December 27, 2024 • 10 mins
Ever wondered why not everyone who faces trauma ends up with PTSD? Join us as we unravel this complex disorder. You'll gain a clear understanding of PTSD's diagnostic criteria as outlined in the DSM-5-TR, exploring the crucial differences between PTSD and acute stress disorder, particularly the significance of symptom duration. We shatter prevalent myths, such as the notion that PTSD solely affects veterans or inevitably results in violence, emphasizing that the disorder arises from a wide range of traumatic experiences and affects individuals uniquely.
Linton also highlights the importance of diagnostic specifiers, which offer essential nuances that can shape effective treatment plans. We explore how factors like social support and resilience can prevent acute stress from evolving into PTSD. Furthermore, the episode delves into adjustment disorder, examining its development due to identifiable stressors. This episode promises a comprehensive exploration of PTSD and adjustment disorder, aiming to expand your understanding and dismantle common misconceptions.
If you need to study for your national licensing exam, try the free samplers at: LicensureExams
This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Let's start with PTSD , or post-traumatic stress
disorder.
According to the DSM-5-TR, thediagnostic criteria for PTSD
include exposure to actual orthreatened death, serious injury
or sexual violence.
The exposure can happendirectly, by witnessing the
(00:22):
event, or indirectly, likelearning about a traumatic event
occurring to a close friend orfamily member.
Speaker 2 (00:31):
And therein lies our first myth to debunk that
everyone who experiences traumadevelops PTSD.
Exposure to a traumatic eventis just part of the criteria
needed to diagnose PTSD.
And what are the other criteriafor PTSD?
Linton.
Speaker 1 (00:49):
Well, after the trauma, the person experiences a
variety of symptoms that aregrouped into four main clusters
One, intrusion symptoms, two,avoidance.
Three, negative changes inthinking and mood and four,
changes in arousal andreactivity.
Speaker 2 (01:11):
So let me give some examples of these.
Intrusive symptoms includedistressing memories, dreams and
flashbacks.
Avoidant symptoms involvebehaviors like not wanting to be
around people or places thatremind them of the traumatic
event.
Cognitive and mood changesinclude negative beliefs,
feelings of guilt, shame, angerand withdrawal from others.
(01:34):
And destructive symptoms couldinclude things like angry
outbursts, stress systems orphysical reactions to reminders
of the trauma.
This could include things likeangry outbursts, hypervigilance
and trouble concentrating Got it.
Speaker 1 (01:50):
The symptomology for PTSD is almost the same as acute
stress disorder.
There's a difference in thetotal number of symptoms
required for each diagnosis.
Acute stress requires ninesymptoms from a long list of
symptoms, while PTSD requires atleast six symptoms, with a
certain number of symptomscoming from specific categories.
(02:12):
However, the most significantdifference between the two
disorders, which you mustremember for the exam, is
duration, or how long thesymptoms last.
With acute stress disorder, thesymptoms last between three
days and one month.
Speaker 2 (02:28):
So what happens if you're working with a client in
New Zealand who has just beenthrough an earthquake and has
been diagnosed with acute stressdisorder, and their symptoms go
on for longer than one month?
Speaker 1 (02:42):
Then you're looking at potentially changing the
diagnosis to PTSD.
Now you've got me curious aboutsomething.
Yes Say, you've got a clientwho is diagnosed with acute
stress disorder.
Do they always go on to developPTSD?
Speaker 2 (02:59):
No, Some cases of acute stress disorder will
resolve in the first month.
There are several reasons forthis.
Early clinical interventionafter a trauma can help prevent
acute stress reactions fromdeveloping into PTSD.
Also, resilience factors likesocial support, healthy coping
strategies and a positiveoutlook can help some clients
(03:20):
recover from acute traumawithout chronic impairment.
Plus, the traumatic eventitself matters.
Sexual trauma, for example, hasa higher risk of PTSD versus
physical trauma sustained from acar accident or an earthquake.
The severity and nature of thetrauma affect the probability of
developing PTSD.
Speaker 1 (03:41):
Thanks for explaining that.
Now, there are a lot ofmisconceptions about PTSD.
One of those is that PTSDalways develops immediately.
But in reality, while symptomsusually begin within the first
three months following thetrauma, it could take several
more months or even years beforethe full criteria for PTSD are
met.
There's even a specifier forthat in the diagnosis PTSD with
(04:05):
delayed expression.
This is noted when fulldiagnostic criteria are not met
until at least six monthsfollowing the traumatic event.
That's not the most commoncourse, but it's still possible.
Speaker 2 (04:19):
There are those diagnostic specifiers that you
love so much.
Are they really that importantfor test takers to know about?
Speaker 1 (04:25):
Yes, this is not the time to start skimping in your
studies.
You need to have a goodfoundational knowledge of
diagnostic criteria andfamiliarize yourself with the
different specifiers used toprovide extra clinical details
about the client's presentation.
Certain specifiers, like thosefor severity, may indicate the
(04:46):
need for more aggressivetreatment.
Specifiers noting remissionsuggest treatment has been
effective so far.
Specifiers allow clinicians toprovide more nuance and detail
in the diagnosis, which can helpguide treatment planning.
I've got more reasons if youwant them.
Speaker 2 (05:03):
Okay, okay, I get the picture Back to PTSD.
Some people think it onlyaffects veterans, but the truth
is it can develop following anytraumatic event like sexual
assault, robbery, accidents orearthquakes in New Zealand.
Speaker 1 (05:19):
Right.
Another misconception is thatpeople with PTSD are prone to
violence.
Most people with PTSD are notviolent.
Irritability can be a symptom,but PTSD treatment actually aids
by improving emotionalregulation.
Speaker 2 (05:35):
Good point.
Let's move on to adjustmentdisorder.
This diagnosis requires thedevelopment of emotional or
behavioral symptoms in responseto an identifiable stressor.
Speaker 1 (05:45):
Yes, the distress must occur within three months
of the onset of the stressor.
What do we mean by stressor?
Well, common stressors includedivorce, job loss and a new life
phase.
Now, one thing that we hear alot of confusion about is the
duration requirements todiagnose adjustment disorder.
(06:07):
Can you explain that, eric?
Speaker 2 (06:09):
So one of the big misconceptions is that
adjustment disorder can onlylast six months.
This is incorrect.
If you learn this, please,please, please, listen closely.
The duration of an adjustmentdisorder can vary.
There's an acute form and achronic form, and to explain
this, I'm going to take it fromthe top.
(06:29):
Adjustment disorder isdiagnosed when emotional or
behavioral symptoms develop inresponse to an identifiable
stressor.
The symptoms must developwithin three months of the
stressor's onset.
Once the stressor or itsconsequences are gone, the
symptoms cannot persist for morethan six months.
Speaker 1 (06:49):
Now.
Can you give us a recap of this?
Speaker 2 (06:51):
Sure.
Adjustment disorder isdiagnosed when emotional or
behavioral symptoms develop inresponse to an identifiable
stressor.
The symptoms must developwithin three months of the
stressor's onset.
Once the stressor or itsconsequences are gone, the
symptoms cannot persist for morethan six months.
If the symptoms resolve in sixmonths after the stressor or its
(07:13):
consequences terminate, youwill use the specifier acute.
If the symptoms persist for sixmonths or longer in response to
a chronic stressor or astressor that has persistent
consequences, then you can tackon a persistent chronic
specifier to the adjustmentdisorder diagnosis Make sense.
Speaker 1 (07:34):
Well, let's move along to the critical difference
between adjustment disorder,acute stress disorder and PTSD.
A key difference is that withadjustment disorder, the
stressor does not have to betraumatic.
Any significant life stressorcan lead to adjustment
difficulties.
The main diagnostic criteriafor PTSD are exposure to actual
(07:57):
or threatened death, seriousinjury or sexual violence,
losing a job and financialhousing struggles, while very
stressful, does not meet thethreshold for a traumatic event
that could cause PTSD.
Adjustment disorder is commonlydiagnosed when someone has
difficulty coping withunemployment.
(08:17):
Ptsd would only be consideredif the job loss itself was
traumatically experienced.
Speaker 2 (08:24):
Right and although you can diagnose adjustment
disorder for someone who hasexperienced a trauma and is
having subsequent issues relatedto the trauma, you have to
consider their entire clinicalpresentation.
For example, are they havingflashbacks?
Are they easily startled?
Are they unable to experiencepositive emotions?
If so, then you might consideracute stress disorder or PTSD as
(08:48):
you make your diagnosis.
Here are the characteristics ofadjustment disorder.
One adjustment disorder developswithin three months of an
identifiable stressor.
Two common stressors includedivorce, job loss and illness.
3.
Common symptoms includedepression, anxiety and or
(09:09):
conduct problems.
4.
If the symptoms resolve in lessthan six months, it's an acute
form.
5.
If the symptoms become chronicand last longer than six months,
it's a persistent form.
And here are thecharacteristics of acute stress
disorder.
Acute stress disorder can occurafter exposure to actual or
threatened death, serious injuryor sexual violence, to symptoms
(09:33):
last three days to one monthafter the trauma.
Three acute stress disorder maypredict the development of PTSD
, for the client experiencesintrusion symptoms, negative
mood, disassociative symptoms,avoidance symptoms and arousal
symptoms.
And finally, thecharacteristics of PTSD.
Ptsd can occur after exposureto actual or threatened death,
(09:59):
serious injury or sexualviolence.
Symptoms are very similar toacute stress disorder.
Symptoms must last more thanone month.
Speaker 1 (10:10):
Well said.
Thank you all for tuning intoday.
We hope we've helped todemystify the trauma and
stressor-related disorders foryou and until the next podcast
remember it's in there.
Let's start with PTSD , or post-traumatic stress
disorder.
According to the DSM-5-TR, thediagnostic criteria for PTSD
include exposure to actual orthreatened death, serious injury
or sexual violence.
The exposure can happendirectly, by witnessing the
(00:22):
event, or indirectly, likelearning about a traumatic event
occurring to a close friend orfamily member.
Speaker 2 (00:31):
And therein lies our first myth to debunk that
everyone who experiences traumadevelops PTSD.
Exposure to a traumatic eventis just part of the criteria
needed to diagnose PTSD.
And what are the other criteriafor PTSD?
Linton.
Speaker 1 (00:49):
Well, after the trauma, the person experiences a
variety of symptoms that aregrouped into four main clusters
One, intrusion symptoms, two,avoidance.
Three, negative changes inthinking and mood and four,
changes in arousal andreactivity.
Speaker 2 (01:11):
So let me give some examples of these.
Intrusive symptoms includedistressing memories, dreams and
flashbacks.
Avoidant symptoms involvebehaviors like not wanting to be
around people or places thatremind them of the traumatic
event.
Cognitive and mood changesinclude negative beliefs,
feelings of guilt, shame, angerand withdrawal from others.
(01:34):
And destructive symptoms couldinclude things like angry
outbursts, stress systems orphysical reactions to reminders
of the trauma.
This could include things likeangry outbursts, hypervigilance
and trouble concentrating Got it.
Speaker 1 (01:50):
The symptomology for PTSD is almost the same as acute
stress disorder.
There's a difference in thetotal number of symptoms
required for each diagnosis.
Acute stress requires ninesymptoms from a long list of
symptoms, while PTSD requires atleast six symptoms, with a
certain number of symptomscoming from specific categories.
(02:12):
However, the most significantdifference between the two
disorders, which you mustremember for the exam, is
duration, or how long thesymptoms last.
With acute stress disorder, thesymptoms last between three
days and one month.
Speaker 2 (02:28):
So what happens if you're working with a client in
New Zealand who has just beenthrough an earthquake and has
been diagnosed with acute stressdisorder, and their symptoms go
on for longer than one month?
Speaker 1 (02:42):
Then you're looking at potentially changing the
diagnosis to PTSD.
Now you've got me curious aboutsomething.
Yes Say, you've got a clientwho is diagnosed with acute
stress disorder.
Do they always go on to developPTSD?
Speaker 2 (02:59):
No, Some cases of acute stress disorder will
resolve in the first month.
There are several reasons forthis.
Early clinical interventionafter a trauma can help prevent
acute stress reactions fromdeveloping into PTSD.
Also, resilience factors likesocial support, healthy coping
strategies and a positiveoutlook can help some clients
(03:20):
recover from acute traumawithout chronic impairment.
Plus, the traumatic eventitself matters.
Sexual trauma, for example, hasa higher risk of PTSD versus
physical trauma sustained from acar accident or an earthquake.
The severity and nature of thetrauma affect the probability of
developing PTSD.
Speaker 1 (03:41):
Thanks for explaining that.
Now, there are a lot ofmisconceptions about PTSD.
One of those is that PTSDalways develops immediately.
But in reality, while symptomsusually begin within the first
three months following thetrauma, it could take several
more months or even years beforethe full criteria for PTSD are
met.
There's even a specifier forthat in the diagnosis PTSD with
(04:05):
delayed expression.
This is noted when fulldiagnostic criteria are not met
until at least six monthsfollowing the traumatic event.
That's not the most commoncourse, but it's still possible.
Speaker 2 (04:19):
There are those diagnostic specifiers that you
love so much.
Are they really that importantfor test takers to know about?
Speaker 1 (04:25):
Yes, this is not the time to start skimping in your
studies.
You need to have a goodfoundational knowledge of
diagnostic criteria andfamiliarize yourself with the
different specifiers used toprovide extra clinical details
about the client's presentation.
Certain specifiers, like thosefor severity, may indicate the
(04:46):
need for more aggressivetreatment.
Specifiers noting remissionsuggest treatment has been
effective so far.
Specifiers allow clinicians toprovide more nuance and detail
in the diagnosis, which can helpguide treatment planning.
I've got more reasons if youwant them.
Speaker 2 (05:03):
Okay, okay, I get the picture Back to PTSD.
Some people think it onlyaffects veterans, but the truth
is it can develop following anytraumatic event like sexual
assault, robbery, accidents orearthquakes in New Zealand.
Speaker 1 (05:19):
Right.
Another misconception is thatpeople with PTSD are prone to
violence.
Most people with PTSD are notviolent.
Irritability can be a symptom,but PTSD treatment actually aids
by improving emotionalregulation.
Speaker 2 (05:35):
Good point.
Let's move on to adjustmentdisorder.
This diagnosis requires thedevelopment of emotional or
behavioral symptoms in responseto an identifiable stressor.
Speaker 1 (05:45):
Yes, the distress must occur within three months
of the onset of the stressor.
What do we mean by stressor?
Well, common stressors includedivorce, job loss and a new life
phase.
Now, one thing that we hear alot of confusion about is the
duration requirements todiagnose adjustment disorder.
(06:07):
Can you explain that, eric?
Speaker 2 (06:09):
So one of the big misconceptions is that
adjustment disorder can onlylast six months.
This is incorrect.
If you learn this, please,please, please, listen closely.
The duration of an adjustmentdisorder can vary.
There's an acute form and achronic form, and to explain
this, I'm going to take it fromthe top.
(06:29):
Adjustment disorder isdiagnosed when emotional or
behavioral symptoms develop inresponse to an identifiable
stressor.
The symptoms must developwithin three months of the
stressor's onset.
Once the stressor or itsconsequences are gone, the
symptoms cannot persist for morethan six months.
Speaker 1 (06:49):
Now.
Can you give us a recap of this?
Speaker 2 (06:51):
Sure.
Adjustment disorder isdiagnosed when emotional or
behavioral symptoms develop inresponse to an identifiable
stressor.
The symptoms must developwithin three months of the
stressor's onset.
Once the stressor or itsconsequences are gone, the
symptoms cannot persist for morethan six months.
If the symptoms resolve in sixmonths after the stressor or its
(07:13):
consequences terminate, youwill use the specifier acute.
If the symptoms persist for sixmonths or longer in response to
a chronic stressor or astressor that has persistent
consequences, then you can tackon a persistent chronic
specifier to the adjustmentdisorder diagnosis Make sense.
Speaker 1 (07:34):
Well, let's move along to the critical difference
between adjustment disorder,acute stress disorder and PTSD.
A key difference is that withadjustment disorder, the
stressor does not have to betraumatic.
Any significant life stressorcan lead to adjustment
difficulties.
The main diagnostic criteriafor PTSD are exposure to actual
(07:57):
or threatened death, seriousinjury or sexual violence,
losing a job and financialhousing struggles, while very
stressful, does not meet thethreshold for a traumatic event
that could cause PTSD.
Adjustment disorder is commonlydiagnosed when someone has
difficulty coping withunemployment.
(08:17):
Ptsd would only be consideredif the job loss itself was
traumatically experienced.
Speaker 2 (08:24):
Right and although you can diagnose adjustment
disorder for someone who hasexperienced a trauma and is
having subsequent issues relatedto the trauma, you have to
consider their entire clinicalpresentation.
For example, are they havingflashbacks?
Are they easily startled?
Are they unable to experiencepositive emotions?
If so, then you might consideracute stress disorder or PTSD as
(08:48):
you make your diagnosis.
Here are the characteristics ofadjustment disorder.
One adjustment disorder developswithin three months of an
identifiable stressor.
Two common stressors includedivorce, job loss and illness.
3.
Common symptoms includedepression, anxiety and or
(09:09):
conduct problems.
4.
If the symptoms resolve in lessthan six months, it's an acute
form.
5.
If the symptoms become chronicand last longer than six months,
it's a persistent form.
And here are thecharacteristics of acute stress
disorder.
Acute stress disorder can occurafter exposure to actual or
threatened death, serious injuryor sexual violence, to symptoms
(09:33):
last three days to one monthafter the trauma.
Three acute stress disorder maypredict the development of PTSD
, for the client experiencesintrusion symptoms, negative
mood, disassociative symptoms,avoidance symptoms and arousal
symptoms.
And finally, thecharacteristics of PTSD.
Ptsd can occur after exposureto actual or threatened death,
(09:59):
serious injury or sexualviolence.
Symptoms are very similar toacute stress disorder.
Symptoms must last more thanone month.
Speaker 1 (10:10):
Well said.
Thank you all for tuning intoday.
We hope we've helped todemystify the trauma and
stressor-related disorders foryou and until the next podcast
remember it's in there.
Popular Podcasts
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Therapy Gecko
An unlicensed lizard psychologist travels the universe talking to strangers about absolutely nothing. TO CALL THE GECKO: follow me on https://www.twitch.tv/lyleforever to get a notification for when I am taking calls. I am usually live Mondays, Wednesdays, and Fridays but lately a lot of other times too. I am a gecko.