Abnormal Psychology Chapter 6

long term memory

1. declarative/explicit - things that can be consciously recalled; semantic and episodic 2. procedural/implicit - memory that aren't consciously recalled but automatically engaged during activity (muscle memory)

Dissociative amnesia

1. cannot recall important autobiographical info, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting 2. distress or impairment 3. not due to substance use or neurological/medical condition

Dissociative Identity Disorder (DID)

1. disruption of identity, characterized by two or more distinct personalities 2. memory: recurrent gaps in recall of everyday events, important personal info, and/or traumatic events 3. not due to substance abuse also known as Multiple Personality Disorder - one of personalities dominates the person's functioning, take control one after another

Dissociative amnesia with dissociative fugue

1. sudden unexpected travel away from home or customary place, with inability to recall some or all of one's past 2. person is unaware that they don't have awareness of their personal identity 3. confusion about one's identity, sometimes a new identity is taken on 4. amnesia may last a few hours to a few years 5. during fugue: appear normal to others 6. considerable variation

What are the two pathways by which the autonomic NS and the endocrine system produce arousal and fear reactions?

1. sympathetic nervous system - stimulate key organs 2. hypothalamic-pituitary-adrenal (HPA) pathway - release stress hormones into bloodstream

Roman's father was diagnosed with cancer just before Roman went off to college for his freshman year. Although he got good grades in high school, Roman is finding himself struggling academically. He is worried about his dad and is disheartened by the fact that he cannot be home to help. After seeing his grades plummet and developing chronic insomnia, Roman decided to go to the UHCS so that he can unload all the feelings he is carrying.

Adjustment Disorder

PTSD and DMV

DMV 3: nature of the stressor (outside range of usual human experience) DMV 4: pathological response to an extreme form of stress DMV 5: tightened criteria (experienced directly or violent death of close one)

Jameson persistently has the sense that he is somehow outside of his body, that he is observing himself doing things like walking around, brushing his teeth, eating lunch. He is unnerved by this sensation and is concerned about his sanity.

Depersonalization Disorder

Janae has noticed that there is food in her refrigerator that she doesn't recall buying; in fact, she doesn't like. Occasionally she encounters people whom she does not recognize but who seem to know her, although they call her by the wrong name and tend to think they met her someplace that she has never been. She is frequently forgetful, she feels like she "loses time" (meaning that she doesn't know how she spent it), and people think she is very moody.

Dissociative Identity Disorder

types of dissociative disorders

Dissociative Identity Disorder (DID), Dissociative Amnesia (including fugue), Depersonalization/Derealization disorder

Mason was in a car accident in which he suffered no physical injuries, but afterward he doesn't recall anything about the accident at all. Otherwise, his memory is fine.

Dissociative amnesia - localized amnesia

Ruthanne was supposed to babysit for her sister's children one morning, but never showed up. Late that afternoon, she found herself walking around in a city that she did not recognize and did not recall how she had gotten there. When someone asked her where she was from, she also realized that she did not recall her identity at all.

Dissociative amnesia with fugue

CBT for PTSD

best psychological treatment exposure therapy, relaxation techniques, cognitive restructuring uncovering and covering

T/F A person can be diagnosed with PTSD if symptoms develop after seeing media exposure of a horrendous event, such as a terrorist attack.

F - DMV 5 no longer includes media exposure to a traumatic event

T/F: The majority of people who have PTSD see improvement within 6 months.

F - about half improve within 6 months, the rest have persistent symptoms

T/F: The majority of people with PTSD developed it as a result of military service.

F - disasters are most common triggers because they occur more often

T/F: To be diagnosed with DID, a person must have at least 3 different personalities.

F - must have at least 2 different personalities

T/F: A traumatic experience always precedes development of Adjustment Disorder.

F - requires exposure to common, identifiable stressor but does not need to be a traumatic experience

T/F: in DID, the subpersonalities are always aware of the existence of each other.

F - there are cases of mutually amnesic relationships and one-way amnesic relationships

T/F: The symptom of dissociation is nearly always a sign of a mental illness.

F - there are everyday dissociation (mindless activities liked driving)

T/F: Experiencing derealization or depersonalization is always a sign that a person has a disorder.

F - transient depersonalization/derealization are fairly common, not enough for diagnosis

Dissociative Identity Disorder (DID) was formerly known as what disorder?

Multiple Personality Disorder

relationships between alters

mutually amnesic, mutually cognizant, one-way amnesic

Anya was abused sexually by her stepfather when she was a child. Even though she's now a college student, she continues to have nightmares of the experience, tends to be overly sensitive to people touching her, refuses to talk about what happened, and feels diminished enjoyment in life.

PTSD

What is the approved medication treatment for PTSD and how helpful is it (what percent of people get full symptom relief from this medication?)

SSRIS - not very helpful, only 20-30% get full symptom relief

T/F: Dissociative amnesia is never caused by a head injury.

T - cannot be caused by a neurological or medical condition (head injury, stroke, seizure)

T/F At least initially, people with dissociative amnesia are frequently unaware (or only partially aware) of their memory loss.

T - unaware until it's brought to their attention

Can exposure therapy be helpful in treating PTSD?

Yes - exposure therapy with relaxation techniques and cognitive restructuring is considered the best treatment

Do people tend to recover from dissociative amnesia?

Yes - often recover on their own, only sometimes do memory problems linger

Is it possible that a person might not be able to recall any information pertaining to his identity or life events, yet be able to recall how to do a learned task like how to type, or how to take apart a rifle and put it back together? Explain your answer.

Yes - they may have lost episodic memories but their procedural memory has remained intact

Assuming a person has been exposed to a trauma, what is one protective factor that decreases the risk of developing PTSD?

a lot of social/psychological support after traumatic event will decrease risk

psychogenic amnesia

amnesia with psychological cause

sense of agency

awareness of initiating, executing, and controlling one's own actions

generalized amnesia

begins with particular event and extends back in time, sudden confusion and purposeless wandering; complete amnesia of one's personal history (can't recall anything)

hyperarousal

being on edge, easily startled, feel tense

factors in developing ASD and PTSD

biological/genetic: brain, biological predisposition, abnormal neurotransmitter/hormone activity (norepinephrine and cortisol) psychological: personalities, attitudes. coping styles, history

Depersonalization/Derealization Disorder

characterized by persistent or recurrent experiences of depersonalization or derealization or both, but in touch with reality; not caused by drugs but usually extremely stressful experiences

There is a specific type of life event that is frequently present in the history of clients who have a dissociative disorder, whether that be DID, or dissociative amnesia, etc. What type of event is this?

childhood abuse - sexual or physical

stressors: chronic vs acute

chronic - long lasting (illness, jobless) acute - recent (lost job, breakup)

What issues can make psychotherapy with DID clients difficult and complex?

clients have to face horrendous traumatic past, subpersonalities may resist treatment because reintegration = death

triggers for ASD and PTSD

disasters, exposure to combat, abuse, terrorism

dissociation

disconnection between things normally associated with each other - split, fragmentation, or separation of mental activities (memory, personal identity, consciousness)

iatrogenic disorder

disorders unintentionally produced by clinicians supported when DID comes after patient has already been therapy

mutually cognizant relationship

each subpersonality is well aware of the rest

Alters (subpersonalities)

each with unique set of memories, behaviors, thoughts, and emotions; with own enduring pattern of perceiving, relating to, and thinking about itself or the world critical of host, different names and personal histories, may have different abilities/knowledge and genders/ages, may not be aware of others but also can conflict

stressor

event that creates demands

derealization

experiences of unreality or detachment with respect to one's surroundings

depersonalization

experiences of unreality, detachment, or being an outside observer with respect to oneself

stress disorder

exposure to a traumatic event or stressor symptoms: anxiety, anhedonia, depression, anger/aggression, dissociation

In ASD or PTSD, what are some ways a person might manifest the symptom of "re-experiencing" the traumatic event?

flashbacks, nightmares, frightening thoughts

What is the essential difference between dissociative amnesia and the subtype of dissociative amnesia with dissociative fugue?

fugue requires sudden travel away from home

explanations for DID

history of traumatic events in childhood (abuse) overwhelming traumatic event --> "walled off" and emerge with different subpersonalities triggered by particular situations

Describe how the alter personalities in DID tend to differ from each other and from the host personality.

host - appears most often, goes by given name, usually passive and guilt-ridden alters - each have own set of behaviors, memories, thoughts, world perceptions

anhedonia

inability to feel pleasure (from hobbies, sexual activity, social interactions, ect)

What is the focus of psychotherapy for a person who has adjustment disorder?

increasing coping ability and/or alleviating the stressor

PTSD symptoms

intrusive symptoms (re-experiencing traumatic event), avoidance of trauma-linked stimuli, changes in mood and cognition, changes in arousal and reactivity (hyperarousal)

What's the major difference between Acute Stress Disorder and Post-Traumatic Stress Disorder?

length of disorder - PTSD must have symptoms for more than a month

types of dissociative amnesia

localized amnesia, selective amnesia, generalized amnesia

localized amnesia

loss of memories in the first few hours after traumatic event; no recall of events that took place in a limited time period after traumatic event

selective amnesia

loss of memory over certain parts; some, but not all, recall of events that took place in a limited time period during a traumatic event

There's been an increase in the number of people diagnosed with DID over the past decades; to what phenomena do some people attribute this increase?

media influence - cases increased after release of popular movies (Sybil)

treatments for PTSD

medications - anti-anxiety and anti-depressants CBT - exposure therapy (uncomfortable, avoided unless extreme symptoms) psychotherapy - bring out deep-seated feelings couple, family, group therapy, support groups

semantic memory

memory of how the world works

episodic memory

memory of specific events to personal life; autobiographical

one-way amnesic relationship

most common pattern; some personalities are aware of others, but the awareness is not mutual can be quiet observers (co-conscious) or critical of other alters

DID statistics

most faces in early adulthood or early childhood after abuse; women receive diagnosis three times as often, 1% prevalence, higher average number of alters than thought, diagnoses increasing in number

What are some changes in mood or cognition that might be symptoms of PTSD?

negative thoughts about self, negative emotions of guilt or blame, loss of interest, trouble remembering features of traumatic event

medications for PTSD

not very helpful SSRIs + anti-anxiety or antipsychotic (get rid of delusions)

People who develop DID almost always have a history of severe and repeated childhood trauma. According to one view, of what relevance is this to the development of DID?

overwhelming traumatic experiences as a child may get "walled off" from normal consciousness and identity and emerge later as separate personalities

In Derealization/Depersonalization Disorder, what distinguishes the experiences of derealization and depersonalization from hallucinations?

patients with the disorder are still in touch with reality

Dissociative amnesia recovery

people often recover on their own, only some cases have lingering memory problems memories may be spontaneously recovered, triggered by stimuli

How do people with DID often come to realize that something in their life is not quite right and that perhaps they have a psychological disorder?

people they don't know recognize them, wake up in different place, things are different - gas mileage, bank account

stress response

person's reaction to the demands influenced by: judgment of event, judgment of our capacity to react to event effectively

risk factors for PTSD

pre-existing factors (prior trauma, genetics, less resilience, poor social and financial support) nature of traumatic event what happens after traumatic event

Not everyone who is exposed to a traumatic experience develops PTSD. What are three things that are risk factors for developing PTSD?

pre-existing factors, nature of traumatic event, what happens after traumatic event

theories of cause of dissociative amnesia

psychoanalytic: amnesia is unconscious act of self-preservation - repress memories and anxiety neurological: normal episodic memory processing is blocked by imbalance of stress hormones

Adjustment Disorder

psychological response within 3 months of exposure to common, identifiable stressor, resulting in clinically significant behavioral or emotional symptoms; mildest diagnosis, to alleviate stressor and prevent more serious diagnosis

stressors: recurrent vs continuous

recurrent: happens at different times continuous: always present

Reintegration treatment for DID

reintegration of various subpersonalities into one host personality; therapist bonds with and educates personalities - each subpersonality has a part of one's personal experience, memories, traumas face traumatic past - difficult, can take years, subpersonalities may push against treatment, further treatment to maintain complete personality

uncovering

reliving trauma in safe environment, prolonged exposure (high drop out but most helpful)

symptoms of dissociative disorders

separation of mental functioning to an extreme degree or very frequently, causes distress or dysfunction; no clear physical cause; dissociative reactions are main symptoms

Why might couples counseling be part of the treatment for PTSD?

social support is important in recovering

Why do some clinicians question whether DID is a real disorder?

some believe it is unintentionally produced by clinicians (iatrogenic disorder)

mutually amnesic relationship

subpersonalities have no awareness of one another

covering

supportive therapy and stress management to seal over pain of trauma; focus on secondary problems (emotional withdrawal from relationships)

Acute stress disorder (ASD)

symptoms begin within four weeks of event and last between 3 and 30 days; recovery is quite fast

Posttraumatic stress disorder (PTSD)

symptoms may begin either shortly after the event, or months or years afterward and last for over one month; if symptoms persist

What is the goal of psychotherapy with DID clients?

to reintegrate various subpersonalities into one host personality

Depersonalization/Derealization Disorder information

transient depersonalization/derealization is common but not enough to meet criteria for diagnosis; most frequently in young adults risk factors: abuse and neglect treatment: antidepressants, psychotherapy

Host personality

usually appears most often, goes by given name, tends to be passive, dependent, depressed, guilt-ridden