Dissociative and Trauma Disorders

Acute Stress vs. Post-Traumatic Stress Disorder

  • Precipitating Event:
    • Both acute stress and PTSD involve witnessing or experiencing an actual event that threatens severe injury or death to the client or others.
    • Both disorders involve the same feelings during the event: fear, hopelessness, and horror.
  • Onset:
    • Acute stress: Begins immediately after the event.
    • PTSD: Onset occurs with delays of days, weeks, months, or even years after the event.
  • Duration:
    • Acute stress: Manifestations last less than 30 days.
    • PTSD: Manifestations last over 30 days.
  • Experiencing the Event:
    • Similarities: Both involve experiencing the event through dreams or images and reliving it through flashbacks.
    • Flashbacks: Intense re-experiencing of the event, feeling as if they are reliving the traumatic situation (e.g., being back in combat).
    • Differences (PTSD): Illusions or hallucinations.
  • Manifestations:
    • Similarities: Irritability and sleep disturbance.
    • Acute Stress:
      • Dissociativeness (e.g., amnesia).
      • Absent emotional response.
      • Decreased awareness of surroundings.
    • PTSD:
      • Difficulty concentrating.
      • Avoidance of stimuli associated with the trauma (persons, places).
      • Inability to show feelings.
  • DREAMS (Mnemonic for PTSD Manifestations):
    • D: Detachment (feeling detached from others, inability to show feelings).
    • R: Re-experiencing the event (flashbacks, nightmares).
    • E: Emotional effects (significant emotional distress).
    • A: Avoidance (avoiding stimuli that trigger traumatic memories).
    • M: Medication (self-medicating with alcohol or illicit drugs to cope with psychological trauma).
    • S: Sympathetic hyperactivity (remaining hypervigilant and in a hyper-aroused state).

Interventions and Treatment Modalities

  • Cognitive Behavior Therapy (CBT):
    • (already covered previously)
  • Prolonged Exposure Therapy:
    • Goal: Reduce anxiety and avoidance behaviors related to trauma.
    • Involves practicing relaxation techniques.
    • Talking about the trauma repeatedly in a safe setting.
    • Confronting trauma-related situations safely.
  • Group and Family Therapy:
    • Sharing experiences with others and supporting each other.
  • Eye Movement Desensitization and Reprocessing (EMDR):
    • Goal: Help the brain process traumatic memories.
    • Client thinks about the traumatic event while following the therapist’s hand movements with their eyes.
    • This process is repeated to reduce emotional distress from traumatic memories.
  • Digital Therapeutics:
    • FDA-approved apps for smartwatches (e.g., Apple Watch) designed for PTSD-related nightmares.
    • The smartwatch detects abnormal heart rates during nightmares.
    • It gently vibrates to interrupt the dream without fully waking the person.

Dissociative Identity Disorder (DID)

  • Formerly known as multiple personality disorder.
  • Name change reflects a better understanding: it’s about dissociation or splitting from the original identity, not multiple personalities.
  • Example: Split (movie).
  • Dissociation as a Defense Mechanism:
    • A mental process where an individual disconnects from their thoughts, feelings, memories, or sense of identity.
    • The brain's way of coping with trauma or stress.
    • Everyone has experienced dissociation to some extent (e.g., driving and missing an exit, becoming deeply absorbed in a novel like Fifty Shades of Grey).
  • Chronic Trauma and Alters:
    • In individuals with chronic traumatic experiences (e.g., sexual abuse), dissociation becomes a frequent coping mechanism.
    • The brain creates "alters," which are distinct personalities or personality states.
    • Alters have their own age, gender, and situation.
    • Alters emerge during traumatic situations to handle situations the original identity cannot.
    • Example: Elizabeth (21-year-old female) with DID. In a situation where someone is yelling at her, an alter (Jabba, a 45-year-old muscular male) might emerge to protect her. In another situation (mother scolding), a different alter (Jessica, a 5-year-old) might appear.
  • Triggers and Switches:
    • Alters are triggered by specific stimuli or reminders of traumatic events.
    • Some switches between alters are rapid and noticeable, while others are gradual.
    • Individuals may literally see themselves as a different alter in the mirror.
  • Communication Between Alters:
    • Alters may or may not be aware of each other.
    • Some alters communicate with each other, while others do not.
    • Memory lapses or amnesia can occur between switches.
  • Therapy and Integration:
    • Therapy aims to integrate all alters into one cohesive identity (e.g., bringing all alters back into Elizabeth).
    • The therapist helps the individual recognize that Elizabeth is all of those alters.
    • Integration is a lengthy process that can take years due to the psychological trauma involved.
    • Complete integration may not always be possible due to the severity of the trauma.