Psychopathology ch 6: disorders of trauma and stress

Stressor

● Event that creates demands

● Causes arousal and fear when viewed as threatening

Stress response

Person’s reactions to demands

Trauma and stressor-related disorders

● Acute stress disorder

● Posttraumatic stress disorder

Dissociative disorders

Group of disorders also triggered by very stressful events; primary symptoms are severe memory and orientation problems

Endocrine system

● Network of glands throughout the body that release hormones, e.g. cortisol

● Hypothalamic-pituitary-adrenal pathway (HPA)

Acute stress disorder

Fear and related symptoms begin within four weeks of traumatic event and last for less than one month.

● Otherwise, symptoms are similar to PTSD.

PTSD

Fear and related symptoms last longer than one month.

● At least 50% of all cases of acute stress disorder develop into PTSD.

Qualifying traumas

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

● Directly experiencing the traumatic event.

● Witnessing, in person, the event occurring to others.

PTSD symptoms

1. Person is exposed to a traumatic event—death or threatened death, severe injury, or sexual violation.

2. Person re-experiences at least one of the following intrusive symptoms:

● Repeated, uncontrolled, and distressing memories

● Repeated and upsetting trauma-linked dreams

● Repeated, uncontrolled, and distressing memories

● Dissociative experiences such as flashbacks

● Significant upset when exposed to trauma-linked

● Physical reactions when reminded of the event cues

• Person continually avoids trauma-linked stimuli

3. The person continually avoids trauma-linked stimuli

Checklist

4. Person experiences negative changes in trauma linked cognitions and moods, such as being death or threatened death, severe injury, or unable to remember key features of the event(s) or.experiencing repeated negative emotions

5.Person displays conspicuous changes in arousal or physical reactivity, such as excessive alertness, startle responses, anger or sleep disturbances

Cause of acute and PTSD

● Biological factors – genetic vulnerability

● Childhood experiences - ACES

● Cognitive factors and coping styles – negative world view, intolerance of uncertainty, inflexible coping style

● Lack of social support

● Severity and nature of the traumas

Acute and Posttraumatic Stress Disorders:

Developmental Psychopathology Perspective

Putting the factors together

Intersection of important variables at key points throughout individual’s life

● Inherited or acquired biological predisposition for overreactivity in brain–body stress routes and dysfunction in brain stress circuit

● Overreactive stress routes contribution to coping via protective factors (e.g., manageable stress)

● Timing of stressors and traumas over the course of development

Goals for PTSD

● 1/3 of all cases of PTSD improve within 12 months; the remainder may persist for years.

● General goals

-End lingering stress reactions

-Gain perspective

-Return to constructive living

Treatments for PTSD

Cognitive-behavioral therapy

● Exposure techniques

-Prolonged exposure

-Eye movement desensitization and reprocessing (EMDR)

-Cognitive processing therapy (CPT)

● Mindfulness-based techniques

● Antidepressant drug therapy

● Sleep medications

● Couple or family therapy

● Counseling for spouses and children

● Group therapy

Dissociative disorders

● Marked by major changes in memory that do not have clear physical causes

● Triggered by stressful/traumatic events

● Occurs when one part of memory or identity becomes separated from other parts

Memory

Key to our sense of identity, provides a link between our past, present, and future

Dissociative Amnesia symptoms

1. Person cannot recall important life-related information, typically traumatic or stressful information. The memory problem is more than simple forgetting.

2. Significant distress or impairment.

3. Symptoms are not caused by a substance or medical condition.

Dissociative amnesia

Inability to recall important information, usually of an upsetting nature, about one’s life

● Memory loss is much more extensive than typical forgetting and is not caused by physical factors.

● Often amnesia episode is directly triggered by a specific upsetting event.

Localized dissociative amnesia

Most common type; loss of all memory of events occurring within a limited period

Selective dissociative amnesia

Loss of memory for some, but not all, events occurring within a period

Generalized dissociative amnesia

Loss of memory beginning with an event, but extending back in time; may lose sense of identity; may fail to recognize family and friends

Dissociative fugue

Extreme version of dissociative amnesia

● People not only forget their personal identities and details of their past, but also flee to an entirely different location.

● May be brief or more severe

● May display new personality characteristics; often more outgoing behaviors

● Majority who go through a dissociative amnesia or fugue regain most or all memories and never have a recurrence.

Dissociative Identity Disorder

● Two or more distinct personalities (subpersonalities or alternate personalities) develop.

● Changing from one subpersonality to another (switching) is usually triggered by stress.

● Women are diagnosed 3:1 compared to men.

DID symptoms

1. Person experiences a disruption to their identity, as reflected by at least two separate personality states or experiences of possession.

2. Person repeatedly experiences memory gaps regarding daily events, key personal information, or traumatic events, beyond ordinary forgetting.

3. Significant distress or impairment.

4. Symptoms are not caused by a substance or medical condition.

3 kinds of DID relationships

● One-way amnesic relationships

● Mutually amnesic relationships

● Mutually cognizant patterns

Psychodynamic Perspective of dissociative disorders

● Dissociative disorders are caused by repression.

-People fight off anxiety by unconsciously

preventing painful memories, thoughts, or

impulses from reaching awareness.

● Dissociative amnesia and fugue are single

episodes of massive repression.

● Dissociative identity disorder

-Children who experience early abuse or

horrifying events may escape threat by self-

hypnosis (mental separation through wish to become another person

DID treatment

Therapists usually try to help clients:

● Recognize fully the nature of their disorder and their personalities

● Recover the gaps in their memory by sharing memories

● Integrate their subpersonalities into one functional personality; fusion

Depersonalization-derealization

disorder

Central symptom is persistent and recurrent episodes of depersonalization and/or derealization.

● Found in around 1 to 2% of population, most often adolescents and young adults

● Triggered by extreme fatigue, physical pain,

intense stress, substance use disorder recovery;

survivors of life-threatening situations

Derealization

• Feeling external world is unreal and strange

● Changing object shape or size

Depersonalization

• Feeling separation from own body

● Seeing self as an observer

● Having mechanical, dreamlike, dizzy feelings