Abnormal PSYC: Chapter #6 - PTSD and dissociative disorders
Role of parasympathetic nervous system
When perceived danger passes, the parasympathetic nervous system help return body process to normal
Continuous dissociative amnesia
forgetting continues into the future; quite rare in cases of dissociative amnesia
Effects of hypnosis
hypnosis can help people remember events that occurred and were forgotten years ago, it can also help people forget facts, events, and their personal identity
Generalized dissociative amnesia
loss of memory beginning with an event, but extending back in time; may lose sense of identity; may fail to recognize family and friends
Selective dissociative amnesia
loss of memory for some, but not all, events occurring within a period
one-way amnesic relationships (DID)
most common pattern; some personalities are aware of others, but the awareness is not mutual. Those subpersonalities that are aware ("co-conscious subpersonalities") are "quiet observers"
Localized dissociative amnesia
most common type; loss of all memory of events occurring within a limited period
Relationships among subpersonalities
mutually amnesic, mutually cognizant, one-way amnesic
host personality (DID)
one subpersonality in control of the body most of the time and therefore appears more often then the others
The pattern of autonomic and endocrine functioning for every person is... particular or the same?
particular
Symptoms of a depersonalization - derealization disorder are persistent/recurrent or intermittent?
persistent or recurrent
Trait anxiety
person's general level of arousal and anxiety
State or situation anxiety
person's sense of which situations are threatening
What are dissociative disorders characterized by?
significant in memory loss or identity disruption
What are corticosteroids?
stress hormones
Pathway #1 for Stress and Arousal: Sympathetic Nervous System
stressor -> SNS -> key organs are stimulated directly (e.g. heart) or indirectly (e.g. adrenal glands)
mutually amnesic relationships (DID)
subpersonalities have no awareness of one another
Vicarious traumatization
the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain, fear, and terror that trauma survivors have endured
Hypnotic amnesia
the failure to retrieve memories following hypnotic suggestions to forget
What is stress?
the reaction of the body and mind to everyday challenges and demands
What do therapist do when people are found before their fugue has ended?
therapists may find it necessary to continually remind them of their own identity
Is treatment for DID more or less successful than treatment for dissociative amnesia
treatment for DID tends to be less successful
Define trauma
"A very difficult or unpleasant experience that causes someone to have mental or emotional problems for a long time ....."
APA definition of trauma
"An emotional response to a terrible event...."
Possible etiology of DID: Self-hypnosis
- "hypnotic amnesia" - self-hypnosis may be analogous to psychodynamic concept of repression
Possible Etiology of DID: Behavioral view
Behaviorists believe that dissociation grows from normal memory processes and is a response learned through operant conditioning - like psychodynamic theorist, behaviorist largely on case histories to support their view on DID
How common is DID?
The number of people diagnosed with the disorder has been increasing. Thousands of cases just documented in America and Canada alone
Fight-or-flight response
reactions on display from two pathways of stress or arousal
Third Criterion for PTSD: Persistent avoidance of stimuli associated with the trauma (C)
- Cognitive or affective avoidance: avoidance of trauma-related thoughts or feelings - Behavioral avoidance: avoidance of trauma-related reminders (people, places, activities, or objects)
First Criterion for PTSD: Exposure to trauma (A)
- Direct exposure to death, threatened death, actual threatened serious injury or violence - May be indirect exposure
Operant conditioning in the behaviorist etiology of DID
- Momentary forgetting of trauma leads to a drop in anxiety, which increases the likelihood of future forgetting - behaviorist see dissociation as a cognitive escape behavior
Possible etiology of DID: state-dependent learning
- People prone to developing DID may have state-to-memory links that are unusually rigid and narrow - Thought, memory, and skill is tied exclusively to particular state of arousal --> they recall a given event only when they experience an arousal state almost identical to the state in which the memory was first acquired
Treatment for dissociative amnesia
- People with dissociative amnesia often recover on their own - Only sometimes do their memory problems linger and require treatment
Transient depersonalization/derealization reactions
- They are quite common. - Occurs when depersonalization symptoms are experienced briefly. - You have a fleeting feeling of being detached from yourself or the environment. You may feel like you're watching yourself in a movie.
Fourth Criterion for PTSD: Negative alterations in cognitions or mood associated with traumatic event (D)
- dissociative amnesia - persistent (often distorted) negative beliefs such self-blame or global negative expectancies of others - persistent negative emotions such as fear, horror, anger, shame - emotional numbing
Stressor stimulus
- first component of stress - Def: event that creates demands
Fifth Criterion for PTSD: Alterations in arousal and reactivity that began or worsened after the traumatic event (E)
- irritable/aggressive behavior - hypervigilance - self-destructive behavior - exaggerated startle response -problems in concentration - sleep disturbance
Treatment for DID: What do therapist do?
- recognize disorder -recover memories - integrate personalities into single identity through a continuous process - after integration, further therapy is needed to maintain complete personality as well as to teach social/coping skills to prevent later dissociation
stress response
- second component of stress - Def: person's reactions to the demands that is influenced by how we judge both the events and our capacity to react to them effectively.
Treatments for DID: Why do patients need it?
- usually require treatment to regain their lost memories and develop an integrated personality - Integrate all alters into one coherent personality Help rebuild the capacity to trust healthy relationships
What factors may account for increase in DID cases?
1. A growing number of clinicians believe that the disorder does exist and are willing to diagnose it 2. Diagnostic procedures have become more accurate
Examples of indirect exposure for PTSD
1. By learning that a close relative was exposed to trauma 2. Repeated or extreme indirect exposure to aversive details such as vicarious traumatization or first responders collected body parts
What are the 6 criterions for Post-traumatic stress?
1. Criterion A: Exposure to Trauma 2. Criterion B: Intrusion symptoms 3. Criterion C: Persistent avoidance of stimuli associated with trauma 4. Criterion D: Negative alterations in cognitions and mood associated with the traumatic event. 5. Criterion E: Alterations in arousal and reactivity that began or worsened after the traumatic event. 6. Criterion F: Significant impairment in functioning, with persistence of symptoms for more than 1 month.
Emotional numbing
1. Diminished interest in pre-traumatic significant activities 2. Alienation (detachment or estrangement) from others 3. Constricted affect - inability to experience positive emotions
PTSD therapies (3)
1. Pharmacotherapy 2. Prolonged exposure 3. Cognitive processing therapy
The two pathways through which arousal and fear are produced
1. Sympathetic Nervous System Pathway 2. Hypothalamic-Pituitary-Adrenal (HPA) Pathway
Examples of traumatic events
1. exposure to combat 2. exposure to natural disasters 3. involvement in accidents 4. sexual assault and other victimization 5. exposure to terrorism
Second Criterion for PTSD: Intrusion Symptoms (B)
1. recurrent, involuntary, intrusive memories 2. traumatic nightmares 3. Dissociative reactions (e.g. flashbacks) occurring on a continuum from brief episodes to complete loss of consciousness 4. intense or prolonged distress (emotional or physiological
What are the two components of stress?
1. stressor stimulus 2. stress response
How much more likely are civilian traumas in comparison to combat-related traumas?
10x more likely
How many veterans report symptoms of PTSD?
20%
Lackland USAF Security Forces
318 SF Airmen on 1-year deployment to Iraq, severe PTSD increased form 1% - 21% post-deployment
Variation in the fugue
A. For some, the fugue is brief - a matter of hours or days - and ends suddenly B. or others, the fugue is more severe: people may travel far from home, take a new name and establish new relationships, and even a new line of work; some display new personality characteristics
Dissociative Fugue
An extreme version of dissociative amnesia - not only forget their personal identities and details of their past, but also flee("take flight") to an entirely different location
Cognitive escape
Escape is a flexible instinctive behavior under cognitive control that has evolved to avoid harm from threats in the environment
Examples of natural disasters, a traumatic event?
Hurricane Harvey (Aug 2017) Winter Storm (Feb 2021)
What is true for all types of dissociative amnesia?
In all types, memory for abstract or encyclopedic information - usually remains intact
Depersonalization
Individual feels as though they have become separated from their body and are observing themselves from outside
When are most cases for DID diagnosed?
Most cases are first diagnosed in late adolescence or early adulthood
Are depersonalization and derealization experiences by themselves indicative of DID?
No
Is stress the same as trauma?
No, they are not the same
Repression
People fight off anxiety by unconsciously preventing painful memories, thoughts, or impulses from reaching awareness
Possible etiologies of DID: psychodynamic view
Psychodynamic theorists believe DID is caused by repression. Most support of this model is drawn from case histories, which report brutal childhood experiences. However, some individuals with DID do not seem to have these experiences of abuse
Pathway #2 for Stress and Arousal: Hypothalamic-Pituitary-Adrenal (HPA)
Stressor -> hypothalamus -> pituitary gland releases adrenocorticotropic hormone (ACTH: "major stress hormone") -> adrenal cortex releases corticosteroids (stress hormones) into the bloodstream
How do subpersonalities differ in DID?
Subpersonalities often display dramatically different characteristics, including: - Identifying features (age, sex, race, family history) - Abilities and preferences (ability to drive, speak a foreign language, play a musical instrument) - Physiological features (autonomic nervous system activity, blood pressure levels)
When do symptoms begin for DID?
Symptoms generally begin in childhood after episodes of abuse. Typical onset may be before age 5
Switching (DID)
The transition from one subpersonality to the next is usually sudden and may be dramatic
The majority of people who experience a fugue regain what?
They regain most or all of their memories and never have a recurrence
Pharmacotherapy
Treatment for PTSD where most acute anxiety (or comorbid depressive) symptoms are managed
Cognitive processing therapy
Treatment for PTSD. - provided info about causes, symptoms of PTSD - encourages labeling of impact: thoughts and feelings - promotes changes in beliefs, attributions regarding the traumatic event - promotes self-regulation and coping skills
Prolonged exposure
Treatment for PTSD. It is aimed at extinction of emotional and physiological reactivity (EMDR: virtual reality therapy)
What portrayal of DID in film is based on an actual case and his recommended to psych students?
Voices Within: The Lives of Truddi Chase
How more often do women receive diagnosis for DID
Women receive the diagnosis three times as often as men
Do fugues tend to end abruptly?
Yes
dissociative amnesia
a condition in which a person cannot remember important information about their life
Dissociative Identity Disorder (DID)
a rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities (Subpersonalities). Each have a unique set of memories, behaviors, thoughts, and emotions Formerly called multiple personality disorder.
Derealization
characterized by the feeling that the external world is unreal and strange
Symptoms of a depersonalization - derealization disorder cause what?
considerable distress, and interfere with social relationships and job performance
Dissociative disorders
disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings
Examples of Dissociative disorders
dissociative amnesia, dissociative fugue, dissociative identity disorder (DID), and depersonalization
Mutually cognizant patterns (DID)
each subpersonality is well aware of the others
How rare are dissociative fugue disorders?
estimated 0.2% of the population. It usually follows a severely stressful event