Trauma, Dissociation, Somatic Disorders Robertson
Trauma, Dissociation, and Somatic Disorders
Page 1: Introduction
Overview of key concepts: trauma, dissociation, and somatic disorders.
Page 2: Table of Contents
Sections include:
Trauma Disorders
Dissociative Disorders
Somatic Symptom Disorders
Page 3: Trauma Disorders
Introduction to Trauma Disorders and their significance.
Page 4: Understanding Trauma
Trauma Definition (DSM):
Exposure to actual/threatened death, serious injury, or sexual violence:
Direct exposure
Witnessing in person
Learning of occurrence to a close family member or friend.
Repeated/extreme exposure to aversive details (e.g., first responders).
Media exposure does NOT count unless work-related
Critique of the definition: Is anything missing?
Page 5: Defining Traumatic Experience
Open-ended question: "How would you define a traumatic experience?"
Page 6: Trauma and Stressor-Related Disorders
DSM insists: Exposure to actual/threatened death or serious injury.
APA defines: Disturbing experience resulting in significant fear, helplessness, dissociation, confusion, with long-lasting negative effects.
Types of trauma: human-caused (rape, war) and natural (earthquakes).
Differentiate “Big T” vs. “Little t” trauma.
Prevalence rates:
PTSD: 6.8% lifetime prevalence.
Trauma: 50-90% lifetime prevalence.
Discussion: Will everyone experience trauma at some point?
Page 7: Biological Etiology of Trauma Disorders
Brain Activity:
Increased amygdala activity, decreased prefrontal cortex activity linked to stress response.
Problems with the HPA axis: lower cortisol levels in PTSD, impairing recovery from stress.
Hyperarousal Symptoms:
Excessive startle response/hypervigilance during trauma.
Page 8: Intergenerational Trauma
Impact of generational trauma and epigenetics influencing psychological well-being.
Page 9: Psychological Factors of Trauma Disorders
Conditioning (classical & operant) contributes to avoidance symptoms.
Maladaptive thought patterns lead to confirmed negative beliefs about self and others.
Page 10: Social, Cultural, and Environmental Factors
Trauma types influenced by gender:
Men: accidents,combat, nonsexual assault
Women: sexual violence highly predictive of PTSD.
Contextual differences in trauma experiences by gender.
Contributing factors: life stress, low SES, and past adversities raise PTSD risk.
Page 11: Protective Factors Against Trauma
Importance of social support from family, friends, and community.
Coping strategies: problem-solving vs. avoidance, possibly influenced by gender/culture.
Concept of Posttraumatic Growth (PTG) and resilience.
Page 12: Trauma and Related Disorders: Continuation
Transition towards deeper exploration of trauma-related disorders.
Page 13: Posttraumatic Stress Disorder (PTSD)
Diagnostic Criteria Overview:
Trauma, Re-experiencing, Avoidance, Mood/Cognition, Arousal symptoms.
Page 14: Criterion A for PTSD
Definition of exposure to trauma through direct experience, witnessing, or learning.
Excludes media exposure unless work-related exposure.
Page 15: Criterion B for PTSD: Intrusion Symptoms
Presence of recurrent memories, distressing dreams, flashbacks, and psychological distress.
Page 16: Criterion C for PTSD: Avoidance Symptoms
Persistent avoidance of distressing thoughts and external reminders related to trauma.
Page 17: Criterion D for PTSD: Negative Cognitions/Mood Alterations
Evidence of 2+ symptoms post-trauma such as amnesia about the trauma or persistent negative beliefs.
Page 18: Criterion E for PTSD: Arousal/Reactivity Changes
Altered behavioral responses post-trauma, requiring evidence of 2+ symptoms like irritability and concentration issues.
Page 19: Criterion F, G, and H for PTSD
Duration of symptoms exceeding 1 month, differential diagnosis includes dissociative symptoms, delay in expression.
Page 20: Acute Stress Disorder
Similar symptom presence as PTSD but shorter duration, diagnosed after 1 month of disturbance.
Page 21: Adjustment Disorder
Development of emotional/behavioral symptoms to identifiable stressors within three months of exposure.
Symptoms must cause significant distress or impairment but don’t classify under other disorders.
Page 22: Adjustment Disorder Additional Specifiers
Variants include details for symptoms like depressed mood, anxiety, conduct disturbances, and duration specifications.
Page 23: Prolonged Grief Disorder (7-10% lifetime prevalence)
Diagnostic criteria includes persistent grief responses more than 12 months post-death and significant emotional symptoms.
Page 24: Discussion on Prolonged Grief Disorder
Invite reflections on including this disorder within the DSM, exploring benefits and consequences.
Page 25: Childhood Disorders Related to Trauma
Reactive Attachment Disorder: significant emotional bond issues due to childhood trauma.
Disinhibited Social Engagement Disorder: inappropriate familiarity due to trauma/neglect.
Page 26: Treatment for Trauma-Related Disorders
Herman’s Triphasic Model of Trauma Treatment: Safety, Trauma Processing, Integration.
Page 27: Importance of Justice in Trauma Treatment
Quote by Judith Herman addressing the social context of trauma and the need for community involvement in recovery.
Page 28: Differential Diagnosis Practice Case 1: Silver
Presented symptoms following a sexual assault indicating PTSD or acute stress responses.
Page 29: Differential Diagnosis Practice Case 2: Grace
Symptoms post-loss of a friend and adjustment to new stresses without fitting criteria for major disorders.
Page 30: Introduction to Dissociative Disorders
Transitioning topics from trauma to dissociation.
Page 31: Understanding Dissociation
Definition: Discontinuity in integration of consciousness/memory/emotion.
Subtypes:
Depersonalization: feeling of unreality of the self.
Derealization: feeling like the world is unreal.
Page 32: Spectrum of Dissociation
Dissociative experiences range from normative to complex, indicating adaptive functions for coping with trauma.
Page 33: Biological Etiology of Dissociative Disorders
Brain activity linking hypoactive amygdala with dissociative responses.
Page 34: Psychological Etiology of Dissociative Disorders
High comorbidity with PTSD and BPD; dissociation as a coping mechanism utilized in face of trauma.
Page 35: Social and Environmental Factors in Dissociative Disorders
Developmental trauma leads to increased risk for complex dissociation; influenced by familial and cultural factors.
Page 36: Dissociative Identity Disorder (DID)
Defined by two or more distinct personality states with significant functional impact.
Page 37: Myths about Dissociative Identity Disorder
Common misconceptions about DID portrayed in media vs. reality.
Page 38: Dissociative Amnesia
Characterized by the inability to recall autobiographical information, often due to trauma.
Page 39: Depersonalization/Derealization Disorder
Persistent experience of depersonalization/derealization without loss of reality testing.
Page 40: Treatment for Dissociative Disorders
Follow Herman’s Triphasic Model, incorporating new methods like Finding Solid Ground for complex dissociation.
Page 41: Helpful Strategies in Treatment
Elements leading to effective treatment of complex dissociation include human connection, empathy, and therapeutic rapport.
Page 42: Differential Diagnosis Practice Case 1: Jason
Reported symptoms of detachment and disconnection; chronic anxiety triggers dissociative experiences.
Page 43: Differential Diagnosis Practice Case 2: Emily
Exhibiting symptoms of severe childhood trauma, memory gaps, and behavioral variance; indicative of dissociative disorders.
Page 44: Introduction to Somatic Symptom & Related Disorders
Transition from dissociative to somatic disorders.
Page 45: Overview of Somatic Symptom Disorders
Focus on the psychological nature of chronic pain and health anxiety.
Page 46: Biological Factors in Somatic Disorders
Genetic components and CNS dysfunction influencing pain perception and anxiety.
Page 47: Psychological Factors in Somatic Disorders
Comorbidity with psychological disorders and the role of maladaptive thought patterns.
Page 48: Social, Cultural, and Environmental Influences
Historical trauma, family influence, and cultural emphasis on somatic symptoms can exacerbate conditions.
Page 49: Somatic Symptom Disorder (SSD)
Defined as significant distress or disruption of daily life due to somatic symptoms without consistent physical causes.
Page 50: Illness Anxiety Disorder
Preoccupation with illness present without significant somatic symptoms; impacts functioning.
Page 51: Factitious Disorder
Defined by deceptive behavior regarding health with no evident external rewards; includes imposed symptoms on self/others.
Page 52: Specifiers for Factitious Disorder
Differentiating episodes and conditions under which the disorder is diagnosed.
Page 53: Malingering vs. Factitious Disorder
Malingering involves seeking external benefits; in contrast, factitious disorder fulfills a psychological need through the sick role.
Page 54: Treatment Approaches for SSRDs
CBT strategies include exposure work and mindfulness; addressing the function of physical symptoms.
Page 55: Differential Diagnosis Practice - Michael
Exaggerated symptoms and self-induced health issues suggest underlying factitious disorder.
Page 56: Differential Diagnosis Practice - Nick
Ongoing fear of illness despite reassurance points to illness anxiety disorder.
Page 57: Differential Diagnosis Practice - Macy
Example of individual fabricating mental health symptoms for financial gain, raising ethical concerns.