PSYC 211 - Stress and Trauma (FIVE)

Stress

discomfort of physical symptoms that arise when a stressor alters the body’s homeostatic equilibrium

Stressor

physical, psychological, or social trigger that causes individuals to experience stress

6 types of stress

1. Acute physical

2. Chronic physical

3. Acute social

4. Chronic social

5. Acute psychological

6. Chronic psychological

2 examples of acute physical stress

1. Infection

2. Drug use

2 examples of chronic physical stress

1. Pregnancy

2. Starvation

Example of acute social stress

Public speaking

2 examples chronic social stress

1. Social isolation

2. Neglect

Example of acute psychological stress

Work deadline

2 examples of chronic psychological stress

1. College

2. Financial problems

3 most problematic types of stressors

1. Unpredictable

2. Chronic

3. Extrem

3 potential results of extreme stressors

1. Hyper-responsive reactions

2. Hypo-responsive reactions

3. Progressive wear and tear on the body (high allostatic load)

8 examples of very problematic stressors

1. Major accidents

2. Natural disasters

3. Kidnapping

4. Physical assaults

5. War and violence

6. Rape

7. Discrimination

8. Child maltreatment

5 types of child maltreatment (and percentage of the most common)

1. Neglect (75%)

2. Physical abuse

3. Sexual abuse

4. Psychological maltreatment

5. Medical neglect

In North America, before they reach adulthood, _____ girls and ______ boys experience sexual abuse or assault by an adult or peer

1 in 4, 1 in 20

What did the longitudinal follow-up on Romanian Orphanages do?

Compared groups adopted at different ages

Age-related finding of longitudinal follow-up on Romanian Orphanages

Adoption before 6 months led to the best outcomes for children

3 negative long-term impacts found in the longitudinal follow-up on Romanian Orphanages

1. Reduced IQ

2. Brain changes

3. Disinhibited attachment

Historical trauma

cumulative emotional and psychological wounding, over the lifespan and across generations, emanating from massive group trauma experiences

2 examples of historical trauma

1. Jewish communities and Holocaust survivors

2. Japanese-American and Native American marginalization and enclosure

Racial trauma

involves ongoing individual and collective injuries due to exposure and re-exposure to race-based stress

Racial trauma impact/relevance

A very real and present public health threat that significantly impacts young people in marginalized groups

Finding on racial discrimination and COVID-19 stress

Stress increased for black mothers during COVID-19

2 types of stress during pregnancy

1. Psychological

2. Metabolic

3 steps of stress during pregnancy

Leads to neuroendocrine effectors → metabolic mediators → inflammatory processes

What has research shown about maternal stress and newborn outcomes?

Maternal lifetime discrimination (but not childhood abuse) impact the mother’s feeling of stress in pregnancy → influences newborn attention outcomes

New category in the DSM-5 that describes PTSD and more

Trauma- and Stress-Related Disorders (T/S-Related Disorders)

5 Trauma- and Stress-Related Disorders

1. Reactive attachment disorder

2. Disinhibited social engagement disorder

3. Posttraumatic stress disorder (PTSD)

4. Acute stress disorder

5. Adjustment disorder

Requirement of stressful events that warrant a DSM diagnosis

Stressors must pose an actual or threatened death or injury, or a threat to one’s physical integrity

2 attachment disorders

1. Reactive attachment disorder

2. Disinhibited social engagement disorder

2 common criterion between Reactive Attachment Disorder and Disinhibited Social Engagement Disorder

1. Unusual unstable, or neglectful upbringing

2. Developmental age of at least 9 months

2 symptoms of reactive attachment disorder

1. Emotional inhibition and withdrawal around caregivers

2. Social and emotional disturbance

Age of onset of reactive attachment disorder

Evident before age 5

3 symptoms of Disinhibited Social Engagement Disorder

1. Active approach and interaction with unfamiliar adults

2. More than just impulsivity

3. Might even walk off with strangers

5 DSM symptoms for PTSD

1. Exposure to actual or threatened harm

2. Intrusive symptoms

3. Persistent avoidance of associated stimuli

4. Negative alterations in cognition and mood

5. Increased arousal and reactivity

How can exposure to actual or threatened harm occur in PTSD?

Experiencing, witnessing, learning about…

3 examples of intrusive symptoms in PTSD

1. Recurrent memories

2. Dreams

3. Re-experiencing the event

3 examples of negative alterations in cognition and mood in PTSD

1. Dissociative amnesia

2. Distorted thoughts

3. Negative emotional state

3 examples of increased arousal and reactivity in PTSD

1. Hyper vigilance

2. Exagerated startle response

3. Trouble sleeping

PTSD symptoms must last for a duration of _________ or longer for a DSM diagnosis

1 month

2 PTSD specifiers

1. With dissociative symptoms

2. With delayed expression

2 aspects of the “with dissociative symptoms” PTSD specifier

1. Depersonalization

2. Derealization

Depersonalization

feeling detached from, and as if one were an outside observer of, one’s mental processes or body

Derealization

surroundings feel unreal, distant, or distorted

“With delayed expression” PTSD specifier

When full criteria are not met until at least 6 months after trauma

Required duration of acute stress disorder for DSM diagnosis

3 days-1month

DSM criteria for acute stress disorder

9 or more symptoms from 5 categories: intrusion, negative mood, dissociation, avoidance, and arousal

For what group is PTSD diagnostic criteria slightly different?

Children under age 6

DSM criteria for PTSD

Meet criteria for all main symptom criterion associated with PTSD

2 biological risk factors for PTSD

• Age 6 or younger

• Female

2 psychological risk factors for PTSD

1. Neuroticism/propensity for anxiety disorders

2. Self-blaming/avoidant coping style

2 environmental risk factors for PTSD

1. Lower SES/education (less resources)

2. Stressful environmental content beyond traumatic event

2 interventions for child maltreatment

1. Focus on changing how parents teach, discipline, and attend to their children

2. Case management

Example of a treatment that can be used in child maltreatment to teach parents

Parent-child interaction therapy (PCIT)

3 interventions for traumatized youth

1. Exposure therapy

2. Trauma-focused cognitive-behavioral therapy (TF-CGT)

3. Gradual exposure, modeling, education, coping, and prevention-skills training