Posttraumatic Stress Disorder in Older Adults

by Maria Böttche

Institution: Freie Universität Berlin
Department: FB Erziehungswissenschaft und Psychologie
Degree: PhD
Year: 2015
Record ID: 1100206
Full text PDF: http://edocs.fu-berlin.de/diss/receive/FUDISS_thesis_000000099026


Posttraumatic stress disorder (PTSD) is a common and disabling psychological consequence in the aftermath of traumatic events in older adults. Nevertheless, symptoms of PTSD are often misdiagnosed in older adults because of concurrent mental and physical problems. The scarcity of evidence-based empirical research on PTSD and its characteristics in older adults lies behind these misdiagnoses. Research so far has led to the understanding that particular challenges in the therapeutic process must be taken into account when providing psychotherapy to older PTSD patients and therefore, age-specific adaption is needed. To address the above-mentioned gaps in research, four research studies investigated the characteristics and treatment of PTSD in older adults with early-lifetime traumatization. The overview set out a summary of the characteristics of PTSD and its current treatment approaches in older adults. Research into characteristics indicated that the timing of the trauma (recent vs. early life) impacts prevalence rates, course and symptom profile of PTSD in older adults. Current data demonstrates generally lower prevalence rates and symptom severity in older than in younger adults with acute traumatization. Regarding early-life traumatization, a decline in PTSD symptom severity could be observed over the life span. However, a change in shape of PTSD symptoms was observed in a subgroup of older adults, indicating an increase in avoidance symptoms and a decrease in re-experiencing symptoms. Research into PTSD treatment approaches for older adults indicated that PTSD-specific interventions could be effectively combined with age-specific approaches. The overview allowed a general classification of the characteristics of PTSD symptoms in older adults. Article II broadens the knowledge about predominant typologies of PTSD in treatment-seeking older adults. The hypothesis was that the typologies in older adults are similar to those in other age cohorts (intermediate and pervasive) and that the pervasive disturbance group would be best characterized by a higher level of avoidance symptoms. The findings suggested that PTSD in treatment-seeking older adults may be characterized by three predominant typologies: an intermediate disturbance class and two pervasive disturbance classes which differed by their level of avoidance symptoms (high and low avoidance). Both pervasive disturbance classes showed higher depression, anxiety and somatization symptoms and a higher number of traumatic events compared to the intermediate disturbance class. Articles III and IV focused on the treatment of PTSD in older adults. Article III evaluated the efficacy of an age-specific Internet-based writing intervention (Integrative Testimonial Therapy) in mitigating PTSD symptoms. ITT combined well-evaluated PTSD-specific CBT components and age-specific components. The pilot study revealed a significant decrease in PTSD symptom severity as well as significant increase in constructive dimensions (quality of life, self-efficacy and posttraumatic…