Abnormal Psych Ch.9- Trauma & Dissociative Disorders
Function related to Trauma:
Reoccurring thoughts of traumatic event could lead to the person trying to escape the situation & avoiding these environments based on the new associations w/the trauma
Trauma from Miscarriage, Stillbirths & Neonatal deaths.
Reproductive-Related Trauma
Disrupted Functioning of the Hippocampus =
Responsible for Declarative Memory, Emotional memory, "Putting things in Context" -Memories aren't integrated properly-they get "stuck" in the Autonomic Nervous System-distorted emotions & thinking
Acute Stress Disorder (ASD)
-Looks just like PTSD -Exposure to a traumatic event (crit A) -Differs from PTSD based on Duration & # of symptoms Duration: -3 days to 1 month # of Symptoms: -9 out of 14 from ANY category
Household Dysfunctions in (ACEs) consist of?
-Mental Illness -Incarcerated Relative -Mother Treated Violently -Substance Abuse -Divorce
DSM-5 Criteria for DID: Criteria C =
(Cause functional impairments) The symptoms cause clinically significant distress or impairments in social, occupational or other important areas of functioning.
Criteria B: Intrusion Symptoms (1)=
-Intrusive Thoughts -Nightmares Dissociation/Flashbacks -Psychological & Physiological Reactivity
Adjustment Disorder
-An abnormal & excessive reaction to an identifiable life stressor. (Doesn't have to be to the extent of being traumatic EX: Moving, Ending of a relationship, Divorce -The reaction is more severe than would normally be expected -Can result in significant impairment in Social, Occupational & Academic functioning.
Biological Treatment Approaches for PTSD
-Antidepressants (Zoloft, Paxil) -Somatic Experiencing -Eye Movement Desensitization & Reprocessing (EMDR)
Responses to trauma may vary & individuals may experience?
-Anxiety -Anhedonia -Externalizing Anger -Dissociative Symptoms
Controversies of DID
-Considered to be rare -Many doubt the diagnosis -Between the 1920s to 1970s there were only a handful of cases actually reported, but since then, the # of reported cases has skyrocketed into the thousands, most of which happened in the 70s during the time the movie Sybil came out. -Repressed memory Controversy
You can specify what kind of Adjustment Disorder it is, which can look like....?
-Depressed Mood -Anxiety -Mixed Anxiety & Depressed Mood -Disturbance of Conduct -Mixed Disturbance of Emotion & Conduct -Unspecified
Criteria D: Negative Alternations in Cognitions & Mood (2) =
-Difficulty Recalling Parts of the Trauma -Negative Beliefs about Self & World -Blame -Distorted Cognitions (Self-Blame) -Negative Emotions -Diminished interest -Detached/Estranged -Difficulty Experiencing Positive Emotions
Changes from DSM-IV-TR to DSM-5
-Explicitly includes Sexual Assault & recurring Exposure -Inclusion of Negative Mood & Cognitions category -Inclusion of Self-Destructive Behavior -Preschool Subtype (PTSD in children under 6) -Dissociative Subtype (Prominent Dissociative Symptoms)
PTSD from a Biological Perspective look at what happens to the body. What happens when someone is faced w/ something that is really scary, dangerous or violent?
-Fight, Flight or Freeze mode >Chronic state of over arousal/dyregulation -Disrupted functioning of the Hippocampus -REM sleep helps consolidate (process) emotional memories/experiences
Feeling Pain from Trauma:
-Frequently -When the traumatic event is relieved or remembered, then all the pain associated w/those memories are re-experienced.
Criteria E: Alterations in Arousal & Reactivity (2) =
-Irritable/Aggressive -Self-Destructive -Hypervigilance -Exaggerated Startle Response -Difficulty Concentrating -Sleep Disturbance
-Medical Trauma -School Violence -Community Violence -Domestic Violence -Early Childhood Trauma -Neglect -Physical Abuse -Sexual Abuse -Traumatic Grief -Complex Trauma
Other Traumatic events
# of events that are types of Trauma identified by Briere & Scott:
-Natural Disasters -House or other Domestic Fires -Motor Vehicle Accidents -Large-Scale Transportation -Emergency Worker Exposure to Trauma -Torture -War -Rape & Sexual Assault -Mass Interpersonal Violence (DV, Stranger Assault) -Child Abuse & Neglect
Criteria C: Avoidance (1)=
-Of Thoughts -Feelings -External Reminders
Neglect in (ACEs) consist of?
-Physical -Emotional
Abuse in (ACEs) consist of?
-Physical -Emotional -Social
Fatality b/c of Trauma:
-Presence of PTSD may lead to suicidal ideation or attempts -May increase the risk of Suicide
Empirically Supported Psychological Treatments for PTSD
-Prolonged Exposure -Present-Centered -Cognitive Processing -Seeking Safety (PTSD w/Substance Use Disorder) -Stress Inoculation -Eye Movement Desensitization & Reprocessing -Psychological Debriefing -Trauma Focused CBT
Behavior from Trauma
-Sympathetic Nervous System -Emotions of Fear -Thoughts of Helplessness -Escape & Avoidance Behaviors (For PTSD, ppl experience recurrent thoughts or images from traumatic event)
Features of Dissociative Identity Disorder
-the host (main) personality is unaware of the existence of the other identities, whereas the other identities are aware of the existence of the host. -the different personalities are completely unaware of one another. -the personalities compete for control of the person
W/in a Classical Conditioning framework, Traumatic experiences are ......................... stimuli that becomes paired w/........................ (.....................) stimuli such as the sights, sounds & even smells associated w/the trauma. Therefore, Anxiety becomes a ..................... .................... that is elicited by exposure to trauma-related stimuli.
-Traumatic experiences = Unconditioned stimuli -Neutral (conditioned) stimuli -Anxiety = Conditioned Response
Individuals with (1) ................ may want to escape the trauma or dissociate, where as for (2) ............... personality states emerge to allow the person to escape & cope w/the trauma.
1) PTSD 2) DID
DSM-5 Diagnostic Criteria Categories for PSTD
A) Stressor B) Intrusion Symptoms (1) C) Avoidance (1) D) Negative Alternations in Cognitions & Mood (2) E) Alterations in Arousal & Reactivity (2)
Dissociative Identity Disorder (DID) used to be called.... Multiple Personality Disorder
A Psychological disorder involving the presence of 2 or more personality states & usually in response to early childhood trauma. -A response to repeated exposure to COMPLEX TRAUMA -Really significant physical & sexual abuse -An extreme dissociation to the point that another personality develops
Post Traumatic Stress Disorder (PTSD)
A mental health condition triggered by a terrifying event-either witnessing or experiencing it. Duration: -1 month or more # of Symptoms: -6 specific to EACH of the 4 categories (have to have something from each of the categories) They HAVE TO HAVE... -re-experiencing -avoidance -changes in thinking & mood -hyperarousal
Complex Trauma
An event, several events or repeated exposure to events that contribute to multiple psychological responses. -1 traumatic experience, then another one later on or it's chronic (on going), gets really complicated.
Trauma affects Frequency: A-Amount of Time B-Behavior C-Curve
A-May vary depending on the Disorder B-Quadripartite Responses (when it affects all 4): -Physiology -Thinking -Behavior -Feelings C-Lifetime prevalence rate of PTSD= 8.7% & 12-month rate = 3.5%
DSM-5 Criteria for DID: Criteria A =
A: Disruption of Identity: characterized by 2 or more distinct personality states. -Some cultures describe it as an experience of possessions. -There is a discontinuity in the sense of self, therefore, other identities can emerge. -it can change their mood, affect, behavior, consciousness, memory, perception, cognition &/or sensory-motor function. EX: u can see that 1 of the personality alters needs glasses or 1 has an accent.
Resiliency
Ability to overcome stress or return to functioning briefly after enduring a trauma.
The major conceptual understanding of PTSD comes from what perspective?
Behavioral or Learning Perspective
Exposure Therapy
Consists of exposing a client to memory of the traumatic event in attempts to extinguish the negatively reinforcing escape/avoidance behavior.
Stillbirths
Death of a child FROM 20 weeks gestation or later. -Usually the child is birthed. -May be due to unknown causes. -Occur more frequently than ppl think, in about 1 in 110 births.
Perinatal Loss
Death of a child occurring during perinatal development. -Can be devastating & detrimental to emotional, psychological & physical well-being.
Miscarriage
Death of child UP TO 20 weeks of gestation
The person may look into a mirror & not recognize themselves or have an experience of being outside of their body & watching themselves do some task that seems mechanical. The know that they are seeing themselves & do NOT think that there is someone else. What disorder is this?
Depersonalization/Derealization Disorder
Dissociative Fugue (Amnesia)
Dissociative amnesia occurring w/fleeing from a residence or wandering. -Involves difficulty in recall of autobiographical info not related to forgetting
Dissociation
Disturbance in the integration of memory & awareness. -Thinking that your environment around you isn't real -Kind of like things are fuzzy & you are in a bubble -Watching yourself out of the body in a sense & watching yourself do something -Not in the present moment -Most often comes from someone who is exposed to chronic trauma as a kid, all the time, over & over... it becomes a protective factor... Ex: Driving home & u can't remember the 5-10 minutes of driving & ask yourself how you got there
Psychological Trauma
Events that pose a threat, intense fear, helplessness & loss of control.
Mass Interpersonal Violence Trauma
Events that threaten or bring fear to a large # of ppl.
Depersonalization
Experiences of being outside of your body or an unreal sense of self. -Have to interfere w/functioning -Dissociation that is not as severe as DID (where there are other personalities stemming from it) -Person does NOT meet the criteria for PTSD
Derealization
Experiences of detachment from surroundings. -Not realizing how you got there -feeling like the world around you is unreal
Repressed Memory (Freud) Controversy of DID
Freud (Psychodynamic Perspective) -Using Repression as a defense mechanism -Our minds way of protecting us from bad things that have happened -Freud said that we should repress the sexual fantasies surrounding childhood sexual abuse--> we should repress that -Unconscious Sexual Trauma >Leading Qs -Elizabeth Loftus >Implanting False Memories >25% of actually believed what she was saying even though the memories didn't actually happen
Depersonalization/Derealization Disorder
Involves persistent experiences of Depersonalization or Derealization.
What did the 10 Adverse Childhood Experiences (1995) look at & what did they find?
Looked at health risks of being exposed to negative things in childhood. -The more of them u experienced in your lifetime, the more likely you are to have negative health outcomes from it.
September 11, 2001 event that occurred involving planes crashing into the World Trade Center & the Pentagon are an example of?
Mass Interpersonal Violence Trauma
DSM-5 Criteria for DID: Criteria B =
Recurrent Gaps in the recall of everyday events/Memory. -Not being able to remember important personal info &/or traumatic events that happened -Not the case of ordinary forgetting Ex: when another identity takes over & u have the host personality & they don't have any recollection of what this person has done when they took over.
Adverse Childhood Experiences (ACEs) are?
Stressful or traumatic events, including Abuse, Neglect & Household Dysfunctions such as Domestic Violence or growing up w/family members who have Substance Use Disorder. -Are strongly related to the development of health problems throughout a person's lifespan including Substance Misuse.
When ppl are presented w/danger or threat, then they typically experience what type of arousal?
Sympathetic Nervous System
Alters
Term used to refer to personality states
What is a common myth about Trauma?
That experiencing trauma mean an inescapable direct path to psychopathology. Therefore, NOT ALL trauma may lead to psychopathology.
DSM-5 Criteria for DID: Criteria D =
The disturbance is NOT a normal part of a broadly accepted cultural or religious practice. EX: If you go to therapy for this, you can't actually diagnose DID if it's a cultural or religious thing that they believe it to be possession & that the person needs an exorcism as opposed to it being multiple personalities.
Criteria A: Stressor (1)=
The person was exposed to: -Death -Threatened Death -Actual or Threatened Serious Injury or Sexual Violence In 1 or more of the following ways: -Direct exposure -Witnessing -Indirect Learning Indirect Exposure
Vicarious Trauma
Trauma resulting from the exposure to another person's trauma. It has the capacity to negatively affect trauma therapists, especially if those therapists have a history of trauma.