Let's start with PTSD , or post-traumatic stress disorder . According to the DSM-5-TR , the diagnostic criteria for PTSD include exposure to actual or threatened death , serious injury or sexual violence . The exposure can happen directly , by witnessing the event , or indirectly , like learning about a traumatic event occurring to a close friend or family member .
And therein lies our first myth to debunk that everyone who experiences trauma develops PTSD . Exposure to a traumatic event is just part of the criteria needed to diagnose PTSD . And what are the other criteria for PTSD ? Linton .
Well , after the trauma , the person experiences a variety of symptoms that are grouped into four main clusters One , intrusion symptoms , two , avoidance . Three , negative changes in thinking and mood and four , changes in arousal and reactivity .
So let me give some examples of these . Intrusive symptoms include distressing memories , dreams and flashbacks . Avoidant symptoms involve behaviors like not wanting to be around people or places that remind them of the traumatic event . Cognitive and mood changes include negative beliefs , feelings of guilt , shame , anger and withdrawal from others .
And destructive symptoms could include things like angry outbursts , stress systems or physical reactions to reminders of the trauma . This could include things like angry outbursts , hypervigilance and trouble concentrating Got it .
The symptomology for PTSD is almost the same as acute stress disorder . There's a difference in the total number of symptoms required for each diagnosis . Acute stress requires nine symptoms from a long list of symptoms , while PTSD requires at least six symptoms , with a certain number of symptoms coming from specific categories .
However , the most significant difference between the two disorders , which you must remember for the exam , is duration , or how long the symptoms last . With acute stress disorder , the symptoms last between three days and one month .
So what happens if you're working with a client in New Zealand who has just been through an earthquake and has been diagnosed with acute stress disorder , and their symptoms go on for longer than one month ?
Then you're looking at potentially changing the diagnosis to PTSD . Now you've got me curious about something . Yes Say , you've got a client who is diagnosed with acute stress disorder . Do they always go on to develop PTSD ?
No , Some cases of acute stress disorder will resolve in the first month . There are several reasons for this . Early clinical intervention after a trauma can help prevent acute stress reactions from developing into PTSD .
Also , resilience factors like social support , healthy coping strategies and a positive outlook can help some clients recover from acute trauma without chronic impairment . Plus , the traumatic event itself matters . Sexual trauma , for example , has a higher risk of PTSD versus physical trauma sustained from a car accident or an earthquake .
The severity and nature of the trauma affect the probability of developing PTSD .
Thanks for explaining that . Now , there are a lot of misconceptions about PTSD . One of those is that PTSD always develops immediately . But in reality , while symptoms usually begin within the first three months following the trauma , it could take several more months or even years before the full criteria for PTSD are met .
There's even a specifier for that in the diagnosis PTSD with delayed expression . This is noted when full diagnostic criteria are not met until at least six months following the traumatic event . That's not the most common course , but it's still possible .
There are those diagnostic specifiers that you love so much . Are they really that important for test takers to know about ?
Yes , this is not the time to start skimping in your studies . You need to have a good foundational knowledge of diagnostic criteria and familiarize yourself with the different specifiers used to provide extra clinical details about the client's presentation . Certain specifiers , like those for severity , may indicate the need for more aggressive treatment .
Specifiers noting remission suggest treatment has been effective so far . Specifiers allow clinicians to provide more nuance and detail in the diagnosis , which can help guide treatment planning . I've got more reasons if you want them .
Okay , okay , I get the picture Back to PTSD . Some people think it only affects veterans , but the truth is it can develop following any traumatic event like sexual assault , robbery , accidents or earthquakes in New Zealand .
Right . Another misconception is that people with PTSD are prone to violence . Most people with PTSD are not violent . Irritability can be a symptom , but PTSD treatment actually aids by improving emotional regulation .
Good point . Let's move on to adjustment disorder . This diagnosis requires the development of emotional or behavioral symptoms in response to an identifiable stressor .
Yes , the distress must occur within three months of the onset of the stressor . What do we mean by stressor ? Well , common stressors include divorce , job loss and a new life phase . Now , one thing that we hear a lot of confusion about is the duration requirements to diagnose adjustment disorder . Can you explain that , eric ?
So one of the big misconceptions is that adjustment disorder can only last six months . This is incorrect . If you learn this , please , please , please , listen closely . The duration of an adjustment disorder can vary . There's an acute form and a chronic form , and to explain this , I'm going to take it from the top .
Adjustment disorder is diagnosed when emotional or behavioral symptoms develop in response to an identifiable stressor . The symptoms must develop within three months of the stressor's onset . Once the stressor or its consequences are gone , the symptoms cannot persist for more than six months .
Now . Can you give us a recap of this ?
Sure . Adjustment disorder is diagnosed when emotional or behavioral symptoms develop in response to an identifiable stressor . The symptoms must develop within three months of the stressor's onset . Once the stressor or its consequences are gone , the symptoms cannot persist for more than six months .
If the symptoms resolve in six months after the stressor or its consequences terminate , you will use the specifier acute . If the symptoms persist for six months or longer in response to a chronic stressor or a stressor that has persistent consequences , then you can tack on a persistent chronic specifier to the adjustment disorder diagnosis Make sense .
Well , let's move along to the critical difference between adjustment disorder , acute stress disorder and PTSD . A key difference is that with adjustment disorder , the stressor does not have to be traumatic . Any significant life stressor can lead to adjustment difficulties .
The main diagnostic criteria for PTSD are exposure to actual or threatened death , serious injury or sexual violence , losing a job and financial housing struggles , while very stressful , does not meet the threshold for a traumatic event that could cause PTSD . Adjustment disorder is commonly diagnosed when someone has difficulty coping with unemployment .
Ptsd would only be considered if the job loss itself was traumatically experienced .
Right and although you can diagnose adjustment disorder for someone who has experienced a trauma and is having subsequent issues related to the trauma , you have to consider their entire clinical presentation . For example , are they having flashbacks ? Are they easily startled ? Are they unable to experience positive emotions ?
If so , then you might consider acute stress disorder or PTSD as you make your diagnosis . Here are the characteristics of adjustment disorder . One adjustment disorder develops within three months of an identifiable stressor . Two common stressors include divorce , job loss and illness . 3 . Common symptoms include depression , anxiety and or conduct problems . 4 .
If the symptoms resolve in less than six months , it's an acute form . 5 . If the symptoms become chronic and last longer than six months , it's a persistent form . And here are the characteristics of acute stress disorder .
Acute stress disorder can occur after exposure to actual or threatened death , serious injury or sexual violence , to symptoms last three days to one month after the trauma . Three acute stress disorder may predict the development of PTSD , for the client experiences intrusion symptoms , negative mood , disassociative symptoms , avoidance symptoms and arousal symptoms .
And finally , the characteristics of PTSD . Ptsd can occur after exposure to actual or threatened death , serious injury or sexual violence . Symptoms are very similar to acute stress disorder . Symptoms must last more than one month .
Well said . Thank you all for tuning in today . We hope we've helped to demystify the trauma and stressor-related disorders for you and until the next podcast remember it's in there .