Buck O’Brian, 36
Primary Diagnostic Features
Exposure to traumatic event
Consistent Re-experiences of the event, which interferes with person’s ability to function.
Duration of one month of longer
II – NONE
III- Suicidal thoughts, severe burns over half of his body
IV- Fireman injured on the job
V- GAF = 58
Post Traumatic Stress Disorder
Acute Stress Disorder
Criterion C & E
There is evidence that some individuals are genetically predisposed to be more susceptible to symptoms of PTSD, such that the traumatic events experienced cause the nervous system to become hypersensitive to similar stressors. Additionally, low levels of GABA and increased levels of norepinephrine have been observed in cases of PTSD. Corrections of abnormalities in serotonin pathways have shown effectiveness in treatment of PTSD. Finally brain structures also play a role, specifically the atrophy of the hippocampus.
The symptoms of PTSD occur because of Classical Conditioning. The person acquires conditioned fear to the stimuli occurring during the traumatic event. Additionally, Operant Conditioning plays a role, negative reinforcement in that avoiding the stimuli will decrease anxiety and results in avoidant behavior. In this case, avoidance of the firehouse, which triggers his anxiety.
Excessive self-blame for the traumatic events that were beyond their control and inappropriate guilt due to the outcome of the event are due to a set of the person’s beliefs about the event. The beliefs can be cause a sense of current threat, whether it is external, such that the person cannot rely on others or feels unsafe, or it can be internal, not trusting one’s own judgment or feeling at fault.
Work related trauma leading to his anxiety, in addition to his triggers being at his workplace. Also, his position of training new incoming firemen gives him a heightened standard that is simply unachievable, blaming himself and consistently making himself feel bad about a bad decision.