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1、DSMIVCriteriaforPTSDASDSMIVCriteriaforPTSDAStressorCriteriontressorCriterion创伤后创伤后应激障碍的应激源标准应激障碍的应激源标准DSMIVDSMIV标准标准DSM-IV Criteria for PTSDA. Stressor Criterion The person has been exposed to a traumatic event in which both of the following have been present: The person has experienced, witnessed,
2、or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of self or others The persons response involved intense fear, helplessness, or horror. Note: in children, it may be expressed instead by disorganized or agitate
3、d behavior.PREVALENCE OF PTSD FOLLOWING DISASTERNatural DisastersBuffalo Creek Disaster Lifetime PTSD 59% at 14 yr follow-up 25% in children 37%Mt. St. Helens Volcanic Eruption PTSD in exposed sample 3.6%, PTSD among non-exposed 2.6%Tornado PTSD 2-21%., Post-traumatic Stress Impairment 59% Earthquak
4、e Post-traumatic Stress Impairment 32-60%, PTSD in children 26-95%Human-Made DisastersTechnological Disaster PTSD 7-50%, Post-traumatic Impairment 22-43%Major Fire Post-traumatic Stress Impairment 54-66%PTSD in burned survivors 100%Transportation Disasters PTSD 29-100% PTSD in children 40-47%Terrori
5、st Kidnapping and Torture PTSD 54%Mass Shooting 5% children 5-47%Rescue Workers pts Reactions 24%DISASTER EXPERIENCES ASSOCIATED WITH CHRONIC PTSDSurvivors/witnesses of mass destruction or death Unresolved bereavement Loss of home or community Survivors with histories of prior exposure to trauma Sur
6、vivors who experience major life stressors Survivors of toxic contamination disasters OTHER FACTORS ASSOCIATED WITH CHRONIC PTSDLow levels of emotional/social support or high levels of social demandCoping via avoidance, self-blame, or rumination(However: maladaptive patterns of coping may be the res
7、ult rather than cause of post-traumatic stress impairment )Coping via substance abuseServing as an emergency worker Children whose parents are persistently psychologically impaired.Children whose parents experience significant peritraumatic distress.DSM-IV Criteria for PTSDB. Intrusive Recollection
8、CriterionThe traumatic event is persistently re-experienced in one (or more) of the following ways: recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in young children, repetitive play may occur in which themes or aspects of the trauma
9、are expressed recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback epis
10、odes, including those that occur upon awakening or when intoxicated). Note: in young children, trauma-specific reenactment may occur intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event physiological reactivity upon expos
11、ure to internal or external cues that symbolize or resemble an aspect of the traumatic event DSM-IV Criteria for PTSDC. Avoidant / Numbing CriterionPersistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three
12、(or more) of the following: efforts to avoid thoughts, feelings, or conversations associated with the trauma efforts to avoid activities, places, or people that arouse recollections of the trauma inability to recall an important aspect of the trauma markedly diminished interest or participation in s
13、ignificant activities feeling of detachment or estrangement from others restricted range of affect (e.g., unable to have loving feelings) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span) DSM-IV Criteria for PTSDD. Hyperarousal Criter
14、ionPersistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: difficulty falling or staying asleep irritability or outbursts of anger difficulty concentrating hypervigilance exaggerated startle response Associated Features of PTSDSurvivo
15、r GuiltImpaired relationshipsImpaired capacity to regulate feelingsSelf destructiveness, impulsive behaviorDissociationSomatizationPersonality changeChange in world view, beliefsShame, despair, hostilitySocial withdrawalComorbid Diagnosis in PTSDDepressionDysthymiaAnxiety DisordersSubstance AbusePersonality DisorderesDifferential Diagnosis of PTSDAcute Stress DisorderAdjustment DisorderBereavementAffective DisorderPhobiaAnxiety Dis.Obsessive Compulsive Dis.Organic Brain Dis.Dissociative Dis.Substance Abuse Dis.Antisocial/ Borderline Personality D.Malingering结束语结束语谢谢大家聆听！谢谢大家聆听！19
