AB PSYCH exam 2 : ch 7
recovered memories
dramatic recollections of long-ago traumatic experiences supposedly blocked from the conscious mind by dissociation.
ASD
Duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after trauma exposure. Note: Symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria.
The essential difference between ASD and PTSD is ____.
durationASD lasts no longer than a month, while PTSD continues or sometimes begins at least a month after the trauma.
shell shock or combat neurosis
"normal" performance is expected in the face of the trauma of combat. Military concern initially focused on battle dropout; that is, men and women who leave the field of action as a result of what in the past has been called (During the Vietnam War, however, battle dropout was less frequent than in earlier wars, but delayed reactions to combat were much more common)
findings from DID study
"symptoms" of DID can be induced by role playing and hypnosis (Lilienfeld et al., 1999). Moreover, accumulating evidence indicates that fantasy proneness and suggestibility play key roles in the development of dissociative disorders (Geisbrecht et al., 2008). Still, analogue studies cannot prove that role playing causes real cases of multiple personality
what is hardiness
, a sense of commitment, control, and challenge in facing stress, predicts lower risk for PTSD ( in workers/first responders )
depersonalization (ptsd)
, feeling cut off from themselves or their environment. They might feel like "a robot," or as if they were sleepwalking.
Almost __ percent of women report having been raped at least once in their lifetime, according to national surveys, and __ percent report having been sexually molested (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). Other evidence suggests a notably higher prevalence when the data include acquaintance rapes, assaults committed by people known to the victim
10 12
The development of PTSD following a trauma also is not random. Those who are anxious and easily upset are more likely to develop PTSD after a trauma, as are people with a family or personal history of mental disorder (Breslau et al., 1998). In fact, a recent prospective study found that over __ percent of those who developed PTSD following trauma exposure met criteria for _____ (Koenen et al., 2008). People who developed PTSD following an earlier trauma also are at greater risk following a second trauma
90; some other diagnosis earlier in their life
DSM once defined trauma as an event "outside the range of usual human experience." Unfortunately, it is not. A random sample of 2,181 adults living in the Detroit area found that almost 90 percent had experienced at least one trauma in their lifetime. About _ percent developed PTSD (Breslau et al., 1998; see Figure 7.1). Similarly, a national study found that ___ percent of the people in the United States suffered from PTSD at some point
9; 6.8
dissociation and sleep
A recent proposal suggests that a fragmented sleep-wake cycle helps explain dissociative symptoms (van der Kloet, Merckelbach, Giesbrech, & Lynn, 2012). In support of this novel view, research finds a relation between sleep disturbance and dissociation—experimental deprivation of sleep increases dissociative experiences, and improved sleep decreases dissociation
does trauma damage the brain?
A study of identical twins—one Vietnam veteran with PTSD and his co-twin who neither served in Vietnam nor suffered from PTSD—found smaller than average hippocampus volume in both twins (Gilbertson et al., 2002). Twin research also shows that pre-existing differences account for lower IQ scores that have been mistakenly attributed to brain damage due to trauma (Gilbertson et al., 2006). Differences between people with and without PTSD are correlations—correlations apparently due to pre-existing differences, not due to brain damage caused by trauma.
Negative mood PTSD: numbing of responsiveness, a reaction sometimes called ________, a term that well captures the dampened feelings. Other people's negativity is more cognitive. They may blame themselves, repeatedly question what they might have done differently, or see the world in an unrealistically negative way.
emotional anesthesia
what is dissociation
the disruption of the normally integrated mental processes involved in memory, consciousness, identity, or perception.
acute stress disorder vs PTSD time period
ASD occurs within a month after exposure to traumatic stress. Posttraumatic stress disorder (PTSD) lasts longer than one month and sometimes has a delayed onset
PTSD and social support
As with less-severe stressors, social support after a trauma can play a crucial role in alleviating long-term psychological damage. A lack of social support is thought to have contributed to the high prevalence of PTSD found among Vietnam veterans (Oei et al., 1990). Rather than being praised as heroes, returning veterans often were treated with disdain. This made it difficult for many veterans to find meaning in their sacrifices and likely increased their risk for PTSD. People who had little social support also were more likely to develop PTSD following September 11
A study of veterans returning from a year-long deployment in Iraq also shows the promise of more naturalistic interventions in preventing PTSD symptoms the army's "treatment as usual," stress education in groups of about 100; battlemind debriefing, discussions in groups of 20 to 32 that included some review of combat experiences but focused on the transition home and building peer support; and battlemind training, focused on finding inner strength in combat, teaching skills to help unit members, and reframing redeployment difficulties as normal problems that require adapting occupational coping skills.
Battlemind debriefing and battlemind training (in small and large groups) significantly reduced symptoms measured on the PTSD Checklist (PCL) when compared to stress education, but only among soldiers exposed to high levels of combat. These results support the benefits of more naturalistic prevention efforts directed toward groups most at risk.
spanos and colleagues conducted experiments on Kenneth Bianchi, the infamous "Hillside Strangler."Bianchi was charged with murdering two college women and was implicated in several other rape-murder cases where victims were left naked on the hillsides of Los Angeles. Considerable evidence supported Bianchi's guilt, but he reported frequent episodes of "blanking out," including an inability to remember events from the night that the murders were committed.
Bianchi actually shook hands with the supposed hallucination—a very unusual behavior for someone under hypnosis. Orne concluded that Bianchi was indeed faking and actually suffered from antisocial personality disorder. Bianchi's insanity defense failed, and he was found guilty of murder.
In rare cases, re-experiencing occurs as a ______ state, where the person feels and acts as if the trauma actually were recurring in the moment. A combat veteran might act as if he were back in battle, and he may even take dangerous actions, like gathering weapons or barricading himself in his residence. Typically, dissociative states are of short duration, but in unusual cases they can last for days.
dissociative
hysteria : history of word
In Greek, hystera means "uterus." 0 hysteria includes somatoform and dissociative disorders. The term hysteria reflects the ancient view that frustrated sexual desires, particularly a woman's desire to have a baby, cause the unusual symptoms Ancient beliefs held that the uterus detached and moved about the body, causing a problem wherever it eventually lodged. This strange belief lived well into the late 19th century, when many experts argued that hysteria occurred only among women
3 types of dissociative disorders
dissociative amnesia, depersonalization disorder, and dissociative identity disorder.
most fascinating dissociative disorder + define
DID- dissociative identity disorder (=multiple personality disorder in past ) This extremely unusual problem is characterized by the existence of two or more distinct personalities in a single individual. Two or more of these personalities repeatedly take control of the person's behavior, with alterations in mood, behavior, and at least some loss of recall between the personalities. The original personality, especially, is likely to have amnesia for subsequent personalities, which may or may not be aware of other "alters" (Aldridge-Morris, 1989). Recent case studies claim to have identified more and more alters.
Most victims of sexual assault show the symptoms of PTSD. Victims may re-experience the horrors of the assault; they may feel numbed in reacting to others, particularly sexual partners; they may avoid any potentially threatening situation; and they may maintain both autonomic hyperarousal and hypervigilance against possible victimization.
Depression is also common. Sadness, crying, and withdrawal from others often are coupled with sleep and appetite disturbances. Loss of interest in sex, insecurities about sexual identity, sexual dysfunction, and negative feelings toward men also are common
PTSD requirement
Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: Directly experiencing the traumatic event(s). Witnessing, in person, the event(s) as it occurred to others. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.
fads . wut da furq r dey
Fads come and go. Hula hoops. Pet rocks. Platform shoes. iPods. Piercing various body parts. Tattoos.
emotional processing
First, victims must engage emotionally with their traumatic memories. Second, victims need to find a way to articulate and organize their chaotic experience. Third, victims must come to believe that, despite the trauma, the world is not a terrible place New York City college students had lower rates of PTSD following the September 11 terrorist attack if they were better at enhancing and suppressing emotional expression - victims of trauma must find a balance between gradually facing their painful emotions while not being overwhelmed by them.
___ is a state of increased alertness.
Hypervigilance
the value of purpose
In contrast, preparedness, purpose, and the absence of blame can aid coping with trauma. Pilots cope more successfully with helicopter crashes if they have training than if they have none, underscoring the importance of preparedness and control (Shalev, 1996). The value of purpose is supported by evidence that, despite greater physical suffering, political activists develop fewer psychological symptoms than nonactivists following torture (Basoglu et al., 1997). On the other hand, self-blame—the rape victim who blames herself, or the driver who thinks he could have avoided an accident—is strongly tied to an increased risk for PTSD
todays diagnostic fads
In more recent years, diagnostic fads have focused on mental disorders in children. The estimated prevalence of autism spectrum disorder increased by a factor of 50 between 1994 and today (Blumberg et al., 2013). That is not a typo. Fifty times as many children are said to suffer from this disorder in 2013 as in 1994. Only slightly less dramatic is the increase in the diagnosis of bipolar disorders in children. Between 1994 and 2003, the diagnosis increased by a factor of 40 (Moreno et al., 2007). The children apparently did not suffer from bipolar disorder. In fact, DSM-5 created a whole new diagnosis to deal with this particular fad.
Research suggests many reasons to disbelieve claims that dissociative disorders are so prevalent
Most cases of dissociative disorders are diagnosed by a handful of ardent advocates. The frequency of the diagnosis of dissociative disorders in general, and DID in particular, increased rapidly after release of the very popular book and movie, Sybil. The number of personalities subsequently claimed to exist in cases of DID grew rapidly, from a handful to 100 or more. Interest in dissociative disorders declined beginning in the middle of 1990s (after Sybil), as specialized treatment units closed and professionals withdrew from organizations and journals devoted to the topic. Dissociative disorders are rarely diagnosed outside of the United States and Canada; for example, only one unequivocal case of DID has been reported in Great Britain in the last 25 years (Casey, 2001). The symptoms of dissociation in the most commonly used instruments like the Dissociative Experiences Questionnaire are far less dramatic than those found in dissociative disorders
PTSD : negative thoughts
People may experience a range of negative feelings in ASD and PTSD. These may include the inability to experience positive emotions, persistent fear, anger, or guilt, or feelings of detachment from others.
PTSD: avoidance
Persistent avoidance of stimuli associated with the trauma is another symptom of ASD and PTSD. Trauma victims may attempt to avoid thoughts or feelings related to the event, or, like Stephanie, they may avoid people, places, or activities that remind them of the trauma. Avoidance also may include refusal to discuss the events or the feelings resulting from trauma. Avoidance of terrifying feelings makes complete sense, especially in the short run. Yet the road to longer-term healing often involves facing feelings, memories, and perhaps some of the circumstances surrounding trauma.
Little systematic research has been conducted on the cause of____. Thus, theory and outright speculation dominate this field.
dissociative disorders
PTSD: antidepressant medication
Psychiatric practice guidelines recommend antidepressants (SSRIs) as a treatment for PTSD (Friedman & Davidson, 2007). The effectiveness of SSRIs is likely at least partially due to the high comorbidity between PTSD and depression (Newport & Nemeroff, 2000). While antidepressants can be helpful, only about 30 percent of treated patients recover fully from PTSD symptoms (Friedman, Resick, & Keane, 2007). Traditional antianxiety medications are not effective for PTSD
, are among the very worst traumas, and they pose an especially high risk for PTSD
Rape and assault, clearly
retrospective reports
Researchers have many concerns about the validity of such retrospective reports—evaluations of the past from the vantage point of the present (see Research Methods). Memories may be selectively recalled, distorted, or even created to conform to a clinician's expectations (Geisbrecht et al., 2008; Kihlstrom, 2005). And recall that most cases of DID are identified by a small group of clinicians who are "believers."
Sample Items from the Dissociative Experiences Questionnaire
Some people find that sometimes they are listening to someone talk and they suddenly realize that they did not hear part or all of what was said. Some people have the experience of being in a familiar place but finding it strange and unfamiliar. Some people have the experience of finding themselves dressed in clothes that they don't remember putting on. Some people are told that they sometimes do not recognize friends or family members. Some people have the experience of feeling that their body does not seem to belong to them. Some people find that in one situation they may act so differently compared with another situation that they feel almost as if they were two different people.
dissociation
Some theories suggest that dissociation is a defense that helps victims to cope with trauma (Oei et al., 1990). However, dissociative symptoms predict more, not less PTSD (Ehlers, Mayou, & Bryant, 1998; Griffin, Resick, & Mechanic, 1997; Harvey, Bryant, & Dang, 1998). Among a sample of Israeli war trauma victims; for example, more dissociation reported within one week following trauma predicted more severe PTSD six months later
common symptoms of ASD and PTSD: re experiencing
Survivors often experience intrusive symptoms following trauma, symptoms sometimes called re-experiencing. Some people experience repeated, distressing memories of the incident. Others relive the trauma in horrifying dreams
ptsd symptoms and how long last and treatment
The symptoms of PTSD, generally, diminish with time. Symptoms improve fairly rapidly during the first year, but more gradually thereafter (see Figure 7.2). Symptoms diminish faster among people who receive treatment. Despite improvements, over one-third of people still report symptoms 10 years after the trauma, regardless of whether they were treated
ultimate goal in treating DID
The ultimate goal in treating DID is not to have one personality triumph over the others. Rather, the objective is to integrate the different personalities into a whole (Coons & Bowman, 2001). Integration is not unlike the task we all face in reconciling our different roles in life into a coherent sense of self. Dallae, for example, needed to reconcile her role as a daughter, including her parents' expectations, together with her role as an independent young woman with her own desires, abilities, and acculturation experiences.
2 disorders that were "fad"/hot in the 90s
Two topics that we discuss here were "hot" in the 1990s: dissociative disorders and recovered memories. As you have read, the recovered memory movement has been largely discredited. But a 1995 study found that 25 percent of therapists said that recovering memories, particularly of sexual abuse, was an important part of their therapy with female clients (Poole et al., 1995). Not a problem? Read about the Franklin case in Critical Thinking Matters. And a 1991 study claimed that 3 percent of adults suffered from dissociative identity disorder (Ross, 1991), when only about 200 case histories of multiple personality were reported in the entire world literature prior to 1980 (Greaves, 1980). Some work has been published on dissociative identity disorders since the 1990s; however, almost all cases can be attributed to a small group of clinicians. There are almost no other documented cases, and laboratory simulations of DID are almost indistinguishable from identified cases (Boysen & VanBergen, 2013). A small group of mental health professionals are still captivated by the DID diagnosis, but the fad is over. In a combined 60-plus years of practice, we have observed a total of one legitimate case of DID. Why did DSM-5 include an estimated community prevalence of 1.5 percent of DID based on an unidentified "small study?"
prolonged exposure
While great sensitivity is required, the most effective evidence-based treatment for PTSD is therapeutic re-exposure to trauma
Cognitive Behavior Therapy for PTSD
While great sensitivity is required, the most effective evidence-based treatment for PTSD is therapeutic re-exposure to trauma called prolonged exposure (Foa, Gillihan, & Bryant, 2013). One of the first studies asked rape victims to relive the trauma repeatedly over nine therapy sessions. While surely painful, exposure reduced PTSD symptoms more, over the long term, than three randomized alternatives, including relaxation/stress management, supportive counseling, and a wait list control group (Foa, Rothbaum, Riggs, & Murdock, 1991). Prolonged exposure has now been successfully used for PTSD following childhood sex abuse (McDonagh et al., 2005), assault (Foa et al., 2005), and combat (Eftekhari et al., 2013), although controversy has erupted due to reported high dropout from prolonged exposure among veterans (Kehle-Forbes, Meis, Spoont, & Polusny, 2016). Another recent question is whether other treatments, specifically interpersonal therapy, may be equally effective (Markowitz et al., 2015). Depending on the client, the therapist, and the circumstances of the trauma, prolonged exposure might involve confronting feared situations in real life or in one's imagination, or by recounting events in therapy
derealization
a marked sense of unreality. Immediately after 9/11, many people awoke wondering if the terrorist attacks had been only a nightmare—a sense of unreality that continued for days or longer.
how might trauma lead to development of multiple personalities? --> state dependent learning. define
a process where learning that takes place in one state of affect or consciousness is best recalled in the same state of affect or consciousness (Bower, 1990). For example, when you are sad rather than happy, you more easily remember what happened when you were sad in the past. By extension, experiences that occur during a dissociated state may be most easily recalled within the same state of consciousness. Perhaps through the repeated experience of trauma, dissociation, and state-dependent learning, more complete and autonomous memories develop—ultimately leading to independent personalities
what is critical incident stress debriefing (CISD),
a single one- to five-hour group meeting offered one to three days following a disaster. CISD involves several phases where participants share their experiences and reactions, and group leaders offer education, assessment, and referral if necessary (Mitchell, 1982; Mitchell & Dyregrov, 1993). CISD is difficult to evaluate, since it is conducted in the midst of a crisis (Tuckey, 2007). Still, research provides no evidence that CISD prevents future PTSD (Bryant & Harvey, 2000; McNally et al., 2003), and some studies find that CISD is actually harmful (Lilienfeld, 2007). CISD may provoke too much emotion too soon after trauma. Another problem is the CISD is unnatural. It is not offered by people who are a part of the victims' world. CISD, generally, is provided by outsiders to groups of individuals who have no relationship to one another.
sybil
actual therapy tapes suggest that her therapist may have implanted Sybil's 16 personalities.
some experts assert that hypnosis is a ________—an altered state of consciousness. Others argue that hypnosis is merely a social role—a subject voluntarily complying with suggestions due to social expectations
dissociative experience
multiple personality disorder is now called ___ in the DSM 5
dissociative identity disorder
Meaning Making
aids coping with trauma ; eventually finding some value or reason for having endured trauma (Ehlers & Clark, 2000). Meaning making is very personal and may involve religion, a renewed appreciation for life, or public service. Stephanie found meaning in her efforts to make others more aware of sexual assault. Importantly, the search for meaning is associated with more PTSD symptoms, whereas finding meaning is linked to better adjustment (Park, 2010). This again suggests that coping is a process, and often a painful one.
hypnosis
altered state of consciousness - susceptible to suggestion subjects experience loss of control over their actions in response to suggestions from the hypnotist. All agree that demonstrations of the power of hypnotic suggestion are impressive, different people are more or less susceptible to hypnosis, and hypnosis offers at least short-term benefits for pain management ... unique form of consciousness or form of relaxation?
People with PTSD show differences in the functioning, and perhaps the structure, of the _______&______. These findings are consistent with the experience of heightened fear reactivity and intrusive memories (Kolassa & Elbert, 2007). Other evidence links PTSD with general psychophysiological arousal; for example, an increased resting heart rate (Pole, 2007). This suggests that the sympathetic nervous system is aroused and the fear response is sensitized in PTSD.
amygdala and hippocampus
DSM-5 defines trauma as
an exposure to actual or threatened death, serious injury, or sexual violation either (1) directly, (2) as a witness, (3) learning of violence to a loved one, or (4) through repeated exposure to details of trauma. Sexual violation is a new part of the definition, reflecting both the frequency and the intensity of this trauma, especially for women
ASD and PTSD were previously classified as ______ because of the hyperarousal symptoms
anxiety disorders
DSM-5 no longer considers ASD and PTSD to be ____ disorders and, instead, created a new diagnostic grouping called ____
anxiety; trauma- and stressor-related disorders. This new category includes adjustment disorders, difficulties coping with normal challenges in life, and a few adjustment problems found among children. In essence, ASD and PTSD are now in their own diagnostic category.
Genes contributed most strongly to ______ and least strongly to _____; Conversely, level of combat exposure predicted re-experiencing and avoidance but not arousal
arousal symptoms; re-experiencing.
a rare case of re-experiencing where the person feels and acts as if the trauma actually were recurring in the moment.
dissociative state
Skeptics worry, in fact, that hypnosis may create __
dissociative symptoms or false memories of abuse
dissociative disorders- symptoms
characterized by persistent, maladaptive disruptions in the integration of memory, consciousness, or identity—verge on the unbelievable. They include psychologically produced amnesia, confused travel of long distances from home (perhaps under a new identity), and the existence of two or more separate personalities in one person. Are these symptoms real? The answer is controversial. Some experts think dissociative disorders are phony—examples of nothing more than the power of suggestion. Others view them as real but rare problems. Still others believe dissociative disorders are misunderstood, overlooked, and prevalent. This controversy is about much more than dissociative disorders. It encompasses alternative views of the very nature of the human psyche.
There is little controversy that dissociative amnesia and fugue usually are precipitated by trauma. What about DID? Many case studies suggest that DID develops in response to trauma, particularly the trauma of____
child abuse. past suicide attempts are common and so are amnesia between personalities. personalities of other genders too.
explicit memory
conscious recollection
the most widely used early intervention for ptsd is
critical incident stress debriefing (CISD),
Though not required for a diagnosis of either ASD or PTSD, ______ are common following trauma.
dissociative symptoms; Many people feel dazed, and act "spaced out."
In DSM-5, media exposure ______ qualify as traumatic stress. Secondary exposure is limited to learning about violence to a loved one, or repeated, extreme exposure; for example, first responders collecting human remains.
does not
what do traumatic stress disorders, dissociative disorders, and somatic symptom disorder share?
dissociation
A study of identical twins strongly supports the role of _____ in PTSD.
environment.... Among 715 monozygotic (MZ) twin pairs who were discordant for military service in Southeast Asia during the Vietnam War era, the prevalence of PTSD was nine times higher for co-twins who served in Vietnam and experienced high levels of combat in comparison to their identical twins who did not serve
exaggerated startle response
excessive fear in reaction to the unexpected.
PTSD treatment: EDMR
eye movement desensitization and reprocessing (EMDR), is a technique that has been greeted with considerable enthusiasm—and skepticism. Psychologist Francine Shapiro (1995) "discovered" that rapid back-and-forth eye movements reduced her own anxiety. She tried the technique on her clients, who appeared to benefit from it. Why should this work? No one has a good theory why, which is the heart of the controversy (Keane, Marshall, & Taft, 2006). Still, Shapiro and other proponents use EMDR as a relaxation technique while clients with PTSD simultaneously relive vivid images of trauma. A recent meta-analysis concluded that EMDR may be effective (Bisson et al., 2007); however, prolonged exposure, not eye movements, appears to be the "active ingredient"
trauma causes DID t/f
f. Even if trauma contributes to dissociative disorders—and we are skeptical about the connection between trauma and DID—it clearly is not a sufficient cause. As we saw with ASD and PTSD, the vast majority of people who experience trauma do not develop a dissociative disorder. Thus, other factors must contribute to their development.
true or false: The symptoms of ASD and PTSD are mainly different
false; they are basically the same, even though DSM-5 defines them somewhat differently.
PTSD: Many people have repeated and intrusive ___, sudden memories during which the trauma is replayed in images or thoughts—often at full emotional intensity.
flashbacks
Dissociation and PTSD
his organization partially reflects controversy about the role of dissociation in PTSD. Some experts have suggested that ASD and PTSD really are dissociative disorders (van der Kolk & McFarlane, 1996). We do not view PTSD as a dissociative disorder, but discuss both problems in this chapter because they raise similar issues about unconscious mental processes. As you look through the DSM-5 Criteria for Posttraumatic Stress Disorder box, note that dissociation is involved in many PTSD symptoms, not just the explicit dissociative symptoms.
ASD and PTSD were previously classified as anxiety disorders because of the ______ symptoms
hyperarousal symptoms However, DSM-5 moved the disorders into a new category, in part, because heightened reactivity can take other forms. Instead of showing increased anxiety, some people become irritable and prone to angry outbursts. Others have trouble concentrating or sleeping.
dissociative disorders (and some somatic symptom disorders, which we discuss shortly) were viewed as forms of ____
hysteria
Both Janet and Freud were eager to explain ____, and both developed theories of _____ to do so.
hysteria ; unconscious mental processes
Perhaps the most important theory about social contributions to dissociative disorders is that they are caused by -___
iatrogenesis
We believe that ____ is the explanation for the explosion of DID cases diagnosed in the United States, especially in the wake of Sybil's popularity. However, we also believe that DID is a real, if rare, problem. DID has been diagnosed in the general population in Turkey, where there is no public awareness of the disorder (Akyuz, Dogan, Sar, Yargic, & Tutkun, 1999). And suggestibility alone does not appear to explain dissociation
iatrogenesis
More naturalistic interventions show more promise. Since World War I, interventions with soldiers who drop out of combat have been based on the three principles of offering the following:
immediate treatment in the proximity of the battlefield with the expectation of return to the front lines upon recovery Results indicated that 60 percent of soldiers treated near the front recovered sufficiently to return to battle within 72 hours. Soldiers who expected to return to the front experienced lower rates of PTSD than did those who did not. Soldiers who were treated on the front lines also were less likely to develop PTSD subsequently compared to soldiers who were treated away from the battlefield
Although DSM-5 describes them somewhat differently, both ASD and PTSD involve, essentially, the same symptoms:
intrusive re-experiencing of the event, avoidance of reminders of the trauma, negative mood or thoughts, exaggerated arousal or reactivity, and often, dissociation.
dissociative amnesia define &-- typically
involves a sudden inability to recall extensive and important personal information that exceeds normal forgetfulness. typically selective amnesia—they do not lose all of their memory but instead cannot remember selected events and information, often related to a traumatic experience. The memory loss is not attributable to substance abuse, head trauma, or a cognitive disorder, such as Alzheimer's disease.
derealization
is a related symptom that involves feelings of unreality or detachment from the environment, such as experiencing the world as being more dreamlike than real.
Depersonalization/derealization disorder
is characterized by feelings of being detached from oneself or the world around you. Occasional experiences of depersonalization or derealization—for example, déjà vu experiences or feeling detached from yourself—are normal and are reported by about half the population. In depersonalization/derealization disorder, the symptoms are persistent or recurrent and cause marked personal distress. Note that these are "as-if" feelings, not delusional beliefs—you feel as if you are a robot; you don't really believe you are one.
French neurologist Jean-Martin Charcot used hypnosis both to induce and treat hysteria. Charcot greatly influenced Sigmund Freud, who observed Charcot's hypnotic treatments early in his training. Charcot also strongly influenced Freud's contemporary and rival, Pierre Janet (1859-1947). Janet was a French philosophy professor who conducted psychological experiments on dissociation and who later trained as a physician in Charcot's clinic.
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Research shows that structured interventions with ASD can lead to the prevention of future PTSD (Bryant et al., 2010). Unlike CISD, these treatments last longer and target the select group of trauma victims who meet ASD diagnostic criteria. The evidence-based ASD treatments use principles of cognitive behavior therapy, although they are briefer, typically involving five 90-minute sessions
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At this time, no systematic research has been conducted on the effectiveness of any treatment for dissociative disorders, let alone on the comparison of alternative treatments (Kihlstrom, 2005; Maldonado, Butler, & Spiegel, 2001). Antianxiety, antidepressant, and antipsychotic medications sometimes are used, but at best these medications reduce distress. They do not cure the disorder. Advances in treatment await a better understanding of the disorders and, more generally, of conscious and unconscious mental processes. In the meantime, you should view treatments championed for dissociative disorders—and the accuracy of the diagnosis itself—with a healthy dose of skepticism.
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depersonalization
less-dramatic symptom where people feel detached from themselves. One example is an out-of-body experience, such as the sensation of floating outside yourself and watching your actions as if you were another person
false memory syndrome
many parents say that misguided therapists have created false memories. In fact, the term, false memory syndrome, was coined to account for the implanting of false beliefs
famous example of DID
multiple personality disorder is Thigpen and Cleckley's (1957) The Three Faces of Eve
an unusual dissociative disorder characterized by the existence of two or more distinct personalities in a single individual
multiple personality disorder/ ____-
People who suffer from ASD symptoms are more likely to develop PTSD. Three symptoms—_____—are the best predictors of future PTSD
numbing, depersonalization, and a sense of reliving the experience
ASD was added to the DSM (in 1994) in the hope that early intervention would prevent the development of PTSD (Frances, First, & Pincus, 1995). In fact, interventions with ASD do reduce the number of expected cases of PTSD
oh
"ordinary" trauma: domestic violence.
ok
ASD really describes normal reactions to trauma, some experts suggest that it should not be called a mental disorder (Bryant et al., 2010). Other experts raise similar questions about PTSD, a diagnosis that may be handed out too easily, particularly to combat veterans. Many normal struggles with combat and readjustment to civilian life may be called PTSD, in part because mental health resources and veterans' benefits are tied to the diagnosis
ok
And case studies are based on patients' memories and clinicians' evaluations. They are not objective assessments of the past.
ok
Any trauma is horrific, but different events have unique psychological consequences
ok
But perspective is hard to obtain in the middle of a fad craze. Right now, DSM-5 diagnoses are "in."
ok
Dissociative disorders sometimes are of more interest to novelists than to scientists. You may be familiar with dramatic portrayals of multiple personality disorder, an old name for a dissociative disorder, in Sybil1 or The Three Faces of Eve, both of which were widely read books that became popular motion pictures. In recent years, psychological scientists have grown more interested in unconscious mental processes
ok
Freud considered dissociation to be normal, a routine means for the ego to defend itself against unacceptable unconscious thoughts. Freud saw dissociation and repression similarly. In fact, he often used the two terms interchangeably (Erdelyi, 1990). Thus, Freud viewed hysteria merely as one expression of unconscious conflict.
ok
In fact, the U.S. Federal Emergency Management Agency (FEMA) provides special funding to community mental health centers during disasters. Emergency treatments range from intensive individual counseling sessions with hurricane victims to group discussions with children following school violence (Litz, 2004). Approaches differ greatly, but offering immediate support to trauma victims is a common goal
ok
In general, however, emergency workers are less than half as likely to develop PTSD as are victims
ok
It is normal for survivors, witnesses, and loved ones to be greatly distressed by trauma. For some, however, the disturbance continues long after the trauma has ended
ok
Janet saw dissociation as an abnormal process. To him, detachment from conscious awareness occurred only as a part of psychopathology.
ok
Janet thought that Freud greatly overstated the importance of the unconscious; Freud thought that Janet greatly underestimated it.
ok
Only about 200 case histories of DID were reported in the entire world literature prior to 1980 (Greaves, 1980). Surely as a result of Sybil influences, the estimated number skyrocketed to about 40,000 in the next two decades (
ok
PTSD can persist even longer. One study found symptoms among World War II prisoners of war—40 years after confinement. Only 30 percent of POWs who had suffered from PTSD were fully recovered; 10 percent either showed no recovery or had a deteriorating course (Kluznik, Speed, Van Valkenburg, & Magraw, 1986). Many victims of the Holocaust also show PTSD symptoms decades later. Still, even following exposure to the unbelievable horrors of the Holocaust, remarkable resilience is the most common outcome (Barel, Van IJzendoorn, Sagi-Schwartz, & Bakermans-Kranenburg, 2010).
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PTSD requires only four of the symptoms we have discussed, while a subtype is defined by the presence of dissociative symptoms, depersonalization, or derealization
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Research shows that memories, even of highly dramatic events, can be inaccurate
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Secondary victimization is a growing concern, as insensitive legal, medical, and even mental health professionals can add to a rape victim's emotional burden. In fact, victims of acquaintance rape show increased symptoms of PTSD when they encounter victim-blaming behaviors from professionals who are supposed to help them (Campbell, 2008). Such findings may help explain why as many as two-thirds of stranger rapes and four-fifths of acquaintance rapes are not reported to authorities.
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Some argue that DID is linked with past, not present, trauma, particularly with chronic physical or sexual child abuse (Gleaves, 1996). Many psychological scientists are skeptical about this assertion, however, because information about childhood trauma is based solely on clients' reports—reports that may be distorted by many factors, including a therapist's expectations
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Some cognitive scientists call the unconscious mind "dumb," not "smart" (Loftus & Klinger, 1992); that is, of limited importance.
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Some experts even doubt the very existence of DID, arguing that DID is created by the power of suggestion
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Some experts question whether derealization/depersonalization should be considered a dissociative disorder, because it involves only limited splitting between conscious and unconscious mental processes, and no memory loss occurs (Spiegel & Cardena, 1991). However, the few descriptive studies that have been completed, based on evaluations of specialty clinics, suggest that the problem is distressing, enduring, and notably impairs functioning
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The same twin study also strongly points to biological factors in PTSD. In an analysis of more than 4,000 twin pairs, MZ twins had a higher concordance rate for exposure to combat than dizygotic (DZ) twins. Following exposure, identical twins also had higher concordance rates for PTSD symptoms than fraternal twins (True et al., 1993). Importantly, genetic contributions differed across symptoms.
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There certainly are good reasons to question the validity of "recovered memories" from early in life, since few people can report any accurate memories before age three or four (Loftus, 2003, 2004). The fact that people are especially likely to remember emotionally intense events is another reason to think critically about claims of recovered memories. Some documented victims of sexual abuse do not recall the experience many years later (Williams, 1994), but most do remember what happened (Goodman et al., 2003). And, of course, documented cases of forgetting do not prove that undocumented cases of remembering are accurate. Are some claims of recovered memories more accurate than others? A recent study found that memories that returned outside of therapy were more likely to be corroborated than memories "recovered" in therapy (Geraerts et al., 2007). Sadly, some patients with recovered memories apparently are victims of their therapists, not of abuse.
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blast waves from exploding artillery shells may damage the brain, creating or exacerbating existing psychological problems (Shively & Perl, 2016). While still in its early stages, this potentially important finding harkens back to the World War I conceptualization of battle dropout as "shell shock." And it may offer a physical explanation for the erratic behavior of some combat veterans.
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dissociation pushes memory into unconscious mind
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small but vocal group of professionals has argued that many patients suffering from dissociative disorders are misdiagnosed as having schizophrenia, borderline personality disorder, depression, panic disorder, or substance abuse (Gleaves, 1996; Ross, 2009). One study claimed that over 10 percent of the general adult population suffers from a dissociative disorder—including 3 percent of adults with DID (Ross, 1991). The same author claimed that 40 percent of hospitalized psychiatric patients met earlier DSM criteria for the diagnosis of a dissociative disorder
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studies of the long-term consequences of child physical or sexual abuse find little evidence of dissociation or, indeed, of any consistent forms of psychopathology
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the malleability of memory suggests many reasons for skepticism.
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trauma causes ASD and PTSD. Because not every traumatized person develops a disorder, however, trauma is a necessary but not a sufficient cause.
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trauma exacerbates or reveals a pre-existing disorder. In most cases, ASD and PTSD develop as a result of a combination of factors, including trauma, personality characteristics that predate the trauma, exposure during the trauma, and emotional processing and social support afterwards (Ozer, Best, Lipsey, & Weiss, 2003; Ozer & Weiss, 2004). We note again, however, that resilience is the most common outcome following trauma exposure (
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unconscious mental processes play a role in both normal and abnormal emotion and cognition
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vhe regularly encouraged New Yorkers to grieve but also to go back to work, to go out, and to go on despite the horrors of the World Trade Center attacks. Such community-based efforts are more appealing, and apparently more effective, than artificial debriefings. Consider this: Government agencies allocated over $150 million to pay for psychotherapy for New Yorkers in the wake of September 11, but $90 million remained unspent two years later
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Extreme cases of dissociation include a split in the functioning of the individual's entire sense of self.
ok The extraordinary symptoms of dissociative disorders apparently involve mental processing outside of conscious awareness.
yes, fads develop for psychological diagnoses
ok We are diagnosing everything, turning normal quirks, disappointments, and stress into mental disorders. In his book, Saving Normal, Frances (2013) critiques many of DSM-5's specific changes. More broadly, he worries that the faddish rise in diagnosing mental disorders is stigmatizing far too many people, helping the pharmaceutical industry promote drugs for all kinds of normal life problems, and helping to break family and national budgets with health-care expenditures. Frances is intensely critical, sometimes over the top. DSM-5 is embracing science. The goal is to help more people, and help them better, by crafting clearer and more accurate diagnoses. But Frances also has a point. The diagnosis of mental disorders is exploding, and that is not always or necessarily a good thing—even though we can have a hard time seeing or admitting to problems when a fad is "hot."
Many people with PTSD also suffer from another mental disorder, particularly depression, anxiety disorders, or substance abuse (Brady, Back, & Coffey, 2004). Other comorbid problems include disturbing nightmares, physical symptoms like headaches and gastrointestinal problems, grief, and relationship difficulties (Cook, Riggs, Thompson, Coyne, & Sheikh, 2004). Anger—at others or at oneself—is another prominent issue (Orth & Wieland, 2006), which is why negative thoughts and emotions became a part of the new DSM-5 definition (Grant, Beck, Marques, Palyo, & Clapp, 2008). Increased risk of taking one's own life is also notable. One study found that 33 percent of rape survivors had thoughts of ending their own lives, and 13 percent actually attempted to take their own lives
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Because they engage in more risky behavior, men, young people, those with a history of conduct disorders, and extroverts all are more likely to experience trauma. People who are anxious or who have a family history of mental illness also experience more trauma, but the reasons why are less clear.
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DSM-5 includes an estimated prevalence of DID of 1.5 percent
okwhile offering the disclaimer that the number is based on a "small study"
what is post traumatic growth
positive changes resulting from trauma, is linked with less depression and greater well-being, but also with more intrusive and avoidant thoughts (Helgeson, Reynolds, & Tomich, 2006). Finding meaning in trauma does not mean forgetting about it.
Others propose elaborate models of unconscious mental processes—for example, that we have two systems of information processing. The ______ system uses abstract, logical knowledge to solve complex problems over time. The _____ system uses intuitive knowledge to respond to problems immediately without the delay of thought. The unconscious experiential system is hypothesized to be emotional, powerful, and often illogical (Epstein, 1994). Rationally, we might know that airplanes are safer than automobiles, for example, but emotionally, we are more likely to fear flying
rational system; experiential system
what is the most common human response to trauma
resilience
more on past memories
retrospective memories may be less flawed than some have suggested. The reviewers agreed that retrospective reports are often inaccurate. For example, only moderate correlations are found between children's and parents' reports about their past relationships, and, on average, children report more negative memories. At the same time, agreement between parents and children increases to an acceptable level for reports of specific, factual aspects of the past. Thus, memory for specific, important events in the family may be fairly reliable and valid, but people may "rewrite" their histories with regard to more global and subjective experiences. Brewin and colleagues (1993) also questioned the blanket assumption that psychopathology impairs memory. They found many flaws in research that supposedly demonstrated memory impairments for various psychological problems and concluded that, except for serious mental illness, there is no evidence for memory impairments associated with anxiety or depression. In particular, depressed people do not erroneously recall more than their share of negative events about the past. Brewin and colleagues (1993) urge that retrospective reports should not be dismissed out of hand. Psychologists have many reasons to prefer prospective, longitudinal research over retrospective methods, but longitudinal research is expensive. Retrospective reports of specific events may be sufficiently reliable and valid to justify using them as an initial, less-expensive research method.
people's reports of the past : concerns
retrospective reports—-current recollections of past experiences; for example, events that occurred during childhood. Problems with retrospective reports are one of several reasons why investigators prefer prospective, longitudinal studies over retrospective research designs. First, normal memory often is inaccurate, particularly memory for events that occurred long ago and early in life. Second, memories held by people with emotional problems may be particularly unreliable. Third, abnormal behavior may systematically bias memory; for example, memory processes may be "mood congruent." Depressed people may tend to remember sad experiences, anxious people may better recall fearful events, and so on.
nicholas spanos argued that multiple personalities are caused by
role playing. Influenced by their own and their therapists' expectations, Spanos (1994) argued that, like an actor who loses all perspective, patients come to believe that the role is real.
define traumatic stress
s defined in DSM-5 as an event that involves actual or threatened death, serious injury or sexual violence to self, witnessing others experience trauma, learning that loved ones have been traumatized, or repeatedly being exposed to details of trauma. Trauma includes rape, military combat, bombings, airplane crashes, earthquakes, major fires, and devastating automobile wrecks.
dissociative fugue
subtype of dissociative amnesia; sudden and unexpected travel, associated with amnesia about identity or other important information.
what is resilience
successful psychological coping
PTSD treatment: imagery rehearsal therapy
successfully reduces recurrent nightmares, a troubling problem frequently associated with PTSD. The exposure involves reliving nightmares while awake, but rewriting the nightmare script in any way the client wishes (Krakow et al., 2001). Across studies, approximately 50 percent of patients still meet diagnostic criteria after treatment with prolonged exposure (Resick, Monson, & Gutner, 2007), as do about 20 percent at 5- to 10-year follow-up (Resnick et al., 2013). Prolonged exposure is the most strongly supported treatment for PTSD (Foa et al., 2013), but perhaps treatment is the beginning, not the end, of the healing process. Meaning making, the ultimate goal, perhaps is too much to expect from any therapy
what is iatrogenesis
the creation of a disorder by an attempt to treat it; the manufacture of a disorder by its treatment. Merskey (1992) reviewed classic case studies of DID and concluded that many "cases" were created by the expectations of therapists. Merskey does not doubt the pain experienced by the patients in these cases. He argues, however, that the patients developed multiple personalities in response to their therapists' leading questions. Like Spanos (1994), Merskey argues that DID is a social role. Because of their susceptibility to suggestion, perhaps highly hypnotizable people are especially likely to suffer from iatrogenic effects
implicit association test
the implicit association test reveals implicit memories by comparing response times to different cues. Comparing response times linking "black" to "good" versus "white" to "good" would be an example that might reveal implicit racial bias. Quicker responses reflect established associations in memory. We respond automatically and quickly to associations that implicitly "make sense." Evidence shows that implicit attitudes about delicate subjects like racial prejudice differ considerably from explicitly reported beliefs
dissociative amnesia
the partial or complete loss of recall for particular events or for a particular period of time. Brain injury or disease can cause amnesia, but dissociative amnesia results from trauma or severe emotional distress. Dissociative amnesia may occur alone or in conjunction with other dissociative experiences. For example, in dissociative identity disorder one personality may report that it does not remember the actions, or even the existence, of another (Spiegel & Cardena, 1991). Recent laboratory evidence calls self-reports of amnesia into question, however, as DID patients show transfer of memories between identities on experimental tasks
Dissociative amnesia is widely viewed as being caused by ___, as is the dissociative fugue that sometime accompanies it.
trauma The trauma, usually, is clear and sudden. After a time, psychological functioning rapidly returns to normal, in most cases.
Dissociative amnesia and fugue, typically, have a sudden onset following ___ or ____ and an equally sudden recovery of memory.
trauma or extreme stress
least controversial and most studied problem,_____
traumatic stress disorders.
true or false: Some psychologists view the unconscious mind as all-powerful. Others doubt its existence.
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dissociative identity disorder
two or more personalities coexist within a single individual. Unless we assume that the symptom is feigned, dissociative identity disorder demonstrates that the mind can function on multiple levels of consciousness.
implicit memory
unconscious and evident only because past experience can change behavior
information processing outside of conscious awareness.
unconscious mental processes
most treatments of dissociative disorders have focused on __________. Presumably, the need for dissociation disappears if the trauma can be expressed and accepted (Horevitz & Loewenstein, 1994). Many clinicians use hypnosis to help patients explore and relive traumatic events. However, no research supports the effectiveness of either abreaction—the emotional reliving of a past traumatic experiences—or hypnosis as a treatment for dissociative disorders (Horevitz & Loewenstein, 1994).
uncovering and recounting traumatic memories
(women or men) ____ are more likely than ____ to develop PTSD following trauma (Tolin & Foa, 2006). Sexual violence is a particular risk for women, while combat exposure is for men. Children are especially vulnerable to trauma, with 20 to 40 percent developing PTSD. Minority group members are more likely to experience PTSD, in large part because of their more difficult living conditions (Pole, Gone, & Kulkarni, 2008). PTSD also is common among crime victims
women more likely than men.
Many people report that, in the long run, trauma actually leads to growth
wtf! OK!
Victims of trauma are more likely to develop PTSD when the trauma is more intense, life threatening, and involves greater exposure
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ptsd: dissociative amnesia
—they are unable to remember aspects of the trauma events (
