Textbook

Eating disorders

What additional diagnostic categories were added in the DSM-5 and why?

  • Avoidant/Restrictive Food Intake Disorder (ARFID)

  • Binge Eating Disorder (BED)

  • Other Specified Feeding or Eating Disorder (OSFED)

Why?

  • To better capture clinically significant eating problems that didn’t meet full criteria for AN or BN in DSM-IV.

  • To reduce the overuse of EDNOS (Eating Disorder Not Otherwise Specified), which was too vague.

What are the central tenets of Fairburn’s transdiagnostic theory of eating disorders?

  • Eating disorders share core psychopathology: overvaluation of shape, weight, and control over eating.

  • This core leads to similar behaviors across disorders (e.g., restriction, binging, purging).

  • Fairburn suggests all eating disorders should be treated similarly, as the underlying mechanisms are shared.

This explains why people often move between different eating disorder diagnoses over time (diagnostic crossover).

What is the primary symptom that distinguishes AN from BN or BED?

  • Significantly low body weight is the key symptom in anorexia nervosa (AN).

    • People with BN or BED are typically normal weight or overweight.

Which restrictive behavior is most prominent in AN?

  • The most prominent is dietary restraint or caloric restriction.
    🟠 Examples:

    • Skipping meals

    • Extreme counting or tracking calories

    • Avoiding entire food groups

    • Fasting or only eating “safe” foods

Why do patients with AN overestimate their body size, and how does this relate to treatment?

  • Likely due to cognitive distortions and body image disturbances, not literal visual distortion.

  • This overestimation leads to denial of illness and resistance to treatment, because they don’t see themselves as underweight or at risk.

What are some physical consequences of malnutrition?

  • Slowed heart rate

  • Low blood pressure

  • Brittle hair/nails

  • Amenorrhea (loss of menstrual cycle)

  • Bone density loss (osteoporosis)

  • Cold intolerance

What is the key symptom of bulimia nervosa (BN)?

  • Recurrent binge eating followed by compensatory behaviors (like vomiting, fasting, or over-exercising)

Objective vs. Subjective Binge:

  • Objective binge = eating a large amount of food + loss of control

  • Subjective binge = feeling out of control, but the amount of food isn’t objectively large

When do binges usually happen, and what triggers them?

  • Most likely to happen at night, when someone is alone.
    🔶 Common triggers:

  • Negative emotions (sadness, stress)

  • Dietary restriction earlier in the day

  • Body dissatisfaction

  • Boredom

What are some physical effects of frequent binging and purging?

  • Electrolyte imbalances

  • Dehydration

  • Tooth enamel erosion

  • Digestive problems

  • Esophagus damage

What differentiates BED from BN?

  • No compensatory behaviors in BED (no vomiting, fasting, etc.)

  • BED often leads to obesity, but not always

  • Similar feelings of loss of control and distress

What is interoceptive awareness and how does it relate to eating disorders?

  • Interoceptive awareness = ability to recognize internal bodily signals (like hunger, fullness, or emotions)

  • People with eating disorders often have low interoceptive awareness, which may lead to:

    • Ignoring hunger

    • Eating in response to emotion instead of need

    • Difficulty identifying feelings

What factors are associated with adopting the “thin ideal”?

  • Media exposure (TV, social media, magazines)

  • Peer pressure and appearance-based comparisons

  • Family emphasis on weight or dieting

  • Perfectionistic personality traits

What family traits are common in eating disordered patients (besides eating habits)?

  • High control or criticism from parents

  • Low emotional warmth

  • Poor communication

  • Conflict avoidance

  • Enmeshment (blurred boundaries)

What do genetic studies suggest about eating disorders and gender differences?

  • Twin studies show moderate heritability for eating disorders—more than 50% for AN and BN.

  • Greater genetic vulnerability in girls may be related to:

    • Puberty-related hormonal changes (like estrogen)

    • Gender-specific stressors (appearance-focused social pressure)

Suggests that biological sensitivity interacts with cultural and social risk factors to influence development of eating disorders—especially in girls.

Bipolar Disorder

  1. Be familiar with the symptoms in Criteria A and B for DSM-V diagnosis.  

    1. Criteria A symptoms

      1. Manic episodes experience

        1. Elated mood

        2. Expansive mood

        3. Irritable mood

      2. An individual has an increased goal-oriented focus

    2. Criteria B symptoms

      1. At least 3 of the following (4 if mood is irritated)

        1. Inflated self-esteem (grandiosity)

        2. Decrease need for sleep

        3. Racing thoughts

          1. rapid source of ideas

          2. Pressured speech

        4. Reckless & impulsive behavior

        5. Increase in energy

        6. Easily distracted

  2. What differentiates a hypomanic from a manic episode? 

    1. Hypomanic are defined as

      1. Shorter duration of symptoms (4 or more day)

      2. Noticeable changes in behavior (does not meet the criteria in the DSM-V)

      3. Functional impairment

      4. Noticeable changes in mood, behavior, or energy by others

      5. Symptoms do not cause impairment in an individuals  financial, emotional or practical lives

    2. Manic are defined as 

      1. symptoms lasting at least one week

      2. Evidence of functional impairment 

        1. Deterioration in family

        2. Deterioration in work

        3. Deterioration in social

      3. If less then a week 

        1. The need to be hospitalized or going to the emergency treatment

  3. What is a mixed episode? 

    1. When an individual experiences both syndrome manic and depressive occur simultaneously

    2. Associated with an earlier onset and higher levels of comorbidity with anxiety and substance.

    3. The DSM-V no longer list mixed episodes as a category.

      1. It’s considered a broad specifier now

    4. Applied only when 3 + sub threshold symptoms from the opposite pole occur during a manic depressive, or hypomanic episode

What differentiates a hypomanic from a manic episode?

Feature

Hypomanic Episode

Manic Episode

Duration

At least 4 days

At least 1 week (or any duration if hospitalization needed)

Severity

Symptoms are noticeable, but not severely impairing

Causes significant impairment in social, work, or daily life

Hospitalization

Not required

May be required due to severity or risk

Psychotic features

Never present in hypomania

Can be present during mania

Others can notice

Yes, others can observe changes in behavior or mood

Yes, and it often disrupts relationships or responsibilities

What is a mixed episode?

A mixed episode is when a person has symptoms of both mania and depression at the same time or in very quick shifts.

  • The DSM-5 no longer lists “mixed episode” as a separate diagnosis.

  • It’s now a specifier: “with mixed features.”

  • Applies when 3 or more sub-threshold symptoms from the opposite pole occur during a manic, hypomanic, or depressive episode.

Example: A person in a manic episode may also feel very hopeless and cry easily (depressive symptoms).

What factors are associated with less impairment in functioning in bipolar disorder?

  • Later onset of illness (less disruptive than early onset)

  • Shorter and less frequent episodes

  • Fewer mixed features

  • No psychotic symptoms

  • Strong social support

  • Better treatment adherence

  • Higher baseline cognitive functioning

What evidence suggests bipolar disorder is associated with creativity?

  • Studies show people with bipolar disorder (especially those with hypomanic traits) tend to score higher on measures of creativity, artistic achievement, and original thinking.

  • Many famous artists, writers, and musicians have had bipolar symptoms.

  • Creativity is most often linked with mild manic or hypomanic states—not with full-blown mania or depression.

Are manic episodes themselves the cause of such creativity?

Not exactly:

  • Hypomanic states (milder mania) can enhance:

    • Confidence

    • Idea generation

    • Energy

    • Drive

  • But full manic episodes often include disorganized thinking, poor judgment, and impaired functioning—not helpful for creative work.

  • So, it’s more accurate to say a certain level of elevated mood and energy may support creativity, but too much disrupts it.

What is expressed emotion (EE) and how does it relate to bipolar disorder?

Expressed Emotion (EE) refers to the emotional climate in a person’s family—especially levels of:

  • Criticism

  • Hostility

  • Emotional overinvolvement

High EE in families is linked to:

  • Higher risk of relapse

  • Worsening of bipolar symptoms

  • Lower treatment response

What early life experiences are related to more severe bipolar disorder later?

  • Childhood trauma, including:

    • Abuse (physical, emotional, sexual)

    • Neglect

    • Loss of a parent or caregiver

  • These experiences can lead to:

    • Earlier onset

    • More severe mood episodes

    • More frequent relapses

    • Higher risk of substance use and anxiety

What evidence suggests childhood adversity increases sensitivity to stress in bipolar disorder?

  • Research shows that individuals with childhood trauma are more likely to have manic or depressive episodes after stressful life events.

  • This means early adversity may "sensitize" the brain, making people more reactive to future stress.

  • This is part of the stress-sensitization hypothesis.

What is the Social Rhythm Stability Hypothesis?

This hypothesis says that disruptions in daily routines (like sleep, meals, social activity) can trigger mood episodes—especially mania—in people with bipolar disorder.

  • People with bipolar disorder often have sensitive internal clocks (circadian rhythms).

  • When their daily routines become unstable (e.g., jet lag, staying up late), it can throw off brain chemistry and trigger an episode.

  • Therapies like Interpersonal and Social Rhythm Therapy (IPSRT) aim to stabilize these routines to prevent relapse.

Extra notes

  • 1 in every 25 persons may be affected with Bipolar Disorder

  • Episodes are highly disruptive, recurrences are frequent, psychosocial impairments are severe even when an individual isn’t symptomatic.

  • Onset is typically in late childhood & adolescence

  • Problems:

    • The reliability to diagnose and differentiate from similar/ neighbor disorders

    • Extent of recurrence timing can be reliably predicted

    • Genetic contributions, biological and psychosocial factors being part of different developmental phases

    • The role medication and psychotherapy have in individuals with treating and maintaining control over bipolar disorder.

  • Bipolar Disorder is defined as a severe change in one’s mood, thinking, and behavior. Individuals experience episodes of extreme highs and lows.

    • The most common representation of Bipolar is mania and depression  alternating themselves in the form of episodes that can last from a week to over a year.

  • Depressive phases are defined by the DSM-V criteria for Major Depressive disorder (MDD)

    • Must have these symptoms for at least 2 weeks to qualify

      • Anhedonia: intense sadness and/or loss of interests

      • Insomnia or hypersomnie

      • Psychomotor agitation or retardation

      • Changes in weight or appetite

      • Loss of energy 

      • Difficulty concentrating

      • Difficulty making decisions

      • Feeling worthless or guilt, hopelessness, worry, and suicidal ideas/behaviors

Schizophrenia

  1. What is meant by “positive” symptoms of schizophrenia? What specific symptoms fall into this category? Be able to identify the different types of common delusions.

    1. Positive symptoms are also known as the psychotic symptoms. They are symptoms that clearly demonstrate a break from reality.

      1. Hallucinations: (a false perceptual experience)

        1. no external stimulus need to experience an hallucination. Individuals who experience hallucinations often associate them with delusional beliefs (e.x. being stalked by aliens)

          1. Hearing voices when no one speaks (most common)

          2. Seeing stuff that is not there

          3. Touching something that is not there

          4. Smelling something none existent

      2. Delusions: (a false belief)

        1. Paranoid delusion: 1 or more people are endangering the individual (no proof of this actually happening)

          1. Example: believing your friend is trying to poison you because you hugged her husband goodbye 

          2. Can strain the individuals social life and/or ability to work

        2. Thought insertion

          1. people are putting thoughts into my mind.

          2. These thoughts are not mine own thoughts

        3. Thought broadcasting

          1. People can hear what I'm thinking

        4. Grandiose delusions

          1. Belief that they are a famous person. (Both fictional or real / living or dead

          2. Example: Anne Boleyn / wonder women/ caption America

        5. Control delusions

          1. The individual beliefs some external force is controlling their body and actions

        6. Bizarre delusions

          1. Example: my lungs have been replaced with empty water bottles.

      3. Disorganized thoughts & behavior

        1. Often seen as disorganized speech.

        2. Is a disconnect of their physical reality and it seems like the individual is a danger to themselves or random

        3. Sometimes is driven by an underlying delusion and other times it has no clear logical reason, delusion or otherwise

        4. Catatonia is a subset of disorganized behavior. Is linked in their presentation and neural underpinnings.

          1. Is a response to what is happening in the individuals environment

            1. Could be presented as a form of Immobility

            2. Could be presented as purposeless repetitive behavior

          2. Can also present itself as a symptom in other Psychotic disorders

  2. What is meant by “negative” symptoms of schizophrenia? What specific symptoms fall into this category? 

    1. Negative symptoms involve the reduction of a part of the normal psychological experience that is common among people.

      1. Reduced emotional experience: a decrease in an individual’s ability to imagine or experience emotional extremes

        1. Little emotions (flat affect)

      2. Abolition: decrease in an individual's motivation 

      3. Alogia: decrease in an individual's output of speech

        1. An individual does not speak much

      4. Diminished emotional expressiveness: decrease of facial expressions for emotions

      5. Anhedonia: decrease in experiencing pleasurable sensations or imagine experiencing a pleasure response to a memory

        1. Not wanting to do anything or interact with others

    2. Can affect almost every aspect of  an individual’s life

    3. Stringer effect than the positive symptoms

  3. What is meant by “cognitive” symptoms of schizophrenia? What specific symptoms fall into this category? 

    1. Cognitive symptoms are the most subtle but the most damaging

      1. Can have problems with attention

        1. Difficulty ignoring distractions in ones environment

          1. Example: focus on a conversation while in a public noisy space

        2. Persisting in a task that requires extended attention 

          1. Example: Reading a paragraph over and over again but not focusing on the information

        3. Inhibiting 

          1. Example: Stopping themselves from pressing the gas pedal when the light turns green when another car is still in the intersection 

      2. Difficulty preforming simple quick mental task

        1. Struggle to make a decision

      3. Decrease in an individuals memory

        1. Long-term verbal memory

      4. Demonstrates difficulty in social cognition

        1. Specific to social information

    2. Affect almost every aspect of  domestic, occupational, academic, & social life.

    3. Best predictors of whether an individual with Schizophrenia  will function well in their everyday life.

  4. What is sensory gating?

    1. The process wear the brain filters out any unnecessary or repetitive information

      1. Helps the brain focus on the important things

    2. In terms of schizophrenia:

      1. It is impaired. Individuals with schizophrenia don’t filter out the unimportant things from their brain

      2. This creates an intense or distracting feeling 

        1. Can lead to feeling overwhelmed

        2. Difficult to stay focused

        3. Confused in busy environments

    3. Hard to ignore unimportant information.

  5. What aspects of the social environment can exacerbate risk for Schizophrenia or cause the worsening of symptoms? 

    1. Things that increase the risk if schizophrenia or worsen the symptoms:

      1. High levels of criticism, hostility, or emotional over-involvement

        1. More likely to help an individual with schizophrenia to relapse

      2. Psychosocial stressors exacerbates the symptoms 

  6. What is the percentage of concordance for schizophrenia for MZ versus DZ twins?

    1. Identical twins (MZ)

      1. If one twin has schizophrenia there is about 30%-50% chance that the other twin will also develop schizophrenia 

    2. Fraternal twins (DZ)

      1. If one twin has schizophrenia there is about 12%-17% chance that the other twin will also develop schizophrenia 

  7. What general conclusion can be drawn from the literature examining twin/adoption studies?

    1. Adoption studies also provide evidence that the tendency for schizophrenia to run in families is due to genetic factors, rather than being caused by shared environmental stressors.

      1. Separates genetic factors from environmental factors 

    2. Twin studies demonstrate that genetics do increase the risk factors of individuals developing schizophrenia. 

      1. genetics is an important factor that increases schizophrenia among individuals.

    3. So, schizophrenia is caused by a combination of genes and life experiences—a “diathesis-stress model,” where someone may have a predisposition (diathesis), and environmental stress can trigger the disorder

      1. Genetics set the stage (they increase vulnerability).

      2. Environment influences whether and how the illness appears.

  8. What is a de novo mutation?

    1. “de novo” means “New”

    2. Its a change in DNA

      1. Parents don’t have the DNA mutation but their child has a mutation in their DNA

    3. In relation to schizophrenia: no family genetics beforehand

  9. What two key pieces of evidence led researchers to focus on dopamine function as a component of schizophrenia? 

    1. Drugs that reduce dopamine activity diminish psychotic symptoms 

    2. Drugs that increase dopamine activity exacerbate or trigger psychotic symptoms.

  10. What research has suggested that the “too much dopamine” hypothesis is probably not valid? 

    1. Research was found that individuals with schizophrenia have too many dopamine receptors. In other words they were too sensitive to the amount of  dopamine present.

      1. Not strong or reliable enough to correlate schizophrenia with an excessive dopamine sensitivity.

    2. After the lack of the support of both hypothesis it is concluded that any relation to excessive dopamine in any capacity declares the hypothesis invalid.

  11. What evidence is there to suggest the role of glutamate in schizophrenia

    1. Drugs that mess with glutamate can cause schizophrenia-like symptoms.

    2. Brain studies and genetics also show glutamate-related changes in people with schizophrenia.

    3. So, researchers believe that schizophrenia might involve too little glutamate activity at NMDA receptors, especially in certain brain areas.

  12. What is the season-of-birth effect? 

    1. Research has found that individuals born in winter or early spring are more likely to develop schizophrenia

      1. Viral infections

      2. Lack of sunlight (low vitamin D)

      3. Seasonal stress or nutrition changes

    2. The season-of-birth effect is a pattern showing that being born in winter or early spring slightly raises the risk of schizophrenia—likely due to environmental factors affecting the baby before birth.

  13. What is the difference between premorbid and prodromal symptoms? 

    1. Premorbid

      1. Time before any observable signs of an illness appearing

      2. Seems healthy but has a few subtle traits/behaviors that become obviously related later

      3. Symptoms are not obvious or specific to schizophrenia 

    2. Prodromal

      1. Early warning phase before the schizophrenia symptoms fully begin

        1. Right before symptoms

      2. Starts to view noticeable changes in the individuals behavior, thinking, emotions

      3. Symptoms are mild-moderate that will get worse later on.

  14. The authors draw a parallel between our understand of schizophrenia and cancer – upon what bases do they make this analogy? 

    1. The analogy helps us understand that schizophrenia, like cancer, is not just one thing, but a cluster of disorders that vary in cause, course, and response to treatment. It also stresses the need for a more nuanced, individualized approach to diagnosis and care.

      1. Both aren’t single, uniform disorders 

      2. Involve complex genetic & environmental factors

      3. Vary in the outcome and severity

      4. Benefit in the advances early detection and personalized medicine

Extra notes:

  • Symptoms begin to appear in young adulthood and proceed into a chronic condition.

  • It affects every aspect of people’s lives, especially building and maintaining that connection. Their ability to make friends, get married, maintain a job, etc.

  • A Psychotic disorder involves experiencing a disconnect from reality, it is one of the defining symptoms. Schizophrenia falls into a broad category of this.

    • Hallucinations

    • Delusions

    • Disorganized and illogical thinking

    • Bizarre 

Diagnostic Criteria

  • It organizes symptoms into 3 categories

  1. Positive

    1. They are called positive because they individuals with psychotic symptoms experience them in their day-to-day lives while other individuals do not.

    2. They come in waves. Often referred to as Psychotic episodes

      1. Mostly seen in individuals who don’t take their medication to treat their symptoms

      2. This however does not mean individuals who take their medication don’t experience this inconsistency

    3. Positive symptoms often (not always) decline in the severity of the symptoms as they get older.

  2. Negative

    1. Involves the reduction of a part of the normal psychological experience that is common among people.

    2. Tend to be stable meaning individuals do not experience waves of intensity

      1. Does not change over time

    3. Don’t generally get better or worse

  3. Cognitive (may be the most subtle but most dangerous)

    1. Tend to be stable meaning individuals do not experience waves of intensity

      1. Does not change over time

    2. Don’t generally get better or worse

  • It is mostly diagnosed between the ages of 20-29 years old.

  • 20%-30% can maintain a job and/or live independently

  • Lifetime prevalence is btw 0.5%-1% across many different cultures, nations, & times.

  • Individuals with schizophrenia have a shorter lifetime by 15 years

  • Symptoms can overlap and reinforce one another

    • Example: someone with schizophrenia might no longer spend time with her friends because she is afraid they are plotting against her (positive symptom), because she can't imagine having a good time if she did hang out with them (negative symptom), and because when she does hang out with them, she finds it difficult to follow their conversation (cognitive symptom).

  • Have important similarities

  • Symptoms are not consistent in their intensity across  the individual’s with schizophrenia lifespan

  • The negative and cognitive symptoms of schizophrenia also often mimic the symptoms of a mood episode, further complicating the distinction.

  • Individuals with schizophrenia are more likely to suffer from depression, anxiety, obsessive‐compulsive, and neurodevelopmental and learning disorders than people in the general population.

Feature

Dopamine Hypothesis

Glutamate Hypothesis

Main Idea

Schizophrenia is caused by too much dopamine activity, especially in certain brain areas.

Schizophrenia is linked to too little glutamate activity, particularly at NMDA receptors.

Key Brain Area

Mesolimbic pathway (associated with positive symptoms)

Cortex and hippocampus (linked to cognition and emotion regulation)

Supported By...

- Antipsychotic drugs block dopamine D2 receptors and reduce positive symptoms. - Drugs like amphetamines increase dopamine and can cause psychosis-like symptoms.

- Drugs like PCP and ketamine block NMDA receptors and cause symptoms similar to schizophrenia. - Genetic studies link schizophrenia to genes involved in glutamate signaling.

Strengths

Explains positive symptoms (hallucinations, delusions) well.

Better explains negative symptoms (like flat affect) and cognitive problems (like memory or attention issues).

Limitations

Doesn’t fully explain negative or cognitive symptoms.

More difficult to study directly; not yet the basis of most current treatments.

Current Status in Research

Still central to treatment (most antipsychotics target dopamine).

Growing area of research; may lead to new treatment approaches in the future.

Dopamine vs. Glutamate in Schizophrenia

  • Dopamine hypothesis explains the "loud" symptoms (like hearing voices or seeing things).

  • Glutamate hypothesis may explain the "quiet" symptoms (like emotional numbness, memory issues).

  • Both are likely pieces of the puzzle—schizophrenia may involve an imbalance between multiple neurotransmitters.

PTSD

Four Symptom Domains of PTSD (DSM-5 Descriptive Labels)

  1. Intrusion Symptoms (Re-experiencing)

    • Recurrent, involuntary, and distressing memories of the trauma.

    • Includes nightmares and flashbacks, where the person feels like the trauma is happening again.

    • Psychological or physical reactions can be triggered by reminders of the trauma, like certain sounds or places.

  2. Avoidance Symptoms

    1. Efforts to avoid thoughts, feelings, or memories related to the trauma.

    2. May also involve avoiding people, places, conversations, or activities that are reminders.

    3. Can lead to social withdrawal and disruption of daily life.

  3. Negative Alterations in Cognitions and Mood

    1. Includes persistent negative beliefs about oneself or the world (“I’m broken,” “The world is dangerous”).

    2. May involve distorted blame, emotional numbness, loss of interest in once-enjoyed activities, or feeling detached from others.

    3. Often accompanied by ongoing negative emotions like guilt, shame, or fear.

  4. Arousal and Reactivity Symptoms

    1. Heightened physiological arousal, including irritability, outbursts of anger, or hypervigilance (constantly on guard).

    2. Also includes difficulty sleeping, trouble concentrating, and an exaggerated startle response.

    3. These symptoms can interfere with a person’s ability to feel safe and relaxed.

Miller et al.'s Three Subtypes of PTSD

  1. Internalizing Subtype

    • Characterized by high levels of anxiety, depression, and withdrawal.

    • These individuals are more likely to turn inward, blaming themselves and experiencing emotional numbness.

    • Often struggle with low self-worth and chronic sadness.

  2. Externalizing Subtype

    1. Features anger, aggression, substance use, and risky behavior.

    2. Individuals may act out in response to distress rather than internalizing it.

    3. More likely to have conflicts with others or engage in impulsive actions.

  3. Low Pathology Subtype

    1. Individuals with fewer overall symptoms and relatively better emotional regulation.

    2. May still meet PTSD criteria but show less impairment and more resilience.

    3. Sometimes overlooked because symptoms are less obvious.

Brewin’s Two Types of Traumatic Memory Storage

  1. Verbally Accessible Memory (VAM)

    • Memories that can be intentionally recalled and described.

    • These memories are processed normally, like other autobiographical events.

  1. Situationally Accessible Memory (SAM)

    1. Memories that are inaccessible to conscious recall unless triggered by a cue.

    2. These are emotionally intense, often linked to flashbacks, nightmares, and intrusive thoughts.

    3. PTSD symptoms are largely thought to result from SAM-type memories, which are poorly integrated.

Ehlers & Clark (2000) – The Paradox of Trauma Memories

  • Trauma memories are both vivid and intrusive yet often fragmented, disorganized, and difficult to describe in a logical narrative.

  • They suggest this paradox is due to the fact that during trauma, the brain is overwhelmed, so memories are stored in a disjointed, sensory-based format.

  • These fragmented memories are more likely to be triggered involuntarily, which leads to symptoms like flashbacks.

Janoff-Bulman’s Three “Shattered Assumptions”

  1. The world is benevolent

    • People generally believe the world is a safe place, but trauma shatters this sense of safety.

  2. The world is meaningful

    1. Trauma challenges the idea that events happen for a reason, leading to a loss of meaning or fairness in life.

  3. The self is worthy

    1. Survivors may begin to see themselves as flawed, guilty, or unlovable, particularly if the trauma involved interpersonal violence or abuse.

Ramage et al. (2016) – Emotions by Trauma Type

  • Different types of trauma are linked to different emotional responses:

    • Shame is more common in survivors of sexual trauma, often due to stigma or internalized blame.

    • Guilt tends to occur in combat-related trauma, where individuals may question their actions or survival.

    • Anger is frequently associated with interpersonal violence, where betrayal or injustice is involved.

  • These emotional patterns may influence treatment focus and severity of symptoms.

Kessler et al. (1995) – Personal vs. Impersonal Trauma

  • Personal trauma: Direct harm to the individual (e.g., assault, rape, abuse)

  • Impersonal trauma: Events not targeted at the person (e.g., natural disaster, accident)

  • Findings: PTSD is more likely to develop after personal trauma, especially when the trauma involves intentional harm by another person.

  • This may be due to the betrayal, loss of trust, and greater disruption to the person’s worldview.

PTSD and Marital/Relationship Impact

  • PTSD is linked to higher divorce rates, relationship conflict, and emotional disconnection.

  • Symptoms that especially affect relationships include:

    • Emotional numbing: makes it hard to connect or express love.

    • Irritability and anger: lead to frequent arguments or emotional withdrawal.

    • Hyperarousal and sleep problems: can create tension and distance in the household.

  • Partners may also experience secondary trauma, stress, or burnout from caregiving.