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.