PSYCH 650 Week 2 Anxiety, Trauma and Stressor-Related Disorders Example

A Bus Driver After a Fatal Crash: Telling Panic, Posttraumatic Stress and Normal Distress Apart, and What Treatment Research Offers

[Student Name]

University of Phoenix

PSYCH/650: Psychopathology

Week 2 Assignment

[Instructor Name]

[Date]

The crisis unit, its staff and the client are composites written for a model paper; diagnostic criteria and research findings come from the sources listed.

Fear and anxiety are normal responses to danger, and most people exposed to trauma recover. For some, fear persists, spreads and disrupts life. Mr. T.'s three weeks of nightmares are the starting point for sorting out which, if any, of these disorders fits, and what the treatment literature can offer him.

The Case

Mr. T., a thirty-four-year-old bus driver for the regional transit system in Phoenix, was driving his evening route when a car struck a pedestrian in the crosswalk directly in front of his bus. He stopped, called for help and stayed with the man, who died before paramedics arrived. Mr. T. took two days off and returned to work. Three weeks later, he came to our crisis stabilization unit, saying he had barely slept. He described nightmares of the crash, flashes of the scene when he closed his eyes, avoiding the intersection by asking to change routes, jumping at the sound of brakes, irritability with his children and guilt that he could not save the man. He also described two episodes, one in a grocery store, of sudden pounding heart, shortness of breath and a feeling that he was dying, peaking within minutes. He has no history of mental health treatment. His wife works nights, and he has few close friends.

How Common Are These Disorders?

Kessler et al. (2005) interviewed more than nine thousand American adults chosen to mirror the country and asked about symptoms across their whole lives. Anxiety disorders were the most prevalent class of disorders, with about twenty-nine percent of adults meeting criteria for at least one in their lifetime; specific phobia and social phobia were most common, and posttraumatic stress disorder affected about seven percent. Most disorders began early in life, with anxiety disorders often starting in childhood or adolescence. Mr. T.'s symptoms began in adulthood after a specific event, which points toward trauma-related rather than lifelong anxiety disorders.

Normal Distress or Disorder?

Many people experience intrusive memories, poor sleep and jumpiness after witnessing a death, and symptoms often fade over weeks. The question is whether Mr. T.'s distress exceeds what is expected and impairs his functioning. His inability to sleep, avoidance of his route, irritability at home and panic episodes suggest significant impairment.

Acute Stress Disorder

The DSM-5-TR (American Psychiatric Association, 2022) defines acute stress disorder as a set of intrusion, negative mood, dissociative, avoidance and arousal symptoms beginning or worsening after a traumatic event and lasting from three days to one month. At three weeks, Mr. T. falls within that window and shows intrusion symptoms such as nightmares and flashbacks, avoidance of the route, arousal symptoms such as startle and sleep problems and negative mood. Acute stress disorder fits his current presentation.

Posttraumatic Stress Disorder

For posttraumatic stress disorder, the person must have faced or seen death or grave injury and then show four families of symptoms, unwanted reliving, steering clear of reminders, darker thoughts and moods and a body stuck on alert, for longer than a month, with real suffering or loss of function. Mr. T. meets the exposure criterion and has symptoms in all clusters, but the duration requirement is not yet met. If his symptoms persist beyond one month, a PTSD diagnosis would be appropriate.

Three weeks after the crash, the calendar, not the symptoms, kept the diagnosis from being PTSD.

Panic Attacks Versus Panic Disorder

Mr. T.'s grocery store episodes fit the description of panic attacks: abrupt surges of intense fear peaking within minutes with physical symptoms. Panic attacks can occur within many disorders, including PTSD, and are listed as a specifier. Panic disorder requires recurrent unexpected attacks followed by at least a month of persistent worry about further attacks or maladaptive changes in behavior. With two attacks in three weeks, both arising in a period of trauma-related arousal, panic disorder is not supported now, though clinicians should monitor whether he begins avoiding places out of fear of attacks.

Adjustment Disorder as an Alternative

If Mr. T.'s symptoms had been milder, or had not included the specific intrusion and avoidance patterns of trauma disorders, adjustment disorder would be a reasonable alternative. Adjustment disorder describes emotional or behavioral symptoms that develop within three months of a stressor, are out of proportion to it or cause significant impairment and do not meet criteria for another disorder. Because Mr. T.'s symptoms do meet acute stress disorder criteria, that diagnosis takes precedence, but adjustment disorder remains relevant if his trauma-specific symptoms fade while low mood or irritability persists.

Guilt and Moral Injury

Mr. T.'s guilt deserves separate attention. He repeatedly said he should have seen the car sooner, although he had no control over it. Trauma-related guilt is common among people who witness deaths in their work, and it can maintain distress even when fear subsides. Cognitive processing therapy addresses such beliefs directly by helping people examine what they could and could not have known and done at the time.

Who Develops PTSD?

Brewin et al. (2000) meta-analyzed studies of risk factors for PTSD in trauma-exposed adults. Pre-trauma factors such as prior psychiatric history, childhood abuse and family psychiatric history had small but consistent effects. What happened during and after the event mattered more: how severe it was, how much new stress piled on and, near the top of the list, whether anyone was there to lean on. Effects of many factors varied across populations and study methods.

For Mr. T., protective factors include no prior psychiatric history; risk factors include the severity of witnessing a death up close, his guilt and his limited social support, with his wife working nights and few friends.

Treatment: Exposure and Inhibitory Learning

Craske et al. (2014) described an inhibitory learning approach to exposure therapy. The older story said fear simply wears down during a session; the newer one says the person learns something new, that the dreaded thing does not happen, and that this fresh memory has to outcompete the old one. Strategies to strengthen this new learning include designing exposures that violate the person's expectations, removing safety behaviors, varying exposure contexts and combining multiple fear cues. The authors argued that these strategies can make treatment gains last longer.

Trauma-focused therapies with strong evidence for PTSD, such as prolonged exposure and cognitive processing therapy, include exposure to trauma memories and reminders and work on beliefs such as guilt.

Plan for Mr. T.

The crisis team recommended a short stay for stabilization and sleep, education about common trauma reactions, a referral to the transit agency's employee assistance program for trauma-focused therapy, encouragement to connect with a peer support group for transit workers and gradual, planned return to his route with a supervisor's support. They also screened for suicide risk and alcohol use, both negative.

Limits

Diagnosis at three weeks is provisional. Mr. T.'s guilt may need specific attention beyond exposure.

Conclusion

Mr. T.'s symptoms fit acute stress disorder with panic attacks, not yet PTSD or panic disorder. Research on prevalence, risk factors and exposure therapy shows that his reaction is common, that support after trauma matters greatly and that effective treatments exist.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68(5), 748-766. https://doi.org/10.1037/0022-006X.68.5.748

Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23. https://doi.org/10.1016/j.brat.2014.04.006

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602. https://doi.org/10.1001/archpsyc.62.6.593