Post-Traumatic Stress Disorder: Defined, Described, Detailed and Debated
Online Course Materials: Articles Audios Articles
Developed by Sage de Beixedon Breslin, Ph.D.
General Course Description
There has been a movement in our society at large of disconnection from the extended family, from long-term friendships, from lifetime careers, and even from community and neighborhood. As a result, we have experienced less attachment and greater capacity for boundary violation and amoral behavior. The statistics for child abuse and sexual assault are alarming and, as a result, there has been a much more pervasive experience of trauma by individuals, as well as within local and global communities. Post-Traumatic Stress DisorderThe increase in terrorism and the continued insertion of troops into foreign wars has caused a widespread experience of trauma and, subsequently, the diagnosis of PTSD has escalated exponentially. But what if the experience by so many in our culture is not something to pathologize, but to appreciate and to alter how we cope with the disintegration of our intimate and extended communities? Given the evidence, what is PTSD really? Throughout the last hundred years, how clinicians have applied the diagnosis of PTSD has evolved significantly: it was initially used to describe purely combat-related sequelae, then became a more generalized account of the impacts of trauma experienced in “every day” situations (e.g., domestic violence, muggings, workplace harassment), and is now an expansive depiction of how all of us are affected by the terrorism in our time. But what about the future of PTSD? In DSM-5, Criterion A significantly changed, eliminating certain criteria and rewording others. How will this affect our understanding of our clients with current PTSD diagnosis and how we treat them?
This PTSD course is one of the most comprehensive explorations of this diagnostic category and the treatment available for the symptoms of PTSD. Through the review of 58 online articles by groundbreakers in the movement (such as Dan Siegel and Francine Shapiro) to understand and treat PTSD, you will not only gain expansive knowledge about the diagnosis and its etiology, but will also learn about the most effective psychotherapeutic and integrative strategies to manage this disorder, as well as the medications currently in use to treat the symptoms of PTSD. The course provides foundational information from Attachment Theory and Interpersonal Neurobiology, as well as creative treatments and therapies such as EMDR. Further, you will be exposed to criticism and debate regarding the use of the label itself and can come to your own conclusions about whether or not PTSD is a useful diagnostic expression, or whether the symptoms that comprise and describe PTSD might simply be a natural response to the increasing traumatic nature of our lives in today’s world. Transcript is provided for the MP3. Additional resources and references are provided for further study, but they are not part of the course.
Disclaimer: This course is purely educational and does not intend to serve as a license (or permission) to mental health professionals to prescribe or practice any of the approaches discussed in this course unless they fall within the scope of practice of your profession. Check with your licensing board about the scope of practice of your profession to make sure you practice within that scope. It also does not serve as a permission to title yourself in any specific way.
- This course will teach the participant to
- Summarize the history of the PTSD diagnosis.
- Define and describe the diagnosis of PTSD per the DSM.
- List the DSM criteria currently in use for making the PTSD diagnosis.
- Discern between PTSD and other alternative diagnoses.
- Summarize the neurobiological bases of traumatic reaction.
- Define “Mindsight.”
- Describe neural integration.
- Name factors which may impact neural integration.
- Note the neurobiological foundations of secure attachment and how they promote resilience to traumatic experience.
- Report the impacts of trauma on the development of Disorganized Attachment and Dissociation.
- Describe how stress may potentiate the development of PTSD.
- Differentiate between Acute Stress Reactions and PTSD.
- Review the impacts of PTSD on the development of alcohol addiction.
- Identify the most common traditional interventions utilized for the treatment of PTSD.
- Report evidence-based research for the use of EMDR for the resolution of PTSD.
- Describe the use of Body Psychotherapy techniques in the treatment of PTSD.
- Note some of the contemporary or innovative treatments currently used to treat PTSD.
- List medications that may be useful to modify or resolve symptoms associated with PTSD.
- Review common critiques of the PTSD diagnosis.
- Bjorck, J. P., & Byron, K. J. (2014). Does Stress-Related Growth Involve Constructive Changes in Coping Intentions? Journal of Positive Psychology, 9, 97-107.
- Braga, L. L., Fiks, J. P., Mari, J. J., & Mello, M. F. (2008). The importance of the concepts of disaster, catastrophe, violence, trauma and barbarism in defining posttraumatic stress disorder in clinical practice. BMC psychiatry, 8 (1), 68.
- Hall, B. J., Saltzman, L. Y., Canetti, D., & Hobfoll, S. E. (2015). A longitudinal investigation of the relationship between posttraumatic stress symptoms and posttraumatic growth in a cohort of Israeli Jews and Palestinians during ongoing violence. PloS one, 10(4), e0124782.
Definitions and Descriptions of PTSD as a Diagnostic Category
- DSM Criteria
- Directly experiencing the traumatic event(s) or witnessing, in person, the event(s) as it occurred to others; learning that the traumatic event(s) occurred to a close family member or close friend; experiencing repeated or extreme exposure to aversive details of the traumatic event(s)
- Intrusive recollection of the event following its occurrence
- Persistent avoidance of stimuli associated with the trauma
- Negative alterations in cognitions and mood associated with the event(s)
- Persistent symptoms of increasing arousal
- Duration of symptoms for at least one month
- Significant impact to functional capacity
History of the Diagnosis
- 1800s: Combat “Exhaustion”, “Railway Spine”, and “Railway Hysteria”
- 1900s: “Soldier’s Heart”, “The Effort Syndrome”, “Shell Shock”, and “Combat Fatigue”
- 1952: “Stress Response Syndrome”
- 1980: Post-Traumatic Stress Disorder, as a subcategory of Anxiety Disorders
- 1994: Post-Traumatic Stress Disorder, as a subcategory of Stress Response, within the Anxiety Disorders category
- 2013: Post-Traumatic Stress Disorder within the Trauma- and Stressor-Related Disorders
Gaining a Comprehensive Understanding of the Mechanisms of PTSD
- Neurobiological foundations of secure attachment and resilience to traumatic experience
- The impact of attachment relationships on brain development
- Brain development and memories
- The development of “self” through human relationships
- Attachment and the developing mind
- The role of emotion
- Interpersonal communication and the development of “Mindsight”
- Complexity, coherent narratives, and neural integration
- Unresolved states, disorganized attachment, and impairments to integration
- Disorganized Attachment, dissociation, and impact of traumatic experience
- Characteristics of Disorganized Infant Behavior
- Genetic factors in the prediction of disorganization
- The role of trauma in Disorganized Attachment
- Psychophysiology of disorganized attachment
- Disorganized attachment classification and neurological impairment
- Etiology of Dissociation
- Genetic vs. Environmental causes of dissociation
- Characteristics of Dissociative Behavior in Children
- Assessment of Dissociation
- The role of Dissociation in Psychopathology and Disorganized attachment
- Implications of Disorganized Attachment in Infancy
- Attachment and Dissociation in Adulthood
- Caregiving and disorganized attachment
- Intergenerational Effects of Trauma
- Characteristics of the Parental Behaviors of Parents with PTSD
- Disorganized Infants
Broad-based Impacts of Stress and Trauma on the Development of PTSD
- Reduced sense of safety and security
- Revised perception of the world as predictable
- Experience of emotions such as anger, frustration, helplessness, fear, and a desire for revenge
- Development of ASD, PTSD, anxiety, depression, nightmares, insomnia, simple phobias, problems with social interaction, and substance use/abuse/addiction
- Eventual resilience
Clinical Treatment of PTSD
- Psychodynamic Psychotherapy
- Existential-Humanistic Psychotherapy
- Cognitive Behavioral Therapy
- Prolonged Exposure Therapy
- Eye Movement Desensitization and Reprocessing Therapy (EMDR)
- Body Psychotherapy
- Antidepressant Medications
- Celexa, Lexapro, Luvox, Paxil, Prozac, Zoloft, Cymbalta
- Effexor, Remeron, Trazadone (for sleep)
- Tricyclic Antidepressant Medications
- Anafranil, Aventyl, Norpramin, Pamelor
- Surmontil, Tofranil, Vivactil
- Monoamine Oxidase Inhibitors (MAOIs)
- Marplan, Nardil, Parnate
- Non-habit-forming Anxiolytic Medication
- Noradrenergic Agents: Alpha Blockers
- Minipress, Catapres, Tenex
- Beta Blockers
- Inderal, Corgard, Tenormin
- Atypical Antipsychotics
- Abilify, Geodon, Risperdal, Seroquel, Zyprexa
- Mood Stabilizers
- Traditional Antipsychotics
- Sleep Medications
Critique of the PTSD Diagnosis