Abnormal Psychology

Anxiety Disorders 311

Posttraumatic Stress Disorder

Within a 15-year span, Howard Hughes suffered more than his share of

brushes with death—of his own and that of other people. He ran over and

killed a pedestrian. He was the pilot in three plane accidents: In the fi rst

one, his cheekbone was crushed; in the second, two of his copilots died; in

the third, he sustained such extensive injuries to his chest that his heart was

pushed to the other side of his chest cavity and he wasn’t expected to live

through the night. Hughes did survive, but he clearly had endured a highly

traumatic event.

Some people who experience a traumatic event go on to develop a stress

disorder, which according to DSM-IV-TR (American Psychiatric Associa-

tion, 2000) is marked by three types of persistent symptoms:

• Reexperiencing the traumatic event. Reexperiencing may involve fl ash-

backs that can include illusions, hallucinations, or a sense of reliving

the experience, as well as intrusive and distressing memories, dreams, or

nightmares of the event.

• Avoidance. The individual avoids anything related to the trauma. The person may

also experience a general emotional numbness.

• Increased arousal and anxiety. Arousal and anxiety symptoms include diffi culty

sleeping, hypervigilance, and a tendency to be easily startled (referred to as a

heightened startle response).

DSM-IV-TR includes two types of stress disorders: acute stress disorder, which

is the diagnosis when the above symptoms emerge within 4 weeks of a traumatic

event and last less than 1 month and the person also experiences dissociation (to be

discussed later); in contrast, posttraumatic stress disorder (PTSD) is the diagnosis if

the symptoms last more than 1 month.

In this section we fi rst explore the difference between everyday stress and the

traumatic stress associated with stress disorders and then discuss posttraumatic stress

disorder in detail. After that, we turn to the factors that give rise to stress disorders.

At the end of the section, we explore treatments for posttraumatic stress disorder.

Stress Versus Traumatic Stress

Most people would agree that Hughes experienced a traumatic event when his air-

plane crashed and he was severely injured. But where is the line that separates a

stressful event from a traumatic one? According to DSM-IV-TR, stress turns into

traumatic stress when “the person has been exposed to a traumatic event in which

both of the following were present:

1. the person experienced, witnessed, or was confronted with an event or events
   that involved actual or threatened death or serious injury, or a threat to the
   physical integrity of self or others [and]

• Medication (such as an SSRI or clomipramine) is the treatment for
  OCD that directly targets neurological factors. The primary treat-
  ment for OCD—exposure with response prevention—directly tar-
  gets psychological factors. Cognitive restructuring to reduce the
  irrationality and frequency of the patient’s intrusive thoughts and
  obsessions may also be employed. Family education or therapy,
  targeting social factors, may be used as an additional treatment
  to help the patient’s family function in a more normal way.

Making a Diagnosis

• Reread Case 7.6 about the woman who took a long time to get out
  of bed and get dressed in the morning, and determine whether
  or not her symptoms meet the criteria for obsessive-compulsive
  disorder. Specifi cally, list which criteria apply and which do not.
  If you would like more information to determine her diagnosis,
  what information—specifically—would you want, and in what
  ways would the information infl uence your decision?

Howard Hughes survived several plane crashes,

including the one shown above, and he ran over

and killed a pedestrian (Fowler, 1986); any of

these events would have been traumatic for most

people. Some people who experience a traumatic

event develop a stress disorder: acute stress dis-

order or posttraumatic stress disorder.

Bettmann/Corbis