD:

1. Even though the above symptoms may present immediately after a trauma, most survivors recover without treatment. As such, a diagnosis of chronic PTSD cannot be made unless symptoms have persisted for more than 30 days (according to the DSM-IV).
2. At any given time, about 7% of adults (9.8 million people) in the U.S. suffer from PTSD.
3. In some populations, the rate can be much higher.
1. The prevalence of PTSD in veterans of Iraq and Afghanistan ranges from 11 to 20%.
2. In groups affected by the World Trade Center attack, PTSD ranges from 12 to 23%.