Psychopathology Ch. 7: PTSD & Dissociative Disorders:

What are the key symptoms of PTSD?

• Intrusive re-experiencing: Recurrent memories, nightmares, flashbacks, dissociative reactions.

• Avoidance: Avoiding reminders of the trauma, including thoughts, feelings, and places.

• Negative alterations in cognition and mood: Persistent negative beliefs about oneself, others, and the world, emotional numbness.

• Increased arousal: Insomnia, irritability, hyper-vigilance, exaggerated startle response.

• Duration: Symptoms last for more than a month.

What makes an event traumatic in the context of PTSD?

• Direct experience of the event.

• Witnessing the event happening to others.

• Learning about the event happening to a close person

• Repeated exposure to aversive details (e.g., police officers exposed to child abuse details).

• Simply learning about a traumatic event does not directly cause PTSD unless experienced personally or directly

What are the DSM-5 criteria for PTSD re-experiencing symptoms?

• Recurrent, involuntary, and intrusive memories.

• Traumatic nightmares.

• Flashbacks: Acting or feeling as if the traumatic event were recurring.

• Dissociative reactions: Feeling detached from reality, experiencing flashbacks.

• Intense distress when exposed to reminders of the trauma.

• Physiological reactivity on exposure to cues that resemble aspects of the trauma

• Duration: Symptoms last for more than a month.

→ Think of OWEN when he choked Yang

How does avoidance manifest in PTSD?

• Avoid distressing memories, thoughts, or feelings related to the traumatic event.

• Avoid external reminders such as places, people, conversations, or activities that may trigger distress.

• Social isolation can occur as a result, cutting off support from others.

What are the increased arousal symptoms of PTSD?

• Difficulty falling or staying asleep (insomnia).

• Irritability or outbursts of anger.

• Difficulty concentrating.

• Hyper-vigilance (being fixated on potential threats in the environment).

• Exaggerated startle response.

• Reckless or risky behavior.

• What dissociative symptoms are seen in PTSD?

• Inability to recall important aspects of the trauma.

• Persistent negative beliefs about oneself, others, and the world.

• Distorted cognitions about the cause or consequences of the event, often leading to self-blame.

• Anhedonia: Diminished interest in activities once enjoyed.

• Feeling detached from others or emotionally numb.

What are the risk factors for developing PTSD?

• Genetic predisposition (family history of mental illness).

• Exposure to trauma, especially intentional abuse (rape, assault) and combat.

• Psychosocial factors: Self-blame, guilt, lack of social support, and social environment.

• Psychological training: Example—pilots trained for crashes have lower PTSD rates.

• Social context: Soldiers returning from wars (e.g., Vietnam) faced with negative societal attitudes have higher PTSD rates

How does PTSD differ from anxiety disorders?

→ Opposite of anxiety (remember the traumatic event)

→ will not remember the traumatic event (bc of how traumatic it was) 

What are the treatment options for PTSD?

• Cognitive Behavioral Therapy (CBT), especially trauma-focused CBT, which includes:

  • Psycho-education about stress reactions.

  • Stress management training.

  • Exposure therapy to the traumatic event.

  • Cognitive processing therapy to address distorted thoughts and beliefs about the trauma.

• Medications: SSRIs (e.g., Prozac) are commonly used; antianxiety medications are not effective for PTSD.

PTSD is NOT —> Anxiety

IS…. Stress

What is the epidemiology of PTSD? (prevalence)

lifetime prevalence of approximately 6.8%.

• Men MOST LIKELY to be exposed to trauma

• Women = HIGHER RATES → Sexual Violence

→ Children and minorities are more vulnerable to developing PTSD after exposure to trauma.

What is the main defining feature of dissociative disorders? (DID)

→ Dissociative Identity Disorder (DID) = Multiple personality Disorder (used to be)

Disruptions in the usual-integrated functions of consciousness, memory, and identity, where one or more parts of these functions are "left out."

What is dissociative amnesia?

reversible inability to retrieve memories, often limited to specific events or periods of time, typically following a stressful event.

→ Main idea: inability to remember a past event 

→ tied to specific incident (you had an event happen to you and then you can’t recall it) 

→ Consider aggressive disorder/Substance abuse

How does dissociative amnesia differ from unselective memory loss, such as in brain injury?

Dissociative amnesia:

• SELECTIVE and related to SPECIFIC events or periods

Unselective memory loss:(like in anterograde amnesia)

• affects the ability to FORM NEW memories

What is dissociative fugue?

A rare subset of dissociative amnesia

• where an individual may suddenly travel away from home and assume a new identity, often with no memory of their past life.

What is the most controversial dissociative disorder?

Dissociative Identity Disorder (DID), formerly known as multiple personality disorder

• No good data

• 200 TOTAL cases worldwide

• Movies made diagnoses skyrocket

What characterizes Dissociative Identity Disorder (DID)?

• The presence of two or more distinct personalities (alters)

  → with each having a unique way of perceiving and relating to the world

• At least two alters recurrently take control of the person's behavior.

What are some common diagnostic signs associated with DID?

• Time distortions → (don’t remember after switching between alters)

• being told of actions the person does not remember

• changes in behavior

• use of the word “we,”

• discovery of writing or drawings the person doesn’t recall producing

What percentage of people with Dissociative Identity Disorder have a history of sexual abuse?

95%

→ Can be easily hypnotized

→ Individuals experience so much trauma that they just self-hypnotize to forget

What are the two main theories explaining the development of DID?

• Post-traumatic Theory: Individuals with trauma lack resources to cope, leading to dissociation and escape into fantasy.

→ Trauma was so bad that they got fucked up and escape reality with fantasy

• Socio-cognitive Theory: Highly suggestible individuals adopt multiple identities due to external influences like clinicians reinforcing or suggesting them.

→ Develop more than one personality bc clinicians reinforce it

→ Possible in college students under hypnosis

What is the main idea of Bliss' Theory of DID?

• Suggests that individuals with DID are highly hypnotizable

• After exposure to severe trauma, they use self-hypnosis to avoid emotional experiences

• Eventually losing control of their trance states, which leads to dissociation and the development of multiple personalities.

According to Bliss’ Theory, what role does trauma play in the development of DID?

• Repeated, severe trauma leads individuals to use self-hypnosis to block out painful emotions and memories, and eventually, they lose control over their trance states, leading to dissociative identity formation.

What is the Humphrey & Dennett model of DID?

→ Opposite of Bliss’ Theory

• Most people have a "fictional unified self" (a single, unified sense of self), which provides the appearance of a coherent identity despite changes over time

• However, people with DID do not develop this unified self, leading to the presence of distinct personalities or alters.

What is the main difference between Bliss' Theory and the Humphrey & Dennett model in terms of DID?

Bliss' Theory:

• DID results from trauma-induced self-hypnosis, leading to dissociation

Humphrey & Dennett's model:

• DID is due to an inability to form a unified self, where individuals lack a "head-of-state" personality to integrate their different experiences.

What is the treatment typically used for dissociative disorders?

• Medications targeting comorbid symptoms (e.g., anxiolytics, antidepressants)

• psychotherapy (CBT, trauma-focused therapy)

What is the stigma associated with dissociative disorders?

People with dissociative symptoms may feel stigmatized due to negative societal beliefs and media portrayals of dissociative disorders as violent or extreme.

What did Freud conclude about the sexual abuse reports from his historical patients?

Freud initially believed that reports of sexual abuse were fantasies resulting from unconscious desires, such as the Oedipal conflict

What controversy surrounds recovered memories of trauma?

The controversy stems from the ease with which false memories can be implanted, raising questions about the accuracy of recovered memories of childhood trauma

What is somatization?

• Tendency to express psychological distress through physical symptoms, such as pain, fatigue, dizziness, or heart palpitations

How does somatization connect mind and body?

Somatization reflects the link between mental and physical health, where psychological issues manifest as physical symptoms, demonstrating the mind-body connection

What are the key features of Somatic Symptom Disorder (DSM-5)?

→ Somatic symptoms:

• Physical symptoms without a clear cause

• Distressing and/or disrupting 

→ Excessive concern:

• Thoughts about the seriousness of symptoms 

• High anxiety about health/symptom

• Time and energy devoted to symptoms

How does Illness Anxiety Disorder differ from Somatic Symptom Disorder?

Illness Anxiety Disorder

• Preoccupation with the fear of having or acquiring a serious illness with minimal or no somatic symptoms

→ Anxiety about HEALTH

Somatic Symptom Disorder:

• Actual physical symptoms.

What are some symptoms of Conversion Disorder?

• Symptoms can include motor or sensory problems such as sudden blindness, deafness, paralysis, loss of feeling, or pseudoseizures, without any neurological or medical explanation

 “similar to somatic but instead focuses on neurological processes” 

What differentiates Factitious Disorder from other somatic symptom disorders?

• Individuals intentionally falsify symptoms for internal rewards, TO GAIN sympathy, as opposed to seeking external rewards like financial gain (which would be seen in malingering).

How are somatic symptom disorders often stigmatized?

These disorders can be stigmatized as "difficult patients" due to the medically unexplained nature of their symptoms, leading to potential delays in treatment

→ Similar to phantom pain

How does malingering differ from factitious disorder?

Malingering:

• Symptoms are fabricated for external rewards (e.g., financial gain)

Factitious disorder:

• falsifying symptoms for internal rewards (e.g., sympathy).

Differentiate Somatic symptom Disorder, Conversion disorder, factitious disorder, and malingering

Somatic Symptom Disorder:

• Excessive worry or anxiety about the symptoms

• Symptoms: Physical symptoms (pain, fatigue, etc.) with no clear medical cause.

• Not intentionally produced; the person truly believes they are ill.

Conversion Disorder:

• Symptoms are often linked to psychological stress or trauma.

• Neurological symptoms (e.g., paralysis, blindness) that don’t match medical findings

• Not intentionally produced; the person may not be aware that their symptoms are psychological.

  → Example: A person suddenly goes blind after a traumatic event, but no medical cause is found

Factitious Disorder:

• Person fakes illness or injury for internal gain (e.g., to receive sympathy, attention, or medical care)

• Symptoms: Intentionally fabricated or exaggerated symptoms.

• The person deliberately creates or exaggerates symptoms without external incentives (e.g., money)

Malingering:

• Symptoms are intentionally produced to avoid responsibilities (e.g., work, military service) or obtain financial gain(e.g., insurance claims)

• Symptoms: Faked or exaggerated symptoms to achieve external gain.

• Motivation: External reward (e.g., money, avoiding legal consequences, avoiding work)

A patient is referred to the psychiatric unit of a hospital, after a series of physiological and physical examinations do not adequately explain the patients reported symptoms

• In order to distinguish somatic symptoms disorder from covnersion disorder from factitious disorder from malingering, what would you ask/ what would you try to determine?

• questions/ infomation you try to get to differentiate them

→ other diagnosis they have

→ if there is a reward attached 

Malingering: external reward

Facticious: internal reward

Conversion: neurological explinations (sudden numbness) 

Somatic: physical symptoms

What are some environmental risk factors for Somatic Symptom Disorders?

• Illness behavior and reinforcement: People may be rewarded for physical symptoms.

• Family upbringing: Families may reinforce illness behaviors.

• Cognitive: Over-attention to bodily changes and a feeling of uncontrollability.

• Cultural: Cultural stigma or norms about how distress should be expressed.

What types of treatments are commonly used for Somatic Symptom Disorders?

• SSRIs for comorbid anxiety or depression, and psychological treatments such as CBT, similar to those for anxiety-related disorders. However, individuals may resist mental health treatment.

How do cultural factors impact Somatic Symptom Disorders?

Certain cultures may be more prone to expressing psychological distress through physical symptoms due to cultural norms and stigma surrounding mental health issues.

What is the role of interoception in Somatic Symptom Disorders?

Interoception refers to the awareness of internal bodily sensations, which, when heightened, can lead individuals to misinterpret normal bodily changes as signs of illness, contributing to somatic symptom disorders

How might family upbringing influence Somatic Symptom Disorders?

Family reinforcement of illness behaviors can contribute to the development of somatic symptom disorders, where family members may unintentionally encourage individuals to focus on physical symptoms

What is the definition of stress?

External demands placed on an organism and its internal biological and psychological responses to those demands

→ FIGHT OR FLIGHT

What are the key characteristics of stress?

• Severity: Ranges from mild to severe.

• Chronicity: How long the stress lasts.

• Timing: When the stress occurs in your life.

• Degree of Impact: How much the stress affects you.

• Level of Expectation: Whether the stress is expected or unexpected.

• Controllability: How much control you have over the stressor

What is the difference between acute and chronic stress?

• Acute Stress: Short-term, situation-specific stress (e.g., exams, job interviews).

• Chronic Stress: Prolonged stress related to ongoing or recurrent stressors (e.g., financial problems, relationship conflicts).

What is the "fight or flight" response?

The immediate stress response where the body prepares for action, activating the sympathetic nervous system to trigger physiological symptoms like increased heart rate and heightened alertness

What is the role of the HPA axis in the stress response?

The HPA axis (Hypothalamic-Pituitary-Adrenal axis) releases hormones like cortisol to prepare the body to handle stress.

What are the benefits/consequences of stress?

PURPOSE OF STRESS

• Stress CAN have beneficial effects

→ can help keep us alert/shut down other bodily functions to divert resources to relevant events

• BUT when inadequate resources to handle stress or stress overload → negative consequences

→ Lack of coping skills → OVERACTIVE/UNDERACTIVE response to stress 

What are some physical health consequences of chronic stress?

• Cardiovascular disease (CVD)

• Hypertension (high blood pressure)

• Obesity

• Immune system dysregulation

• Increased inflammation

• Muscular atrophy (loss of muscle)

What does "allostatic load" refer to?

cumulative "wear and tear" on the body from prolonged or chronic stress

Allostasis: Process of ADAPTATION TO ACUTE STRESS (returning to homeostasis)

How does stress relate to mental health disorders?

• A common trigger for the onset and recurrence of mental health disorders, and a diathesis-stress model explains how genetic predisposition combined with stress can lead to the development of disorders.

What are the two main types of coping strategies for stress?

• Problem-Focused Coping: Actively attempting to change or modify the stressor (e.g., finding a new job).

→ IF job is the stressor (looking for a different job could be an option) 

• Emotion-Focused Coping: Managing internal distress that arises from the stressor (e.g., self-care or relaxation).

→ It’s about how you adapt with the fact that it’s happening 

“Self-care: Exercising” 

Perceptions of Stress (2 types)

Primary & secondary appraisal

• Primary appraisal: This is when we first look at a stressful situation and decide how serious or harmful it might be.

  →Ex: if you're facing a big exam, you might think, "Is this going to be really hard?" or "Is this going to hurt me in some way?"

• Secondary appraisal: After figuring out how serious the stressor is, we then think about how we can handle it. This is when you assess your own abilities or resources to deal with the stress

  → Ex: "Do I have enough time to study?" or "Can I manage my anxiety with breathing exercises?"

How is inflammation related to mental health?

Inflammation can contribute to symptoms like anhedonia (lack of pleasure) and is linked to depression

• Elevated inflammation responses to stress may increase the risk of developing depression.

• Inflammation levels naturally fluctuate across pregnancy

(Increased inflammation later in pregnancy) 

• Prenatal inflammation predicts greater postnatal depressive symptoms

→ Particularly third trimester inflammation

What is childhood adversity, and why is it significant?

Childhood adversity refers to stressful or traumatic experiences before the age of 18.

• It is significant because it increases the risk of mental and physical health problems and can lead to chronic stress responses.

What are social determinants of health?

Social, economic, and environmental factors that influence health, such as income, education, healthcare access, and neighborhood safety.

How do structural inequities impact health?

Structural inequities, like poverty and discrimination, create chronic stress and limited access to healthcare, contributing to health disparities.

What does the (Adverse Childhood Experiences (ACEs) questionnaire) REVEAL???

• Evidence for environmental influences on psychopathology

• Proposed mechanism for preventing the development of psychopathology

• Identification of children at risk

• Early intervention

• Emergence of the study of resiliency

• Strengths-based approach

Child adversity: Due to other factors that increase stress

Why is sleep important for stress management?

Sleep plays a vital role in stress management, physical health, immune function, and cardiovascular health

• Poor sleep is associated with various mental health disorders, including depression and anxiety.

What are the DSM-5 criteria for insomnia disorder?

• Difficulty falling/staying asleep or waking early.

• Occurs at least 3 times per week for 3+ months.

• Causes significant distress or impairment.

• Not better explained by another disorder or substance use

→ Common in middle-aged and older adults

40-50% have comorbid mental disorder

→ Situational, recurrent, or persistent