Zoc Summary - Psych 3010 Past Paper PDF 2024

Zoc Summary TITLE: COURSE NAME: Tue, Oct 8, 2024 11:47 AM Psych 3010 The document discusses the challenges and therapeutic approaches for individuals with obsessive-compulsive disorder (OCD) and related conditions, such as body dysmorphic...

Zoc Summary TITLE: COURSE NAME: Tue, Oct 8, 2024 11:47 AM Psych 3010 The document discusses the challenges and therapeutic approaches for individuals with obsessive-compulsive disorder (OCD) and related conditions, such as body dysmorphic disorder and hoarding disorder. The individual frequently forgets to turn off something, indicating a repetitive behavior or memory issue. Obsessive-compulsive disorder (OCD) often requires behavior therapies like systematic desensitization and implosive therapy, as medication is usually ineffective. Body dysmorphic disorder involves an obsessive preoccupation with perceived physical flaws, leading to repetitive behaviors like mirror checking and excessive grooming, which significantly impair daily functioning. Hoarding disorder is characterized by the excessive accumulation of items due to a perceived need to save them, differing from malingering, which is a lack of motivation to clean. Therapeutic interventions for these disorders are complex and require skilled therapists to help individuals engage in activities that counteract their ritualistic behaviors. Hoarding disorder involves a persistent difficulty in discarding possessions, leading to cluttered living spaces that compromise their intended use and cause significant distress or impairment. Hoarders experience anxiety when discarding items, even if they have no actual value, and often require third-party intervention to manage their cluttered environments. Hoarding is distinct from other conditions like malingering, obsessive-compulsive disorder (OCD), and major depressive disorder, which may exhibit similar behaviors but have different underlying causes and symptoms. Hoarding is not attributable to other medical conditions such as brain injury, dementia, or autism spectrum disorder, and must be differentiated from these to ensure accurate diagnosis and treatment. Hoarding can lead to unsafe living conditions, posing risks to the hoarder and others, and is not simply a result of laziness or lack of cleanliness. The document discusses various trauma and stressor-related disorders, including post- traumatic stress disorder (PTSD), dissociative disorders, and their symptoms, treatments, and impacts on individuals. PTSD symptoms include hypervigilance, excessive startle response, difficulty concentrating, and potential rage and violent impulses, often leading individuals to hide their symptoms to avoid appearing "crazy." Effective treatment for trauma, such as rape, involves immediate psychotherapeutic intervention close to where the trauma occurred, rather than relocating the individual, to help them process and overcome the trauma. Dissociative disorders, such as dissociative amnesia and dissociative fugue, involve individuals trying to escape from traumatic memories, sometimes resulting in memory loss or adopting new identities to avoid reminders of the trauma. Dissociative identity disorder (formerly multiple personality disorder) involves the presence of two or more distinct personality structures within an individual, each with unique behaviors and social relationships, and is considered one of the rarest and most complex disorders. The speaker hosted an author named Eve, who signed copies of her textbook "I'm Eve" for the class. A soiree was held at the speaker's home, allowing students and friends to meet Eve in a more intimate setting. Eve gave a presentation that was open to the community, and she was described as a delightful person. The speaker expressed gratitude for Eve's willingness to engage with both the class and the community. The speaker concluded by advising the audience to make thoughtful decisions and wished them a great weekend. Zoc Topics 1. Obsessive-Compulsive Disorder (OCD): Impact on Daily Life and Therapeutic Interventions Discussion on how OCD affects daily life and the various therapeutic interventions used to treat it. Bullet points: OCD can interfere with effective behavior significantly. Medication usually does not work with obsessive-compulsive disorder individuals. Behavior therapies are often revisited for treating OCD. Systematic desensitization is one of the behavior therapies used. Implosive types of therapy are also used for treating OCD. Therapeutic interventions for OCD are complex and require skilled therapists. Changing obsessive-compulsive behavior to more normal behavior is a lengthy process. Hoarding can be seen in some OCD cases but not all. Trichotillomania, a hair-pulling disorder, is related to OCD. 2. Body Dysmorphic Disorder (BDD) Exploration of BDD as a form of OCD-related disorder and its symptoms Bullet points: BDD is a form of OCD or related disorder. BDD involves a preoccupation with one or more perceived deficits or flaws in physical appearance that are not observable or appear slight to others. BDD is not considered OCD by itself because it is very specific in its focus. Symptoms of BDD include repetitive behaviors like mirror checking, excessive grooming, skin picking, and reassurance seeking. Individuals with BDD may compare their appearance with others in response to their appearance concerns. These preoccupations cause significant stress or impairment in social, occupational, or other important areas of functioning. The preoccupations in BDD are not better accounted for by concerns with body fat or weight as in eating disorders. At some point during the disorder, the person has performed repetitive behaviors or mental acts in response to appearance concerns.  BDD is not a narcissistic personality disorder; the focus is on perceived flaws rather than self-admiration. 3. Hoarding Disorder Explanation of hoarding disorder, its symptoms, and differentiation from malingering. Bullet points: Hoarding disorder is not better accounted for by the symptoms of another DSM-5TR disorder. Hoarding in obsessive-compulsive disorder (OCD) is less severe than in hoarding disorder. Hoarding disorder causes clinically significant distress or impairment in important areas of functioning. Hoarding disorder includes maintaining safe environments for self and others. Hoarding disorder is an anxiety-related disorder. Malingering can be a symptom of certain types of disorders but is different from hoarding disorder. Hoarders experience significant anxiety when someone tries to clean their space. Malingerers do not see value in their clutter and are indifferent to others cleaning it. Malingerers are often too lazy to clean their space, unlike hoarders who are anxious about it. 4. Post-Traumatic Stress Disorder (PTSD) Overview of PTSD, its causes, symptoms, and treatment approaches Bullet points: PTSD results from an actual, threatened, or imagined serious injury. A person can develop PTSD even if the injury did not happen to them but to someone else. PTSD can cause obsessive thought patterns. PTSD is a specific form of obsessive-compulsive disorder. Symptoms of PTSD can include rage and violent impulses. Individuals with PTSD might hide their symptoms to avoid appearing crazy. PTSD can lead to a fear of driving if the trauma involved a car accident. PTSD is one of several trauma and stressor-related disorders. There are other trauma and stressor-related disorders besides PTSD. Discussion on PTSD will be detailed later in the course. 5. Dissociative Disorders Introduction to dissociative disorders, including dissociative amnesia and dissociative identity disorder. Bullet points: Dissociative disorders involve individuals trying to escape from themselves due to trauma. Dissociative amnesia is one way individuals try to escape from trauma. Dissociative identity disorder was previously known as multiple personality disorder in the DSM-3. Each personality in dissociative identity disorder has its own unique behavior patterns and social relationships. Individuals with dissociative identity disorder generally have high intelligence. Dissociative identity disorder is perhaps the rarest of all disorders. The diagnosis of dissociative identity disorder is almost non-existent outside of the United States. Elderly individuals generally do not get dissociative amnesia; they develop dementia instead. Dissociative amnesia is relatively rare but does occur. Dissociative amnesia can be triggered by severe trauma, such as witnessing a friend's decapitation. Zoc Transcript I always forgot to forget to turn that off. I always forgot to forget to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. 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I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I always forgot to turn that off. I have to clean my house several times a day, you know, seven, eight, 10 times a day. Am I going to be able to hold down a job? The answer is no. You know, if I have to clean my house seven, eight, 10 times a day, am I going to be able to engage in successful relationships with neighbors and friends? And the answer is no. So it's going to interfere with effective behavior quite a bit. Therapeutic interventions, we go back to the behavior therapies. You know, we take a look at medication, medication usually does not work with obsessive compulsive disordered individual, individuals, excuse me. So we go back to the behavior therapies. You know, we go back to things like systematic desensitization. We go back to implosive types of therapy. What we might do with this woman is we might get her involved in like finger painting. You know, she doesn't want to admit. She knows that there is something wrong with her. She knows that she is not right. You know, it's that neurotic paradox. I do understand that there is something wrong with me, but I continue to adhere to my abnormal behavior rather than dealing with it on a more effective level. And like I say, when we sit there and do that, what we've got to try to do is we've got to try to get the person involved with activities that tend to be antithetical, that they are departures, that they are very different from her ritualistic behaviors. Okay, things like finger painting. You know, she's finger painting, can she sit there or we get her out of the house if she's out of the house, you know, can she sit there and clean up the house? And we reinforce, we reward that type of behavior. And again, it sounds like this is an easy therapeutic intervention, folks, but it's not easy. You know, this individual has had this disorder for a number of years, and it's not going to take a week or two to be able to change that behavior from an obsessive compulsive behavior to something which is more normal. So again, you know, we talk about it in simple terms, but actually working with these individuals, it's a highly complex procedure, and the therapist has got to be very skilled in doing so. All right? None of you leave. Okay, I don't want any of you to leave because I'm going to give each one of you five extra credit points for showing up today. So stay on until I have time to write down your names and give you five extra credit points. You know, like I say, attendance is horrible today, but we have half the attendance. So to reward you, to reinforce your behavior, that I'll give you folks, I think you've earned it when compared to the students that decided not to show up today. So again, remind me to do that as well. I may forget, my head is very congested. So remind me to do that and stay on and you'll get five extra credit points. So think about five extra credit points. Does that increase the grade on your last test by a full grade? More than likely it has. Body dysmorphic disorder. Body dysmorphic disorder, folks, is it's a form of an OCD. It's an OCD or related, and related disorder. Body dysmorphic disorder, it's not considered OCD by itself, even though if we look at it, it seems like it's OCD, that it's not because it's very specific in what is happening. It's a preoccupation with one or more perceived deficits or flaws in the physical appearance of the individual that are not observable or appear to be very slight to other people. I have a zit, I have a zit on my forehead today, and I have a body dysmorphic disorder. Okay, does this become the central point of my life today? Yes, it does. Okay, if I have body dysmorphic disorder, and this is just a simple example of this, that we get much more complex behaviors with body dysmorphic disorders, folks, that we take a look at this, but I'm going to be obsessing about that, a specific aspect of my body the entire day, maybe for several days. I don't even go outside because I don't want people to see a pimple, perhaps, on my forehead. Again, it's generally much more complex, much more severe than what we're talking about there. At some point during the course of this disorder, the person has performed repetitive behaviors. Gosh, obsession, or compulsions, excuse me. Things like mirror checking. They look in the mirror 40, 50, 70, 100 times a day, making certain everything is okay. My face is okay, my body is okay. There's mirror checking, excessive grooming. These folks are primping all the time. It's not a narcissistic personality disorder where the individual is focused on them. Again, that they are concerned with body dysmorphism. It's skin picking or reassurance seeking. I'm always asking people, you know, do I look okay? Or there can be mental acts, obsessions, comparing their appearance with that of others in response to their appearance concerns. These preoccupations cause clinically significant stress or impairment in social, occupational, or other important areas of functioning. Are they able to function out in the real world? The answer is absolutely not. The preoccupations are not better accounted for by concerns with body fat or weight as in eating disorders. Folks, if I'm checking my body because I am anorexic, quite obviously I'm not, but if I were anorexic and I'm checking my body several times a day, you know, I'm inching myself, making certain that I'm not getting fat or anything like this, that is not body dysmorphism. That is an eating disorder. In this particular case, it would be anorexia. It could be bulimia as well, but more than likely it's some type of anorexic response. So the specifiers for the disorder, the specifiers for the symptoms of that particular disorder are more exacting to be able to place it in body dysmorphic disorder instead of, for example, obsessive compulsive disorder or eating disorders or something similar. Okay, that I have body dysmorphic disorder, folks. You know, I've had seven or eight nose jobs. That I have body dysmorphic disorder. You know, gosh, that even though I exercise all day, I just can't get that six pack. So I go and get plastic surgery to have that six pack done. You know, these individuals tend to go to physicians frequently to try to clear up what they perceive as some type of body dysfunction. Something is wrong with me physically. You know, I can sit there and see that I'm not, I don't appear the way that I want to appear. And as a result, I try to get that particular concern taken care of, and that might only be able to be taken care of by a physician. Now, this does not mean, folks, if you've got in and you've had a nose job, okay, that there was something wrong with your nose, you had a nose job, you were happy with your nose job afterwards, does that mean you have body dysmorphia? No, it doesn't. It doesn't, okay, that that is just one particular aspect. You know, could that have bothered you for a long period of time? A lot of individuals believe that women getting breast augmentation, that that's a form of body dysmorphia. You know, if you've had seven or eight, nine different breast augmentations, and it'd be almost impossible to have that many because if you're getting your breasts enlarged that frequently, your skin is going to be so thin it could rupture very easily, that's what we're talking about. You know, we're not talking about the individual that feels, gosh, it's this particular aspect, I want to get this particular aspect fixed. I get it fixed, I feel better about myself, is that okay? Yeah, you know, is it okay if I have this problem and I just deal with the problem? Yeah, that's okay as well. You know, gosh, I wish I was this way, you know, but the only way I could get there is through surgery and I'm not willing to do that. For me, that is just something I don't want to do, let's assume, and that's fine as well. So I hope there's this, again, you know, a surgery now, again, for something that is a concern. I had a baby, I've had seven babies and because of, or let's say I had a friend that lost 400 pounds and after losing 400 pounds, gosh, he just had excess skin that went the entire width of his body, actually it went the entire radius of his body, the circumference of his body. And he was very, I mean, it sagged incredibly. You can imagine if he lost 400 pounds, how much sagging there would be around the arms and around the belly. And he always wanted to get that fixed and we found a surgeon that would do it. He had it done and that was fine. You know, even though he had a scar that went completely around his midsection, that he felt that that scar was better than carrying around that loose skin. Did he have body dysmorphic disorder? Absolutely not. You know, if he kept going back for more surgeries and more surgeries, well, gosh, you know, my nose is not right, my eyes are not right, I need to get an eye lift because I have bags under my eyes or something like this that could that be it. You dye your hair and you have to have your hair dyed every month, is that a body dysmorphic disorder? No, you know, that that's just basically a preference. Okay, I hope that makes sense. Now, another anxiety-related disorder, folks, are the hoarding disorders. Now, I wanna talk about the difference between hoarding disorder and malingering. Now, I highlighted hoarding disorder because malingering, while it can be a part of, it can be a symptom of certain types of disorders. I want you guys to try to understand the difference between a hoarder and a malingerer. That I've watched hoarding shows on television a few times. And I've only seen them three, maybe four times. Students have said, yeah, you ought to watch this program. Some of those individuals were in fact true hoarders. Okay, that this would be the kitchen of a hoarder. This would be the bathroom of a malingerer. Okay, can you see a difference? You know, you take a look at this. Can you sit there and use this bathtub? No, this bathtub, what did they throw in there? They threw in there anything that they wanted to. They threw in, you know, like soda cups. They threw in like wipes, disinfectant wipes. They threw in bottles. You know, this sludge in the bathtub, that is not hoarding, folks. That is malingering. Malingering, I am too lazy to clean. Okay, these individuals are not too lazy to clean. They think everything in their kitchen has some value. Okay, this particular box here, even though it's empty, it has some value. I might need to send a present to somebody sometime. So I'm keeping this box just in case. Well, what type of present? Well, who knows? What type of gift? Who knows? You know, but I may need it at some time. For me, it has value. I may need it at some time, so I'm keeping it. You know, you take a look at the malingerer. Do they see any value in this type of situation? And the answer is absolutely not. So there's a big difference. And when these programs talk about hoarding, sometimes they get into people that are malingering. You know, the hoarder, somebody comes in and they wanna help clean the place up. Does the individual have a great deal of anxiety as a result of that? Absolutely. The person that comes into a malingerer's house and wants to clean this up, the malingerer says, hey, go for it. They're too lazy to clean it. Is there anything of value? No, there's nothing of value there. Go ahead and clean it out. I'm just too damn lazy to clean up myself. We come back a year after it's been cleaned. Does it look like this again? Yeah, the answer is absolutely yes. So it's important, you know, what they show on television, folks, is often incorrect. What they show on television is more theatrical than factual. And again, when we see those shows showing something like this, showing a house that is full of this kind of situation, that is not a hoarder in that particular case. Folks, hoarding disorder is when there is a persistent difficulty when discarding or parting with possessions regardless of their actual value. The box has value to me. The box may not have value to you, but the box has value to me. Well, what kind of value? Well, I've already told you that. I might need to mail something sometime, and this is a perfectly good box, or I might want to put things in there to store them. This is a perfectly good box that I could sit there and do that to. You take a look at hoarding disorder, you know, and we take a look at it, and we tend to see the hoarding takes place usually in areas that are frequently used. I'll talk about that in the second. Well, let's talk about this first, the second bulleted point. Let's talk about that first. The symptoms result in the accumulation of possessions that congest and clutter active living areas. A kitchen, a bedroom. Okay, should those places be fairly free of clutter? Can they be messy? Sure they can. You know, if you came over to my house right now, my kitchen is quite messy. Is that because I'm a hoarder? No, it's because I just haven't had the time to take to clean up. I have people that do come in once a week and clean my house, and I kind of wait until they come in to do that. They throw things out. Am I bothered by that? Absolutely not. But they congest and clutter active living areas and substantially compromise their intended use. My bedroom, if I was a hoarder, folks, my bedroom would be so full of stuff. Would I be able to sit there and sleep on my bed? The answer is no. That my kitchen is so cluttered, could I sit there and cook? Here's the stove, folks. You know, can I cook on that stove? No, you know, there's too much stuff on there. And that's what we're talking about when we get into hoarding as being an actual disorder. This difficulty is due to perceived need to save the items and distress or anxiety associated with discarding them. If you've ever seen a hoarder, you know, gosh, you start taking things out and they will absolutely go nuts, even though in actuality, that item has absolutely no value. For that person, it does have value. If living areas are uncluttered for a hoarder, it is only because of the intervention of some type of third-party intermediary, like family members have come and uncluttered those areas. They haven't thrown the stuff out, but they've uncluttered it, that they've organized it perhaps a little bit better. They put it on the back porch or on the deck or whatever the case may be. Cleaners or authorities, at times authorities might get involved in these types of situations. The hoarding, and this is why it's considered a disorder, that the hoarding causes clinically significant distress or impairment in important areas of functioning, including maintaining the safe environments for self and others. You know, I've been in houses. There was, and the reason why I'm pausing is I don't want to identify this person. And so I wanna pick my words very carefully, so there's no way that an individual would be able to find out who this person was. An individual, an attorney that I worked with on several cases, and there's been several attorneys that I've worked with on several cases, so that person would not be easily identifiable. But this individual was a hoarder, and this individual, for years, did not want me to go into the house. Finally, they needed some help where they asked me to come in and help them with something. And they had things like newspapers. They had things like the National Enquirer. They had them tied in bundles, and they had them stacked in their bedroom, in their kitchen, down hallways, that you had to go down a hallway sideways because it was so cluttered. Was it neatly cluttered? Yeah, everything was nice and neat, but could that stuff have fallen? It was all the way up to the ceiling in some areas. Could that stuff have fallen on that particular person and caused her, because it weighs so much, caused her not to be able to get out, and she dies as a result of that? Yeah, and that's what we're talking about here. That environment is not safe for themselves or other people. Was it safe for me? No, and I says, hey, I'm not gonna help you. I walked in there, looked around a little bit, says, this is not for me, that in the types of environments and in relationships. So once again, it's interfering with effective types of behavior. The hoarding is not attributable to another medical condition. For example, brain injury. I'm involved, even though I'm not a hoarder, that I'm involved in a car accident today. Okay, it's very serious that I have massive brain damage as a result. Could I begin to hoard things as a result? Yeah, well, again, that's due to the medical condition. That's not due to psychological aspects. That's due to just absolute medical conditions. It's not due to cerebrovascular disease, you know, hardening of the arteries of the brain. It's not due to dementia. You know, we're able to rule those things out, and if we're able to rule those things out, quite obviously, when we're dealing with somebody under those circumstances that has a hoarding disorder. Now, the person, the attorney I was talking about, was that individual's house, well, I already said her house, was it a mess? No, but could she do things? Could she sleep early in her bedroom? Not really. You know, could she clean? Could she cook in her kitchen? No, because there was stuff stacked. It was neatly stacked, but it was stacked all over. Wherever there was free space that she would have that filled with something. Where did she eat? That she ate all of her meals out, you know, so she would not need to cook. She had sometimes brought the stuff home, but let's say that I decide, gosh, I'm going to eat at McDonald's this afternoon, and I don't feel like going in. I'm just gonna drive through, but I don't wanna take it home, so I eat it in my car, and before I leave, I ditch it all into a container, a trash container at McDonald's, or at a grocery store, or someplace like that, so I don't bring it home and mess up my house. Is my house already messed up? Yeah. Okay, makes sense. Okay. The hoarding is not better accounted for by the symptoms of another DSM-5TR disorder. For example, could we get hoarding in an obsessive-compulsive disorder? You can, okay, but you would not get the amount that you're seeing with a hoarding disorder. It would be very, and this is why we go to graduate school, you know, to learn the subtle differences between different types of disorders. You know, can I sit there and look at something and notice that, well, this is not OCD, this is hoarding? And the answer is yes. In some OCD, can you sit there and see some forms of hoarding? Yeah, but you're going to sit there and see a lot of other factors occurring in that particular situation as well. It's not due to some type of decreased energy. The person has been diagnosed as suffering from a major depressive disorder. They can't get out of bed. As a result, their bedroom is dirty. You know, again, that person's bedroom would look more like this bathroom than it would here. But, you know, that the individual in a major depressive disorder, do they have the energy to sit there and clean up? No. Are they related to some type of delusions? I feel like if I throw this out, somebody's going to take it and they're going to use it against me. They're going to sit there and take it in front of a court and say that this and this and this, that this person was using this because, again, I'm delusional. I have false beliefs that it's not that. You know, if it is that, then it's a schizophrenic type of disorder. It is not a hoarding type of disorder or other type of psychotic disorder. It's not due to some cognitive, I'll try this again, deficits in dementia. And it's not due to any type of restricted interests as we see in children with autism spectrum disorder. Can we see hoarding in a lot of these different categories? You can. You don't see them in all of them and you don't see them in every person that has them. You don't see hoarding in autism spectrum disorder. And it's not really hoarding at that particular point in time, but it's that my interest in autism spectrum disorder is so minutely focused on other events that I just don't pay attention to those sorts of things. Okay? Other OCD related disorders, folks, there's a hair pulling disorder. This is known as trichotillomania. You know, a person who sits there all day long and pulls at their hair, twirls their hair. And I'm not talking about like an hour or something like this. I'm just talking about all day long. And it's such an obsession. It's such a compulsion, folks, that the individual is pulling out large hunks of the hair. It may not be intentional. They're not intentionally trying to do that. If they are intentionally trying to do that, it might be a form of schizophrenia. But, you know, in trichotillomania, that could be an OCD related type of disorder. Skin picking disorders, that this could be related to that. Substance induced obsessive compulsive or related disorder. Boy, we've got to make certain that we rule out substances. OCD or related disorders, not elsewhere classified. Again, that's a catch all category. That if we know it's some type of OCD related disorder, but it doesn't fit easily into any of these categories. But again, it is OCD. Well, we put it there. You know, that that's sort of a last result if we can't find another category. We search the literature. You know, we have a particular client who is exhibiting some very bizarre, excuse me, very strange behaviors. That, you know, we look in the literature to see, has this type of disorder been diagnosed somewhere else? How has it been diagnosed? So it's not that we just give up, that we take a look at, we research this to see if it's been diagnosed somewhere before. Trauma and stressor related disorder. Gosh, there's several of these. And the most common one of these, as you guys are aware of, is post-traumatic stress disorder. Post-traumatic stress disorder, this results basically from an actual, or a threatened, or an imagined serious injury. That I was in a very bad car accident. I did not get hurt in that accident, but a friend of mine who was riding in the car with me died. Could I develop post-traumatic stress disorder? Could I develop, you know, a fear of driving? Is that related to phobia? No, no, it's not. This would be a post-traumatic stress disorder in this particular case. You know, it's as a result of an actual serious injury. The injury was not to me. The injury was due to somebody else, or it happened to somebody else. It did not happen to me. Again, it could be threatened, it could be imagined. It's, when I have post-traumatic stress disorder, folks, my mind is obsessing. Is it kind of a form of obsessive-compulsive disorder? It absolutely is. But because it is quite specific, it is called post-traumatic stress disorder. I begin to be obsessed by recurrent and intrusive recollections. I think about her dying every day of my life, you know, hours and hours and hours a day, that, you know, I can't get it out of my mind. When I dream, I dream about that accident. You know, it's just obsessing on my part. There's a persistent avoidance of stimuli associated with the stress. Let's take a different tact. Instead of saying it's this car accident, let's take the tact that I was raped. I was raped one night when I was in bed. Somebody broke into the house and raped me. As a result of that, I cannot sleep in that bed anymore. I cannot get into that bedroom. You know, I've had to throw the entire bedroom set out because there are too many remembrances of what has happened to me in that particular case. Do we generally see that in OCD? And the answer is no. That these are very specific types of aspects related to a disorder that bring us to this particular point. In this we can have sleep disorders, disturbances, sleep disorders you have insomnia, sleep disorders you have nightmares, there's increased irritability, usually I'm a laid back person, I have post traumatic stress disorder because of this woman dying in my car, the accident was my fault or the accident wasn't my fault, I just couldn't help that person, that I'm usually a laid back individual, you come in and say hi to me and I start yelling and screaming at you, you're always saying hi, hi, no matter what day it is, hi, hi, how you doing? You know I'm sick of that. We have difficulty concentrating, you know, why? Because I'm concentrating but I'm obsessing about something else. We tend to be hyper vigilant, we tend to be on edge all the time, there's an excessive startle pattern in many of these people, excessive startle pattern, that there's a loud noise outside of my house and I jump up, you know, that there's a noticeable startle response to that particular situation. I could be hypersensitive to external stimulation, you know, that kind of goes back to this excessive startle response, you know, but I listen, but I can remember when I was raped that night that there was a dog barking and I hear a dog barking, you know, it's not the same dog that was barking but I hear a dog barking, that I'm hypersensitive to that type of stimulation. You know, a dog barks, it could be over here, it could be over there, it could be there, it could be back over here and it's going to take my thought patterns away and there can be in some people, there's usually not, but there can be rage and violent impulses, you know, that I take this out on other people. Some individuals who have post-traumatic stress disorder, me for example, again, let's assume that I was raped, I might seem to friends and family that I'm doing okay, okay, but that's not the case. I'm exhibiting all of these disorders or these symptoms, excuse me, of the disorder, but I'm not showing them in front of you because again, I don't want to appear crazy. I know these are crazy types of symptoms, I don't want you to think that I'm crazy, so this is what I do. I seem to be taking that stress quite well, but it's building up. Is it likely to build up to a point where I erupt at some point? Yeah, and this is when we could get those rage and violent impulses. How do we generally treat these individuals? Well, in some cases, might medication, certain types of medication be helpful? Yeah, they certainly could be, but you want to treat them. You know, my daughter was raped, she was living in Seattle, you know, and she calls mom and me up and she said, folks, I was raped, I want to come home. Mom and I fly up there, I'm going to try to discourage her to come home because having her come home, now we might decide that this would be best for her, but in general, that I might try to dissuade her from coming home because is this something she has to deal with? Yeah, and if she comes home and she's living with mom and dad once again, does she have to deal with that? No. You know, we try to treat this, you know, obviously she needs help. Mom and I stay up there, you know, we get a hotel room, we get an apartment for an extended period of time and we're there if she needs us, but we get her help, we get her psychotherapeutic intervention immediately and in close proximity to where it happened. Again, we don't want to bring her home and get her that help. At times, would that be the best thing to do? Yes, absolutely. There are times when that would be very important to do, but in many cases, like I say, my daughter would have a better chance of getting over it if she is treated in Seattle and she's treated right away. We don't wait for several months for this to happen. She said, mom, dad, this happened right now. We're on a plane up there this afternoon and we're going to make certain that she gets the help that she needs. Are we going to be support groups? We're absolutely. We're going to sit there and support her, but one of the big support aspects that we're going to suggest very strongly is she get treatment right away. Okay. Bad disorders, bad disorders, other trauma and stressor related disorders, reactive attachment disorder, you know, gosh, I'm attached to somebody, they leave, I develop trauma as a result of that. Disinhibited social engagement disorder, acute stressor disorder, adjustment disorder, prolonged grief disorder. Out of these, we'll talk about prolonged grief disorder, but folks, instead of talking about it now, I always talk about it when we discuss the concept of depression. So we will discuss this disorder in much more detail later on, but I just, I throw these up, you know, just because I want you guys to know that there are other trauma and stressor related disorders. Would trauma, stressor disorder, not elsewhere classified be here? Absolutely. You know, that we would include that in this particular area, but we'll spend quite a bit of time talking about the difference in just the idea of depression and the idea of prolonged grief disorder related to some type of depressive behavior in the individual's life. All right. We're still doing good. Remind me in about 10, 10 and I'll take attendance and you guys will get five extra credit points. Dissociative disorders, folks, dissociative disorders, we'll talk about three of these. They all represent basically the same generalized idea and they represent the individual trying to escape from themselves. Some type of trauma has taken hold of me and it's been so severe that I developed a disorder as a result of that. And in my particular disorder, I tried to escape from myself. I tried to escape from that, that trauma in certain ways. How can I do this? Well, through dissociative amnesia. Okay. There's, there's actually about five, there's four for certain. There's probably five or six different types of, of amnesia syndromes that we can talk about. We're not going to spend time localized, you know, that there's, there's just some aspects of an event that I have problems with. Same way with selective. This usually occurs within the first few hours following the trauma that guy was talking about last time who, who was involved in that car accident. His best friend had his head ripped off. He was decapitated. You know, that individual actually developed amnesia of that. He finally came out of it, but it was years later. But usually this develops within the first few hours. Again, I just cannot deal with it right now. I'm not psychologically ready to be able to effectively deal with a trauma that I was able to take a look at. We can have total generalized, total generalized, you know, local selective. We're picking particular areas out, total generalized. We're forgetting everything. More common in women and adolescents, it's rare in the elderly. Now can elderly begin to forget things? Yeah, but that's dementia. Can it happen in military situations? Yeah, it can. It absolutely can. Again, it's rare in elderly. Elderly generally do not get amnesia. They develop dementia. And as a disorder, it is relatively rare. Does it happen? I've seen it in several individuals, but it's not something you're going to see every day. Dissociative. Am I trying to escape from the self? Yeah, something bad has happened. In this case, the friend had been decapitated. I want to escape from this. I want to escape from myself and what happened at that particular point in time. So I develop amnesia. Has that provided me with an escape? It has. If it's as if it never happened, and I sit there and continue to exert a psychopathological influence on my behavior, the answer is no, it does. It still does in other areas, but in my mind, it probably doesn't. Same thing. Escape from oneself. Psychogenic or dissociative fugue. In the DSM-5 TR, it's called dissociative fugue. Sometimes you might read it's called a psychogenic fugue. The correct diagnosis is a dissociative fugue. And this is where we have a situation where the individual does not feel comfortable just by developing amnesia. Okay, amnesia, they're still there. This accident I think I told you happened in Boise, Idaho. And this particular individual, you know, he did develop selective amnesia, but could have developed a dissociative fugue. Gosh, you know, staying in Boise, that I'm going to probably have to drive down that road. And we're not, we're not cognitively, we are cognitively on one level thinking about that, but it's more on a subconscious level. We're not necessarily aware of this, that on more of an unconscious level, my mind is sitting there saying, you know, that living in Boise, I'm still going to go past that area where this accident happened, you know, several times a month. And that's only going to bring back those memories. So what I do instead is I leave Boise, Idaho. I end up in Ogden, Utah, and in Ogden, Utah, will it be that reminder, will that street be there? And the answer is absolutely no. In some cases, the person might assume a new identity. I wind up in California, you know, and I take on a new identity. It's a very rare, I've only seen a couple of cases where I was certain that the person was not using this, trying to use this as a defense in a court of law. It's a very rare type of disorder. It's so rare, we don't have a lot of stable age or gender data related to it. We have a couple minutes, let me get into this, folks. The one dissociative disorder that people really enjoy talking about, that there's a lot of interest in this, is dissociative identity, dissociative personality disorder. The old term, the old diagnosis in previous DSMs, it was called multiple personality disorder. In the DSM-3, it was called multiple personality disorder. We don't use that term because, again, we know that there's a dissociation that the individual is trying to escape. And basically what happens in this, and again, gosh, I actually taught an entire class one time, an entire semester, and I didn't put in that particular photo, but I actually taught an entire semester on this particular disorder. So it's hard to talk about it, you know, in like five or ten minutes, though we don't, we're not going to do it justice. It is a rare disorder, but we know a lot about the disorder because it was so compelling to a lot of people, a lot of money was put into it to study the different effects. Okay, with that, stay on, let me put your names down. So that I have that, and you guys will be getting five extra credit points since there was such a low number of people here. And I'm writing down your first and last name, like I said, don't get off yet, let me, I'll let you know when you can get off. So later on today, probably not right after this class, because I've got to get prepared for my next class, but at some time today that I don't have anything happening after my next class, that I will put this, you'll see on your grade that there'll be five extra credit points. So guys, can you guys still do that naloxone training and get another ten extra credit points? Yes. And again, you guys are doing well in the class, but could this help you even more? And the answer is certainly. So I would certainly encourage you guys to continue to think about doing the naloxone training and go with that. We have a couple of more minutes, we have four minutes, let me talk about this a little bit more, since we do have some time. Don't leave, if you leave, I'm not going to give you the five extra credit points. We will get through it in the next couple of minutes. There's the existence within an individual, two or more distinct personality structures, each of which is dominant at a particular point in time. I'm going to go through these and then I will explain them as a group on Tuesday. The dominant personality at that particular time determines the behavior of that person. Each personality is complex with its own unique behavior patterns and social relationships. That gosh, they have different, they have very unique individualistic types of behaviors. Generally, individuals with dissociative identity disorders have high intelligence, because gosh, do you have to be bright to be able to keep all of this stuff straight? It's perhaps the rarest of all disorders. The diagnosis of this disorder outside of the United States is pretty much non-existent, In Britain, it's considered the diagnosis of dissociative identity disorder. It's been described as a wacky American fad. The reason why I have these pictures, we'll talk about this next time, but the reason why I have these pictures, this is me about 40 years ago. This was the first documented case of multiple personality. Her name was Chris Sizemore. She and I got to be friends, I think that I told you folks, before coming to Ogden. I taught at a school in Virginia and I got to meet Chris when I was there. The movie and the book, The Three Faces of Eve, were based on her life. And again, it just coincidentally happened that I was able to meet her while I was there, that she actually invited me over for dinner with her family on several occasions. We'll talk a little bit about what her husband talked about with respect to her disorder, what her kids talked about with respect to her disorder, but this is actually the person. The movie and the book, The Three Faces of Eve, were based on her particular life. Again, she was not the first case, she's considered the first case. She's the first documented case, but there were obviously cases of this. Were there cases of this back 4,00 or 5,00 years ago? I'm sure there were, but they weren't documented. Gosh, they were crazy people and we killed them back then. She was invited to go on all of the local television programs. This was her part of class. I used one of her books, not one of her books, her book as the linchpin in that class. It's called I'm Eve, you can't really read it, but it's called I'm Eve. And people in the class, when she came in and talked to the class, she was happy to sign copies of the textbook for them. And we even had a, I had a sort of a soiree at my home for her, where I invited students and friends to come by and meet her on a more intimate level. We had a presentation by her where the community could come to, and she was just a delightful person. I was very lucky to get to meet her, get to know her. And I was very lucky that she agreed to come out and do a presentation, not only for my class, but for the community as well. Okay, well with that, folks, I've got you guys down. You guys have a great weekend. Stay safe. Make great decisions. Think about the decisions that you're going to make. Reflect on those before you make them. And we will see you folks in a few days. We'll see you guys on Tuesday. You guys take care. Thank you. Thank you. Thank you, guys.