trauma/dissociative/somatic

reactive attachment disorder criteria

a) inhibited and emotionally withdrawn from caregivers, don’t seek or respond to comfort when distressed

b) (2+) minimal social/emotional responsiveness to others, limited positive affect, unexplained irritability, sadness, or fearfulness when interacting with caregivers

c) history of extreme insufficient care

d) symptoms before age 5, with a developmental age of at least 9 months

disorder that involves withdrawal from caregivers and negative affect towards them due to extreme insufficient care. symptoms must come before age 5

reactive attachment disorder

disinhibited social engagement disorder criteria

pattern of inappropriate interactions with unfamiliar adults as demonstrated by (4+) reduced reticence approaching/interacting with strangers, diminished checking with adults after being separated, willingness to go with a stranger with no hesitation. must have history of extreme insufficient care and developmental age of at least 9 months.

disorder marked by a pattern of inappropriate interactions with unfamiliar adults as demonstrated by (4+) reduced reticence approaching/interacting with strangers, diminished checking with adults after being separated, willingness to go with a stranger with no hesitation. must have history of extreme insufficient care and developmental age of at least 9 months.

disinhibited social engagement disorder

ptsd criteria

some differences across ages, but for any age:

a. exposure to actual or threatened death/injury/violence

b. intrusion, avoidance, neg mood/cog, alterations in arousal/reactivity

c. 1+ months

brain areas involved in ptsd

hyperactive amygdala and anterior cingulate cortex

hypoactive VMPFC

reduced hippocampal volume

relationship between amygdala and VMPFC in ptsd

normally the VMPFC inhibits activity of amygdala, so since the VMPFC is hypoactive in ptsd, the amygdala isn’t controlled so there is an exaggerated fear response

neurotransmitters in ptsd

high: dopamine, norepinephrine, glutamate

low: serotonin, gaba

behavioral treatments for ptsd in adults

first-line: CPT, PE, trauma-focused CBT are first line

2nd line: CT, EMDR, and narrative exposure therapy (NET)

meds for ptsd

none are 1st line treatment, but SSRIs (fluoxetine, paroxetine, sertraline) and the SNRI venlafaxine are 2nd line treatments.

3 integrated/concurrent treatment options for comorbid PTSD and SUD

a. treatment of ptsd and sud using prolonged exposure (COPE)

b. prolonged exposure for ptsd and treatment as usual for SUD

c. trauma-focused CBT and treatment as usual for SUD

what’s treated first, the substance use or the trauma symptoms?

we used to treat substance first but now we treat both concurrently

acute stress disorder symptoms

9+ from 5 categories (intrusion, avoidance, neg mood, dissociation, arousal) for 3 days to 1 month

trauma disorder where 9+ from 5 categories (intrusion, avoidance, neg mood, dissociation, arousal) for 3 days to 1 month

acute stress disorder

adjustment disorder

exposed to a stressor (doesn’t have to be a trauma) and, within 3 months, symptoms develop but don’t last longer than 6 months. no minimum number of symptoms and symptoms can occur immediately after exposure (vs acute stress disorder which requires 9 symptoms starting 3 days after)

exposed to a stressor and, within 3 months, symptoms develop but don’t last longer than 6 months. no minimum symptoms required, and symptoms can start within hours of exposure.

adjustment disorder

prolonged grief disorder

death of someone close to them 12+ months ago (or 6+ for kids). must include:

a. yearning and/or preoccupation with thought about that person

b. 3+ of eight symptoms (disbelief, avoidance of reminders, emotional numbness, intense loneliness)

death of someone close to them 12+ months ago (or 6+ for kids). must include:

a. yearning and/or preoccupation with thought about that person

b. 3+ of eight symptoms (disbelief, avoidance of reminders, emotional numbness, intense loneliness)

prolonged grief disorder

dissociative amnesia criteria

inability to recall important personal info, often after a trauma. 4 forms:

• localized amnesia (most common) - forget all events that occurred during a certain period of time

• selective amnesia - forget some events from a certain period of time

• generalized amnesia - forget all events of their entire life

• systematized amnesia - forget all memory from a specific category (e.g., can’t remember any new events as they happen)

specifier: dissociative fugue (purposeful travel or purposeless wandering associated with loss of memory).

localized amnesia

most common type of amnesia in dissociative amnesia. forget all events that occurred during a limited period of time

most common type of amnesia in dissociative amnesia. forget all events that occurred during a limited period of time

localized amnesia

dissociative amnesia where you forget all events from your entire life

generalized amnesia

generalized amnesia

dissociative amnesia where you forget all events from your entire life

selective amnesia

dissociative amnesia where you forget only some events from a certain period of time

dissociative amnesia where you forget only some events from a certain period of time

selective amnesia

systematized amnesia

dissociative amnesia where you forget all memory from a specific category (e.g., can’t remember any new events as they happen)

dissociative amnesia where you forget all memory from a specific category (e.g., can’t remember any new events as they happen)

systematized amnesia

what is it called when someone is purposefully traveling or wandering purposelessly because of memory problems

dissociative fugue (as part of dissociative amnesia disorder)

dissociative fugue (as specifier for dissociative amnesia disorder)

when someone is purposefully traveling or wandering purposelessly because of memory problems

depersonalization/derealization disorder

depersonalization (unreality, detachment, or outside observer of one’s self)

derealization (unreality or detachment with one’s surroundings)

intact reality testing

somatic symptom disorder criteria and specifiers

significant daily disruption with excessive thoughts, feelings, or behaviors related to 1+ symptoms (disproportionate or persistent thoughts about the seriousness of symptoms, persistent anxiety about health, excessive time/energy spent on health)

specifiers: mild, moderate, severe, predominant pain, persistent (severe, marked impairment, 6+ months)

significant daily disruption with excessive thoughts, feelings, or behaviors related to 1+ symptoms (disproportionate or persistent thoughts about the seriousness of symptoms, persistent anxiety about health, excessive time/energy spent on health)

somatic symptom disorder

illness anxiety disorder

6+ months. preoccupation with having a serious illness with no or mild symptoms, excessive anxiety about health, and excessive behaviors or avoidance of care.

6+ months. preoccupation with having a serious illness with no or mild symptoms, excessive anxiety about health, and excessive behaviors or avoidance of care.

illness anxiety disorder

functional neurological symptom disorder (conversion disorder) and specifiers

1+ symptoms that involve disturbance in voluntary motor or sensory functioning (paralysis, blindness). sometimes has psychogenic non-epileptic seizures (PNES)

specifiers: symptom type, course (acute or persistent), presence or absence of a psychological stressor

1+ symptoms that involve disturbance in voluntary motor or sensory functioning (paralysis, blindness). sometimes includes psychogenic non-epileptic seizures (PNES)

functional neurological symptom disorder (conversion disorder)

psychogenic non-epileptic seizures (PNES)

sometimes part of functional neurological (conversion) disorder. behavioral symptoms of a seizure but no EEG activity

sometimes part of functional neurological (conversion) disorder. behavioral symptoms of a seizure but no EEG activity

psychogenic non-epileptic seizures (PNES)

factitious disorder

can be imposed on self or others. falsify or induce symptoms with deception (ingestion of a drug to produce abnormal results). they engage in deception even when there’s no obvious reward for doing so.

can be imposed on self or others. falsify or induce symptoms with deception (ingestion of a drug to produce abnormal results). they engage in deception even when there’s no obvious reward for doing so.

factitious disorder

factitious disorder vs malingering

malingering is when its for the purpose of obtaining a drug, financial compensation, or other external reward. in factitious disorder, the deceptive behavior can’t be fully due to personal benefit.

4 reasons someone may be suspected of malingering

1. seeking evaluation for legal reasons

2. marked discrepancy between symptoms and objective findings

3. uncooperative with treatment

4. and/or personality disorder

self-report method for detecting malingering

forced-choice method. must choose correct answer from 2+ choices. if they are malingering they will answer incorrectly at a higher rate

feigned memory loss vs genuine memory loss from injury

genuine = gradual and still remember some things, may be hazy, often believe that hints or clues will help them remember.

feigned = sudden onset and termination, don’t remember anything

test of memory malingering (TOMM)

detects feigned memory loss. uses forced-choice format by asking which of two images was shown to them prior to testing. if they are malingering they will be wrong 50%+ of the time. they may also exacerbate impairment or have an typical pattern of responding.

detects feigned memory loss. uses forced-choice format by asking which of two images was shown to them prior to testing. if they are malingering they will be wrong 50%+ of the time. they may also exacerbate impairment or have an typical pattern of responding.

test of memory malingering (TOMM)

pre trauma risk factors for PTSD

prior trauma, prior psychiatric disorder, negative affectivity, female, low education level, low SES, lack of social support, exposure to racial/ethnic discrimination