Introduction to Traumatic Stress (part one) Conceptualisations & Models of PTSD Dr Alastair Hull

125 Pages·2012·0.57 MB·English

Introduction to Traumatic
Stress (part one)
An overview of traumatic events,
reactions, conceptualisations &
neurobiology
Alastair Hull
Consultant Psychiatrist in Psychotherapy

United Kingdom Psychological Trauma Society, Regional Conference, City Hall, Cardiff, 2012
Importance of Trauma
• patients with chronic depression
– a history of early life trauma predicts the need for
psychotherapy as an adjunct to pharmacotherapy
(CBASP: Nemeroff et al, 2003)
• high percentage of patients with bipolar disorder
have a history of childhood deprivation or abuse

(50%; Garno et al, 2005)
• high rates of trauma exposure in the population
and in psychiatric inpatients
• non-recording of significant trauma common
(Mueser et al, 1998; Hull et al, 2010)
Importance of Trauma
• Trauma exposure is associated with effects upon
physical health
– Health care utilisation
– Infections, pain disorders, hypertension, diabetes,
asthma, allergies
• Post-traumatic Stress Disorder (PTSD) is
associated with effects upon physical health
– Excess all-cause mortality
– Chronic diseases such as cardiovascular, digestive
(including liver disease), musculoskeletal, endocrine and
respiratory
– Stands up even when control for other factors (including
alcohol and drugs)
Traumatic events

INDIVIDUALS EXPOSED
• Unintentional
• Intentional
(i.e., accidental*)
– assault
– motor vehicle accident
– robbery
– industrial accident
– rape

*with apologies to the BMJ
Traumatic events
COMMUNITIES/POPULATIONS EXPOSED
(i.e., disasters)
• Natural
• Human made
– hurricane, tornado
– technological

– earthquake, flood
– train /plane crash
Background about Trauma
What we think we know about traumatic events:
• Easy to define what = traumatic event (DSM & ICD)
• There are differences between technological and natural
trauma (for example, disasters)
• Traumatic events are equal opportunity events
• Some individuals more at risk of adverse psychological
reactions
• Early intervention is helpful
• The Media are intrusive & unhelpful
Media and the community
• Overseas disasters “one of them” until realise one of our citizens
affected, becomes “one of us” (for example, Tsunami)
• Piper Alpha
– “us” stories in local papers, TV stations in Scotland
– despite many men being from England
• Chilean miners
– BBC reported by other media as using up a large proportion of budget on 1
disaster- accuracy of report?
• Media loves mythologies
– creation of heroes
– Around causality and victimisation
• (e.g., 3 Mile Island; The China
Syndrome)
Positive experience of trauma
• 50 years after surviving the Bataan Death
March & 42 months internment in a POW
camp “wouldn’t repeat for a million dollars”

but, recalled as the most enriching &
ennobling experience of his life

• approximately 2/3rds of survivors of Piper
Alpha disaster described positive sequelae

• examples of cognitive reframing
Definition of a disaster
“…a severe disruption, ecological and psychosocial,
which greatly exceeds the coping capacity of the
affected community”

(World Health Organisation, 1992)
Media and the community
• BUT, media not moving on to the next event
causes problems
– new disaster not covered- becomes a hidden disaster
– for example, Tennessee floods happened at same time
as another disaster and terrorist attack
– less funds raised for relief
– people felt marginalised
• What message is given to individual trauma survivor by
the excessive interest in disaster survivor?
– the psychological effects are same/similar