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Chapter 14. Trauma- and Stressor-Related Disorders

Frederick Stoddard, M.D.; Naomi Simon, M.D., M.Sc.; Roger Pitman, M.D.
DOI: 10.1176/appi.books.9781585625031.805241

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Excerpt

Across the age spectrum, trauma- and stressor-related disorders represent long-lasting suffering and functional impairment for many but also offer opportunity for helpful diagnosis, early intervention, and therapeutic benefit. These disorders, and the individuals and families affected by them, have been the subject of intensive research at every level—from epidemiological and clinical to translational, neurobiological, and neuropsychological. In this chapter we address the rapidly expanding, complex body of knowledge accumulated from this research and pre-sent several different models for understanding trauma- and stressor-related disorders.

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Heart rate responses to trauma scripts in two posttraumatic stress disorder (PTSD) populations and a control group, and the effects of psychotherapy in a randomized controlled trial.HR = heart rate; TG = treatment group posttreatment; WG = waitlist group posttreatment.*P < 0.05.Source. Courtesy of Dr. Ramón Lindauer, from Lindauer RT, van Meijel EP, Jalink M, et al: “Heart Rate Responsivity to Script-Driven Imagery in Posttraumatic Stress Disorder: Specificity of Response and Effects of Psychotherapy.” Psychosomatic Medicine 68:33–40, 2006. Copyright 2006, Lippincott Williams & Wilkins. Used with permission.

Correlation between changes in blood-oxygenation-level–dependent (BOLD) activity and changes in total severity of posttraumatic stress disorder (PTSD)—i.e., changes in total score on the Clinician-Administered PTSD Scale (CAPS)—following exposure-based treatment.To view this figure in color, see Plate 7 in Color Gallery in middle of book.The functional maps display the areas where changes in BOLD activity in the anterior cingulate cortex (ACC) and amygdala correlated with changes in total CAPS score; the color scale represents the strength of the correlation. The scatter plots display the direction of these correlations (improvement on total CAPS on the horizontal axis; extent of BOLD activity on the vertical axis).Source. Courtesy of Dr. Kim Felmingham. Image prepared by Dr. Felmingham and used with her permission.

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