Psych of Trauma Exam 1

Everyday Stress

- Involves thoughts, emotions, behavior, and bodily reactions

- Can be acute (short-term) or chronic (long-term)

- Not always harmful; moderate stress can enhance performance and adaptation

Traumatic Stress

a catastrophic event that involves a real or perceived threat to life or physical well-being

A Traumatic event

Exposure to actual threat or, Death, Sexual Violence, serious injury

When stress becomes overwhelming.

when it shifts from a temporary, helpful response into a constant state that stops you from handling daily tasks and harms your health

Impact of trauma exposure

PTSD

- post traumatic stress disorder

-Intrusions and Avoidance after a month

PTSD Criterion B

Intrusion symptoms

- Intrusive memories

- Nightmares

- Flashbacks or dissociative re-experiencing

- Psychological distress to reminders

- Physiological reactions to reminders

PTSD Criterion

Aviodance

- Avoiding trauma-related thoughts or feelings

Avoiding reminders

- People

- Places

- Activities

- Conversations

- Situation

PTSD criterion D

Negative mood & cognition changes (2 or more)

- Memory gaps about event

- Negative beliefs ("I am bad," "The world is unsafe")

- Persistent blame of self or others

- Negative emotions: fear, anger, shame, horror

- Loss of interest

- Social withdrawal

- Lack of positive emotions

PTSD Criterion E

Alterations in arousal & reactivity (2 or more)

- Irritable or aggressive behavior

- Hypervigilance

- Exaggerated startle response

- Problems with concentration

- Sleep disturbance

- Reckless /self-destructive behavior

PTSD other Criteria

Criterion F

- Duration: > 1 month

Criterion G

- Distress or impairment

Criterion H

-Not due to substances or medical causes

Acute Stress Disorder (ASD)

Occurs 3 days-1 month after trauma

- Exposure to trauma

- DSM-5 requires 9 symptoms from:

- Intrusion• Negative mood

- Dissociation

- Avoidance

- Arousal

ICD-11 does NOT include ASD — uses "acute stress reaction" (normal response)

Adjustment Disorder

A. Triggered by an identifiable life stressor, not necessarily trauma, occurs within 3 months of stressor

B. Emotional, behavioral symptoms exceed expected reactions,

C. No other explanation (e.g., prolonged grief disorder, do not meet criteria for other mental disorder)

D. Symptoms do not persist more than 6 months after stressor/consequences is terminated

Specifiers:

- With depressed mood, With anxiety, Mixed anxiety/depression, Disturbance of conduct, Mixed symptoms

- Unspecified

- Acute (less than 6 Mo )/ Persistent (more than 6 Mo)

Prolonged Grief Disorder

A. Death of a closed one- at least 12 months ago

B. One or both of the following:

- Yearning for or preoccupation with thoughts of the deceased

C. Since Death, 3 of the following:

- Identity disruption, disbelief, emotional pain, avoidance of reminders, difficulty with reintegration, meaninglessness of life, emotional numbness, loneliness

D. Clinically significant distress

E. Intense, persistent grief beyond cultural expectations

F. Not due to an explained mental health condition

ICD-11: Diagnosis after 6 months

How chronic/repeated trauma can produce effects beyond a narrow fear-based PTSD presentation.

Chronic, repeated trauma fundamentally alters an individual's neurobiology, identity, and relational systems, producing a broad spectrum of clinical features that extend far beyond the narrow, fear-based boundaries of classic Post-Traumatic Stress Disorder (PTSD). While standard PTSD centers primarily on a hyperactive fear-defense circuit triggered by reminders of a discrete event, cumulative and interpersonal trauma (such as childhood abuse, domestic violence, or captivity) degrades the foundational mechanisms

Hysteria

- 1880s-1890s

- Charcot and Janet studied dissociation

- Women reported abuse and overwhelming experiences

- Trauma theory emerged, then faded

War Trauma

- 1914-1945

- Shell shock and combat stress

- Recognition during wartime

- Decline in attention after wars

Feminist Era

- (1970s-Present)

- Child abuse, rape, domestic violence

- Survivor advocacy and research growth

The core cycle

- Approach

- Avoidance

- Rediscovery

Prevalence

Number of people victimized at least once within a population and period

- Numerator: persons or households affected

- Question: How common is it?

Incidence numerator/denominator for each.

New events or cases during a specified period

Numerator: number of victimizations

Question: What occurred this year?

Conditional Prevalence

Among people with a specified exposure, how many developed the disorder?

Hyperarousal

- One of the 3 post-traumatic patterns

- Means danger may return

- startle + vigilance

- irritability + sleep disruption

- Safe settings feel unsafe

intrusion

- flashbacks/nightmares

- reminders trigger reliving

- time stops at the traumatic moment

Constriction/Numbing

- Surrender shutdown

- Freeze

- Detachment or unreality

- less feeling, less initiative

The dialectic of trauma

Caught between extremes of reliving trauma or totally repressing it; between floods of intensive, overwhelming feelings and no feelings at all; between irritable, impulsive action and complete inhibition and immobility.

How trauma can affect memory

How trauma can affect Emotion

Can be hard to regulate your emotions.

How trauma can affect identity

You can just feel so much shame.

How trauma can affect relationships, and meaning

Relationships

- It can make it hard to trust people.

Meaning

- They can lose hope

Dissociation

a split in consciousness, which allows some thoughts and behaviors to occur simultaneously with others

Multiple trajectories are possible after trauma

- BONANNO: trajectories

- HERMAN: tasks

- SYNTHESIS: no one-size-fits-all

Herman's recovery model

- What helps when life is disrupted?

- 1. Safety-restore control

- 2. Remember- integrate memory

- 3. Reconnection- rebuild life

not a staircase but a spiral

Safety

- Restore power and control

- Safety comes before intensive trauma processing.

- Body

- Emotion

- Thinking

- Relationships

- Enviorment

Where is safety missing

Remembrance and mourning

- When ready, the story becomes speakable.

- trauma → narrative memory

- avoidance ↔ overwhelm

grieve what was lost

mourning cannot be rushed

Goal: integration, not forced disclosure.

Mourning traumatic loss

Trauma brings losses that may be invisible.

- bodily integrity, trust, relationships, identity, meaning

-future assumptions.

-Mourning honors the loss without letting trauma own the whole life story.

Reconnection

- The survivor turns toward a future

-NEW SELF -identity

New relationship- trust + boundaries

- New meaning- faith/worldview

- New action-b mission /advocacy

- Helplessness + isolation → empowerment + connection

Learning theory

- How neutral cues become threat cues

-ask what cues trigger fear

- Trauma -> intense fear + cues -> later fear

- Cues may be places, smells, sounds, darkness, bodily sensations, or thoughts

- Generalization: the cue network can spread

Cognitive theories

- Trauma as a crisis of meaning.

- Asks what does the trauma mean

- Trauma can alter:

*Beliefs about self;

*beliefs about others;

*beliefs about the world/future

Memory theories

Potentially morally injurious experiences and moral injury.

- Rules for right and wrong

-Shared expectations about behavior

-Deep assumptions about self, others, and justice

Litz's transgression-focused model

-Transgression of deeply held moral beliefs

- Potentially morally injurious events involve perpetrating, failing to prevent, or witnessing acts that violate deeply held moral beliefs.

-I did this

- I failed to stop this

-I witnessed this

Core emotions: shame, guilt, grief, anger

Shay's betrayal-by-authority model

- Betrayal by authority

- Moral injury is a betrayal of "what's right" by legitimate authority in a high-stakes situation.

- Betrayal of the moral order

-Powerholder or leader is the violator

-Trust collapses under serious stakes

Institutional betrayal

- Wrongdoing by an institution against people who depend on it, including failure to prevent or respond supportively to harm.

- A protective system fails, harms, silences, or abandons

- Trust collapses when trust was expected

How institutional betrayal develops

Before - Knowing risk ignored

During - Protection fails

After - Response harms

Pragmatic harm

Access lost

Resources delayed

Safety reduced

Retaliation risk

The institutional response can become a second injury.

Psychological harm

Disbelief

Shame

Mistrust

Helplessness

The institutional response can become a second injury.

Institutional DARVO

- Deny

- Attack

- Reverse

When done by a system, DARVO becomes institutional betrayal.

The differences

PTSD- Am I safe?

Moral Injury- Can I live with what happened

Institutional Betrayal- Do I trust the system?

Overlap: safety, meaning, trust, belonging, and power.

Broad roles of the amygdala

- Threat detection and regulation.

- salience/threat/fight-flight-freeze

Broad roles of the Hippocampus

- Context, declarative memory, and distinction

- ties together different perceptions into an event memory

- supports memories that can be stated in words

-helps distinguish safe from dangerous contexts

- Smaller hippocampal volume is often found in

PTSD groups, but causality is debated

broad roles of the prefrontal cortex/memory

- executive control and emotion regulation

-

Psychophysiological reactivity

Exaggerated startle, hyper vigilance, elevated perspiration and shortness of breath

double think

- The child must hold contradictory realities

Reality A -"My caregiver protects me."

Reality B - "My caregiver hurts or frightens me."

Preserve attachment and hope while living with fear, betrayal, or danger.

double self.

-GOOD self (for others) vs. BAD self (for oneself)

- If I am bad, maybe I can become good enough to make it stop.

Types and categories of ACEs

Abuse

Neglect

Household Challenges

ACEs futuer

ACEs increase risk but do not determine an individual's outcome; protective factors matter.