Stress and Trauma disorders

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Questions and Answers

Which is a characteristic symptom of Complex PTSD (CPTSD)?

Withdrawal from social activities (correct)

Symptoms solely due to accidents

Delayed Expression

Exaggerated startle response

What is a common misconception about the relation between dissociative symptoms and stress disorders?

They are solely linked to traumatic events.

They are indicative of greater impairment.

They should not include emotional detachment.

They only occur in combat veterans. (correct)

Which condition is specifically characterized by symptoms lasting longer than one month?

Survival guilt

Post-traumatic stress disorder (PTSD) (correct)

Dissociative disorder

Acute stress disorder

What is a primary condition that can lead to Acute and Post-Traumatic Stress Disorders?

Exposure to actual or threatened death, serious injury, or sexual violence Signup and view all the answers

Which of the following experiences is NOT a recognized method of trauma exposure leading to PTSD?

Learning about a trauma through social media Signup and view all the answers

Which group is at risk from inappropriate sexual experiences mentioned in the context of trauma exposure?

Children, regardless of the presence of violence Signup and view all the answers

What type of exposure is considered extreme and can lead to trauma, specifically illustrated by first responders?

Experiencing repeated exposure to aversive details of the traumatic events Signup and view all the answers

In what circumstance must the traumatic event involve a family member or close friend for it to contribute to PTSD?

If the event was violent or accidental in nature Signup and view all the answers

What emotional response does the individual report experiencing while performing his duties as a security guard?

He experiences boredom and excessive time for reflection. Signup and view all the answers

How does the individual cope with intrusive memories related to his traumatic experiences?

He avoids socializing with friends from his Reserve unit. Signup and view all the answers

What is the primary source of stress for flight attendant Doreen Welsh during flights?

Memories of a near-drowning experience during the crash. Signup and view all the answers

What physiological reaction does the flight attendant describe in response to stress?

Experiencing an adrenaline rush and heart palpitations. Signup and view all the answers

Which of the following best describes the nature of the memories the security guard experiences?

They are intrusive and occur daily without details being shared. Signup and view all the answers

Which factor has been shown to increase the risk of developing PTSD?

Family history of PTSD Signup and view all the answers

Which of the following best describes Complex PTSD (CPTSD)?

A special case of PTSD due to repeated trauma Signup and view all the answers

Which of the following factors is NOT considered a risk for developing trauma and stress-related disorders?

Robust coping mechanisms Signup and view all the answers

Which of the following is NOT a hallmark symptom associated with chronic hyperarousal in trauma-related disorders?

Increased energy levels Signup and view all the answers

Which of the following conditions is characterized by symptoms lasting more than one month as a result of traumatic events?

Post-traumatic stress disorder Signup and view all the answers

Which symptom is indicative of dissociative symptoms in stress disorders?

Emotional detachment Signup and view all the answers

Which of the following scenarios is associated with an increased risk of developing Acute and Post-Traumatic Stress Disorders?

Learning about the violent death of a close friend Signup and view all the answers

What is a possible way an individual could be exposed to traumatic details that may lead to stress disorders?

Experiencing repeated exposure to details as a first responder Signup and view all the answers

Which of the following best describes the nature of inappropriate sexual experiences as a form of trauma in children?

Can occur without any violent behavior Signup and view all the answers

What type of exposure is recognized as directly increasing the risk of PTSD in individuals?

Witnessing traumatic events first-hand Signup and view all the answers

Which requirement must be met for a traumatic event involving a family member to potentially lead to PTSD?

The event must have involved a violent or accidental death Signup and view all the answers

What is a significant difference between Complex PTSD (CPTSD) and traditional PTSD?

CPTSD includes changes in personal worldview and relationships. Signup and view all the answers

Which therapeutic approach relies on the visualization of trauma-related cues to address fear responses?

Exposure therapy Signup and view all the answers

In the context of trauma therapy, what does 'sublimation' refer to?

Finding personal meaning in a tragic event. Signup and view all the answers

What phase of Critical Incident Stress Debriefing involves soliciting symptomatology and suggesting coping strategies?

Symptom phase Signup and view all the answers

What is a primary criticism of therapies such as EMDR and Polyvagal therapy?

They are based on questionable neurological models. Signup and view all the answers

What emotional response does the security guard report while performing his duties?

Boredom and time to think excessively Signup and view all the answers

What is a key behavior that the security guard exhibits in relation to his traumatic experiences?

He avoids reminders of his past experiences. Signup and view all the answers

What physical reaction does flight attendant Doreen Welsh specifically mention experiencing during stressful flights?

An adrenaline rush making her heart skip a beat Signup and view all the answers

What aspect of the experiences reported by the flight attendant contributes significantly to her stress during flights?

Visions of potential catastrophic outcomes Signup and view all the answers

What type of memory does the security guard experience daily related to his traumatic past?

Intrusive memories without wanting to share details Signup and view all the answers

What primary emotional state does the 10-year-old girl exhibit following the traumatic earthquake experience?

Sadness and fear Signup and view all the answers

Which symptom is NOT reported by the 27-year-old infantryman related to his post-traumatic stress?

Emotional numbness Signup and view all the answers

Following her traumatic experience, how did the 10-year-old girl’s temperament compare to her pre-morbid state?

She became less interactive and withdrawn Signup and view all the answers

What aspect of the infantryman's behavior reveals his struggle with social interaction following his tours?

He often spends time alone to avoid snapping at people Signup and view all the answers

What is a significant symptom exhibited by the girl that suggests the development of acute stress disorder?

Disturbing dreams and hypervigilance Signup and view all the answers

Which form of exposure to traumatic events does NOT relate specifically to direct personal experience?

Having a violent nightmare related to the event Signup and view all the answers

What type of exposure can lead to PTSD when it involves learning of a traumatic event affecting someone close?

Learning about the event's violent or accidental nature Signup and view all the answers

Which of the following scenarios involves a repeated form of exposure that may cause trauma?

Witnessing the aftermath of an accident repeatedly as a first responder Signup and view all the answers

Which of the following methods of exposure is NOT included in the criteria for PTSD?

Watching a documentary about traumatic events Signup and view all the answers

In what situation does exposure to a traumatic event lead to the potential for PTSD?

Experiencing the death of a family member through violent means Signup and view all the answers

Which system helps return your heart rate back to normal?

parasympathetic NS Signup and view all the answers

What does the sympathetic nervous system release in response to a stressor?

Adrenaline (epinephrine) and norepinephrine Signup and view all the answers

What does the HPA pathway release in response to a stressor?

ACTH then Cortisol Signup and view all the answers

What is the structure and function of the autonomic nervous system (ANS)?

A bundle of nerve fibers that connects your CNS to all other organs in the body, it regulates involuntary bodily functions such as heart rate and digestion Signup and view all the answers

Which areas of the brain are affected by PTSD?

All of the above Signup and view all the answers

What is the result of the dysfunction between the amygdala, prefrontal cortex, and hippocampus associated with PTSD?

Difficulty in emotional regulation Signup and view all the answers

Derealization is _, while depersonalization is _.

The feeling of disconnect from surroundings; the feeling of disconnect from self Signup and view all the answers

Which group has the highest risk for sexual assault?

non-college women aged 18-24 Signup and view all the answers

What kind of symptoms would be more common in non-westernized cultures for PTSD?

Somatic (physical) symptoms like dizziness or pain Signup and view all the answers

Which of the following avoidant lifestyle factors can hamper PTSD recovery? (Select all that apply)

all of the above Signup and view all the answers

Study Notes

Introduction to Psychopathology

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Exposure to actual or threatened death, serious injury, or sexual violence (including inappropriate experiences in children) can cause disorders.
Exposure can be direct, witnessing, learning about it affecting a close family member, or extreme/repeated exposure to details.
Trauma exposure through electronic media (TV, movies, etc.) does not fall under this category unless work-related.

Reactions to Extreme Trauma

Intrusive recollections (flashbacks, nightmares, illusions).
Acute distress with trauma cues.
Dissociative symptoms (psychic numbing): presence in stress disorders indicates greater impairment.
Emotional detachment, "daze".
Avoiding trauma-related topics.
Intrusive recollections.
Avoidance of trauma-related topics.
Forgetfulness or "fogginess" related to trauma (often seen in combat veterans).
Time distortion during trauma.
Feeling detached from body (depersonalization).
Feeling the environment is "dreamlike" (derealization).
Chronic hyperarousal (exaggerated startle, insomnia, hypervigilance, and motor restlessness).
Irritability, unprovoked anger outbursts, and aggression (particularly in males).
Feelings of guilt or shame related to survival experiences.
Impulsive or reckless behaviors related to survival guilt or shame.

Acute stress disorder (ASD): Disability lasting 2 days to 1 month, can occur even without interpersonal trauma. Extreme anxiety interfering with daily life is a symptom (sleep problems, energy levels, concentration, withdrawal, etc.).
Post-traumatic stress disorder (PTSD): Disability lasting a month or longer after the trauma. Prevalences depend on the type and severity of trauma and pre-existing risk factors.
Complex PTSD (CPTSD): Prolonged exposure to trauma. Not formally part of DSM-5-TR but identified as a concern.
Delayed expression of PTSD: Symptoms not prominent in acute phase, show gradual increase over months. Can develop into PTSD.

Case Studies

Case studies of acute stress disorder and post-traumatic stress disorder are presented, including specifics about individuals' experiences and reactions.

Acute and Post-Traumatic Stress Disorders (Specific Examples)

U.S. Airways Flight 1549: Case study of acute and post traumatic responses regarding a forced water landing. Case study of a passenger. Case studies of crew members.

9/11/2001

Historical event and example of potential trauma response.

Post-Traumatic Stress Disorder

Prevalence: Lifetime prevalence is ~7% worldwide, among adolescents it is 5-8%. Female-to-male ratio is 2:1.
Symptom onset: ~90% of ASD sufferers develop PTSD within 3 months; among those without diagnosable ASD, 10% show delayed symptom expression.
Gender differences: Males may display irritability and alcohol abuse. Females may experience more avoidance and anxiety.
Developmental impacts: Children can show regression in language and toileting skills, increased aggression, social isolation, and distressing dreams.
Complicating factors: Existing diagnoses of people with PTSD may be hampered by the development of avoidant lifestyles or anxiety disorders, in addition to alcohol or drug use. Somatic symptoms (e.g., dizziness, short of breath, heat sensations) may be more common in non-Western cultures.

Sexual violence: Includes attempted or completed rape and sexual assault, with significant gender disparities in prevalence.
Military combat: High rates of PTSD amongst veterans, including combat veterans and POWs.
Physical/emotional abuse: Includes childhood sexual/physical abuse, domestic violence, and workplace abuse.
Human calamities: Deliberate violence, such as bombings, torture, and terrorism; accidental events, such as accidents, fires, and natural disasters.
Other: Physical trauma (surgery, illness, disfigurement) and climate-related disasters are also listed as types of stressor-related problems.

Trauma severity and duration.
Family history of depression or anxiety.
Family history of PTSD.
Racial/ethnic minority status potentially due to discrimination, adversity, and limited access to quality treatment or social support.
Poor coping habits (e.g., smoking, drinking).
Intergenerational trauma: cultures with horrific histories have learned to not trust others or the external world.
Poor social support, particularly in combat veterans and victims of other serious trauma.

Complex PTSD (CPTSD)

Special case of PTSD resulting from repeated or continuous trauma over months or years.
Symptoms are more extreme and persistent than in "simple" PTSD.

Psychotherapy for PTSD

1st-line treatment is exposure therapy (visualization of trauma).
Cognitive-behavioral therapy (CBT), including Cognitive Processing Therapy (CPT).
EMDR (Eye movement desensitization and reprocessing) - neurologically dubious; generic supportive therapy is a better choice.
Polyvagal therapy.
Group therapy/support groups.
Stress management training.
Finding meaning to help with reworking relationships with abusers.

Group Management for Acute Stress: Critical Incident Stress Debriefing

Steps in debriefing sessions.

Medication Treatment of ASD and PTSD

Medications for anxiety, panic attacks, depression, sleep disorders, and other symptoms; includes anxiolytics, antidepressants, antipsychotics, and sleep medications.
Special mention for antihypertensive drug prazosin (Minipress) for anxiety, flashbacks, nightmares.
Experimental post-stressor propanolol (Inderal) as a problematic memory-dulling medication.
Psychedelic administration as a topic of potential research but needs further study to determine effectiveness.

Mental Health Law and Regulations

Laws regarding confidentiality, including duty to warn, protect, and reporting child/elder abuse.
Laws on involuntary commitment (5150/5250 holds).
Laws on conservatorships.
Laws on assisted outpatient treatment (AOT)
California's Lanterman, Petris, and Short (LPS) Act

Additional Considerations and Concerns

Crisis of placement: mental illness individuals more likely involved with police than medical help due to behaviors resulting in unnecessary jailing.
Chilling reports/case studies presented to illustrate consequences of trauma and/or stressor-related disorders.

Other

Legal aspects.
Case studies.
Statistics.

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Test your knowledge on traumatic and stressor-related disorders in psychopathology. This quiz covers key concepts and definitions that are crucial for understanding mental health issues.