PSYC251 LECTURE 4

Lecture Overview

  • Instructor: Mala Khare

  • Course: UOW PSYC251

  • Lecture: 4

  • Main topics: Trauma and Addictive behaviors (both are important for exams)

Trauma

What is Trauma?

  • Trauma happens when a stressful event is too much for a person to handle.

  • Stressful events can include:

    • Feeling like you or someone else might die or get seriously hurt.

    • Threats to your or someone else's body, sexuality, or mental wellbeing.

  • People usually react with strong feelings of fear, helplessness, or terror.

Childhood Trauma

What is Childhood Trauma?

  • Childhood trauma is an upsetting or painful event that overwhelms a child's ability to cope.

  • Things that cause childhood trauma:

    • Being threatened repeatedly (constant, uncontrollable danger).

    • Being neglected or not getting the care you need.

  • Long-term effects: Ongoing stress that causes lasting mental and physical problems.

Different Types of Childhood Trauma

  1. Single Incident Trauma

    • This is a one-time event.

    • Example: Seeing a car accident or being robbed at gunpoint.

  2. Complex Trauma

    • This involves repeated threats, often from someone the child is supposed to be close to (like a parent or caregiver).

    • Includes abuse, neglect, domestic violence, and living in unsafe communities.

DSM-5 Criteria for PTSD (Post-Traumatic Stress Disorder)

How PTSD is Diagnosed (Criteria A-H)

  • A: Exposure to Trauma: Someone experiences or sees actual or threatened death, serious injury, or sexual violence. This can be:

    • Directly experiencing it.

    • Witnessing it happen to others.

    • Learning it happened to a close family member or friend.

    • Repeatedly being exposed to upsetting details of trauma (e.g., first responders).

  • B: Intrusion Symptoms: Having at least one unwanted symptom related to the trauma, like unwanted memories, bad dreams, feeling out of touch with reality (dissociation), or flashbacks.

  • C: Avoidance: Always trying to avoid things that remind them of the trauma.

  • D: Changes in Thoughts and Mood: Changes in how someone thinks and feels, such as not being able to remember parts of the trauma or having ongoing negative thoughts about themselves.

  • E: Arousal and Reactivity: Being easily startled or on edge, like having trouble sleeping or being hyper-alert.

  • F: Duration: Symptoms last for more than 11 month.

  • G: Distress or Impairment: Symptoms cause significant problems in daily life or make the person very upset.

  • H: Not Due to Substances: Symptoms are not caused by drugs or other medical conditions.

Complex Trauma vs. Developmental Trauma

  • Complex Trauma: Happens from repeated exposure to interpersonal threats, especially when adults who should protect the child fail to do so.

  • Developmental Trauma: Injuries caused by ongoing, uncontrolled stress early in life that can harm a child’s brain development.

    • Impacts: Problems with social skills, emotions, thinking, and a higher risk for health issues (like heart disease, obesity), substance abuse, depression, and difficulty forming healthy relationships.

  • Developmental trauma comes from unmet needs in childhood relationships and prolonged stress reactions.

Symptoms of Traumatic Stress

Main Symptoms

  1. Dissociation: Feeling detached from experiences, like you're watching yourself from outside your body, or a loss of senses.

  2. Hyperarousal: Always feeling stressed and ready to 'fight or flight', leading to being overly alert, aggressive, or defiant.

    • Younger children often dissociate more than they become hyperaroused.

  3. Attachment Challenges: Finding it hard to form secure bonds with others; behaving like wanting closeness then pushing people away.

  4. Control Issues: Struggling with self-control, doing self-destructive things, having sleep problems, and taking high risks.

  5. Biological Symptoms: Physical problems like being very sensitive to touch, unexplained body aches, and problems with basic body functions.

  6. Mood Regulation Problems: Difficulty managing emotions, constant feelings of fear, anxiety, depression, acting on impulse, and feeling powerless.

  7. Cognitive Difficulties: Problems focusing, finishing tasks, learning, and developing language.

  8. Self-Concept Disturbances: Low self-esteem, shame, confusion about who they are, and negative beliefs about themselves (e.g., thinking they are a 'bad kid').

  9. Memory Problems: Difficulty remembering trauma events in a clear, story-like way; memories might be tied to how they felt at the time (state-dependent); fears about the world; and unrecognized sadness because traumatic memories are not processed like normal memories.

How Childhood Trauma Connects to PTSD

  • Ongoing or complex trauma in children is often diagnosed with PTSD.

  • Key PTSD symptoms in children:

    • Reliving the trauma through nightmares and unwanted memories.

    • Always avoiding thoughts, places, and people connected to the trauma.

    • Feeling numb emotionally and being easily startled or on edge.

  • Common misdiagnoses: Sometimes, children with trauma are wrongly diagnosed with reactive attachment disorder, ADHD, or conduct disorder, which can hide the real impact of trauma on their development.

Impact of Trauma on Brain Function

How Trauma Changes Brain Development and Function

  • Trauma changes how the brain works, especially making it harder for the stress response systems to function properly.

  • Stages of Brain Development:

    • Neocortex (thinking brain)

    • Limbic system (emotional brain)

    • Brainstem (reacting brain)

Reacting Brain vs. Thinking Brain

  • Reacting Brain: This part controls automatic body functions and quick responses to danger. It develops early.

  • Thinking Brain: This part handles reasoning, planning, and self-control. It develops later in life.

The Body's Alarm System and Responses

  • The fight/flight/freeze response is a natural reaction to immediate physical danger. However, in long-lasting trauma, this system can malfunction, leading to unhelpful behaviors.

  • If 'freezing' is misunderstood, anxious symptoms might not be treated correctly.

Trauma’s Effects on Stress Response Systems

  • Short-term stress: Involves adrenaline and makes someone very sensitive to triggers.

  • Long-term stress: Involves the HPA axis (hypothalamic-pituitary-adrenal axis), which releases stress hormones (glucocorticoids) for too long, affecting the immune system and causing physical health problems.

  • Amygdala: Becomes overactive, making trauma responses worse without proper regulation.

  • Hippocampus: Shrinks, causing problems with memory and learning.

  • Frontal Cortex: This area, which controls impulse and flexible thinking, can shut down due to trauma.

Attachment and Recovery

Steps to Recovery

  1. Establish safety: Making sure the person feels physically and emotionally secure and safe.

  2. Increase reflection: Helping the person understand and talk about their traumatic experiences, turning them into manageable memories.

  3. Resume normal functioning: Encouraging the person to get back to their usual activities and relationships.

Therapy Approaches

  • Trauma-informed treatment usually involves about 8-12 sessions, focusing on how attachment problems and childhood trauma are connected.

  • The caregiver's role is critical; they need to provide stable, understanding interactions to help the child recover.

Addictive Behaviors

What is Addiction?

  • Addictive behavior means consistently engaging in a core life activity (like using a substance or doing an activity) that causes physical, mental, or social problems and withdrawal from responsibilities.

  • Categories:

    • Substance addictions: Involve drugs or alcohol.

    • Behavioral addictions: Involve activities like gambling or sexual activity.

Models of Addiction

  • Biopsychosocial Model: This model sees addiction as a complex issue influenced by many factors working together:

    • Biological factors: Genes, changes in brain chemistry, and how a person reacts to substances early on.

    • Psychological factors: Ways of coping, mental health issues (like low self-esteem, PTSD), and personality.

    • Social/Environmental factors: Influence from friends, family life, cultural norms, easy access to substances, abusive living situations, and economic status.

  • This model highlights that addiction is a complex disorder, not just a moral failing, and needs thorough treatment.

Types of Addictive Behaviors

  • Substance Addictions:

    • Alcohol (e.g., beer, wine, spirits)

    • Opioids (e.g., pain killers like oxycodone, fentanyl; illegal drugs like heroin)

    • Stimulants (e.g., cocaine, methamphetamines, prescription ADHD meds like Adderall)

    • Cannabis (e.g., marijuana)

    • Sedatives/Hypnotics/Anxiolytics (e.g., tranquilizers like benzodiazepines that reduce anxiety or help sleep)

    • Hallucinogens (e.g., LSD, psilocybin/magic mushrooms)

    • Tobacco/Nicotine (e.g., cigarettes, vapes)

  • Behavioral Addictions:

    • Gambling

    • Sex addiction

    • Internet/Video games

    • Overeating

    • Shopping

    • Excessive Exercise

The Addiction Process

  • It starts with being drawn to pleasurable experiences, often to hide emotional pain with substances or activities.

  • Friends and wanting to fit in can also encourage these behaviors.

Signs of Addiction

  • Obsession: Constantly thinking about the addictive behavior.

  • Loss of Control: Not being able to predict or stop the destructive impacts of the behavior.

  • Negative Consequences: Experiencing losses in physical health, legal trouble, social life, or family relationships.

  • Denial: Not realizing that the behavior is harmful to oneself.

Risk Factors for Addiction

Biological Factors

  • Early strong reactions to substances.

  • Learning difficulties.

  • Family history of addiction and mood disorders (which can be genetic).

Psychological Factors

  • Low self-esteem.

  • Post-traumatic stress.

Environmental Factors

  • Peer pressure (what friends do).

  • Easy access to substances.

  • Abusive environments.

Treatment Approaches for Addiction

  1. Assessment: Understanding how severe the addiction is and its impact, including social and physical effects.

  2. Motivation: Using models like the transtheoretical model to see if the person is ready to change.

  3. Targeted Interventions: Specific help tailored to the individual's unique needs.

  4. Harm Minimization: Actions to reduce the negative effects of substance use, while knowing that completely stopping is the safest way.

Final Thoughts on Addiction Treatment

  • Treatment should be personal, offer hope, and accept that relapses are a normal part of getting better.

  • It's important to treat any other mental health conditions (co-morbid conditions) at the same time for the best results.