PSY110P-Chapter-5b-Trauma-and-Stressor-Related-Disorder.pptx

Trauma and StressorRelated Disorder Trauma and StressorRelated Disorders  Attachment disorders  Posttraumatic stress disorder Traumatic Events Natural Disasters Traumatic Events Abuse Traumatic Events Combat -/ War-related traumas Traumatic Events Common Traumatic Events Post Trauma...

Trauma and StressorRelated Disorder Trauma and StressorRelated Disorders  Attachment disorders  Posttraumatic stress disorder Traumatic Events Natural Disasters Traumatic Events Abuse Traumatic Events Combat -/ War-related traumas Traumatic Events Common Traumatic Events Post Traumatic Stress Disorder  Clinical description › Trauma exposure › Extreme fear, helplessness, or horror › Continued re-experiencing  (e.g., memories, nightmares, flashbacks) › Avoidance › Emotional numbing › Reckless or self-destructive behavior › Interpersonal problems › Dysfunction › One month 1. Intrusively reexperiencing the traumatic event. The person may have repetitive memories or nightmares of the event.  Ex. helicopter sounds that remind a veteran of the battlefield; darkness that reminds a woman of a rape 2. Avoidance of stimuli associated with the event. Some may try to avoid all reminders of the event.  For example, a Turkish earthquake survivor stopped sleeping indoors after he was buried alive at night.   3. Other signs of mood and cognitive change after the trauma. These can include inability to remember important aspects of the event, persistently negative cognition, blaming self or others for the event, pervasive negative emotions, lack of interest or involvement in significant activities, feeling detached from others, or inability to experience positive emotions. 4. Symptoms of increased arousal and reactivity. These symptoms include irritable or aggressive behavior, reckless or self-destructive behavior, difficulty falling asleep or staying asleep, difficulty concentrating, hypervigilance, and an exaggerated startle response. Specifiers  With delayed expression: If the diagnostic threshold is not exceeded until at least 6 months after the event (although it is understood that onset and expression of some symptoms may be immediate).  With Dissociative Symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of depersonalization or derealization.  Statistics › 6.8% (life); 3.5% (year) › Prevalence varies  Type of trauma  Proximity  Most common traumas › Sexual assault 2.4 to 3.5 increase › Accidents › Combat Etiology of PTSD Social Factors  Psychological Factors  Biological Factors  Social Factors The nature of a traumatic event plays an important role in determining people's likelihood of developing PTSD in response to the event. The response of family members and friends to a trauma survivor is a critical influence on the survivor's vulnerability to PTSD.  Severity, duration, and proximity of trauma  Social Support Severity, duration, and proximity of trauma  People who experience more severe and long-lasting traumas and are directly affected by traumatic event are more prone to develop PTSD if they were on the front lines of the war for an extended period of time or if they were taken prisoner of war than if they were not. War veterans who were on the front lines for months at a time more prone to PTSD. Social Support  People who have others who will support them emotionally through recovery from their traumas, allowing them to discuss their feelings and memories of the trauma, recover more quickly than those who do not. Women whose husbands commit suicide are less prone to PTSD if they can discuss it with friends. Psychological Factors People facing the same circumstance around a trauma vary greatly in their risk for PTSD. At least three psychological factors have been identified to explain differences between people in response to trauma.  Shattered Assumptions  Pre-existing Distress  Coping styles Shattered Assumptions Personal Invulnerability  The world is meaningful and just and that things happen for a good reason  People who are good, who “play by the rules,” do not experience bad things.  Personal Invulnerability  Most people believe that bad things happen to other people and that they are relatively invulnerable to trauma. When trauma happens, people lose their illusion of invulnerability. It makes them chronically feeling vulnerable, hypervigilant, and shows signs of chronic anxiety. The world is meaningful and just and that things happen for a good reason  This assumption can be shattered by events that seem senseless, unjust, or perhaps evil, such as terrorist bombing of a day care center. People who are good, who “play by the rules,” do not experience bad things.  Trauma victims often say that they have lived a good life, have been good people, and thus can't understand how trauma happened to them. Preexisting Distress  People who are already experiencing increased symptoms of anxiety or depression are more likely to develop PTSD than those who were not anxious or depressed. Coping styles  The style of coping with stressful events and with their own symptoms of distress may also influence their vulnerability to PTSD.  Self Destructive/ Avoidant coping strategies  Dissociation  Making Sense Self Destructive/ Avoidant coping strategies  People who engage in drinking or self isolation as coping styles are more likely to experience PTSD. Dissociation  People who dissociate following a trauma may feel they are in another place or in someone else's body, watching the trauma and its aftermath unfold. People who dissociate shortly after a trauma are at increased risk to develop PTSD. Making Sense  Psychodynamic and Existential Theorist argued that searching for meaning in trauma is a healthy process, which can lead people to gain a sense of mastery over their traumas and to integrate their traumas into their understanding of themselves. People make sense through their religious or philosophical beliefs. Biological Factors Physiological hyperreactivity Genetics Physiological hyperreactivity      The difference occurs in activity levels in the parts of the brain involved in the regulation of emotion and the fight or flight response. Amygdala Hippocampus Cortisol Exaggerated Physiological Response to Stress Amygdala  The amygdala appears to be hyperreactive to trauma related stimuli in PTSD sufferers. Increased blood flow in this area can be seen while imagining traumatic experience. Hippocampus   Shrinkage in the hippocampus among PTSD patients was shown in some studies. The hippocampus is involved in the memory. Damage to it may result in some of the memory problems that PTSD patients report. Hippocampus plays a role in the extinction of responses, so damage could interfere with an individual's ability to overcome fearful response reminiscent of the trauma. Cortisol   Hyperactivity of HPA Axis Resting levels of cortisol among PTSD sufferers tend to be lower than among people without PTSD. Cortisol shuts down sympathetic nervous system activity after stress, so the lower the levels of cortisol may prolong the activity of the sympathetic nervous system following stress. As a result, they may easily develop a conditioned fear of stimuli associated with trauma and subsequently develop PTSD. Genetics  One study of about 4000 twins who had served in the Vietnam War found that, if one twin developed PTSD, the other twin was more likely to develop PTSD if he was an identical twin than if he was a fraternal twin. Treatment for PTSD 1. Medication – SSRI  2. Psychotherapy  › Imaginal exposure - is used—the person deliberately remembers the event. › Virtual reality (VR) - this technology can provide more vivid exposure than some clients may be able to generate in their imaginations. Acute Stress Disorder  Acute Stress Disorder is characterized by the development of severe anxiety, dissociative, and other symptoms that occurs within one month after exposure to an extreme traumatic stressor Note: The disturbance is from 2 days to one month Acute Stress Disorder Dissociative symptoms are prominent      A subjective sense of numbing, detachment, or absence of emotional responsiveness A reduction in awareness of his or her surroundings (e.g., "being in a daze") Derealization Depersonalization Dissociative amnesia (i.e., inability to recall an important aspect of the trauma) Acute Stress Disorder Shares the symptoms experienced by PTSD sufferers.  Reexperiencing traumatic event  Emotional numbness and detachment  Constantly aroused Adjustment Disorder  Adjustment Disorder is an abnormal and excessive reaction to an identifiable life stressor. The reaction is more severe than would normally be expected, and can result in significant impairment in social, occupational or academic functioning. Note: The disorder is time-limited, usually beginning within 3 months of the stressful event, and symptoms lessen within 6 months upon removal of the stressor or when new adaptation occurs. AD sufferers reaction to stress A. Depressed Mood – tearfulness, or feelings of hopelessness B. Anxiety – nervousness, worry or jitteriness C. Mixed anxiety and depressed mood – combination of A and B D. Disturbance of conduct – violates rights of others or of major age appropriate societal norms and rules E. Mixed disturbance of emotion and conduct – combination of A, B, and D. F. Unspecified – maladaptive reactions New DSM 5 Trauma/Stress Related Disorder Reactive Attachment Disorder  Disinhibited Social Engagement Disorder  Reactive attachment disorder  Reactive attachment disorder of infancy or early childhood is characterized by a pattern of markedly disturbed and developmentally inappropriate attachment behaviors, in which a child rarely or minimally turns preferentially to an attachment figure for comfort, support, protection, and nurturance. Clinical Description (RAD)      Inhibited, emotionally withdrawn behavior toward adult caregivers Social and emotional disturbance Experienced a pattern of extremes of insufficient care Disturbance is evident before age 5 years Child has a developmental age of at least 9 months › Specify if: Persistent: The disorder has been present for more than 12 months › Specify current severity: Reactive attachment disorder is specified as severe when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels. Disinhibited Social Engagement Disorder    The child actively approaches and interacts with unfamiliar adults The child has experienced a pattern of extremes of insufficient care The child is at least 9 months. › Specify if: Persistent: The disorder has been present for more than 12 months. › Specify current severity: Disinhibited social engagement disorder is specified as severe when the child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.