Neurobiological Basis for PTSD Illness

The neurobiology of PTSD is broad and incorporates neuroanatomical, neurochemical, and neuroendocrine changes that happen in neural networks. The main coordinator of how people respond to stress is the hypothalamic-pituitary-adrenal (HPA) axis (Dutra & Sadeh, 2018). The stress response begins within the hypothalamus where corticotropin-releasing hormone (CRH) is secreted by the paraventricular neurons. CRH then stimulates adrenocorticotropin hormone to be released from the pituitary gland stimulating the adrenal cortex to release glucocorticoids. Individuals with PTSD have glucocorticoid signaling dysregulation caused by the heightening of negative feedback sensitivity. This leads to low levels of cortisol and blunted responses of ACTH resulting from heightened CRH levels. Due to this, there will be CRH receptors down regularly on the pituitary glands. PTSD development is predicted by low cortisol at the time when an individual is exposed to trauma. Another risk factor for PTSD development is hypocortisolemia. A core component of PTSD’s neurochemical makeup is the inappropriate regulation of catecholamine, amino acid, serotonin, opioid neurons, peptide, and all of which are present in the brain circuits that control and coordinate stress and anxiety reactions.

The DSM-5-TR Diagnostic Criteria for PTSD

Based on DSM-5-TR criteria, posttraumatic stress disorder (PTSD)is characterized by a sad mood, intrusion of dreams, memories, flashbacks, insomnia, decreased energy, dissociative symptoms, hopelessness, and loss of interest in social activities (APA, 2020). Individuals also present symptoms such as recurrent distressing dreams and memories, negative mood, altered reality sense, avoidance, arousal, and many more (Rumball, Happé & Grey, 2020). After engaging in an accident along with his father, Joe experienced symptoms of PTSD such as intrusive dreams, negative alterations, sleep problems avoiding people and places, and hypervigilance. Complex PTSD results from multiple traumatic events that an individual experiences over some time. PTSD resulting from the experience of the accident could be a major cause of Joe’s negative conduct, separation anxiety, and depressive moods besides being oppositional defiant. The video provides sufficient information for deriving PTSD as a diagnosis. Dr. Todd explains that Joe had substantial comorbidity such as intrusive memories of the accident and that he was extremely anxious about anything reminding him of the accident. Other critical symptoms of PTSD presented by Joe are also explained. I agree with other diagnoses presented including ADHD, MDD, conduct disorder, and oppositional defiant disorder presented in the case. This is because Dr. Todd explains the reasons behind these diagnoses demonstrated by Joe.

Psychotherapy Treatment Option

An effective intervention for Joe’s PTSD is cognitive-behavioral therapy. CBT will help him learn specific skills for improving his symptoms and build his confidence in managing the symptoms and avoiding the triggers (APA, 2020). My treatment option is considered gold standard treatment for several reasons. Since CBT focuses on updating unhelpful thinking patterns and finding active coping strategies, it is likely to work well with a patient who is experiencing several mental health issues. CBT is grounded on the cognitive model theory which states that the way an individual views a situation is significantly connected to the person’s reaction than the situation itself. A person’s perceptions are often unhelpful and distorted especially when the person is distressed. Using gold standard, evidence-based treatments is critical because it decreases the probability of harm as well as supports the effectiveness, efficiency, and affordability of psychological therapies. Besides, improved levels of general health and well-being, in addition to higher standards of excellence and accountability, are all related to the gold standard, evidence-based psychotherapies. By avoiding treatments with little to no proven benefit or efficacy, practitioners can save both time and resources.

References

American Psychiatric Association (APA). (2020). Assessment measures. In Diagnostic and statistical manual of mental disorders. Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.AssessmentMeasures

Dutra, S. J., & Sadeh, N. (2018). Psychological flexibility mitigates the effects of PTSD symptoms and negative urgency on aggressive behavior in trauma-exposed veterans. Personality Disorders: Theory, Research, and Treatment, 9(4), 315. https://doi.org/10.1037/per0000251

Rumball, F., Happé, F., & Grey, N. (2020). Experience of trauma and PTSD symptoms in autistic adults: risk of PTSD development following DSM‐5 and non‐DSM‐5 traumatic life events. Autism Research, 13(12), 2122-2132. https://doi.org/10.1002/aur.2306