Lecture 11 - Trauma and Stressor-Related Disorders

what are the 4 parenting styles?

authoritative, permissive, authoritarian and uninvolved

authoritative

 considered the best parenting style, mix of demanding but still warm

permissive

undemanding and warm, have a hard time setting boundaries

authoritarian

mix of demanding and cold, very dictative/controlling approach

uninvolved

mix of cold and undemanding

continuum of care

ranges from positive/healthy parenting to emotionally abusive/neglectful parenting, poor/dysfunctional parenting is in the middle

positive/healthy parenting

provides a variety of sensory stimulation and positive emotional expressions, expresses joy at child’s efforts and accomplishments, engages in competent, child-centered interactions to encourage development, friendly, positive interactions that encourage independent exploration

poor/dysfunctional parenting

shows rigid emotional expression + inflexibility in responding to child, seems unconcerned with child’s developmental/psychological needs, often insensitive to child’s needs; unfriendly, poor balance between child independence and dependence on parent, not noticing impact it has cause rly stubborn in the way they approach things, don't think about what they can do to make them thrive in their development

emotionally abusive/neglectful

expresses conditional love and ambivalent feelings towards the child, shows little or no sensitivity to child’s needs, emotionally or physically rejects child’s attention, takes advantage of child’s dependency status through coercion, threats or bribes, very ambivalent about being a parent, not rly attached to that child

neglect

can be more emotional than physical, harder to do anything about it, impacts your development and ability to trust others, hard to connect with your own experiences and emotions, means that emotional needs were not met, parent may be there but not emotionally, kids of these parents struggle to trust others or understand how they feel in certain situations, alarm signals aren’t as good, lack secure foundation and struggle to get into relationships when they grow up

ambivalence

in emotionally abusive/neglectful parenting, it could be due to feeling overwhelmed from labor, the pregnancy or responsibility of the child itself, doubting if you are good at parenting, postpartum depression is also a thing for fathers too, more narcissism in emotionally abusive/neglectful parents

types of abuse

physical, psychological or sexual (there is a boundary and its causing damage to that child to cross that boundary

paradoxical dilemmas

want to stop violence but also wants to belong to the family in which they are being abused (still want an attachment from that family member, disorganized attachment style, afraid of major attachment figure but still want that relationship, still care about how you are perceived by that person), affection and attention may coexist with violence and abuse, intensity of violence tends to increase with time but sometimes it might decrease or stop (boundary gets crossed it gets easier to cross it each time something happens), hard to not make excuses for them because you have mixed feelings

DSM 5 vs law definition of abuse

has to cause physical harm to the child but in the law there is an endangerment component (legally take into account the emotional state of the parent, was the force used reasonable?, psychological state of the parent is important because it raises flags that the next time it could be more violent)

what symptom do children experiencing abuse have?

depression, emotional distress and  suicidal ideation (due to feeling stuck and not wanting to stay in that victim role), greater risk of substance abuse, those who have experienced sexual abuse can lead to eating disorders (anorexia nervosa and bulimia nervosa)

poor emotion regulation

maltreated infants/toodlers have difficulty establishing consistent interaction with caregivers, they have a hard time understanding, labelling and regulating internal emotional states, they exhibit insecure-disorganized attachment, learn to inhibit emotional expression and regulation, remaining more fearful and on alert, need the parents to step up and be calm during the meltdowns

neurobiological factors that indicate abuse

show long term alterations in the HPA axis and norepinephrine systems, affected brain areas include the hippocampus, prefrontal cortex and amygdala, acute and chronic forms of stress are associated with it and may cause changes in brain development and structure from an early age, the neuroendocrine system will become highly sensitive to stress, trauma will cause epigenetic changes for genes related to mental health, metabolite diseases, obesity, etc due to inflammation created by chronic stress

what are the causes of physical abuse and neglect?

family stress, poor exposure to positive parental models and supports, information processing disturbances, lack of understanding developmental expectations, conditioning of negative arousal and emotions with certain events, family conflict and marital stress

poor exposure to positive parental models and supports

maybe due to coming from dysfunctional families, greater degree of family stress

information processing disturbances

may cause parents to mislabel their child’s behavior that will lead to inappropriate responses that are too harsh, how do they describe or explain certain features

lack of understanding appropriate developmental expectations

when there is a child with special needs it increases the risk of abuse and neglect, with ADHD there is more abuse cause parents are having a harder time cause they don’t adjust their expectations and can't just accept their behavior cause it isn't something they can control

conditioning of negative arousal and emotions with certain events

when a child is crying, if a parent feels anger that is very dangerous, doesn't understand that it doesn't necessarily mean the child wants something from them could just be they want to be comforted

trauma and stress

when this occurs in childhood or adolescence it might involve actual or threatened death or injury or threat to one’s physical integrity (ex: major accidents, natural disasters, kidnapping, brutal physical assaults, war and violence or sexual abuse), causes elevated risk of PTSD

reactive attachment disorder

condition where a child, typically before the age of 5 struggles to form healthy emotional attachment with caregivers due to severe neglect or abuse, leading to inhibited or disinhibited social and emotional behaviors, absent or minimal attachments to any caregiver whatsoever

disorganized attachment

different from RAD because they have developed attachment relationships with a primary caregiver

disinhibited social engagement disorder

don’t check back with their major attachment figure, can follow a stranger without any hesitations, really trusting too much and not being afraid to be with a stranger, certain things you only do with your parent, supposed to be unique, observe it in kids that may have similar backgrounds, never develop weariness around strangers

RAD essential feature

inhibited and emotionally withdrawn behavior toward caregiver: rarely seeking comfort when distressed, minimally responding to comfort from others

DSED essential feature

indiscriminately approaches and interacts with unfamiliar adults, associated with a lack of social inhibition

associated features RAD

little social and emotional responsiveness to others, limited positive emotions, unexplained periods of sadness, fearfulness or irritability 

associated features DSED

lack of fear when interacting with unfamiliar adults, overly familiar verbal or physical behavior, not checking back with caregiver when in an unfamiliar setting, willingness to wander off with strangers

PTSD

acute stress disorder, development occurs during or within 1 month after exposure to an extreme traumatic stressor and at least 9 symptoms associated with intrusion, negative mood, dissociation, avoidance and arousal, children who react to more common and less severe forms of stress in an unusual or disproportionate manner may qualify for a diagnosis of adjustment disorder

associated problems and adult outcomes in PTSD

it can be a chronic psychiatric disorder persisting years, may have remission of the symptoms due to a recent stressor/another traumatic event that happens, have a delay where the symptoms come back

exposure based therapy to treat PTSD

needs to tackle that avoidance, need to have quick interventions right after, when many ppl are involved in the trauma its easier to intervene, do exposure to have a clear understanding of all of the trauma, more understanding of the cognitive perspective, could have a lot of anger towards the abuser, for kids it could be a mix of trauma

abuse prevalence

emotional abuse prevalence is 53% in people with eating eating disorder and physical abuse is 45%

emotional neglect and eating disorders

causes them to loss the ability to regulate intensity of feelings and impulses, eating symptoms can be viewed as a way to cope to regulate overwhelming emotional state and avoid trauma related memories, body is hypervigilant and gives you fake energy, can’t do CBT in that state of mind, this distracts your mind to what’s really going on, neglect is the kind of trauma associated with dissociation in bulimic individuals, causes OCD like symptoms in anorexia nervosa

eating disorder etiology

experience shame and disgust, mixed sometimes with self injury but definitely harming your own body to regain a sense of control over your life, some will meet the criteria for an ED but its not about being thin but rather the aspect of gaining control and numbing the emotions

CBT perspective on ED etiology

affective disturbance characterized by low self esteem, cognitive disturbance characterized by distorted perceptions of weight, shape and body image, behavioral disturbance marked by maladaptive eating habits (fasting + purging to alleviate guilt and fears of weight gain)

tripartite influence model (ED etiology)

alternative social-cultural model for development of eating disorders that shows 3 factors that influence girls eating behavior: peers, parents and the media

parental restriction in childhood (ED etiology)

they are judgy about their kids shape, weight or eating habits imposing strict rules about eating, cause those kids to overeat later in childhood

negative reinforcement of binging

depression at baseline predicted bingeing in teens and adults, suggests that youths with BED might binge to alleviate anxiety, depression or dysphoria

DSM 5 criteria for anorexia nervosa

• Restriction of food intake leading to a really low BMI, specifier: how severe the anorexia is based on the BMI

• Disturbance where your weight and body shape are disconnected, don't recognize severity of being that sick and how that impacts your health

• Intense fear of weight gain

• Repeated restrictions and binge-purge cycle of eating

• Very high levels of serotonin making you feel more obsessive, plumbing lots of your body’s signals

DSM 5 criteria for bulimia nervosa

• Recurrent episodes of binge eating: crucial aspect is how you feel when you’re doing that, loss of control/dissociation behavior

• All about the BMI

• Need to have the frequency and duration to meet the criteria

• Cant have bulimia and anorexia at the same time

DSM 5 criteria for binge eating disorder

• Eating much more rapidly than normal, often they are not hungry/could be after dinner, just doing it to feel better

• Will feel uncomfortably full, embarrassment and eating alone because of it

• Co-occurring with depression often

• Not associated with recurrent use of compensatory behavior