Abnormal Psych chapter 4

Stressors

can be any event- either witnessed firsthand, experienced personally or experienced by a close family member- that increases physical or psychological demands on an individual. these events are significant enough that they pose a threat, whether real or imagined, to the individual

Stress disorder

occurs when an individual has difficulty coping with or adjusting to a recent stressor

Chronic Disorder

include events that persist over an extended period of time, such as caring for a parent with dementia, long-term unemployment, or imprisonment

Acute Stressors

involve brief focal events that sometimes continue to be experienced as overwhelming well after the event has ended, such as falling on an icy sidewalk and breaking your leg

Traumatic Events

• PTSD can develop after experiencing or witnessing a traumatic event, including:

  • Serious accidents

  • Physical or sexual assault

  • Abuse (childhood or domestic)

  • Exposure to traumatic events at work, including remote exposure

  • Serious health problems

  • Childbirth experiences, such as losing a baby

  • The death of someone close to you

  • War and conflict

  • Torture

  • Natural disasters

  • Life-threatening medical diagnosis or treatment

  • Terrorist acts

  • Intimate partner violence

  • Fire, mugging, robbery, plane crash, kidnapping 

Life changes

leading to difficulties in relationships, work, daily tasks, and emotional well-being, potentially causing social isolation and impacting overall quality of life. 

Daily Hassles

intrusive memories, difficulty concentrating, sleeping problems, irritability, and a heightened sense of danger, significantly impacting their daily lives and relationships

Post Traumatic Stress Disorder (PTSD) criteria

Must have symptoms for at least one month from among the following four categories:

1) Recurrent Experiences trauma-related flashbacks,nightmares, etc.

2) Avoidance when an individual tries to get away from that which can "trigger the memory of the traumatic event"

3) Negative Alterations in Cognitions or Mood when an individual struggles to remember an aspect or part of the traumatic event

(4) Alterations in Arousal and Reactivity individuals may be quick-tempered and aggressive because of a heightened startle response

The development of physiological,psychological, and emotional symptoms following exposure to a traumatic event"

Post Traumatic Stress Disorder (PTSD) risk factors for development

-Traumatic Experience

-Greater Trauma Severity

-Lack of immediate social support (the more social support the more deterrent to PTSD)

-More subsequent life stress

-Personality characteristics

Neuroticism

Somatization

Other factorsFemale gender Low socioeconomic status Low intelligence Personal and/or family hx of mental disorders Hx of childhood adversity and / or traumatic experiences during adulthood

General Treatment for PTSD

CBT

Exposure Therapy

EDMR

Acute Stress Disorder (ASD) Criteria

PTSD-like symptoms that occur from 3 days to 1month after a traumatic event-If lasts more than one month diagnosis changes to PTSD- if resolved by day 3, ASD criteria not met

Must experience nine symptoms across five categories which must cause significant distress or impairment:(1) intrusion symptoms "involuntary and intrusive distressing memories of the trauma or recurrent distressing dreams"(2) negative mood "a persistent inability to experience positive emotions, such as happiness or love"(3) dissociative symptoms "time slowing, seeing oneself from an outsider's perspective, orbeing in a daze"(4) avoidance symptoms "avoidance of memories,thoughts, feelings,people, or places associated with the trauma"(5) arousal symptoms "difficulty falling or staying asleep,irritable behavior,or problems with concentration

Adjustment Disorder Criteria

Symptoms occur within 3 months of an identifiable stressor and cause significant distress and impairment• This stressor can be a single event (loss of job, death of a family member) or a series of multiple stressors (cancer treatment, divorce/child custody issues).Less intense than PTSD and ASD Must be classified"with" certain moods/behaviors unless"unspecified":• With depressed mood F43.21• With anxiety F43.22• With mixed anxiety and depressed mood F43.23• With disturbance of conduct F43.24• With mixed disturbance of emotions and conduct F43.25

Prolonged Grief Disorder criteria

Defined by intense yearning/longing and /or preoccupation with thoughts or memories of the deceased who died at least 12 months ago Presents with at least 3 symptoms: feeling as though part of oneself has died, disbelief about the death, emotional numbness, feeling that life is meaningless, intense loneliness, problems engaging with friends or pursuing interests, intense emotional pain, avoiding reminders that the person has died Often hold maladaptive cognitions about self, feel guilt about the death,hold negative views about life goals and expectancy Harmful health behaviors due to decreased self care and concern; may have hallucinations about the deceased, feel bitter and angry, berestless, blame others for the death, may see a reduction in the quantity and quality of sleep

Treatments used for trauma disorder

Psychological Debriefing, Exposure Therapy, Cognitive Behavioral Therapy (CBT), Eye movement desensitization and reprocessing (EDMR), Brainspotting, Psychopharmacological treatment, Imagery rehearsal therapy, Cognitive Processing Therapy (CPT)

Disassociation

is a "disruption and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, motor control, and behavior

State Disassociation

transient and temporary (lasts for a few minutes or hours) ex: daydreaming

Trait Disassociation

describes a more stable, enduring pattern of dissociative experiences that are part of an individual's personality, meaning they experience dissociation more frequently and across various situations

Dissociative Identity Disorder (DID) criteria

Aka multiple personality disorder - not referring to possession states occurring as part of a cultural or religious practice

To be diagnosed with DID,there must be at least two distinct personality states or expressions which have their own tone of voice,physical gestures,behaviors, etc.

There must also be a gapin recall of events,information, and/or trauma due to the switching of personalities

These personalities cannot be secondary effects of a substance or medical condition to be diagnosed under DID

There is generally a dominant or primary personality that is present most of the time; others are called subpersonalities(women usually have an average of 15 subpersonalities, whereas men have an average of 8) Switching between personalities varies between individuals but it can look like the individual falling asleep or experiencing excessive bodily movements;usually, switching is caused by a stressor

Individuals with DID are sometimes aware of their multiple personalities, but some individuals aren't

Dissociative Amnesia Disorder (DAD) criteria

when someone experiences an inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting, and this memory loss is not due to a medical condition or substance use

Retrograde

past events forgotten (most common)

Anterograde

lose new info

Localized Amnesia

the most common type where one is unable to recall events during a specific period

Selective Amnesia

a component of localized amnesia in that the individual can recall some, but not all, the details and/or events during a specific time period

Systematized Amnesia

failure to recall a specific category of important info (they are married)

Generalized Amnesia

a rare condition where there is a complete loss of memory of their entire life history, including their own identity; individuals experience deficits in semantic and procedural knowledge (i.e., common knowledge and learned skills

Dissociative Fugue

the most extreme type of dissociative amnesia where not only does an individual forget personal information, but they also flee to a different location; can last hours to years, after which it goes away suddenly (only specifier of DAD)

Depersonalization/ Derealization Disorder

Categorized by recurrent episodes of depersonalization and/or derealization which can last hours to months Triggered by intense stress or trauma

Depersonalization - a feeling of unreality or detachment from oneself; can feel like an outer body experience; a lack of speech, motor control deficits,and distortions of one's physical body are also possible

Derealization - includes feelings of unreality or detachment from the world,including individuals, objects,or their surroundings; can include sensory changes and distortions in time, distance,and size/shape of objects

Depersonalization/ Derealization Disorder criteria

A. The presence of persistent or recurrent experiences of depersonalization, derealization or both:

Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one's thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing).

Derealization: "Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted."

B. During the depersonalization or derealization experiences, reality testing remains intact.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or other medical condition (e.g., seizures).

E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.

Dissociative Identity Disorder Treatment

Final Fusion

Dissociative Amnesia Treatment

Hypnosis and Barbiturates, or "truth serums"

Depersonalization/Derealization Disorder Treatment

SSRIs can be effective in improving mood, but medications work best when paired with psychological treatments (i.e., CBT)