COUC 546 Week 2 DB Forum 2 Example

Discussion Board Forum 2: Thread and Replies

COUC 546 Psychopathology, Discussion Board Forum 2 (thread and two replies)

Thread by [Student Name]

The prompt, the writer's background and the classmates' posts are composites standing in for the course's own forum; the manual, textbook, Scripture and studies are real and described from their published sources; the requirements follow Liberty's public course guide for COUC 546.

Thread

One man I supervised on probation had been held at gunpoint during a robbery at the store where he worked. He did not describe fear when he talked about it. He described rage at himself for freezing, and he had stopped trusting anyone. Under DSM-IV, his presentation sat awkwardly in the anxiety chapter. Under DSM-5, it fits much better, and the reason is one of the most important changes in this module's reading.

DSM-5 moved posttraumatic stress disorder out of the anxiety disorders and into a new chapter of trauma- and stressor-related disorders, along with acute stress disorder, adjustment disorders, reactive attachment disorder and disinhibited social engagement disorder (American Psychiatric Association, 2013). What unites the chapter is not a type of emotion but a cause: exposure to a traumatic or stressful event is an explicit part of each diagnosis. The same reorganization gave obsessive-compulsive and related disorders their own chapter, so the old anxiety category was split three ways, each defined more precisely.

Friedman et al. (2011) reviewed the evidence that shaped the new criteria. They found little support for keeping the DSM-IV requirement that a person respond to trauma with intense fear, helplessness or horror, and they recommended removing it. Factor analyses suggested four symptom clusters rather than three, and research showed that trauma is often followed not only by fear but by anhedonia and dysphoria, anger and aggression, guilt and shame, dissociation, and negative beliefs about oneself and the world. The final criteria therefore separate avoidance from a new cluster of negative changes in thinking and mood, and they add symptoms such as persistent self-blame and reckless behavior.

For counselors, the change means that a trauma survivor who is angry, ashamed or numb, rather than afraid, may still be suffering from PTSD and deserves to be assessed for it. Kring et al. (2016) note that PTSD is one of the few diagnoses that names its cause, which makes a careful trauma history central to assessment. My probationer would likely have been seen as an anger problem and sent to an anger management class; today he would be screened for PTSD, and his self-blame would be recognized as a symptom rather than a character flaw.

Psalm 147:3 says the Lord heals the brokenhearted and binds up their wounds (English Standard Version Bible, 2001/2016). Recognizing the wound accurately, whatever emotion it shows up as, is the first part of binding it.

Classmates: have you seen trauma show up as anger or shame rather than fear?

Reply to Melissa

Melissa, you pointed out that most people experience at least one traumatic event but only some develop PTSD, and you asked what makes the difference. Large surveys give a sense of scale. Kessler et al. (2017) reviewed the World Mental Health surveys, which assessed 68,894 adults in 24 countries for 29 types of lifetime trauma. They found that 70.4% of respondents had experienced at least one trauma, with an average of 3.2 per person. Risk of PTSD varied considerably by trauma type, and traumas involving interpersonal violence carried the highest risk. Rape, other sexual assault, being stalked and the unexpected death of a loved one accounted for the largest shares of the overall PTSD burden.

Those findings support your point and add something important: the kind of event matters. For counselors, it suggests that a trauma history should ask about specific types of experiences rather than a general question about "anything traumatic," since clients may not label interpersonal violence or a sudden death as trauma. It also suggests that we should pay particular attention to clients who have experienced violence by another person. Do you think the unexpected death of a loved one belongs in the same category as violent trauma for treatment purposes?

Reply to Jonathan

Jonathan, you asked whether counselors should diagnose acute stress disorder in the first month after a trauma as a way of catching PTSD early. It is a reasonable idea, and it was one of the original purposes of the diagnosis. Bryant et al. (2011) reviewed the evidence while DSM-5 was being prepared and concluded that acute stress disorder does not adequately identify most people who later develop PTSD. They argued that its emphasis on dissociation was too restrictive and recommended describing severe acute stress reactions instead of treating the diagnosis as a precursor to PTSD.

That review changes how I would use the diagnosis. Acute stress disorder can describe someone who is suffering badly in the first weeks and needs help now, but a client who does not meet its criteria is not necessarily safe from later PTSD. In practice, a counselor might use a brief screen soon after a trauma, offer support and psychoeducation, and plan a follow-up assessment a month or two later. Watchful follow-up seems more useful than relying on any single early label, especially because many people recover naturally in the first months. How would you explain that kind of follow-up plan to a client who wants to know whether they will be okay?

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Bryant, R. A., Friedman, M. J., Spiegel, D., Ursano, R., & Strain, J. (2011). A review of acute stress disorder in DSM-5. Depression and Anxiety, 28(9), 802-817. https://doi.org/10.1002/da.20737

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Friedman, M. J., Resick, P. A., Bryant, R. A., & Brewin, C. R. (2011). Considering PTSD for DSM-5. Depression and Anxiety, 28(9), 750-769. https://doi.org/10.1002/da.20767

Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Benjet, C., Bromet, E. J., Cardoso, G., Degenhardt, L., de Girolamo, G., Dinolova, R. V., Ferry, F., Florescu, S., Gureje, O., Haro, J. M., Huang, Y., Karam, E. G., Kawakami, N., Lee, S., Lepine, J.-P., Levinson, D., ... Koenen, K. C. (2017). Trauma and PTSD in the WHO World Mental Health Surveys. European Journal of Psychotraumatology, 8(sup5), Article 1353383. https://doi.org/10.1080/20008198.2017.1353383

Kring, A. M., Johnson, S. L., Davison, G. C., & Neale, J. M. (2016). Abnormal psychology: The science and treatment of psychological disorders (13th ed.). Wiley.