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