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.
This dysregulation is often mediated by alterations in neurotransmitters (e.g., exaggerated noradrenergic/catecholamine signaling) and the Hypothalamic-Pituitary-Adrenal (HPA) axis, which governs the body's stress response, often showing a blunted cortisol response to stressors.
DSM-5-TR Diagnostic Criteria for PTSD and Case Analysis
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) requires the presence of symptoms across five distinct clusters that must persist for more than one month, cause clinically significant distress or functional impairment, and not be attributable to substance use or another medical condition.
DSM-5-TR Criterion Cluster
Requirement
Relation to Case Study Symptoms
A. Stressor
Exposure to actual or threatened death, serious injury, or sexual violence (directly, witnessing, learning it happened to a close person, or repeated indirect exposure as a professional).
Present (Inferred): The video case client mentions a sexual assault and domestic violence, which clearly meets the Criterion A definition of exposure to actual or threatened serious injury or sexual violence.
B. Intrusion
$\ge 1$ symptom: Recurrent distressing memories, dreams, flashbacks, or intense/prolonged distress/physiological reaction to cues.
Present (Example): The client reports having nightmares and feeling anxious when near the site of the traumatic event.
C. Avoidance
$\ge 1$ symptom: Avoidance of internal (thoughts, feelings) or external (people, places) reminders.
Present (Example): The client reports avoiding the neighborhood where the assault occurred, which is an avoidance of external reminders.
D. Negative Alterations in Cognitions & Mood
$\ge 2$ symptoms: Inability to recall key parts, negative beliefs about self/world, distorted blame, persistent negative emotional state, decreased interest, detachment, inability to experience positive emotions.
Present (Examples): The client reports feeling guilty ("it was my fault"), which is distorted blame, and feeling numb or having a negative emotional state.
Present (Examples): The client reports difficulty sleeping and being easily startled.
F, G, H
Duration $> 1$ month, significant distress/impairment, not due to substance/medical condition.
Present (Inferred): Symptoms are implied to be chronic and clearly cause functional impairment (avoiding travel, social withdrawal).
Sufficient Information to Derive a PTSD Diagnosis?
No. While the case presentation provides strong evidence and meets the criteria for every symptom cluster (B, C, D, E), it lacks the duration criterion (F) and the necessary structured clinical interview depth to make a definitive diagnosis.
Justification:
Duration (Criterion F): The video does not specify how long the client has been experiencing the symptoms. A PTSD diagnosis requires symptoms to persist for more than one month.8 Without this time frame, the diagnosis could be Acute Stress Disorder (ASD) if the symptoms have lasted less than a month, or a differential diagnosis must be fully ruled out.
Exclusion/Differential Diagnosis (Criterion H): The information provided is insufficient to rule out all other potential causes, such as substance-induced symptoms or another underlying medical condition, which is required by the final criterion.
Required Number of Symptoms: While examples are given, a definitive diagnosis requires a specific number of symptoms to be endorsed within each cluster (e.g., one from B, one from C, two from D, two from E).9 The clinical interview would need to confirm that the required number in each cluster is met.
Agreement with Other Diagnoses
(Assuming the other diagnoses mentioned in the case presentation are Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD), which are common comorbidities and frequently overlap with PTSD symptoms):
Yes, I generally agree with the consideration of MDD and GAD as potential comorbidities, but a thorough differential diagnosis is essential.
Why:
MDD Overlap: Many PTSD Criterion D symptoms (e.g., persistent negative emotional state, markedly diminished interest, inability to experience positive emotions) overlap with symptoms of Major Depressive Disorder. Given the client's guilt and persistent negative mood, an MDD comorbidity is highly plausible.
GAD Overlap: Symptoms of hypervigilance, difficulty sleeping, and being easily startled (PTSD Criterion E) are similar to the chronic, excessive worry and physical tension characteristic of Generalized Anxiety Disorder.10 Given the client's ongoing anxiety about being near the trauma site, GAD is a strong possibility.
Crucially, in the presence of trauma, the NP must first determine if the symptoms are better explained by PTSD before diagnosing comorbidity. If the negative mood/anxiety is purely related to the trauma, PTSD may be the sole diagnosis.
Other Psychotherapy Treatment Option and Practice Guidelines
Other Psychotherapy Option: Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is a structured, phase-based therapy that aims to help the client process distressing trauma memories, reducing their lasting influence.11 The core mechanism involves the client briefly focusing on the trauma memory while simultaneously experiencing bilateral stimulation (e.g., guided eye movements, taps, or tones).12 The goal is to help the brain successfully process the memory, linking the emotional and cognitive components to facilitate adaptive resolution.
Sample Answer
The neurobiological basis for Post-Traumatic Stress Disorder (PTSD) involves a persistent dysregulation of the brain's fear circuit following exposure to trauma. This involves functional and structural changes in three key brain regions that normally work together to process threats:
Amygdala (The "Fear Center"): Individuals with PTSD exhibit hyperactivation (over-responsiveness) of the amygdala, leading to exaggerated fear, anxiety, and a heightened startle response. This results in the brain constantly perceiving a threat, even in safe environments.
Medial Prefrontal Cortex (mPFC, The "Brake"): The mPFC, which includes the anterior cingulate cortex (ACC), is responsible for emotional regulation and inhibiting the amygdala's fear response. In PTSD, there is often hypoactivation (under-responsiveness) or decreased functional connectivity, resulting in a failure to properly suppress fear and hyperarousal.
Hippocampus (The "Contextualizer/Memory Center"): The hippocampus is responsible for organizing memories and placing them into context (time, place). In PTSD, there is often a reduction in hippocampal volume and dysfunction, which may impair the ability to properly differentiate between the trauma memory and the safe present context, leading to intrusive symptoms like flashbacks.