Posttraumatic Stress Disorder (PTSD)
The Neurobiological Basis for PTSD Illness
The neurobiological basis for PTSD illness includes complex changes in the neuroendocrine and the neurochemical environment, as well as neuroanatomical changes. The neuroendocrine leading to the development of PTSD occur in the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis plays a central role in how individuals respond to stress. Exposure to or experiencing traumatic events, which are highly stressful events in an unexpected way, causes the hypothalamus to secrete corticotropin-releasing hormone (CRH), stimulating the release of adrenocorticotropin hormone (ACH) (Dunlop & Wong, 2019). ACH is responsible for stimulating the release of glucocorticoids, such as cortisol. As cortisol is responsible for the HPA’s negative feedback control and stress response, sustained cortisol exposure due to traumatic events heightens the HPA’s negative feedback sensitivity, high CRH and low ACH response to the CRH. Therefore, there is a dysregulation of glucocorticoid release, hence low levels of cortisol, which are associated with the development of PTSD (Rauch et al., 2020).
The changes in the neurochemical environment that occur due to exposure to traumatic events forming the basis for PTSD illness involve the dysregulation in neurotransmitter production such as serotonin and dopamine affect how the individual gets aroused and reacts to stress. There is a varying degree in the decrease or increase of the neurotransmitters responsible for reactivity to stress and anxiety during traumatic experiences. For instance, serotonin concentration decreases in the dorsal/median raphe, influencing the inability to regulate moods. With low levels of serotonin, the individual may become more aggressive, impulsive, more vigilant, with development of intrusive thoughts associated with PTSD. Another neurotransmitter, noradrenaline, responsible for stress response, can increase with exposure to extreme stress, leading to fear conditioning and the development of emotional memories. Genetic variances can influence the production of neurotransmitters such as dopamine, which is responsible for managing anxiety and can predict the development of PTSD (Dunlop & Wong, 2019). Exposure to high levels of stress also alters the functioning of other neurotransmitter systems, such as GABA and glutamate, affecting how an individual develops memories, interprets experiences, and responds to stress and anxiety, hence the risk of developing PTSD (Mann & Marwaha, 2023).
The neurochemical changes in the brain due to exposure to traumatic events are related to the neuroanatomical changes leading to the development of stress. The main neuroanatomical changes due to sustained exposure to stress occur majorly in the amygdala, the hippocampus, and the prefrontal cortex. Sustained stress increases the activity of the amygdala responsible for processing emotions such as fear, which increases the hyper-emotional response to stress. Hippocampal damage can occur due to elevated glucocorticoid levels with exposure to traumatic and stressful events (Vedantham et al., 2000). The hippocampus can shrink, affecting its functional capacity, hence functional memory deficits and risk for intrusive memories. Additionally, as exposure to traumatic events dysregulates emotional control and increases reactivity and impulsivity, the sustained stress exposure tends to make the medial prefrontal cortex grow smaller and less active in emotional regulation, hence the inability of people with PTSD to manage their fears (Mann & Marwaha, 2023).
DSM-5-TR Diagnostic Criteria for PTSD and Application in the Presented Case Study
DSM-5-TR criteria for PTSD, ICD-10 code 309.81 (F43.10), requires the diagnosis of PTSD in individuals six years and older to be based on exposure to or witnessing of actual traumatic events such as a death threat, serious injury, and or sexual violence (American Psychiatric Association, 2022). Such exposure or witnessing of the traumatic event can be a single extreme exposure or repeated exposure. Consideration should also be given to the presence of intrusive thought, nightmares without clear content, and hyperreactivity with exposure to the related events causing the trauma. The DSM-5-TR also requires a PTSD diagnosis to be based on the presence of negative cognitive and mood alterations attributed to the traumatic event experiences, including the inability to recall critical aspects of the experience, prolonged negative emotions, detachment, and exaggerated negative emotions related to the events. Other DSM-5-TR criteria for PTSD include avoidance of reminders and hyperreactivity.
DSM-5-TR criteria for PTSD relates to the symptomology presented in the case involving 8-year-old Joe. Firstly, Joe was involved in a car accident, witnessed the verbal argument between his father and the other driver, and witnessed the other driver pursuing them. Being a child, this exposure is consistent with criteria A of the DSM-5-TR in the diagnosis of PTSD. The main symptoms Joe manifests following this experience include having intrusive memories, avoidance, and heightened arousal. He is experiencing intrusive thoughts and has difficulties falling, and avoids all reminders of the event. Joe has also become highly anxious and physically aggressive at school and home. All of these symptoms align with DSM-5-TR’s criteria A to D in the diagnosis of PTSD.
The video, Presentation Example: Posttraumatic Stress Disorder (PTSD) (Links to an external site), provides sufficient information to derive a PTSD diagnosis as it provides details of the patient, including age, gender, nature of the family, and the event they were involved in (Grande, 2019). The video also provides the development of Joe’s symptoms following the accident and how he has been coping. The only other diagnoses I agree with are conduct disorder and separation anxiety disorder. Both can be due to Joe’s abandonment by his mother. The conduct disorder can be based on the symptomology, including Joe’s disruptive and aggressive behavior.
Psychotherapy Treatment Options for Joe
The trauma-focused cognitive behavioral therapy (TF-CBT) is the “gold standard treatment” for PTSD. The other option for Joe is exposure therapy. Although not considered a “gold standard treatment” from a clinical practice guideline perspective, it can help him address the avoidance behaviors and fears. The gold standard, evidence-based treatments like TF-CBT in psychiatric-mental health, is important as such treatments are empirically tested and proven to be effective in managing PTSD and other mental health issues.
The Scholarliness of the Supporting Sources
All of the supporting sources for this article are considered scholarly as all have been published in peer-reviewed journals, are current, have been published by individuals with authority in the subject, and utilize widely accepted academic journal structures such as an introduction, research methods, data analysis, and presentation of findings.
References
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders. Diagnostic and Statistical Manual of Mental Disorders. https://doi.org/10.1176/APPI.BOOKS.9780890425787
Dunlop, B. W., & Wong, A. (2019). The hypothalamic-pituitary-adrenal axis in PTSD: Pathophysiology and treatment interventions. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 89, 361–379. https://doi.org/10.1016/J.PNPBP.2018.10.010
Grande, T. (2019, August 21). Presentation example: Posttraumatic Stress Disorder (PTSD) [Video]. YouTube. https://www.youtube.com/watch?v=RkSv_zPH-M4
Mann, S. K., & Marwaha, R. (2023). Posttraumatic stress disorder. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK559129/
Rauch, S. A. M., King, A., Kim, H. M., Powell, C., Rajaram, N., Venners, M., Simon, N. M., Hamner, M., & Liberzon, I. (2020). Cortisol awakening response in PTSD treatment: Predictor or mechanism of change. Psychoneuroendocrinology, 118, 104714. https://doi.org/10.1016/J.PSYNEUEN.2020.104714
Vedantham, K., Brunet, A., Neylan, T. C., Weiss, D. S., & Mannar, C. R. (2000). Neurobiological findings in posttraumatic stress disorder: A review. Dialogues in Clinical Neuroscience, 2(1), 23–29. https://doi.org/10.31887/DCNS.2000.2.1/KVEDANTHAM
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Question 
Posttraumatic Stress Disorder
YouTube. https://www.youtube.com/watch?v=RkSv_zPH-M4
Briefly explain the neurobiological basis for PTSD illness.
Discuss the DSM-5-TR diagnostic criteria for PTSD and relate these criteria to the symptomology presented in the case study. Does the video case presentation provide sufficient information to derive a PTSD diagnosis? Justify your reasoning. Do you agree with the other diagnoses in the case presentation? Why or why not?
Discuss one other psychotherapy treatment option for the client in this case study. Explain whether your treatment option is considered a “gold standard treatment” from a clinical practice guideline perspective, and why using gold standard, evidence-based treatments from clinical practice guidelines is important for psychiatric-mental health nurse practitioners.
Support your Assignment with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.