Psychology Essay

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M o d u le 1 3 .6 : P o s t t r a u m a t ic S t r e s s D is o r d e r

Extrem ely stressful or traum atic events, such as com bat, natural disasters, and terrorist attacks, place the people w ho experience them at an

increased risk for developing psychological disorders such as posttraum atic stress disorder (PTSD ). Throughout m uch of the 20th century, this

disorder w as called shell shock and com bat neurosis because its sym ptom s w ere observed in soldiers w ho had engaged in w artim e com bat. By

the late 1970s it had becom e clear that w om en w ho had experienced sexual traum as (e.g., rape, dom estic battery, and incest) often

experienced the sam e set of sym ptom s as did soldiers. The term posttraum atic stress disorder w as developed given that these sym ptom s could

happen to anyone w ho experienced psychological traum a.

A B ro a d e r D e fin itio n o f P T S D

In the D SM -5, PTSD is listed am ong Traum a-and-Stressor-Related D isorders. For a person to be diagnosed w ith PTSD , she be m ust exposed to,

w itness, or experience the details of a traum atic experience (e.g., a ﬁrst responder), one that involves "actual or threatened death, serious

injury, or sexual violence" (APA, 2013, p. 271). These experiences can include such events as com bat, threatened or actual physical attack,

sexual assault, natural disasters, terrorist attacks, and autom obile accidents. This criterion m akes PTSD the only disorder listed in the D SM in

w hich a cause (extrem e traum a) is explicitly speciﬁed.

Sym ptom s of PTSD include intrusive and distressing m em ories of the event, ﬂashbacks (states that can last from a few seconds to several days,

during w hich the individual relives the event and behaves as if the event w ere occurring at that m om ent), avoidance of stim uli connected to the

event, persistently negative em otional states (e.g., fear, anger, guilt, and sham e), feelings of detachm ent from others, irritability, proneness

tow ard outbursts, and an exaggerated startle response (jum piness). For PTSD to be diagnosed, these sym ptom s m ust occur for at least one

m onth.

Roughly 7% of adults in the U nited States, including 9.7% of w om en and 3.6% of m en, experience PTSD in their lifetim e, w ith higher rates

am ong people exposed to m ass traum a and people w hose jobs involve duty-related traum a exposure (e.g., police oﬃ cers, ﬁreﬁghters, and

em ergency m edical personnel). N early 21% of residents of areas affected by H urricane Katrina suffered from PTSD one year follow ing the

hurricane, and 12.6% of M anhattan residents w ere observed as having PTSD 2-3 years after the 9/11 terrorist attacks.

R is k F a c to rs fo r P T S D

O f course, not everyone w ho experiences a traum atic event w ill go on to develop PTSD . Several factors strongly predict the developm ent of

PTSD , including traum a experience, greater traum a severity, lack of im m ediate social support, and m ore subsequent life stress. Traum atic

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Figure 13.14 PTSD was ﬁrst recognized in

soldiers who had engaged in com bat.

Research has shown that strong social

support decreases the risk of PTSD. This

person stands at the Vietnam Traveling

M em orial W all. (credit: Kevin Stanchﬁeld)

events that involve harm by others (e.g., com bat, rape, and sexual m olestation) carry greater risk than do other traum as (e.g., natural disasters).

Factors that increase the risk of PTSD include fem ale gender, low socioeconom ic status, low intelligence, personal history of m ental disorders,

history of childhood adversity (abuse or other traum a during childhood), and fam ily history of m ental disorders. Personality characteristics such

as neuroticism and som atization (the tendency to experience physical sym ptom s w hen one encounters stress) have been show n to elevate the

risk of PTSD . People w ho experience childhood adversity and/or traum atic experiences during adulthood are at signiﬁcantly higher risk of

developing PTSD if they possess one or tw o short versions of a gene that regulates the neurotransm itter serotonin. This suggests a possible

diathesis-stress interpretation of PTSD : its developm ent is inﬂuenced by the interaction of psychosocial and biological factors.

S u p p o rt fo r S u ffe re rs o f P T S D

Research has show n that social support follow ing a traum atic event can reduce the likelihood of PTSD .

Social support is often deﬁned as the com fort, advice, and assistance received from relatives, friends,

and neighbors. Social support can help individuals cope during diﬃ cult tim es by allow ing them to discuss

feelings and experiences and providing a sense of being loved and appreciated. A 14-year study of 1,377

Am erican Legionnaires w ho had served in the Vietnam W ar found that those w ho perceived less social

support w hen they cam e hom e w ere m ore likely to develop PTSD than w ere those w ho perceived greater

support (Figure 13.14). In addition, those w ho becam e involved in the com m unity w ere less likely to

develop PTSD , and they w ere m ore likely to experience a rem ission of PTSD than w ere those w ho w ere

less involved.

L e a rn in g a n d th e D e v e lo p m e n t o f P T S D

PTSD learning m odels suggest that som e sym ptom s are developed and m aintained through classical

conditioning. The traum atic event m ay act as an unconditioned stim ulus that elicits an unconditioned

response characterized by extrem e fear and anxiety. Cognitive, em otional, physiological, and

environm ental cues accom panying or related to the event are conditioned stim uli. These traum atic

rem inders evoke conditioned responses (extrem e fear and anxiety) sim ilar to those caused by the event

itself. A person w ho w as in the vicinity of the Tw in Tow ers during the 9/11 terrorist attacks and w ho

developed PTSD m ay display excessive hypervigilance and distress w hen planes ﬂy overhead; this

behavior constitutes a conditioned response to the traum atic rem inder (conditioned stim ulus of the sight

and sound of an airplane). Conditioning studies dem onstrate facilitated acquisition of conditioned

responses and delayed extinction of conditioned responses in people w ith PTSD .

Cognitive factors are im portant in the developm ent and m aintenance of PTSD . O ne m odel suggests that

tw o key processes are crucial: disturbances in m em ory for the event, and negative appraisals of the 2017/8/2 PSY101 - Module 13.6

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traum a and its afterm ath. According to this theory, som e people w ho experience traum as do not form coherent m em ories of the traum a;

m em ories of the traum atic event are poorly encoded and, thus, are fragm ented, disorganized, and lacking in detail. Therefore, these individuals

are unable to rem em ber the event in a w ay that gives it m eaning and context. A rape victim w ho cannot coherently rem em ber the event m ay

rem em ber only bits and pieces (e.g., the attacker repeatedly telling her she is stupid); because she w as unable to develop a fully integrated

m em ory, the fragm entary m em ory tends to stand out. Although unable to retrieve a com plete m em ory of the event, she m ay be haunted by

intrusive fragm ents involuntarily triggered by stim uli associated w ith the event (e.g., m em ories of the attacker's com m ents w hen encountering

a person w ho resem bles the attacker). This interpretation proposes that negative appraisals of the event ("I deserved to be raped because I'm

stupid") m ay lead to dysfunctional behavioral strategies (e.g., avoiding social activities w here m en are likely to be present) that m aintain PTSD

sym ptom s by preventing both a change in the nature of the m em ory and a change in the problem atic appraisals.

M odule 13.5 M odule 13.7