PTSD Clinical Formulation: Predisposition and Perpetuators

Sonja-Batten

Booz Allen
Department of Veterans Affairs
Yale University
University of Nevada, Reno

Key Points

  1. Deborah’s predisposition to mental health issues stemmed from her mother’s anxiety and alcoholism, and an attempted sexual assault.
  2. Deborah’s avoidance behaviors, such as drinking and using marijuana, perpetuated and even worsened her symptoms.
  3. Experiential avoidance is described as evaluating thoughts, feelings, memories, bodily sensations, or other private events as negative, then taking steps to reduce or avoid contact with them.
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Predisposition

Family History

We need to know about Deborah’s family history, especially if there are any predispositions to mental health issues. She reported that there was a family history of anxiety. Although she didn’t use a specific diagnostic label, her description suggested that her mom had undiagnosed general anxiety disorder symptoms as well as alcoholism. Her mom never acknowledged those problems or sought treatment, but would always think about the worst thing that could happen and be anxious about that. She instilled this sense of “what could go wrong” in Deborah.

When bad things would happen in Deborah’s life as she was growing up, even when it was just bad luck and she bore no responsibility, her mom would imply that Deborah caused the situations or made bad choices that led to them. This made Deborah try harder not to let bad things happen to her. But as we know, she couldn’t control that.

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