Chapter 7: Acute and Posttraumatic Stress Disorders and Dissociative Disorders

Traumatic Stress

An event that involves actual or threatened death, serious injury, or sexual violence to self, or witnessing others experience trauma, learning that loved ones have been traumatized, or repeatedly being exposed to details of trauma

Posttraumatic Stress Disorder (PTSD)

A psychological disorder characterized by recurring symptoms of numbing, re-experiencing, and hyperarousal following exposure to a traumatic stressor

Acute Stress Disorder (ASD)

Defined as a reaction occurring within four weeks of a traumatic stressor. It is characterized by dissociative symptoms, re-experiencing, avoidance, and marked anxiety and arousal.

Contrats with PTSD, which either lasts longer or has a delayed onset.

Symptoms of ASD and PTSD

(1) Intrusive Reexperiencing
(2) Avoidance
(3) Increased Arousal or Reactivity
(4) Negative Mood or Thoughts
(5) Dissociative Symptoms

Symptoms of ASD & PTSD: Re-experiencing

Intrusive, repeated, distressing memories of a trauma or reliving a trauma in horrifying dreams

Psychological/physiological distress at exposure to cues that symbolize or resemble events

Symptoms of ASD & PTSD: Exaggerated Startle Response

A symptom in which people have excessive fear in reaction to the unexpected

Symptoms of ASD & PTSD: Dissociative State

A rare case of re-experiencing where the people feel and acts as if the trauma actually were recurring in the moment

Symptoms of ASD & PTSD: Derealization

A symptom in which people have a marked sense of unreality that may continue for days or longer

Symptoms of ASD & PTSD: Dissociative Amnesia

A symptom in which people are unable to remember aspects of a trauma event

Symptoms of ASD & PTSD: Flashbacks

Sudden, repeated, and intrusive memories during which the trauma is replayed in images or thoughts; often at full emotional intensity

Symptoms of ASD & PTSD: Depersonalization

A symptom in which people feel cut off from themselves or their environment; they might feel like a robot, or as if they were sleepwalking

DSM-5 Criteria for PTSD

A. Exposure to trauma stressor

B. Experiencing symptoms from the following 4 categories of symptoms (1 or 2 from each category for a total of 6 symptoms)
i. Instruvie symptoms
ii. Persistent avoidance of stimuli associated with trauma
iii. Negative alteration in thoughts and mood associated w/ trauma
iv. Marked changes in arousal/reactivity

C. Duration of disturbance is more than a 1 month

D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

E. The disturbance is not attributable to the physiological effects of a substance or another medical condition

DSM-5 Criteria for ASD

A. Exposure to trauma stressor

B. The presence of 9 or more symptoms from the following five categories
i. Intrusive Symptoms
ii. Negative mood
iii. Dissociation Symptoms
iv. Avoidance Symptoms
v. Arousal Symptoms

C. Duration of disturbance is 3 days to 1 month after trauma exposure. Symptoms typically begin immediately after the trauma, but persistence for at least 3 days to up to a month is needed to meet disorder criteria.

D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

E. The disturbance is not attributable to the physiological effects of a substance or another medical condition

Prolonged Exposure Therapy

A cognitive-behavioral treatment for PTSD that involves repeatedly exposing individuals to stimuli that remind them of their past trauma in order to alter their fear networks.

Image Rehearsal Therapy

An effective form of treatment for recurring nightmares that is based on talking and in which a counselor asks a person to imagine their nightmare and then come up with a strategy to make it less scary

Eye Movement Desensitization and Reprocessing (EMDR)

A technique that involves rapid back-and-forth eye movements used to reduce anxiety.

Antidepressant Medication for PTSD

Psychiatrists may prescribe antidepressants (like SSRIs) for PTSD treatment.

The effectiveness of SSRIs is likely at least partially due to the high comorbidity between PTSD and depression.

Only 30% of PTSD patients can fully recovery from PTSD symptoms.

Dissociative Disorder

A category of psychological disorders characterized by persistent maladaptive disruptions in the integration of memory, consciousness, or identity

Hypnosis

An altered state of consciousness during which hypnotized subjects are particularly susceptible to suggestions.

There is considerable debate as to whether hypnosis is a unique state of consciousness or merely a form of relaxation.

Explicit Memory

Conscious recollection, memory of facts and experiences

Implicit Memory

Unconscious and evident only because past experiences can change behavior

Implicit Association Test

Tests that reveal implicit memories by comparing response times to different cues

Dissociative Identity Disorder (DID)

A dissociative disorder when two or more personalities within a single individual.

Demonstrates that the mind can function on multiple levels of consciousness

At least two personalities repeatedly take control over the person's behavior and some personalities have limited or no memory of the other.

Dissociative Amnesia Disorder

A type of dissociative disorder characterized by the sudden inability to recall extensive and important personal information

The onset often is sudden and may occur in response to trauma or extreme stress.

Depersonalization/Derealization Disorder

A dissociative disorder is characterized by feelings of being detached from oneself or. the world around you.

Iatrogenesis

The creation of a disorder by an attempt to treat it.

Merskey (1992) argues that DID is a social role, that highly hypnotizable people are likely to suffer from iatrogenic effects.