PTSD & DID Study Guide

What is the main difference between Acute Stress Disorder (ASD) and Post Traumatic Stress Disorder (PTSD)?

The duration of symptoms; ASD - less than 1 month, PTSD - longer than 1 month

True or False: Although women tend to experience more traumatic events, men are more likely to develop PTSD

False: Women are more likely to develop PTSD while men are more likely to experience traumatic events

What is the difference between the common usage of '“trauma” and the clinical usage?

General usage is much broader and lighter

What percent of people diagnosed with Acute Stress Disorder are end up also being diagnosed with Post Traumatic Stress Disorder?

80%

What are the 4 main symptoms of PTSD?

1. Intrusions

2. Avoidance

3. Negative thoughts & association

4. Increased arousal & anxiety

True or False: C-PTSD or Complex PTSD is recognized as U.S diagnosis and is listed in DSM-5

False

What are the symptoms of PTSD?

1. Exposed to actual or threatened death

2. Serious injury, or sexual violation

3. Re-experiencing the traumatic event through intrusive symptoms,

4. Persistent avoidance of stimuli

5. Negative alterations in cognitions & mood

6. Marked alterations in arousal and reactivity

Hearing your husband was killed in the Twin Towers on 9/11 would be enough on its own to trigger PTSD

True

The inability to remember an important aspect of a traumatic event would fall under which symptom of PTSD?

Negative alterations in cognitions & mood

What is the PTSD subtype called?

PTSD with prominent dissociative symptoms

In PTSD with prominent dissociative symptoms, people can experience symptoms of self or consciousness becoming disconnected from one another. This is called ______

Dissociation

What is Depersonalization?

Feeling detached from oneself

What is Derealization?

Feeling detached from the external world

Why can’t researchers latch on to an exclusively biological perspective to explain PTSD?

By definition, PTSD requires an environmental input (without trauma, there is no PTSD)

True or False: Because there is no current agreement on a purely biological explanation for PTSD, that means trauma cannot has not effect on any changes in the brain.

False

What are some common correlates for explaining who is more likely to develop PTSD?

1. Very violent experiences

2. Great level of severity

3. Duration of the trauma

4. Proximity of the trauma

What is one example of a possible correlate as to why women are typically diagnosed with PTSD compared to men?

Women are more likely to be raped than men, which is still highly stigmatized so is not discussed out of shame and embarrassment. That lack of social support is related to the development of PTSD

What are some psychological vulnerabilities associated with developing PTSD?

1. Psychological issues

2. People with lower IQ’s

3. Classical & operant conditioning

What are some social factors associated with developing PTSD?

1. Low socioeconomic status

2. social support immediately after trauma

What are some brain-related factors associated with developing PTSD?

1. Greater responsiveness in subcortical structure of the amygdala (brain’s threat detector)

2. With decreased prefrontal cortex response (regulates emotional response to threat)

3. Greater hippocampal functioning activity during memory tasks

4. Tendency to have smaller hippocampi

If the hippocampus activity is activated more greatly in patients with PTSD, how can you explain why they tend to have smaller hippocampi?

The trauma itself does not shrink the hippocampus but perhaps already having a smaller hippocampus might place someone at an increased vulnerability should they experience a trauma.

According to Gina Poe’s research about PTSD on rats, what did she discover about REM sleep?

The REM dream sleep after a rat has experienced a trauma can be hyperactive

What was one of the conclusions made in Gina Poe’s research on rats on delay sleep after a trauma?

Delaying sleep after a trauma may lessen the impact of disturbing experiences and even prevent the nightmares of of PTSD from taking shape

What are the major neurotransmitters in PTSD?

Norepinephrine, Epinephrine, Cortisol

People with PTSD tend to have ______ levels of resting cortisol relative to people without PTSD

Low

How does cortisol function in PTSD?

Helps to tamp down on an extended sympathetic nervous system response; helps bring down high levels of epinephrine & norepinephrine from fight or flight

If cortisol levels are ______, then SNS response should start to calm down, whereas if cortisol levels are __________ after a stressor, then the SNS response may remain high

high, low

Epinephrine & Norepinephrine are considered __________

Catecholamines

Catecholamines play a significant role in _________

Memory Consolidation

How do therapists use CBT for trauma & stress disorders?

1. Imaginal exposure

2. Developing a narrative of traumatic event to process understanding and writing it down

3. Challenge maladaptive beliefs about the world (survivor’s guilt)

4. Relaxing & breathing

What does EMDR stand for?

Eye Movement Desensitization Reprocessing

What is EMDR designed to simulate?

The eye movements that happen during REM sleep

According to the video on EMDR, how can EMDR mimicking REM sleep eye movements be functional in this type of therapy?

REM sleep is the brain’s natural state of restorative healing process, and can be used while a person is awake to to help reprocess traumatic events

What does the general EMDR look like?

Patients follow the therapist’s fingers while answering a series of questions about negative memories

What are some another explanations for EMDR requiring the movement of fingers?

It forces attentional shifts that occur when you move your eyes back and forth; simply following the fingers back and forth to elicit eye movement

EMDR stems from the logic that

The symptoms of PTSD arise from the inability to process images and cognitions

True or False: EMDR is better than no therapy, supportive listening done by a therapist, and even CBT

False: Does not appear to be different in terms of success compared to CBT

What is the main controversy behind EMDR?

Whether the eye movement aspect of this therapy is truly necessary or if the exposure is the significant element

According to a recent study, what is the finding about trigger warnings?

Trigger warnings not at all impact the distress that students felt or did not impact their intrusive thoughts

What did research on thought suppression by Dan Wegner reinforce?

When people attempt to avoid or push away thoughts, they do not actually go away but rather persistently intrude

What is the ultimate conclusion about trigger warnings?

They actually encourage behavior that is psychologically dysfunctional; Also because triggers are typically associations and anything could be an association, so nothing can ever fully insulate anyone from the trauma

What was Dissociative Identity Disorder (DID) formerly called?

Multiple Personality Disorder

What is the defining feature of DID?

Dissociation of personality

More than 2 distinct personalities within a single person are called _______

Alters

What are distinct features of DID from the DSM?

1. Disruption of identity characterized by 2 or more distinct personality states, recurrent gaps in the recall of everyday events

2. Important personal information, and/or traumatic events that are inconsistent with ordinary forgetting

3. The symptoms cause clinically significant distress

4. The disturbance is not a normal part of broadly accepted cultural or religious practice and is not attributable to the physiological effects of a substance or another medical condition.

In DID, the identity that keeps other identities together is known as the _____

Host

In DID, the ____ is the transition from one personality to another

Switch

True or False: In DID, switches between identities is slow and gradual

False: They are instantaneous

In DID, what is a two-way amnesiac relationship?

The alters do not know about each other

In DID, what is a one-way amnesiac relationship?

One identity will know another but that may not be reciprocated by the other

In DID, what is a mutually aware relationship?

All of the alters are aware of each other

How common is DID?

1% prevalence

For DID, what is the ratio between females to males for this disorder?

9 females:1 male

At what age do people report experiencing the development of DID (retrospectively)? And what age do they tend to be by the time they receive treatment?

Age 5; Age 30

What does the Post Traumatic Model (PTM) argue?

People dissociate to deal with trauma

How does the Post Traumatic Model (PTM) apply to DID?

The dissociation is so severe that the individual splits into different alters

What percent of patients of those diagnosed with DID claim to have experienced severe physical and sexual abuse when they were children?

97%

What is the problem with the PTM model?

Consider that Child Protective Services (CPS) takes in about 4 million cases per year in the U.S relating to cases about child abuse, statistically, DID should be more common than the 1% rate if it really is a coping mechanism, children do not show presence of alters, so if it is a coping mechanism, it is questionable as to why the alters do not appear in childhood

What is the socio-cognitive approach of DID?

The social interactions between the therapist, the patient, and even the culture create DID, fantast proneness overlaps with dissociation

What are recovered memories?

Fairly easy to create false memories through suggestibility

According to Elizabeth Loftus’ research, recovered memories of abuse have been shown to be ________

False

True or False: Therapists need to be well-trained in memory function and be careful not to suggest an untrue history by mistake

True

What disorder is DID most commonly co-morbid with and what percent?

Depression; 91.5%

What is the other main disorder therapists need to rule out before arriving at DID?

Factitious disorder

What is a general signal of someone faking DID (factitious disorder)?

They tend to overplay the role with commonly known symptoms such as dissociative amnesia, and “enjoy” letting people know of their “DID”, and appears very cliche, while those who truly have it are usually depressed and also tend to be ashamed and overwhelmed by their symptoms

What are some significant similarity between DID and Borderline Personality Disorder (BPD)?

Identity disturbance, dissociative symptoms, self-harm, suicidality

How would a therapist approaching DID from a Post-Traumatic Model?

Would want to map out the identities and features of the various alters and patients may have to confront early trauma all to focus on reintegration of them

How would a therapist approaching DID from a Socio-Cognitive Model?

Likely won’t even acknowledge the alters since that would be reinforcing; rather they would focus on current issues of distress and dysfunction

In a survey, how many therapists believed that DID should remain in the DSM and why?

1/3; Because DID is so rare and so controversial, there is not enough supported or controlled research on the effectiveness of any treatment, so there is no verdict on what actually works