PTSD AND OCD.pdf

ABNORMAL PSYCHOLOGY Prepared by: Camille Faye J. Elcano-de la Paz, RPm, MA(Cand) TRAUMA AND STRESSOR- RELATED DISORDERS AND OBSESSIVE COMPULSIVE DISORDERS Prepared by: Camille Faye J. Elcano-de la Paz, RPm,...

ABNORMAL PSYCHOLOGY Prepared by: Camille Faye J. Elcano-de la Paz, RPm, MA(Cand) TRAUMA AND STRESSOR- RELATED DISORDERS AND OBSESSIVE COMPULSIVE DISORDERS Prepared by: Camille Faye J. Elcano-de la Paz, RPm, MA(Cand) STRESS-RELATED DISORDERS The DSM-5TR combines various disorders that arise following a particularly stressful life event, typically an extremely stressful or traumatic experience. POSTTRAUMATIC STRESS DISORDER (PTSD) Traumatic Event Exposure PTSD typically arises from exposure to a traumatic event where an individual experiences or witnesses death, serious injury, or sexual violation. POSTTRAUMATIC STRESS DISORDER (PTSD) Setting Events Besides direct exposure, learning about a traumatic event happening to a loved one or repeatedly encountering traumatic details (e.g., first responders dealing with human remains) can also trigger PTSD. POSTTRAUMATIC STRESS DISORDER (PTSD) Reexperiencing Symptoms Victims often relive the traumatic event through memories and nightmares. Flashbacks occur when memories suddenly resurface with intense emotions, making victims feel as if they are reliving the event. 01. POSTTRAUMATIC DISORDER 01. INTRUSIVE MEMORIES AND FLASHBACKS Experiencing distressing memories, nightmares, and flashbacks of a traumatic event. FLASHBACK, NOT JUST MEMORIES 02. AVOIDANCE SYMPTOMS They may avoid reminders of the traumatic event, including places, people, activities, or situations that bring back memories of the trauma. They may also avoid talking about the event. 03. HYPERAROUSAL AND REACTIVITY Hypervigilant and being easily startled, feeling tense or on edge, having difficulty sleeping, experiencing angry outbursts, and having difficulty concentrating. POSTTRAUMATIC STRESS DISORDER (PTSD) 04. NEGATIVE CHANGES IN THINKING AND MOOD Persistent negative thoughts, guilt, shame, reduced interest in activities, and social detachment. Tendency to blame self for the traumatic event. 05. DURATION AND IMPAIRMENT Symptoms lasting more than one month, causing significant distress or impairment in social, occupational, or other important areas of functioning. POSTTRAUMATIC STRESS DISORDER (PTSD) SPECIFIER With dissociative symptoms (SEVERE CASES) Confirm if the individual's symptoms align with the criteria for posttraumatic stress disorder. Additionally, when faced with the stressor, the individual encounters ongoing or recurring symptoms from either of the following: 1. Depersonalization: Continual experiences of feeling detached from one's mental processes or body, as if observing from an external standpoint (e.g., feeling like being in a dream; sensing an unreal aspect of self, body, or time passage). 2. Derealization: Persistent experiences of surroundings feeling unreal (e.g., perceiving the world as dreamlike, distant, or distorted). Specify if: With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate). POSTTRAUMATIC STRESS DISORDER  POSTTRAUMATIC STRESS DISORDER PREVALENCE TRAGIC RATES PTSD is higher in Remarkably low prevalence amonng prevalence in women who have populations of experienced trauma victims repeated sexual assaults.  WHY DO OTHERS DEVELOP TRAUMA EASIER THAN OTHERS? SEVERITY OF PERSONAL LACK OF SOCIAL TRAUMA VULNERABILITY SUPPORT COPING SUBSEQUENT BIOLOGICAL MECHANISM STRESSORS FACTORS  TREATMENT OF POSTTRAUMATIC STRESS DISORDER COGNITIVE PSYCHO- BEHAVIORAL THE TRICK IS IN ANALYTIC THERAPY (CBT) ARRANGING THE THERAPY REEXPOSURE SO Process traumatic THAT IT WILL BE Reliving emotioal memories, change traume to relieve negative thought THERAPEUTIC emotional patterns, and develop RATHER THAN suffering is called coping skills to TRAUMATIC CATHARSIS. manage symptoms.  PSYCHOLOGICAL FIRST-AID AND DEBRIEFING SESSION FOR TRAUMA SURVIVORS  BEWARE: On the other hand, there is evidence that subjecting trauma victims to a single debriefing session, in which they are forced to express their feelings as to whether they are distressed or not, can be harmful (Ehlers & Clark, 2003). TREATMENT OF POSTTRAUMATIC STRESS DISORDER MEDICATION Selective Serotonin Reuptake Inhibitors (SSRIs) Antidepressant medications like sertraline, paroxetine, and fluoxetine are commonly prescribed to manage PTSD symptoms, including depression, anxiety, and intrusive thoughts. ACUTE STRESS DISORDER  ACUTE STRESS DISORDER Acute Stress Disorder (ASD) is a short-term psychological condition caused by trauma, with symptoms including intrusive memories, nightmares, avoidance behaviors, negative mood, and increased arousal. Untreated ASD can lead to Posttraumatic Stress Disorder (PTSD). 01. TRAUMA EXPOSURE Exposure to death, injury, or violence through direct experience, witnessing, learning, or repeated exposure. 02. SYMPTOMS CRITERIA Intrusion Symptoms: Distressing memories, dreams, flashbacks. Negative Mood: Inability to feel positive emotions. Dissociative Symptoms Altered reality, memory issues. Avoidance Symptoms Trying to avoid reminders. Arousal Symptoms: Sleep issues, irritability, hypervigilance. ACUTE STRESS DISORDER 03. DURATION AND TIMING Symptoms persist for 3 days to 1 month after trauma exposure. Onset typically immediate but must persist for at least 3 days to meet criteria. 04. FUNCTIONAL IMPAIRMENT The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. ACUTE STRESS DISORDER ADJUSTMENT DISORDER  ADJUSTMENT DISORDER Adjustment disorders involve anxious or depressive reactions to life stress, impacting functioning without being as severe as acute stress disorder or PTSD. Stressors may not be traumatic but still lead to coping difficulties and impairment in various areas of life, requiring intervention. 01. ONSET AND RESPONSE Development of emotional or behavioral symptoms within 3 months of an identifiable stressor 02. CLINICAL SIGNIFICANCE (1 or more) 1. Feeling distress that goes beyond the typical response to a stressor, taking into account external factors and cultural norms. 2. Showing significant difficulties in different aspects of life like social interactions, work, or other important activities. 03. TERMPORAL DURATION Symptoms do not persist for more than 6 months after the stressor ends. Symptoms resolve within 6 months after the stressor ends ADJUSTMENT DISORDER SUBTYPES AND SPECIFIERS: Subtypes of Adjustment Disorder: F43.21: With depressed mood F43.22: With anxiety F43.23: With mixed anxiety and depressed mood F43.24: With disturbance of conduct F43.25: With mixed disturbance of emotions and conduct F43.20: Unspecified Duration Specifiers: Acute: Symptoms persist for less than 6 months. Persistent (chronic): Symptoms persist for 6 months or longer, typically in response to chronic stressors or those with enduring consequences. ADJUSTMENT DISORDER  PROLONGED GRIEF DISORDER PROLONGED GRIEF DISORDER Involves persistent and intense grief after a close person's death, with symptoms like yearning for the deceased, avoidance of reminders, emotional pain, and loneliness. It differs from other disorders and is not linked to substance use or medical issues. 01. TIME FRAME Death of a close person at least 12 months ago (6 months for children/adolescents). 02. PERSISTENT GRIEF RESPONSE Intense yearning/longing for the deceased. Preoccupation with thoughts or memories of the deceased. 03. EXCEEDS CULTURAL NORMS Duration and severity exceed expected social, cultural, or religious norms. PROLONGED GRIEF DISORDER 04. ADDITIONAL SYMPTOMS Identity disruption Disbelief about the death Avoidance of reminders Intense emotional pain Difficulty in relationships and activities Emotional numbness Feeling life is meaningless Intense loneliness PROLONGED GRIEF DISORDER ATTACHMENT DISORDERS WHAT IS ATTACHMENT DISORDER? Disturbed and developmentally inappropriate behaviors in young children, emerging before age five, where the child struggles to form normal attachment relationships with caregivers. WHAT CAUSES ATTACHMENT DISORDER? Result from poor or abusive child-rearing, like frequent caregiver changes in foster care or neglect at home. TWO FORMS OF ATTACHMENT DISORDER: Reactive Attachment Disorder Disinhibited Social Engagement Disorder REACTIVE ATTACHMENT DISORDER The child will rarely seek caregiver support or respond to caregiver offers for protection, support, and nurturance. They might show lack of responsiveness, limited positive affect, and heightened emotionality like fearfulness and intense sadness. Disturbance must be evident before age 5 01. INHIBITED BEHAVIOR TOWARDS CAREGIVERS Child rarely seeks or responds to comfort when distressed. 02. PERSISTENT SOCIAL AND EMOTIONAL DISTURBANCE Requires minimal emotional responsivenes, limited positive affect episodes of irritability, sadness, or fearfulness during nonthreatening interactions 03. PATTERN OF INSUFFICIENT CARE Experiencing social neglect, changing caregivers frequently, and growing up in environments with limited attachment opportunities can have negative effects. REACTIVE ATTACHMENT DISORDER SPECIFIERS: Persistent Specifier The disorder persists for more than 12 months Severity Specification Severity is classified as severe when all symptoms are present at high levels. ADJUSTMENT DISORDER DISINHIBITED SOCIAL ENGAGEMENT DISORDER Early and persistent harsh punishment in child-rearing can lead to a child displaying inappropriate attachment behaviors, such as approaching adults without inhibitions or consulting a caregiver. 01. PATTERN OF BEHAVIOR (at least 2) Child actively approaches and interacts with unfamiliar adults. Verbal or physical behavior that exceeds social boundaries. May not check back with their adult caregiver after venturing away, even in unfamiliar settings. Readily go off with unfamiliar adults without hesitation or reservation. 02. PATTERN OF INSUFFICIENT CARE Child has experienced extremes of insufficient care, evidenced by: Social neglect or deprivation. Repeated changes of primary caregivers. Rearing in settings limiting opportunities to form attachments. DISINHIBITED SOCIAL ENGAGEMENT DISORDER 03. RELATIONSHIP BETWEEN CARE AND BEHAVIOR The disturbed behavior is presumed to result from the inadequate care experienced by the child. 04. DURATION AND SEVERITY Specify if Persistent: Present for more than 12 months. Specify current severity: Severe if all symptoms manifest at relatively high levels. DISINHIBITED SOCIAL ENGAGEMENT DISORDER TRAUMA AND STRESSOR- RELATED DISORDERS AND OBSESSIVE-COMPULSIVE DISORDERS Prepared by: Camille Faye J. Elcano-de la Paz, RPm, MA(Cand)  OBSESSIVE- COMPULSIVE DISORDERS OBSESSIVE- COMPULSIVE DISORDERS OCD involves internal fears, not external threats like in other anxiety disorders  OBSESSIVE-COMPULSIVE DISORDERS OBSESSION COMPULSION are intrusive and mostly are the thoughts or nonsensical thoughts, actions used to images, or urges that suppress the the individual tries to obsessions and resist or eliminate. provide relief.  COMMON OBSESSION AND COMPULSION OBSESSION COMPULSION Contamination Checking Symmetry and Order Cleaning and Washing Intrusive Thoughts Counting and Ordering Fear of Harm Repeating Unwanted Impulses Mental Rituals 01. PRESENCE OF OBSESSIONS AND COMPULSIONS Obsessions are intrusive thoughts causing anxiety. Compulsions are repetitive behaviors aimed at reducing anxiety. 02. TIME-CONSUMING OR DISTRESSING SYMPTOMS Obsessions or compulsions take more than 1 hour per day or cause significant distress or impairment in daily functioning OBSESSIVE-COMPULSIVE DISORDERS 03. INSIGHT SPECIFICATION With Good or Fair Insight: Individual recognizes the irrationality of OCD beliefs. With Poor Insight: Individual believes OCD beliefs are probably true. With Absent Insight/Delusional Beliefs: Individual is convinced OCD beliefs are true. OBSESSIVE-COMPULSIVE DISORDERS  BODY DYSMORPHIC DISORDER BODY DYSMORPHIC DISORDER Body Dysmorphic Disorder (BDD) causes individuals to obsess over perceived flaws in their appearance, leading to distress and avoidance of social situations. 01. PREOCCUPATION WITH PERCEIVED DEFECTS Preoccupation with one or more perceived defects or flaws in physical appearance, not observable or appear slight to others. 02. REPETITIVE BEHAVIORS OR MENTAL ACTS Engaging in repetitive behaviors or mental acts related to appearance concerns, like mirror checking, excessive grooming, or comparing looks with others. BODY DYSMORPHIC DISORDER 03. MUSCLE DYSMORPHIA SPECIFICATION Preoccupation with body build being too small or insufficiently muscular. 04. INSIGHT SPECIFICATION With Good or Fair Insight: Individual recognizes that BDD beliefs are not true or may not be true. With Poor Insight: Individual thinks BDD beliefs are probably true. With Absent Insight/Delusional Beliefs: Individual is completely convinced BDD beliefs are true. BODY DYSMORPHIC DISORDER HOARDING DISORDER HOARDING DISORDER Hoarding Disorder is a mental health condition causing difficulty discarding possessions, leading to clutter and distress. 01. PERSISTENT DIFFICULTY DISCARDING POSSESSIONS Difficulty discarding possessions regardless of their value. 02. PERCEIVED NEED TO SAVE ITEMS Difficulty is due to a perceived need to save items and distress associated with discarding them. 03. ACCUMULATION OF POSSESSIONS Accumulation of possessions that congest and clutter living areas, compromising their intended use. HOARDING DISORDER 04. SPECIFIER: EXCESSIVE ACQUISITION Accompanied by excessive acquisition of items not needed or with no available space. 05. INSIGHT SPECIFICATION With Good or Fair Insight: Individual recognizes hoarding-related beliefs and behaviors as problematic. With Poor Insight: Individual is mostly convinced hoarding-related beliefs and behaviors are not problematic despite evidence. With Absent Insight/Delusional Beliefs: Individual is completely convinced hoarding-related beliefs and behaviors are not problematic despite evidence. HOARDING DISORDER OTHER OCD-RELATED DISORDERS (Trichotillomania, Excoriation)  TRICHOTILLOMANIA (HAIR-PULLING DISORDER) CLINICALLY RECURRENT ATTEMPTS TO SIGNIFICANT HAIR-PULLING STOP DISTRESS OR IMPAIRMENT Recurrent pulling Repeated attempts Hair pulling out of one's hair, to decrease or stop results in distress leading to hair loss. hair pulling. or impairment in daily life.  EXCORIATION (SKIN- PICKING DISORDER) CLINICALLY RECURRENT SKIN ATTEMPTS TO SIGNIFICANT PICKING STOP DISTRESS OR IMPAIRMENT Recurrent skin Repeated attempts Skin picking leads picking resulting in to decrease or stop to distress or skin lesions. skin picking. impairment in daily functioning.