abnormal psych - trauma and stressor related disorders

adjustment disorder

somewhere b/n effective coping strategies and PTSD

DSM criteria of adjustment disorder

development of symptoms in response to an identifiable source occurring within three months of the onset of the stressor

stressors in adjustment disorder

- may be a single event

- may be multiple

- may be continuous

comorbidity in adjustment disorders

- diagnosed in addition to another mental disorder ONLY if the other mental disorder does not explain the symptoms that occur in reaction to the stressor(s)

- often diagnosed w/o another mental disorder

- common accompaniments of medical illness

what is an ACEs test?

Adverse Childhood Experiences questionnaire for adults

types of stress (2)

- distress: negative

- eustress: positive

stress

any circumstances that threatens or is perceived to threaten one's wellbeing and therefore taxes one's coping ability

who is Hans Salye?

- "Father of Stress Research"

- 40 years of research

- general adaptation syndrome

3 stages of general adaptation syndrome

1. alarm reaction

2. resistance

3. exhaustion

alarm reaction

body recognizes and prepares for fight or flight

What does the hypothalamus trigger during the alarm reaction?

- autonomic nervous system: connects CNS to all organs

- sympathetic nervous system: quickens heartbeat and is responsible for body changes

- endocrine nervous system: release hormones; mobilize body's defenses

parasympathetic nervous system

nervous system that calms us down after a stressful event

resistance response

- copes better with original stressor, but resistance to other stress is decreased

- body repairs any damage

exhaustion response

- body's resources exhausted and depleted

- decreased ability to resist stress

appraisal of stress

how stressed we feel depends on how we appraise events

4 ways to appraise stress

familiarity, controllability, predictability, imminence

familiarity

- first time doing something = more stress

- more unfamiliar, more stress

controllability

if events are viewed as controllable, there tends to be less stressed and feel more peaceful (perceived control)

predictability

- we prefer predictable stress over surprises

- can use anticipatory coping to prepare for stress

imminence

as threatening events come closer to occurring, stress goes up

trauma results from ...

an EVENT that is EXPERIENCED and has lasting adverse EFFECTS

trauma results from an EVENT...

... series of events, or set of circumstances

that is EXPERIENCED...

... by an individual as physically or emotionally harmful or life threatening and

has lasting adverse EFFECTS on...

functioning and mental, physical, social, emotional, or spiritual well-being

types of trauma

acute, chronic, complex, generational, vicarious

What can trauma ultimately result in?

early death

4 R's of trauma-informed care

- realize the prevalence of trauma

- recognize how trauma affects individuals

- respond by putting this knowledge to practice

- resist re-traumatization

reactive attachment disorder

inhibited, emotionally withdrawn behavior toward adult caregivers; child does not seek or respond to comfort when distressed

some causes of reactive attachment disorder

- social and emotional disturbance

- insufficient care (neglect) caused problem

diagnosing reactive attachment disorder

- R/O Autism Spectrum Disorder

- symptoms evident before age 5

- developmental age of 9 months or older

prevalence of reactive attachment disorder

- unknown prevalence

- rare disorder

- of those with severe neglect, 10% may qualify for this diagnosis

disinhibited social engagement disorder

actively approach and interact with unfamiliar adults; not limited to impulsivity, but includes socially disinhibited behavior

causes of disinhibited social engagement disorder

insufficient care (social neglect)

diagnosing disinhibited social engagement disorder

developmental age of 9 months or older

prevalence of disinhibited social engagement disorder

- prevalence is unknown

- rare disorder

- of those with severe neglect, 20% may qualify for this diagnosis

posttraumatic stress disorder

exposure to actual or threatened death, serious injury, sexual violence

more symptoms of PTSD

- differing symptoms for children under 6 years

- intrusive symptoms, keep coming back

- avoidance of stimuli associated with traumatic events

- negative alterations in cognition or mood (2 symptoms)

- distress and impaired functioning

- R/O substance abuse or medical condition

- duration: more than 1 month

80%

percentage of those with Acute Stress Disorder who develop PTSD

Acute Stress Disorder

- exposure to actual or threatened death, serious injury, sexual violence

- distress and impaired functioning

- duration: 3 days to 1 month

- 9 symptoms form 5 categories: intrusion, negative mood, dissociation, avoidance, arousal

Stress Disorder stats

- 3.5% per year; 7-9% prevalence

- 2/3 seek treatment

- women:men = 2:1 (sexual violence)

causes of Stress Disorders

1. military combat (shell shock): 50% develop symptoms if they do > 1 tour of service

2. disasters: natural or manmade, tornadoes, earthquakes, floods, etc.

3. victimization: physical or sexual abuse, kidnapped, hostage, torture, terrorist attack, prisoner or war, concentration camp

risk factors for stress disorders (6)

1. biological and genetic factors (cortisol and norepinephrine)

2. personality factors (preexisting high anxiety)

3. negative childhood experiences (divorce before 10, poverty, abuse, etc.)

4. weak social support

5. multicultural factors (specifically Hispanic Americans)

6. severity of trauma and more direct exposure to it

treatment for stress disorders (6)

1. drug therapy - antianxiety and antidepressants

2. behavioral exposure - flooding, relaxation, EMDR

3. insight therapy

4. family therapy

5. group therapy

6. critical incident stress debriefing - may not be as effective as believed

effectiveness of treatment for stress disorders

- 1/2 cases of PTSD improve in 6 months

- 1/3 fail to improve

disassociation =

separation

dissociative disorders cause changes in...

- memory

- identity

- consciousness

dissociative disorders and stress disorders

- symptoms can occur in PTSD and Acute Stress Disorders, but that does not necessarily = a dissociative disorder

- but it makes them more vulnerable to developing a Dissociative Disorder

dissociative amnesia

- unable to recall important information (more than normal forgetting)

- often triggered by an upsetting event

- episodic memory affected (autobiographical memory of personal material)

- seems to begin during serious threat to health and safety

four types of dissociative amnesia

1. localized

2. selective

3. generalized

4. continuous

dissociative amnesia with dissociative fuge

- forget personal identity and details of the past

- flee to new location (purposeful travel or bewildered wandering)

- usually follows stressful event

- 0.2% of population

- may need to be reminded of their identity

- regain most or all of memories (over time)

- never have recurrence

depersonalization/derealization disorder

- depersonalization: experiences of unreality, detachment, or being an outside observer of oneself

- derealization: detachment from surroundings (individuals or objects); unreal, foggy, dreamlike

prevalence/onset/triggers of depersonalization/derealization disorder

- occurs more frequently in adolescents and young adults

- sudden onset

- long-lasting; really no explanation

- triggered by extreme fatigue, physical pain, stress