Chapter 6 - Disorders of Trauma and Stress

Chapter Overview

• Title: Disorders of Trauma and Stress

• Authors: Ronald J. Comer & Jonathan S. Comer

• Edition: Twelfth Edition

• Copyright: © 2024 by Macmillan Learning, all rights reserved.

Understanding Stress

• Components of Stress:

  • Stressor: An event that creates demands (e.g., traffic) that can cause arousal and fear if perceived as threatening.

  • Stress Response: The individual’s reactions to these demands, influenced by personal judgment of the situation and their ability to cope.

  • Increased exposure to stress is linked with vulnerability to anxiety and other psychological disorders.

Extraordinary Stress and Trauma

Impact on Psychological Disorders

• Significant stress symptoms may arise from extraordinary stress and trauma, including:

  • Heightened arousal

  • Anxiety and mood problems

  • Memory and orientation issues

  • Behavioral disturbances

• Long-term reactions can severely impair daily functioning.

DSM-5-TR Disorders

• Trauma and Stressor-Related Disorders:

  • Acute Stress Disorder

  • Posttraumatic Stress Disorder (PTSD)

• Dissociative Disorders:

  • Triggered by trauma; characterized by memory and orientation disturbances.

Stress and Arousal

The Fight-or-Flight Response

• Hypothalamus Activation: Controls arousal and fear responses through two systems:

  • Autonomic Nervous System (ANS): Connects the brain and spinal cord to bodily organs; controls involuntary activities like heartbeat and blood pressure.

    • Subdivided into sympathetic and parasympathetic systems.

  • Endocrine System: Releases hormones to regulate bodily functions.

HPA Axis

• Activation Pathways: Two main pathways for producing arousal:

  • Sympathetic Nervous System: Increases heart rate and adrenaline release in response to danger.

  • HPA Axis: Hypothalamus activates the pituitary gland to secrete ACTH, stimulating the adrenal cortex to release cortisol, promoting further arousal.

• Recovery: Parasympathetic nervous system returns bodily functions to normal after threat subsides.

Acute and Posttraumatic Stress Disorders

Definition of Trauma

• Trauma involves exposure to actual or threatened death, serious injury, or sexual violation.

• Situations deemed traumatic include rape, combat, natural disasters, mass shootings.

Acute vs. PTSD

• Acute Stress Disorder (ASD): Symptoms arise within four weeks post-event and last less than one month.

• Posttraumatic Stress Disorder (PTSD): Symptoms can appear shortly after traumatic events or even years later.

  • Longitudinal progression is possible; many experience gradual onset of severe symptoms.

PTSD Symptoms Checklist

1. Exposure to trauma.

2. Intrusive symptoms (e.g., memories, dreams, flashbacks).

3. Avoidance of reminders and stimuli linked to the trauma.

4. Negative changes in cognitions and mood.

5. Changes in arousal and reactivity.

6. Significant distress or impairment for over a month.

Prevalence of Acute and PTSD

• Affects about 3.5% to 6% annually in the U.S.; lifetime prevalence ranges from 7% to 12%.

• Higher susceptibility observed among women, low-income populations, and LGBTQ+ communities.

Contextual Factors of Trauma

• Combat Related Trauma:

  • Historical terms: “Soldier’s heart,” “shell shock,” and “combat fatigue.”

  • High prevalence rates of PTSD among Vietnam War veterans.

• Civic Trauma:

  • Civilian disasters (e.g., floods, accidents) result in higher morbidity from PTSD than warfare.

  • 25% of traffic accident victims may develop PTSD; higher correlations with severe chronic health issues.

Sexual Assault and PTSD

• Significant psychological impact post-rape; 94% meet ASD criteria with high risk for long-term effects.

  • Survivors often display an array of psychological distress, including anxiety, depression, and functional impairments.

Prevention and Awareness

Campus Safety and Sexual Assault

• Increased awareness and activism regarding the reporting and prevention of sexual assault on campuses.

Responses to Violence and Trauma

Terrorism and Mass Shootings

• Immediate reactions of shock and fear can lead to long-term PTSD symptoms post-events like 9/11 and subsequent attacks.

Torture and Psychological Impact

• Defines various forms of torture and indicates about 30% could develop PTSD.

Factors Leading to PTSD Development

Biological Factors

• Stress pathways (HPA axis) and predispositions play critical roles.

Childhood Experiences

• ACEs (Adverse Childhood Experiences) increase PTSD risk through trauma exposure in formative years.

Psychological Factors

• Cognitive patterns, coping styles, and social support significantly influence stress response and recovery.

Treatment Strategies

Therapeutic Approaches

• For Combat Veterans:

  • Usually combines medication (antidepressants), cognitive-behavioral therapies, mindfulness approaches, and support systems.

• For Dissociative Disorders:

  • Psychodynamic therapy, cognitive therapies, and integration practices are essential.

• Treatments include hypnotherapy and guidance towards memory recall.

Understanding Dissociative Disorders

Definitions and Types

• Dissociative Amnesia: Memory loss exceeding typical forgetting, often triggered by traumatic incidents.

• Dissociative Identity Disorder (DID): Characterized by alternating identities, each with distinct memories and behaviors.

• Depersonalization-Derealization Disorder: Experience of detachment from self or reality, common yet distinguishable from other dissociative disorders.

Interaction of Subpersonalities in DID

• Subpersonalities exhibit diverse features and varying degrees of awareness of each other over memories and experiences.

Theoretical Perspectives on Dissociative Disorders

Psychodynamic view

• Suggests that repression plays a significant role in dissociative disorders, often rooted in early traumatic experiences.

Cognitive theories

• Explore state-dependent learning and the psychological mechanisms underlying dissociative memories and identities.

• Research indicates the complex interaction between mood states and memory retrieval abilities.

Final Thoughts

• Growing understanding of trauma's impact and the importance of comprehensive treatment approaches combining various therapeutic methods.