Post-Traumatic Stress Disorder
Trauma and stressor-related disorders include conditions in which exposure to a stressful or traumatic event is explicitly listed as a diagnostic criterion. Post-traumatic stress disorder (PTSD) is an example of trauma and stressor-related condition in which actual or threatened exposure to a traumatic/stressful event causes a cascade of symptoms and presentations that impairs an individual’s functioning.
The purpose of the following discussion, with reference to a video case scenario, is to offer an overview of the disease’s neurobiology, the DSM5 diagnostic criteria, and a psychotherapy treatment choice for the client in the case scenario.
Neurobiological Basis for PTSD
Much of the neurobiology of PTSD is unknown; however, new study discoveries are accruing. The hippocampus, left amygdala, and anterior cingulate cortex are brain regions implicated in PTSD, with evidence demonstrating a reduced volume of the stated areas in PTSD compared to matched controls (Abdallah et al., 2019). Studies show that patients with PTSD have aberrant amounts of stress hormones, notably norepinephrine, which has been shown to rise with the downregulation of central adrenergic receptors (Abdallah et al., 2019).
The hormones allow the body to initiate a fight or flight response, which accounts for the numbing feelings and hyperarousal seen during PTSD episodes. Researchers also assume that genetics play a role in PTSD susceptibility, with studies indicating that one of four variants in the stress-related gene FKBP5 is linked to an elevated risk of PTSD (Zhang et al., 2020). Even though the precise neurobiological process of PTSD is yet unknown, neurochemical, genetic, and environmental factors all have a role.
DSM5 Diagnostic Criteria
Joe is an eight-year-old child living in the United Kingdom with his father and two siblings. Joe was a passenger in a minor automobile accident one day while traveling in the front seat of his father’s car. Joe had no injuries, while his father sustained minor injuries to his knee. They drove home after a little altercation with the other car’s driver. Joe was sent to a mental health facility a few weeks after the incident because he was experiencing intrusive recollections of the accident, was anxious, and avoided items that reminded him of the occurrence, such as television coverage of auto racing. He also had difficulties sleeping, had nightmares, and became physically violent at school, flipping over tables and quickly getting into an argument with his older brothers.
A person is diagnosed with PTSD if the following symptoms are satisfied, according to the DSM5 criteria: exposure to an actual or threatened traumatic event, as Joe was in a motor vehicle accident; the presence of intrusive memories of the traumatic event, as evidenced in Joe; persistent avoidance or efforts to avoid the distressing memories, as seen in Joe’s attempt to avoid television events of car racing; alterations in arousals associated with the event, such as angry outbursts and sleep disturbances, both of which are present in Joe; negative alterations in thinking and significant distress in social and occupational functioning (APA, 2013).
As a result, the video case scenario has enough information to make a PTSD diagnosis. I disagree with the patient’s diagnosis of major depressive illness since it is not related to a traumatic incident, takes a long time to develop, and there is no discernible mood abnormality in the patient. Furthermore, the case scenario fails to elicit an irritated mood, argumentative conduct, or spiteful/vindictive behavior; hence, I disagree with the diagnosis of the oppositional defiant disorder. Moreover, the case scenario lacks a convincing history to diagnose a conduct problem and a separation anxiety disorder but is indicative of a traumatic incident with its sequela presentation, which rationalizes the diagnosis of PTSD.
Psychotherapeutic Treatment Option
Prolonged exposure therapy is the gold standard intervention for people with PTSD and is regarded as the first-line psychotherapy method. If a patient has been avoiding events that remind him of the traumatic occurrences, prolonged exposure therapy might help them face their fears (Watkins et al., 2018). The patient collaborates closely with the therapist to create a list of items that cause him fear and learn how to confront them one by one. As a gold standard, prolonged exposure lowers PTSD symptoms while also lowering comorbid disorders such as anger, guilt, poor health beliefs, and depression.
Conclusion
Trauma and stressor-related illnesses are among the mental diseases for which patients seek early treatment owing to severe symptoms. A PSTD is a paragon of trauma and stress-related disorder in which the original etiology is exposure to a traumatic life event, which causes a cascade of symptoms for which patients seek psychiatric assistance. While its neurobiology is unknown, various factors such as genetics, neurochemistry, and environmental factors all have a role. Joe’s presentation in the video scenario is quintessentially a PTSD case, and trauma-focused cognitive treatment and extended exposure therapy may be beneficial in his care.
References
Abdallah, C. G., Averill, L. A., Akiki, T. J., Raza, M., Averill, C. L., Gomaa, H., Adikey, A., & Krystal, J. H. (2019). The neurobiology and pharmacotherapy of posttraumatic stress disorder. Annual Review of Pharmacology and Toxicology, 59(1), 171–189. https://doi.org/10.1146/annurev-pharmtox-010818-021701
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596
Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 12, 258. https://doi.org/10.3389/fnbeh.2018.00258
Zhang, K., Wang, L., Li, G., Cao, C., Fang, R., Liu, P., Luo, S., & Zhang, X. (2020). Correlation between hypothalamic-pituitary-adrenal axis gene polymorphisms and posttraumatic stress disorder symptoms. Hormones and Behavior, 117(104604), 104604. https://doi.org/10.1016/j.yhbeh.2019.104604
Post-Traumatic Stress Disorder Instructions
Week 9: Psychotherapy With Trauma and Stressor-Related Disorders
Disorders resulting from trauma are significantly different from other psychiatric-mental health issues. Unlike disorders such as schizophrenia or major depressive disorder, trauma-related disorders do not occur randomly in the population. Instead, trauma is something that occurs as a result of the lived experience of a traumatic event. According to the National Institute of Mental Health (2017), more than half of the population will experience a traumatic event during their lifetime. Although most people will recover from the trauma on their own, some require therapeutic interventions. While there are medications that can help individuals with trauma and posttraumatic stress disorder (PTSD), the foundation of treatment continues to be psychotherapy.
This week, you explore psychotherapy for trauma by assessing a case presentation for clients presenting with posttraumatic stress disorder. You also examine therapies for treating these clients and consider potential outcomes.
Reference: National Institute of Mental Health. (2017). Post-traumatic stress disorder (PTSD). https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd.shtml
Learning Objectives
Students will:
Explain the neurobiological basis for PTSD
Apply assessment and diagnostic reasoning skills to clients presenting with posttraumatic stress disorder
Recommend therapeutic approaches for treating clients presenting with posttraumatic stress disorder
Analyze the importance of using evidence-based psychotherapy treatments for clients with posttraumatic stress disorder
Learning Resources
Required Readings (click to expand/reduce)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
For reference as needed
American Psychiatric Association. (2017). Clinical practice guideline of PTSD. https://www.apa.org/ptsd-guideline
Substance Abuse and Mental Health Services Administration. (2014). SAMHSA\'s concept of trauma and guidance for a trauma-informed approach. https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf
Credit: Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
Tye, S., Van Voorhees, E., Hu, C., & Lineberry, T. (2015). Preclinical perspectives on posttraumatic stress disorder criteria in DSM-5. Harvard Review of Psychiatry, 23(1), 51–58. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4542003/
Credit: Preclinical Perspectives on Posttraumatic Stress Disorder Criteria in DSM-5 by Susannah Tye, PhD, Elizabeth Van Voorhees, PhD, Chunling Hu, MD, PhD, and Timothy Lineberry, MD, in HARVARD REVIEW OF PSYCHIATRY, Vol. 23/Issue 1. Copyright 2015 by ROUTLEDGE. Reprinted by permission of ROUTLEDGE via the Copyright Clearance Center.
Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.
Chapter 3, “Assessment and Diagnosis†(Previously read in Week 2)
Chapter 7, “Eye Movement Desensitization and Reprocessing Therapyâ€
Chapter 11, “Trauma Resiliency Model Therapyâ€
Chapter 15, “Trauma-Informed Medication Managementâ€
Chapter 17, “Stabilization for Trauma and Dissociationâ€
Chapter 18, “Dialectical Behavior Therapy for Complex Traumaâ€
Required Media (click to expand/reduce)
Grande, T. (2019, August 21). Presentation example: Posttraumatic stress disorder (PTSD) [Video]. YouTube. https://www.youtube.com/watch?v=RkSv_zPH-M4
Gift from Within. (Producer). (2008). PTSD and veterans: A conversation with Dr. Frank Ochberg [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/ptsd-and-veterans-a-conversation-with-dr-frank-ochberg
Assignment: Posttraumatic Stress Disorder
Photo Credit: Getty Images/iStockphoto
It is estimated that more almost 7% of the U.S. population will experience posttraumatic stress disorder (PTSD) in their lifetime (National Institute of Mental Health, 2017). This debilitating disorder often interferes with an individual’s ability to function in daily life. Common symptoms of anxiousness and depression frequently lead to behavioral issues, adolescent substance abuse issues, and even physical ailments. For this Assignment, you examine a PTSD video case study and consider how you might assess and treat clients presenting with PTSD.
To prepare:
Review this week’s Learning Resources and reflect on the insights they provide about diagnosing and treating PTSD.
View the media Presentation Example: Posttraumatic Stress Disorder (PTSD) and assess the client in the case study.
For guidance on assessing the client, refer to Chapter 3 of the Wheeler text.
Note: To complete this Assignment, you must assess the client, but you are not required to submit a formal comprehensive client assessment.
The Assignment
Succinctly, in 1–2 pages, address the following:
Briefly explain the neurobiological basis for PTSD illness.
Discuss the DSM-5 diagnostic criteria for PTSD and relate these criteria to the symptomology presented in the case study. Does the video case presentation provide sufficient information to derive a PTSD diagnosis? Justify your reasoning. Do you agree with the other diagnoses in the case presentation? Why or why not?
Discuss one other psychotherapy treatment option for the client in this case study. Explain whether your treatment option is considered a “gold standard treatment†from a clinical practice guideline perspective, and why using gold standard, evidence-based treatments from clinical practice guidelines is important for psychiatric-mental health nurse practitioners.
Support your Assignment with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.
By Day 7
Submit your Assignment. Also attach and submit PDFs of the sources you used.
Submission and Grading Information
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Click the Week 9 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 9 Assignment link. You will also be able to “View Rubric†for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK9Assgn+last name+first initial.(extension)†and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 9 Assignment Rubric
Check Your Assignment Draft for Authenticity
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Submit your Week 9 Assignment draft and review the originality report.
Submit your Assignment by Day 7
To Participate in this Assignment:
Week 9 Assignment
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