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DEVELOPMENTAL HAZARD PRESENTATION: PTSD IN ADULTS By: Emmanuel Dealca Kristin Davis Kaitlyn Downing Amber Arwine Shelby Fluegge

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DSM V & PTSD The diagnostic criteria for the manuals next edition identify the trigger to PTSD as exposure to actual or threatened death, serious injury or sexual violation. The exposure must result from one or more of the following scenarios, in which the individual: directly experiences the traumatic event witnesses the traumatic event in person learns that the traumatic event occurred to a close family member or close friend (with the actual or threatened death being either violent or accidental); or experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television or movies unless work-related). American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed.). Washington, DC: Author.

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DSM V SOME NEW ADDED DIAGNOSTIC CRITERIA Draws a clearer line when detailing what constitutes a traumatic event Sexual assault is specifically included Recurring exposure that could apply to police officers and first responders Language stipulating an individuals response to the event- intense fear, helplessness, or horror according to DSM-IV has been deleted, that criterion proved to have no utility in predicting the onset of PTSD. DSM V pays more attention to 4 distinct clusters: Re-experiencing, avoidance, negative cognitions and mood, and arousal. Re-conceptualized as a stress-response syndrome rather then an anxiety disorder American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed.). Washington, DC: Author.

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EPIDEMIOLOGY Statistics 7 or 8 of every 100 people will have PTSD at some point in their lives. About 5.2 million adults have PTSD during a given year. Women more likely to develop PTSD - 10% women 5% men will experience PTSD in their lifetime. Prevalence 6.8% of the U.S. population experiences lifetime prevalence. 3.5% of the U.S. population experiences 12 month prevalence. http://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asphttp://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp) http://www.nimh.nih.gov/statistics/1ad_ptsd_adult.shtml

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EPIDEMIOLOGY CONTD People with PTSD have among the highest rates of healthcare service use. People with PTSD present with a range of symptoms, the cause of which may be overlooked or undiagnosed as having resulted from past trauma. The annual cost to society of anxiety disorders is estimated to be approximately $42.3 billion. Research suggests that prolonged trauma may disrupt and alter brain chemistry. For some people, this may lead to the development of PTSD. http://www.sidran.org/sub.cfm?contentID=66&sectionid=4

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WHO IS MOST LIKELY TO DEVELOP PTSD? Those directly exposed to trauma as witness or victim Those seriously hurt during the event. Experienced lost lasting, very severe trauma. from http://www.ptsd.va.gov/public/PTSD-overview/basics/how-common- is-ptsd.asp)

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PTSD & THE MILITARY 11-20% of Veterans of Iraq & Afghanistan wars. 30% of Vietnam Veterans Symptoms Re-experiencing the trauma Avoidance and/or emotional numbness Feeling on edge or wary of danger Disparities Those with PTSD report experiencing a barrier to care, more so than those with other anxiety disorders. Only half of those with PTSD receive even minimal treatment. http://www.nimh.nih.gov/statistics/1ad_ptsd_adult.shtml http://www.nimh.nih.gov/statistics/1ad_ptsd_adult.shtml

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PTSD & THE MILITARY

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RISK FACTORS Environmental Demographic Cognitive Biological Genetic Halligan, S. & Yehuda, R. (2000). Risk Factors for PTSD. The National Center for Post Traumatic Stress Disorder. 11(3). http://ncptsd.org

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ENVIRONMENTAL RISK FACTORS A history of exposure to trauma or to chronic stress especially at an young age Prior assault Prior trauma A history of family instability Halligan, S. & Yehuda, R. (2000). Risk Factors for PTSD. The National Center for Post Traumatic Stress Disorder. 11(3). http://ncptsd.org

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DEMOGRAPHIC RISK FACTORS Gender Lower level of education, income, and being divorced or widowed. Higher risk in ethnic minorities Halligan, S. & Yehuda, R. (2000). Risk Factors for PTSD. The National Center for Post Traumatic Stress Disorder. 11(3). http://ncptsd.org

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COGNITIVE RISK FACTORS Lower intellectual functioning individuals Studies show that the soldiers that entered combat found that lower level pre-combat intelligence was associated with increased risk of PTSD Impairments in explicit memory in high risk groups (veterans) Halligan, S. & Yehuda, R. (2000). Risk Factors for PTSD. The National Center for Post Traumatic Stress Disorder. 11(3). http://ncptsd.org

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BIOLOGICAL RISK FACTORS An early exploration of biologic change in a group is known to be at high risk of PTSD. High level of stress within family Dissociative reactions Borderline personality and dependent personality disorders Halligan, S. & Yehuda, R. (2000). Risk Factors for PTSD. The National Center for Post Traumatic Stress Disorder. 11(3). http://ncptsd.org

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GENETIC RISK FACTORS Individuals with PTSD have parents or relatives with mood, anxiety, and substance abuse Intergenerational effects of stress and/or trauma Family history of PTSD or depression Halligan, S. & Yehuda, R. (2000). Risk Factors for PTSD. The National Center for Post Traumatic Stress Disorder. 11(3). http://ncptsd.org Post Traumatic Stress Disorder. (2014). Helpguide.org A trusted non-profit Resource. http://www.helpguide.org/mental/post_traumatic_stress_disorder_symptoms_ treatment.htm

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OTHER RISK FACTORS Lack of support from family/community Lack of coping skills Blaming the victim of the trauma Low self-esteem Post Traumatic Stress Disorder. (2014). Helpguide.org A trusted non-profit Resource. http://www.helpguide.org/mental/post_traumatic_stress_disorder_symptoms _treatment.htm

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PROTECTIVE FACTORS: INTIMATE PARTNER VIOLENCE strong social support system counseling religious belief education and income levels current employment (Astin et al., 1993; Mertin & Mohr, 2001; O'Keefe, 1998; Saunders, 1994; Vogel & Marshall, 2001)

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PROTECTIVE FACTORS: WAR TRAUMA & TORTURE Turk Civilians Preparedness Repeated exposure Social support OEF, & OIF era Veterans Post-trauma social support Pre-deployment preparation/training Study conclusion: PTSD prevention efforts should vary by veteran experience Pre-deployment prep did not seem sufficient Johnson, H., & Thompson, A. (2008). The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: A review. Clinical Psychology Review, 28, 36-47. doi:10.1016/j.cpr.2007.01.017 Renshaw, K. D. (2011). An integrated model of risk and protective factors for post-deployment PTSD symptoms in OEF/OIF era combat veterans. Journal of Affective Disorders, 128, 321-326. doi:10.1016/j.jad.2010.07.022

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PROTECTIVE FACTORS: INJURED MILITARY PERSONNEL Morphine 243 patients who received a PTSD diagnosis- 61% treated with morphine 453 who did not receive PTSD diagnosis- 76% treated with morphine A highly significant difference (p