Chapter 6: Disorders of Trauma and Stress

1. Drug therapy. 2. Behavioral exposure. 3. Cognitive and other insight therapies. 4. Family therapy. 5. Group therapy (e.g., rap groups)

What are the 5 treatments for stress disorders?

1. Biological factors. 2. Personality. 3. Childhood experiences. 4. Social support. 5. Multicultural factors. 6. The severity of the traumatic event.

What are the risk factors for a psychological stress disorder?

1. Sympathetic nervous system. 2. Hypothalamic-pituitary-adrenal pathway.

What are the two pathways that the ANS and endocrine system use to produce arousal and fear reactions?

Iatrogenic

unintentionally produced by practitioners (Lynn & Deming, 2010; Piper & Merskey, 2005, 2004).

Hypnosis myths

• Hypnosis relies on having a good imagination. • Hypnosis is dangerous. • Hypnotized people lose control of themselves. • People remember more accurately under hypnosis. • Hypnotized people can be led to do immoral acts.

Hypnosis realities

• Vivid imaginations are unrelated to hypnotizability • Hypnosis is no more distressing than a lecture. • Hypnotized people are fully awake. • Hypnotized people are perfectly capable of saying no. • Hypnosis can help create false memories. • Hypnotized people fully adhere to their usual values. Information from: Nash & Barnier, 2008; Nash, 2006, 2005, 2004, 2001.

Dissociative identity disorder

Based on the symptoms displayed in The video (Three Faces of Eve: The Real Person), what diagnosis should be given to "Eve" (whose real name is Chris Costner Sizemore)?

Sexual assault

Being forced into a sexual act against one's will.

Evoked potentials

Brain-response patterns recorded on an electroencephalograph (Putnam, 1984).

Repression

The most basic ego defense mechanism: People fight off anxiety by unconsciously preventing painful memories, thoughts, or impulses from reaching awareness. Boo

One-way amnesic relationships

The most common relationship pattern, some subpersonalities are aware of others, but the awareness is not mutual.

Parasympathetic nervous system (PNS)

The nerve fibers of the autonomic nervous system that help return bodily processes to normal.

Sympathetic nervous system (SNS)

The nerve fibers of the autonomic nervous system that quicken the heartbeat and produce other changes experienced as arousal and fear.

Autonomic nervous system (ANS)

The network of nerve fibers that connect the central nervous system to all the other organs of the body.

Stress response

The person's reaction to the demands.

Self-hypnosis

The process of hypnotizing oneself, sometimes for the purpose of forgetting unpleasant events.

1. Extreme repression. 2. Operant conditioning. 3. State-dependent learning. 4. Self-hypnosis.

What Are some 4 processes that have been cited for dissociative disorders?

1. Localized amnesia. 2. Selective amnesia. 3. Generalized amnesia.

What are the 3 kinds of dissociative amnesia?

1. Mutually amnesic relationships. 2. Mutually cognizant patterns. 3. One way-amnesiac relationships.

What are the 3 kinds of relationships for subpersonalities?

1. Psychodynamic therapy. 2. Hypnotic therapy. 3. Drug therapy.

What are the 3 leading treatments for dissociative amnesia?

1. Recognize fully the nature of their disorder. 2. Recover the gaps in their memory. 3. Integrate their subpersonalities into one functional personality (Gentile et al., 2013; Howell, 2011; North & Yutzy, 2005).

What are the 3 main things therapists usually try to help the clients who have dissociative identity disorder?

1. Psychodynamic therapy. 2. Hypnotic therapy. 3. Sodium amobarbital (or sodium pentobarbital).

What are the 3 treatment approaches for dissociative disorders?

1. Physical torture (beatings, water boarding, electrocution). 2. Psychological torture (threats of death, mock executions, verbal abuse, degradation). 3. Sexual torture (rape, violence to the genitals, sexual humiliation). 4. Torture through deprivation (sleep, sensory, social, nutritional, medical, or hygiene deprivation).

What are the 4 main types of torture?

Rape trauma syndrome (RTS)

A pattern of problematic physical and psychological symptoms. A form of PTSD.

Dissociative identity disorder (DID)

A disorder in which a person develops two or more distinct personalities. Previously known as "Multiple Personality Disorder". Dx Checklist: 1. Person experiences a disruption to his or her identity, as reflected by at least two separate personality states or experiences of possession. 2. Person repeatedly experiences memory gaps regarding daily events, key personal information, or traumatic events, beyond ordinary forgetting. 3. Significant distress or impairment. 4. The symptoms are not caused by a substance or medical condition.

Acute stress disorder

A disorder in which fear and related symptoms are experienced soon after a traumatic event and last less than a month.

Posttraumatic stress disorder (PTSD)

A disorder in which fear and related symptoms continue to be experienced long after a traumatic event. 1. Person is exposed to a traumatic event—death or threatened death, severe injury, or sexual violation. 2. Person experienced at least one of the following intrusive symptoms: • Repeated, uncontrolled and distressing memories. • Repeated and upsetting trauma-linked dreams. • Dissociative experiences such as flashbacks. • Significant upset when exposed to trauma-linked cues. • Pronounced physical reactions when reminded of the event(s). 3. Person continually avoids trauma-linked stimuli. 4. Person experience led negative changes in trauma-linked cognitions and moods, such as being unable to remember key features of the event(s) or experiencing repeated negative emotions. 5. Person displays conspicuous changes in arousal and reactivity, such as excessive alertness, extreme startle responses, or sleep disturbances. 6. Person experiences significant distress or impairment, with symptoms lasting more than a month. Information from: APA, 2013.

Dissociative amnesia

A dissociative disorder marked by an inability to recall important personal events and information. Dx Checklist: 1. Person cannot recall important life-related information, typically traumatic or stressful information. The memory problem is more than simple forgetting. 2. Significant distress or impairment. 3. The symptoms are not caused by a substance or medical condition.

depersonalization-derealization disorder

A dissociative disorder marked by the presence of persistent and recurrent episodes of depersonalization, derealization, or both. A feeling that one has become separated from their body and are observing themselves from the outside.

Psychological debriefing (critical incident stress debriefing)

A form of crisis intervention in which victims are helped to talk about their feelings and reactions to traumatic incidents. Training in how to help survivors of disasters or other horrifying events talk about their feelings and reactions to the traumatic incidents.

Dissociative fugue

A form of dissociative amnesia in which a person travels to a new location and may assume a new identity, simultaneously forgetting their past.

Dissociative disorders

A group of disorders in which some parts of one's memory or identity seem to be dissociated, or separated, from other parts of one's memory or identity.

Corticosteroids

A group of hormones, including cortisol, released by the adrenal glands at times of stress.

Olfactotherapy

A method that uses the smells and vibrations of essential oils to help elicit memories from clients.

Trait anxiety

A person's general level of arousal and anxiety is sometimes called this because it seems to be a general trait that each of us brings to the events in our lives (Tolmunen et al., 2014; Spielberger, 1985, 1972, 1966).

Primary personality (host personality)

A subpersonality that appears more often than other personalities.

One-way amnesic

A three of Chris Sizemore's subpersonalities on display in this video appear to be aware of the others and remember events from each others lives. However, given that Sizemore had many other sub personalities that were never refer to during this period and that's never known about by her therapist at the time one could say that size more sub personalities often lived in a ______ relationship pattern.

Hypnotic therapy (hypnotherapy)

A treatment in which the patient undergoes hypnosis and is then guided to recall forgotten events or perform other therapeutic activities.

Epinephrine

Adrenaline.

Déjà vu

Almost all of us have at some time had the strange sensation of recognizing a scene that we happen upon for the first time. We feel sure we have been there before.

Eye movement desensitization and reprocessing (EMDR)

An exposure treatment in which clients move their eyes in a rhythmic matter from side to side while flooding their minds with images of objects and situations they ordinarily avoid.

Special process

An out-of-the-ordinary kind of functioning.

Memory while under anesthesia

As many as 2 of every 1,000 anesthetized patients process enough of what is said in their presence during surgery to affect their recovery. In many such cases, the ability to understand language has continued under anesthesia, even though the patient cannot explicitly recall it.

Shell shock.

During World War I, some of the symptoms now recognized as PTSD were commonly known as _____.

50%.

During the study shown in the video (Repressed Memories or False Memories?), ______ of the subjects eventually believe that they had been on a hot air balloon ride, even though they had not.

Mutually cognizant patterns

Each subpersonality is well aware of the rest. They may hear one another's voices and even talk among themselves. Some are on good terms, while others do not get along at all.

Memory for music

Even as a small child, Mozart could memorize and reproduce a piece of music after having heard it only once. While no one yet has matched the genius of Mozart, many musicians can mentally hear whole pieces of music, so that they can rehearse anywhere, far from their instruments.

Rape

Forced sexual intercourse or another sexual act committed against a nonconsenting person or intercourse with an underage person.

Continuous amnesia

Forgetting continues into the present.

Psychodynamic.

From the brief evidence seen in this video. Sizemore's therapist is employing a _____ approach to investigate the pasta of the various subpersonalities and ultimately to achieve fusion among the subpersonalities (a goal Sizemore ultimately achieved).

Adrenal glands

Glands located on top of the kidneys.

They cast doubt on the reports of people who suddenly remember abuse later in life.

How do the results of studies like the one shown in the video affect the controversy over "repressed memories"?

Hypnotic amnesia

Hypnosis that can make people forget facts, events, and even their personal identities.

Generalized amnesia

In addition to forgetting trauma-linked events, a person may not remember events that occurred earlier in life.

coconscious subpersonalities

In one-way amnesic relationships, those who are aware. "Quiet observers" who watch the actions and thoughts of the other subpersonalities but do not interact with them.

Primary personality.

In the video, it is the personality named "Eve White" that must be returned to each time Chris Sizemore switches from one personality to another. This helps establish "Eve White" as the...

30-50% (Taylor et al., 2013; Okawa & Hauss, 2007).

It appears that between ______ of torture victims develop PTSD.

5-35% (ORR, 2011, 2006; Al, 2000; Baker, 1992).

It has been estimated that between ____ and _____ of the world's 15 million refugees have suffered at least one episode of torture and that more than 400,000 torture survivors from around the world now live in the United States.

5-35% (ORR, 2011, 2006; Al, 2000; Baker, 1992).

It has been estimated that between _____ of the world's 15 million refugees have suffered at least one episode of torture.

State-dependent learning

Learning that becomes associated with the conditions under which it occurred, so that it is best remembered under the same conditions.

Reduced responsiveness or dissociation.

Many people suffering from stress disorders feel dazed and separated from their familiar surroundings, or even their bodies. This symptom of stress disorders is known by clinicians as....

Visual memory

Most people recall visual information better than other kinds of information: they easily can bring to their mind the appearance of places, objects, faces, or the pages of a book. They almost never forget a face, yet they may well forget the name attached to it. Other people have stronger verbal memories: they remember sounds of words particularly well, and the memories that come to their minds are often puns or rhymes (Baars, 2010; Turkington & Harris, 2009, 2001; Mathews & Wang, 2007).

Norepinephrine

Noradrenaline

Absentmindedness

Often we fail to register information because our thoughts are focused on other things. If we haven't absorbed the information in the first place, it's no surprise that later we can't recall it.

Hypothalamic-pituitary-adrenal (HPA) pathway

One route by which the brain and body produce arousal and fear.

Selective amnesia

People remember some, but not all, events that occurred during a period of time. The second most common form of dissociative amnesia.

Memory, even when it is specific and strong, can be quite unreliable.

The main conclusion drawn from the experiment in the video is that...

Eidetic images

Some people have such vivid visual after images that they can describe a picture in detail after looking at it just once. The images may be memories of pictures, events, fantasies, or dreams.

Jamais vu

Sometimes we have the opposite experience: a situation or scene that is part of our daily life seems suddenly unfamiliar. "I knew it was my car, but I felt as if I'd never seen it before."

Antidepressants.

Stress disorders are commonly treated with a combination of insight therapies, exposure treatments, and drug therapies. Among the commonly prescribed drugs for PTSD are anti-anxiety drugs and _____.

Get a number of details wrong, no matter how certain they are that they remember the events correctly.

Studies have shown that when describing memories of their experiences of very significant events such as the 9/11 attacks or the space shuttle challenger explosion, people usually...

Adrenocorticotropic hormone (ACTH)

The body's "major stress hormone".

Stressor

The event that creates the demands.

Memory

The faculty for recalling past events and past learning.

Hypothalamus.

The features of arousal and fear are set in motion by the brain area called the...

Fusion

The final merging of two or more subpersonalities in dissociative identity disorder.

Amnestic episode

The forgotten period.

1. Autonomic nervous system. 2. Endocrine system.

The hypothalamus activates what two important systems (Lundberg, 2011)?

Rap group

The initial term for group therapy sessions among veterans, in which members meet to talk about and explore problems in an atmosphere of mutual support.

Doubling

The sensation that one's mind seems to be floating a few feet above them.

Depersonalization

The sense that one's own mental functioning or body are unreal or detached.

Derealization

The sense that one's surroundings are unreal or detached.

1. Stressor. 2. Stress response.

The state of arousal has what two components?

Mutually amnesic relationships

The subpersonalities have no awareness of one another (Ellenberger, 1970).

Endocrine system

The system of glands located throughout the body that help control important activities such as growth and sexual activity.

Switching

The transition from one subpersonality to another, usually sudden and may be dramatic.

Subpersonalities (alternate personalities)

The two or more distinct personalities found in individuals suffering with dissociative identity disorder.

Torture

The use of brutal, degrading, and disorienting strategies to reduce victims to a state of utter helplessness.

The tip-of-the-tongue phenomenon

To have something on the tip of the tongue is an acute "feeling of knowing": we are unable to recall some piece of information, but we know that we know it.

29% (Hermes, Hoff, & Rosenheck, 2014; Krippner & Paulson, 2006; Weiss et al., 1992).

We now know that as many as _____ of all Vietnam veterans suffered an accident or posttraumatic stress disorder.

1. Memories of the war replay in his mind at all times of the day and during his dreams, beyond his control. 2. He stays away from busy streets where he will be reminded of Vietnam. 3. He is especiallly startled, suspicious, and jumpy most of the time.

Which of the following indicates a primary symptom of post-traumatic stress disorder in Dennis, the Vietnam veteran portrayed in the video (One Man's Return from Combat)?

Localized amnesia

a person loses all memory of events that took place within a limited period of time, almost always beginning with some very disturbing occurrence: The most common type of dissociative amnesia.