Psychopathology: Disorders of Trauma and Stress Ch6

Disorders of Trauma and Stress: Overview

  • Components of Stress
    • Stressor: Event creating demands, causing arousal and fear.
    • Stress Response: Person's reactions to demands.
  • Extraordinary Stress and Trauma
    • Can provoke significant stress symptoms: heightened arousal, anxiety/mood issues, memory/orientation difficulties, behavioral disturbances.
    • DSM-$5$-TR lists Trauma and Stressor-Related Disorders (Acute Stress Disorder, PTSD) and Dissociative Disorders (severe memory/orientation problems).

Stress and Arousal: The Fight-or-Flight Response

  • Features of arousal and fear originate in the hypothalamus.
  • Two activated systems: Autonomic Nervous System (ANS) and Endocrine System.
  • Two brain-body routes: Sympathetic Nervous System pathway and Hypothalamic-Pituitary-Adrenal (HPA) axis.

Acute and Posttraumatic Stress Disorders (PTSD)

  • Acute Stress Disorder: Symptoms begin within $4$ weeks of event, last less than $1$ month.
  • Posttraumatic Stress Disorder (PTSD): Symptoms may begin shortly after event, or months/years later. $25 percent of cases start $6$ months or more post-trauma.
  • About half of acute stress disorder cases develop into PTSD.
  • PTSD Checklist: Exposure to traumatic event (death, injury, sexual violation), plus one intrusive symptom (memories, dreams, flashbacks, physical reactions to cues), avoidance of trauma-linked stimuli, negative changes in cognitions/moods, and changes in arousal/reactivity (alertness, startle response, sleep issues).
  • Symptoms last more than $1$ month and cause significant distress/impairment.
  • Prevalence: Affects $3.5$ to $6 percent annually; $7$ to $12 percent lifetime. Higher in women, lower incomes, people of color, LGTBQ+ populations.
  • Triggers: Combat, disasters (earthquakes, floods, accidents), victimization (sexual assault, terrorism, torture).

Causes of Stress Disorders

  • Biological Factors: Brain-body stress routes, brain's stress circuit dysfunction, inherited predisposition.
  • Childhood Experiences: Adverse childhood experiences (ACEs) like neglect, abuse, poverty, parental conflict, family psychological disorders.
  • Cognitive Factors/Coping Styles: Preexisting memory impairments, intolerance of uncertainty, inflexible coping, negative worldview (vs. resiliency).
  • Social Support Systems: Limited family/inadequate social support.
  • Severity and Nature of Trauma: Prolonged trauma, direct exposure, mutilation, severe injury, sexual assault, witnessing injury/death. Can lead to Complex PTSD.
  • Developmental Psychopathology: Intersection of variables including biological predisposition and timing of stressors over development.

Prolonged Grief Disorder

  • New DSM-$5$-TR trauma- and stressor-related disorder.
  • Persistent, severe, wide-ranging grief symptoms for a year or more after a loved one's death, causing significant distress or impairment.

Treatment for Stress Disorders

  • General Goals: End lingering reactions, gain perspective, return to constructive living.
  • Therapies: Antidepressant drug therapy, Cognitive-Behavioral Therapy (Cognitive Processing Therapy, mindfulness, exposure techniques, Written Exposure Therapy, Eye Movement Desensitization and Reprocessing), Virtual Reality Therapy.
  • Support: Couple/family therapy, group therapy, community interventions (Psychological Debriefing, Psychological First Aid).

Dissociative Disorders

  • Nature: Major memory changes without physical causes, triggered by trauma; a part of memory or identity separates.
  • Types: Dissociative Amnesia, Dissociative Identity Disorder, Depersonalization-Derealization Disorder.
  • Dissociative Amnesia: Inability to recall important, usually traumatic, life information. More than forgetting.
    • Forms: Localized (most common), Selective, Generalized, Continuous.
    • Dissociative Fugue: Extreme amnesia where individuals also flee to a new location, forgetting personal identity and past.
  • Dissociative Identity Disorder (DID): Two or more distinct subpersonalities, each with unique memories, behaviors, thoughts, emotions. Switching is stress-triggered. Women are diagnosed more frequently $3$ times than men.
    • Subpersonality Interactions: Mutually amnesic, mutually cognizant, one-way amnesic relationships.
  • Theories of Dissociative Amnesia and DID:
    • Psychodynamic: Repression of painful memories, thoughts, or impulses.
    • Cognitive: State-dependent learning (memory linked to conditions of learning); rigid and narrow state-to-memory links.
    • Self-Hypnosis: Individuals hypnotize themselves to forget unpleasant events or mentally separate from threat (in childhood abuse).
  • Treatment for Dissociative Amnesia/DID:
    • Dissociative Amnesia: Psychodynamic therapy, hypnotic therapy, drug therapy (barbiturates) to regain memories.
    • DID: Complex and difficult; requires recognizing the disorder, recovering memory gaps, and integrating subpersonalities (fusion).
  • Depersonalization-Derealization Disorder: Persistent/recurrent episodes of depersonalization (feeling detached from self/body) and/or derealization (feeling the external world is unreal). Not primarily memory difficulty. Prevalent in $1$ to $2 percent, often adolescents/young adults. Triggered by extreme fatigue, pain, stress, substance use. Symptoms cause significant distress/impairment.