II. Causes: Common Related Traumas leading to Acute Stress Disorder and PTSD

  1. Natural disaster
    1. Earthquake
    2. Flooding
    3. Hurricane
  2. Structure Fire or explosion
  3. Transportation or Motor Vehicle accident
  4. Other serious accident (home, work, recreational)
  5. Toxic substance exposure
  6. Physical assault or assault with a weapon
  7. Sexual Assault or other unwanted sexual experience
  8. War-related Trauma (combat or war zone exposure)
  9. Captivity
  10. Life-threatening illness or injury
  11. Severe suffering
  12. Sudden violent death of someone else
  13. Serious injury, or sudden death of someone close
  14. Spontaneous Abortion

III. Pathophysiology: Spectrum of Trauma Response

  1. Acute stress reaction (normal Trauma response)
    1. Timing
      1. Onset within minutes of Traumatic event
      2. Resolves in hour to days
    2. Symptoms
      1. Transient symptoms (e.g. anxiety, Fatigue, decreased concentration)
      2. Intensity of response varies with event severity
      3. Re-experiencing symptoms
        1. Thoughts
        2. Dreams
        3. Images
      4. Intense emotional reactions
        1. Fear
        2. Bewilderment
        3. Anger
        4. Helplessness
        5. Despair
  2. Acute Stress Disorder (exaggerated response)
    1. Timing
      1. Onset within 4 weeks of the Trauma
      2. Duration of symptoms 2 days to 4 weeks
    2. Symptoms
      1. Similar symptoms as for acute stress reaction, but more severe and persistent
      2. Marked symptoms causing significant distress or Impairment
  3. Posttraumatic Stress Disorder
    1. Timing
      1. Persists >4 weeks
    2. Symptoms
      1. Marked symptoms, distress and Impairment persist
      2. Abnormal response to environmental triggers
      3. Classical conditioned response to Trauma
        1. Traumatic event with serious threat to life
        2. Response to initial event
          1. Intense fear
          2. Helplessness
          3. Horror
        3. Hypothalamic-Pituitary axis involvement
          1. Excessive cortisol release

IV. Risk Factors: PTSD

  1. Severity of Trauma
  2. Genetic vulnerability (30% association in twins)
  3. History of previous Trauma
  4. Preexisting psychiatric disorder
  5. Family History of psychiatric disorder
  6. Limited support systems
  7. Exposure to reactivating environmental events

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