DIAGNOSTIC FEATURES OF ACUTE STRESS DISORDER

1. This disorder, which occurs within a month of a traumatic event, causes clinically significant
distress or impairment that lasts between 2 days and 4 weeks. The diagnosis is assigned to people
who experience significant distress or impairment associated with exposure to a traumatic even
in which :

a) They experienced, witnessed, or confronted event(s) involving actual or threatened death

or serious injury, or a physical threat to themselves or others.

b) They respond with intense fear, helplessness or horror

2. Either during or after the event, the individual has three or more of the following dissociative
symptoms:

a) Sense o ' , detachment, numbing or lack of emotional responsiveness

b) Reduce feeling of awareness of surroundings, as if in a daze.

c) Feelings of unreality (derealization)

d) Sensation of being detached from oneself (depersonalization^

e) Inability to recall an important aspect of the trauma (dissociative amnesia)

3. The traumatic event is re-experienced through recurrent images, thoughts, dreams, illusions,
flashback episodes, or a sense of reliving the experience, or the person feels intense distress when
exposed to reminders of the event.

4. The individual avoids stimuli that evoke recollections of the trauma.

5. The individual experiences symptoms of anxiety or increased arousal, such as difficulty sleeping,
irritability, poor concentration, hyper vigilance, exaggerated startle response and restless-ess.

POST-TRAUMATIC STRESS DISORDER Diagnostic Features

1. This disorder, which causes clinically significant distress or impairment, is assigned to people
who have been exposed to a traumatic even in which:

a) They experienced, witnessed or confronted an event involving actual or . - threatened

death or serious injury, or a physical threat to themselves or others.
 b) They responded with intense fear, helplessness or horror

2. For at lest one month there is a persistent re-experiencing of the traumatic even in one or more of
the following ways:

a) Recurrent and intrusive distressing recollections ot the event.

b) Recurrent distressing dreams ol the event

c) Acting of feeling as if the event were recurring ( e.g. a reliving of the experience, illusions,
hallucitions, dissonative flash backs)

d) Internal distress at exposure to internal or external ones that symbolize or resemble an aspect
of the event.

e) Psychological reactivity on exposure to internal or external ones that symbolize or resemble

an aspect of the event.

3 For at least, one month, there is avoidance of stimuli associated with the trauma and a numbing of
general responsiveness, as indicated by at least three of the following:

a) Efforts to avoid thoughts, feelings or conversations associated with the trauma.

b) Efforts to avoid activities, places, or people that evoke recollections of the trauma.

c) Inability to recall an important aspect of the trauma.

d) Markedly diminished interest or participation in significant activities.

e) Feelings of detachment or estrangement from others.

0 Restricted range of affect (e.g. inability tc experience loving feelings)

g) Sense of foreshortened future (erg pessimism about career, family and life).
4. For at least one month, there are persistent symptoms of increased arousal as indicated by at least
two of the following: •

• Difficulty falling or staying a sleep.

• Irritability or outbursts of anger.
• Concentration difficulty.
• Hyper vigilance.
• Exaggerate startle response. .

54
 r4 Imormal pfycholcnyy

Biological Perspectives

Biological abnormalities can cause PTSD. Once a traumatic experience has occurred, parts of the
individual nervous system become primed or hypersensitive to possible danger in the future.

Psychological Perspectives

- According to Freud, PTSD represents a flooding of the ego’s defenses with uncontrollable anxiety
originating from the intense and threatening experiences. The experience may trigger painful
memories of earlier unresolved unconscious conflicts and may have anxiety to over flow as a result of
an inability to keep these memories repressed.

- According to behaviorists a person with PTSD has acquired a conditioned fear to the stimuli that were
present at the time of the trauma. Because of learned association, the individual experiences anxiety
when these or similar stimuli are present, even in the absence of the traumatizing went. Such
reactions lead to avoidance. To escape from the traumatic event becomes reinforcing and this
reinforcement then strengthens the withdrawal icaction seen in PTSD victims.
• • I • * ‘iff nPlf J
- Cognitive - behavioral theorists have incorporated the concept of how people’s beliefs about
a traumatic event influence how people cope with it. Thoughts that lead to PTSD include excessive
self-blame for events beyond personal control and quit over the outcome of these events.
*• 9T

Socio-cultural perspectives

These include devastating wars. The Vietnam soldiers instead of receiving a hero 's welcome felt that their
efforts were neither valued nor respected. This lack of social support, rather than the combat experience
itself, may have contributed to the disorder. Culturally, in certain ethnic groups tremendous.stigma is
associated with seeking professional psychological tielp. This can aggravate the experience of PTSD.

Treatment
.M ,
1. Medication
••
2. Psychotherap y - such as supportive therapy and stress management
3. Tmaginal flooding and systematic desensitization
4. Rational thinking such as breaking their problems into manageable units.

.Donald Meichehaum describes a six-step cognitive- behavioral therapy

1. Establish a good working relationship with clients, characterized by nurturance and compassion.

2. Encourage clients’ view their symptoms in a more positive light e.g. numbing can be viewed as a
way of slowing the pace in order to deal with intense levels of distress.

Kenya Instiluie of Professional Counsellin

 A bno-rmul jnycbxrUyt^y

DIAGNOSTIC FEATURES OF ACUTE STRESS DISORDER

1. This disorder, which occurs within a month of a traumatic event, causes clinically significant
distress or impairment that lasts between 2 days and 4 weeks. The diagnosis is assigned to people
who experience significant distress or impairment associated with exposure to a traumatic even
in which :

a) They experienced, witnessed, or confronted event(s) involving actual or threatened death

or serious injury, or a physical threat to themselves or others.

b) They respond with intense fear, helplessness or horror

2. Either during or after the event, the individual has three or more of the following dissociative
symptoms:

a) Sense oi detachment, numbing or lack of emotional responsiveness

b) Reduce feeling of awareness of surroundings, as if in adaze.

c) Feelings of unreality (derealization)

d) Sensation of being detached from oneself (depersonalization!

e) Inability to recall an important aspect of the trauma (dissociative amnesia)

3. The traumatic event is re-experienced through recurrent images, thoughts, dreams, illusions,
flashback episodes, or a sense of reliving the experience, or the person feels intense distress when
exposed to reminders of the event.

4. The individual avoids stimuli that evoke recollections of the trauma.

- vir
5. The individual experiences symptoms of anxiety or increased arousal, such as difficulty sleeping,
irritability, poor concentration, hyper vigilance, exaggerated startle response and restlessness.

POST-TRAUMATIC STRESS DISORDER

w
Agnostic Features

f This disorder, which causes clinically significant distress or impairment, is assigned to people who
have been exposed to a traumatic even in which:

a) They experienced, witnessed or confronted an event involving actual or * threatened

death or serious injury, or a physical threat to themselves or others.

Kenya Institute of Professional Counselling 53

 A bnorwiciL p^ychaUgjy

b) They responded with intense fear, helplessness or horror

2. For at lest one month there is a persistent re-experiencing of the traumatic even in one or more of the
following ways:

a) Recurrent and intrusive distressing recollections of the event.

b) Recurrent distressing dreams of the event

c) Acting of feeling as if the event were recurring ( e.g. a reliving of the experience, illusions,
hallucitions, dissonative flash backs)

d) Internal distress at exposure to internal or external ones that symbolize or resemble an aspect of
the event.

e) Psychological reactivity on exposure to internal or external ones that symbolize or resemble an

aspect of the event.

3. For at least, one month, there is avoidance of stimuli associated writh the trauma and a numbing of
general responsiveness, as indicated by at least three of the following:

a) Efforts to avoid thoughts, feelings or conversations associated with the trauma.

b) Efforts to avoid activities, places, or people that evoke recollections of the trauma.

c) Inability to recall an important aspect of the trauma.

d) Markedly diminished interest or participation in significant activities.

*iarrr
"IMP*

e) Feelings of detachment or estrangement from others.

f) Restricted range of affect (e.g. inability tc experience loving feelings)

g) Sense of foreshortened future (erg pessimism about career, family and life).
4. For at least one month, there are persistent symptoms of increased arousal as indicated by at least two
of the following:

• Difficulty falling or staying a sleep.

• Irritability or outbursts of anger.
• Concentration difficulty.
• Flyper vigilance.
• Exaggerate startle response. .

Kenya Institute of Professional Counselling 54

 (4 bnoi'niai/ psychology

Biological Perspectives

Biological abnormalities can cause PTSD. Once a traumatic experience has occurred, parts of the
individual nervous system become primed or hypersensitive to possible danger in the future.

Psychological Perspectives

According to Freud. PTSD repiesents a flooding of the ego’s defenses with uncontrollable anxiety
originating from the intense and threatening experiences. The experience may trigger painful
memories of earlier unresolved unconscious conflicts and may have anxiety to over flow as a result of
an inability to keep these memories repressed.

According to behaviorists a person with PTSD has acquired a conditioned fear to the stimuli that
were present at the time of the trauma. Because of learned association, the individual experiences
anxiety when these or similar stimuli are present, even in the absence of the traumatizing went. Such
reactions lead to avoidance. To escape from the traumatic event becomes reinforcing and this
reinforcement then strengthens the withdrawal reaction seen in PTSD victims.
./***!'fftfk
. ** Jr ."iff? $k)
- Cognitive - behavioral theorists have incorporated the concept of how people’s beliefs about a traumatic
event influence how people cope with it. Thoughts that lead to PTSD include excessive self-blame
for events beyond personal control and quit over the outcome of these events.

Socio-cultural perspectives

These include devastating wars. The Vietnam soldiers instead of receiving a hero's welcome felt that their
efforts were neither valued nor respected. This lack of social support, rather than the combat experience
itself, may have contributed to the disorder. Culturally, in certain ethnic groups tremendous stigma is
associated with seeking professional psychological nelp. This can aggravate the experience of PTSD.

Treatment
dm,
1. Medication
2. Psychotherapy - such as supportive therapy and stress management
3. Imaginal flooding and systematic desensitization
4. Rational thinking such as breaking their problems into manageable units.

Mfeicjfebaum describes a six-step cognitive - behavioral therapy

* E Establish a good working relationship with clients, characterized by nurturance and compassion.

2. Encourage clients’ view their symptoms in a more positive light e.g. numbing can be viewed as a
way of slowing the pace in order to deal with intense levels of distress.

Kenya Inslilu/e of Professional Counselling 55