Post-Traumatic Stress Disorder
From its initial definition and frequent revisions in the Diagnostic and Statistical Manual of Mental Disorders, assessing and treating posttraumatic stress disorder (PTSD) has presented many challenges to clinicians and researchers alike. However, throug
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Overview
In this chapter, we briefly review the diagnostic features and assessment practices for posttraumatic stress disorder (PTSD). We also detail the mechanisms involved in the maintenance and treatment of PTSD and the evidence-supported treatment (EST) approaches for the disorder. Finally, we outline the basic and expert clinician competencies involved in the treatment of PTSD from an evidence-based, cognitive-behavioral perspective.
6.1.1 Diagnostic Features As defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2000), PTSD is characterized by (A) exposure to a traumatic event in which the individual experienced, witnessed, or was confronted with an event that involved the actual or threatened death or serious injury to one’s self or others and the individual’s response to said event which involves intense fear and helplessness. Traumatic events that commonly result in PTSD include, but are not limited to, military combat, being a victim of a violent assault or other crimes, natural or man-made disasters, motor vehicle accidents, or being diagnosed with a life-threatening illness. In addition, three symptom clusters are associated with the event, involving: (B) persistent reexperiencing of the traumatic event, including distressing recollections or dreams, acting or feelings as if the event were recurring, and intense psychological distress or physiological reactivity on exposure to cues that symbolize the event; (C) persistent avoidance of stimuli associated with the traumatic event, including avoidance of thoughts, feelings, memories, activities, places, or people that serve as reminders of the trauma, and general emotional numbing, including diminished interested in activities, feelings of detachment, restricted affect, and sense of a foreshortened future; and (D) persistent symptoms of increased arousal, including sleeping disturbance, increased irritability and anger, difficulty J. Thomas, M. Hersen (eds.), Handbook of Clinical Psychology Competencies, DOI 10.1007/978-0-387-09757-2_28, © Springer Science+Business Media, LLC 2010
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c oncentrating, hypervigilance, and an exaggerated startle response. The symptoms must (E) present for at least 1 month and (F) result in significant impairment in social and/or occupational functioning.
6.1.2 Prevalence, Course, and Risk Factors Although more than half of all US adults are exposed to at least one traumatic event (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995), lifetime prevalence for PTSD is estimated around 8% of the adult population (American Psychiatric Association, 2000). However, research demonstrates a dose–response relation between the severity of a traumatic event and the onset of PTSD (for review, see Friedman, Resick, & Keane, 2007), whereas prevalence of PTSD is higher among victims of more severe traumatic events (e.g., survivors of rape, childhood sexual abuse, and military combat and captivity). The course of PTSD is variable as the disorder c
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