Stress and Trauma Disorders

• Disorders of Stress and Trauma: Focuses on disorders arising from significant stress or trauma, including symptoms, diagnostic criteria, causes, and treatments.
• Importance is placed on understanding the body’s response and how individuals are affected by traumatic experiences.

Key Terms and Important Points

• Stress Reaction: The body's physiological and psychological response to a stressor.
• Hypothalamic-Pituitary-Adrenal (HPA) Axis: The body's central stress response system.
• Pathway: The hypothalamus releases corticotropin-releasing hormone (CRH), which stimulates the pituitary gland to release adrenocorticotropic hormone (ACTH); ACTH stimulates the adrenal glands to release cortisol.
• Organs involved: Hypothalamus, Pituitary gland, and Adrenal glands.
• Neurotransmitters/Hormones: CRH, ACTH, and Cortisol.
• Posttraumatic Stress Disorder (PTSD): A disorder that develops after exposure to a traumatic event.

Symptoms

• Major Stress: Exposure to actual or threatened death, serious injury, or sexual violence.
• Trauma Definition (DSM-5): Direct exposure, witnessing an event, learning about an event happening to a close contact, or repeated exposure to aversive details.
• Re-experiencing: Intrusive thoughts, nightmares, and flashbacks.
• Flashback: Feeling or acting as if the traumatic event is recurring.
• Avoidance: Efforts to avoid thoughts, feelings, or reminders of the trauma.
• Negative Alterations in Cognition and Mood: Persistent negative beliefs about oneself, distorted blame, negative emotions, and feeling detached.
• Marked Alterations in Arousal and Reactivity: Irritability, exaggerated startle response, hypervigilance, difficulty concentrating, and sleep disturbance.
• Hypervigilance: Enhanced sensory sensitivity to detect threats.
• Acute Stress Disorder: Similar to PTSD, but symptoms last shorter (3 days to 1 month).
• Main difference from PTSD: Duration of symptoms; Acute Stress Disorder is shorter (less than a month), while PTSD is longer (more than a month).
• Adjustment Disorder: Emotional or behavioral symptoms in response to a stressor, occurring within 3 months of the stressor onset.
• Major Symptoms: Marked distress that is disproportionate to the stressor; significant impairment in social, occupational, or other important areas.
• Major Difference from PTSD and Acute Stress Disorder: The stressor is not necessarily life-threatening.
• Etiology: The origins or causes of a disorder.
• Diathesis-Stress Model: Predisposition to a mental disorder that remains unexpressed until triggered by stress.
• Trauma: Includes combat, disaster, and victimization.
• Vulnerability (Distal Factors): Factors increasing the likelihood of developing a disorder.
• Biological Factor: Smaller hippocampus size.
• Personality Factor: Inflexible coping style.
• Childhood Experience: Childhood sexual abuse.
• Social Support System: Lack or weak social support.

Treatment

• Anti-depressant Medications: Used to manage PTSD symptoms and related disorders.
• Eye Movement Desensitization and Reprocessing (EMDR): Psychotherapy technique to treat PTSD.

Dissociative Disorders

• Disorders are characterized by disruptions in consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior.
• These disorders often arise as a defense mechanism against severe trauma.

Key terms and important points:

• Dissociative Amnesia: Inability to recall important autobiographical information, usually due to a traumatic or stressful nature.

Types of Memory Loss:

• Localized amnesia: Loss of memory for a specific period of time.
• Selective amnesia: Loss of memory for some events during a period, but not all.
• Generalized amnesia: Complete loss of memory for one's life history.
• Continuous amnesia: Inability to form new memories.
• Systematized amnesia: Loss of memory for a specific category of information.
• Dissociative Identity Disorder (DID): Characterized by the presence of two or more distinct personality states or identities.
• Major Symptoms: Disruption of identity characterized by two or more personality states, which may include experiences of possession.
• Iatrogenic: Relating to illness caused by medical examination or treatment.
• Derealization/Depersonalization Disorder: Characterized by persistent or recurrent experiences of derealization and/or depersonalization.

Major Symptoms:

• Derealization: Experiences of unreality or detachment with respect to surroundings.
• Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions.

Mood Disorders

• This section covers disorders characterized by disturbances in mood, including depressive disorders and bipolar disorders.

Key Terms and Important Points

• Major Depressive Disorder (MDD): Characterized by persistent feelings of sadness, loss of interest or pleasure, and other cognitive, behavioral, and physical symptoms.

Symptoms of Major Depressive Episode:

• Depressed mood, loss of interest/pleasure (anhedonia), weight loss/gain, insomnia/hypersomnia, psychomotor agitation/retardation, fatigue/loss of energy, feelings of worthlessness/guilt, difficulty concentrating, recurrent thoughts of death/suicide.

Differences Between MDD and Bereavement (Grief)

• MDD: Persistent depressed mood and anhedonia are more prominent.
• Grief: Predominant affect is feelings of emptiness and loss; depressed mood decreases in intensity over days/weeks and is associated with thoughts/reminders of the deceased.
• Self-Esteem: MDD involves self-critical or pessimistic rumination; in grief, self-esteem is usually preserved.
• Suicidal Ideation: In MDD, suicidal thoughts relate to ending one's life due to worthlessness; in grief, suicidal thoughts may relate to joining the deceased.
• Premenstrual Dysphoric Disorder (PMDD): A severe form of premenstrual syndrome (PMS) that includes significant mood symptoms.

Key major symptoms:

• Marked affective lability (e.g., mood swings, increased sensitivity to rejection); marked irritability/anger or interpersonal conflicts; depressed mood; anxiety/tension.
• Persistent Depressive Disorder (Dysthymic Disorder): A chronic form of depression with less severe symptoms than MDD.

Key Major Symptoms:

• Depressed mood most of the day, more days than not, for at least two years.
• Presence of two or more of the following poor appetite/overeating, insomnia/hypersomnia, low energy/fatigue, low self-esteem, poor concentration/difficulty making decisions, and feelings of hopelessness.
• Difference from MDD: PDD has a longer duration and less severe symptoms than MDD; MDD involves discrete episodes, while PDD is more chronic.

Etiology:

• Biological Model: Focuses on genetic and neurochemical factors; basic finding is serotonin dysfunction.
• Psychodynamic Model: Focuses on early childhood experiences and unconscious conflicts.
• Anaclitic Depression: Relates to feelings of abandonment and dependence.
• Introjective Depression: Relates to feelings of guilt and self-criticism.
• Behavioral Model: Focuses on the role of reinforcement and punishment in development.
• Cognitive Model: Focuses on negative thoughts and beliefs in development.
• Cognitive Triad: Negative views of the self, the world, and the future.
• Learned Helplessness: Belief that one has no control over aversive events.
• Attribution-Helplessness Model: Emphasizes the role of attributions (explanations) for negative events.
• Internal Attribution: Blaming oneself for negative events.
• Stable Attribution: Belief that negative events will continue to occur in the future.
• Global Attribution: Belief that negative events will affect many areas of one's life.
• Diathesis-Stress Model (Page 3).

Cognitive Vulnerability

• Rumination: Repetitive and passive focus on negative emotions and their causes.
• Irrational Thought: Illogical or unrealistic thinking patterns.
• Automatic Thought: Spontaneous, unintentional thoughts that can be negative and self-defeating.

Multicultural Model (Page 3)

• Gender Difference: Social and economic disparities occur between men and women; women tend to ruminate on negative emotions more than men.

Treatment (Page 3)

Medications

• Monoamine Oxidase Inhibitors (MAOIs): Inhibit monoamine oxidase, which breaks down neurotransmitters like serotonin, norepinephrine, and dopamine.
• Tricyclic Antidepressants (TCAs): Block the reuptake of serotonin and norepinephrine.
• Selective Serotonin Reuptake Inhibitors (SSRIs): Selectively block serotonin reuptake.
• Ketamine: An anesthetic with antidepressant effects.

Psychotherapy:

• Cognitive Behavioral Therapy (CBT)
• Interpersonal Therapy (IPT)

Bipolar Disorders

• Disorders characterized by fluctuations in mood, including periods of mania/hypomania and periods of depression.

Key Terms and Important Points

• Episode in the Diagnosis of Mood Disorders (Page 3)
• Major Depressive Episode: As described in the MDD section.
• Manic Episode: An abnormally and persistently elevated, expansive, or irritable mood and increased activity/energy, lasting at least one week.

Major Symptoms:

• Inflated self-esteem or grandiosity, decreased need for sleep, more talkative, flight of ideas, distractibility, goal-directed activity/psychomotor agitation, and excessive involvement in activities with high painful consequences.
• Hypomanic Episode: Similar to a manic episode, but less severe and shorter in duration (lasting at least four consecutive days).

Major Symptoms:

• Similar to manic episode, but less severe.

Differences from Manic Episode:

• Hypomania does not cause marked impairment in social/occupational functioning, require hospitalization, or involve psychotic features.
• Bipolar I Disorder: Characterized by at least one manic episode (Page 3).

Criteria:

• At least one manic episode; major depressive episodes are common but not required.
• Difference from Bipolar II: Bipolar I involves full-blown manic episodes, while Bipolar II involves hypomanic episodes.
• Bipolar II Disorder: Characterized by at least one hypomanic episode and at least one major depressive episode (Page 3).

Criteria:

• At least one hypomanic episode and at least one major depressive episode; there has never been a manic episode.
• Difference from Bipolar I: Bipolar II involves hypomanic episodes, while Bipolar I involves full-blown manic episodes.
• Cyclothymic Disorder: Chronic, fluctuating mood disturbance involving numerous periods of hypomanic/depressive symptoms that do not meet the full criteria for major episodes.
• Key Symptoms: Numerous periods with hypomanic/depressive symptoms that do not meet the full criteria, lasting at least two years (one year in children and adolescents).

Treatment of Bipolar Disorders (Page 3)

• Biological
• Lithium: A mood stabilizer.
• Mood Stabilizers: Include valproate, lamotrigine, and carbamazepine.

Specifiers

• Additional features that can be added to a diagnosis to provide more information about the nature of the disorder.

Key Terms and Important Points

• Specifiers: Additional features added to specify more nature of a disorder (Page 4).
• Melancholic Features: A specifier for depressive disorders characterized by a loss of pleasure in all or almost all activities. other features include but not limited to lack of reaction, distinct depressed mood, worsened mornings, unusual anorexia or significant weight loss, and excessive/inappropriate guilt
• Seasonal Pattern: Regular seasonal mood episodes specifier for depression and bipolar disorders
• Rapid Cycling: Specifier for bipolar disorders characterized by four or more mood episodes (manic, hypomanic, or major depressive) in a 12-month period.
• Therapy for Major Depressive Disorder with Seasonal Pattern: Light therapy (Page 4).