PS440 Unit 7 PTSD Case Paper Example

The Smell of a Neighbor's Burn Pile: A PS440 Unit 7 Trauma and Stressor-Related Disorder Paper

[Student Name]

Purdue University Global

PS440: Psychopathology

Unit 7 Trauma and Stressor-Related Disorder Paper

[Instructor Name]

[Date]

The guest, his crew and the crisis center are composite; the manual, meta-analysis and review cited are real.

The Case

Jesse is a 31-year-old seasonal wildland firefighter based in the Black Hills of South Dakota. Last August, on a fire in Wyoming, a sudden wind shift sent flames over his crew's position. The crew deployed fire shelters. Jesse and five others came through with minor burns, but his closest friend on the crew, whose shelter was poorly sealed, was flown out with severe burns and spent six weeks in a burn unit. He survived but will not return to fire work.

Five months later, on a January night, Jesse called the crisis line after drinking most of a bottle of whiskey and said he did not want to wake up. He agreed to a ride to the center from a mobile crisis worker. He had no plan and no weapon at home, and he stayed three days.

He described nightmares about the roar of the fire most nights, sudden images of his friend's face during the day and a pounding heart when he smelled smoke, including a neighbor's burn pile that sent him back into his house in a panic. He has avoided the fire station and stopped seeing his crew. He blames himself for not checking his friend's shelter, though he was forty feet away. He feels numb, sleeps four or five hours, startles at loud noises and snapped at his girlfriend so often that she moved out. He has been drinking heavily to sleep. On the night he called, he had found an old crew photo while looking for a tax form, and he told staff he had not cried once since the fire until that moment.

Diagnosis

The DSM-5-TR places posttraumatic stress disorder among trauma- and stressor-related disorders and requires a qualifying event: the person must have come close to dying, been badly hurt or sexually assaulted, or seen such things happen to someone else (American Psychiatric Association, 2022). Its symptoms come in four groups. The first is the past breaking into the present through nightmares, flashbacks and unwanted images. The second is steering clear of anything that recalls the event. The third is a darkening of beliefs and feelings, including blame of oneself or others and a sense of being cut off. The fourth is a body stuck on alert, with jumpiness, poor sleep and a short temper. The picture has to persist beyond one month and interfere seriously with life or cause marked distress.

Jesse meets every criterion. He was exposed to threatened death and witnessed serious injury. He has intrusive memories, nightmares and intense reactions to smoke. He avoids the station and his crew. He blames himself, feels numb and has withdrawn. He is irritable, sleeps poorly and startles easily. The symptoms have lasted five months and have cost him his relationship and nearly his life. The counselor also noted an alcohol use disorder, moderate, which often accompanies PTSD.

Jesse's self-blame is not a symptom added to his trauma; it is one of the ways the trauma keeps working on him.

Why Jesse and Not the Others

Six crew members survived the same burnover. As far as Jesse knows, four are back at work without major problems. Most people exposed to trauma do not develop PTSD, which raises the question of what made him vulnerable.

Brewin et al. (2000) pooled studies of adults who had lived through trauma and compared fourteen candidate risk factors. Factors in place before the event, such as earlier psychiatric problems, a hard childhood or mental illness in the family, showed small effects that held fairly steadily across studies. Factors during and after the trauma had larger effects. Trauma severity mattered, but the strongest predictors were how little support people had afterward and how much new stress piled on.

Jesse's history fits that pattern. Before the fire, his risk factors were modest: his father was a heavy drinker, and Jesse had a period of depression after his parents divorced. The trauma itself was severe, and he had a close personal connection to the person most badly hurt. The largest factors came afterward. When the season ended in October, the crew scattered, and the people who understood what had happened went home to other states. His friend's long recovery reminded him of his guilt daily. His girlfriend left in December. He spent the winter alone, laid off from seasonal work, drinking to sleep. Each of those post-trauma factors removed a source of support or added stress at the moment he needed the opposite.

Treatment

Watkins et al. (2018) reviewed evidence-based psychotherapies for PTSD. They described strong research support for trauma-focused therapies, especially prolonged exposure, in which clients gradually approach trauma memories and avoided reminders, and cognitive processing therapy, in which clients question the conclusions they drew from the trauma, for instance that it was their fault. They also reviewed evidence for eye movement desensitization and reprocessing and for several other approaches, noting differences in the strength of evidence and the need to match treatments to clients.

Cognitive processing therapy fits Jesse well. His self-blame about the shelter is a central belief that can be examined directly: what he knew at the moment, what he could have done from forty feet away and what his friend has said about it. The therapy usually runs about twelve sessions, which could be completed before the next fire season. Prolonged exposure could address his avoidance of smoke and the station, which will matter if he wants to return to fire work.

His drinking needs to be addressed alongside PTSD treatment, not afterward, since he uses alcohol to manage symptoms. Reconnecting with his crew, several of whom have reached out, would address the lack of support that Brewin's analysis identified as the strongest risk factor.

Plan

At discharge, Jesse agreed to begin cognitive processing therapy with a therapist experienced in work with first responders, by video when weather closes the roads. A referral to an outpatient substance use program, a safety plan that includes his brother as a contact, and a peer support group for wildland firefighters complete the plan. The counselor encouraged him to call the crewmate who had been texting him. He did, the day before he left.

Conclusion

Jesse's PTSD followed a severe trauma, but the meta-analysis suggests that what happened after the burnover, a winter of isolation, loss and drinking, did as much as the fire itself to make him ill. The diagnostic criteria capture his symptoms, the risk factor research explains his vulnerability, and the treatment review points to therapies that target his self-blame and avoidance. Rebuilding the support he lost is part of treatment, not an extra.

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

Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 12, Article 258. https://doi.org/10.3389/fnbeh.2018.00258