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Disorders of Trauma and Stress

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Disorders of Trauma and Stress Chapter 5 Dissociative Identity Disorder Traditionally, DID was believed to be rare Some researchers even argue that many or all cases ... – PowerPoint PPT presentation

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Title: Disorders of Trauma and Stress


1
Disorders of Traumaand Stress
  • Chapter 5

2
Stress, Coping, and the Anxiety Response
  • The state of stress has two components
  • Stressor event that creates demands
  • Stress response persons reactions to the
    demands
  • Influenced by how we judge both the events and
    our capacity to react to them effectively

3
Stress, Coping, and the Anxiety Response
  • Extraordinary stress and trauma also play central
    role in certain psychological disorders
  • Acute stress disorder
  • Posttraumatic stress disorder (PTSD)
  • as well as the Dissociative disorders
  • Dissociative amnesia
  • Dissociative identity disorder
  • Depersonalization-derealization disorder

4
Stress and Arousal The Fight-or-Flight Response
  • Features of arousal and fear are set in motion by
    hypothalamus
  • Two important systems are activated
  • Autonomic nervous system (ANS)
  • Extensive network of nerve fibers that connect
    CNS to all other organs
  • Endocrine system
  • Network of glands throughout body that release
    hormones

5
Stress and Arousal The Fight-or-Flight Response
  • There are two pathways, or routes, by which the
    ANS and endocrine system produce arousal and fear
    reactions
  • Sympathetic nervous system pathway
  • Hypothalamic-pituitary-adrenal pathway

6
The Autonomic Nervous System
7
The Hypothalamic-Pituitary-Adrenal (HPA) Axis
8
Trauma
  • Usually involves actual or threatened serious
    injury to self or others
  • During and immediately after trauma, temporarily
    experience high levels of arousal and upset

9
Acute and Posttraumatic Stress Disorders
  • Acute stress disorder (ASD)
  • Symptoms begin immediately or soon after the
    traumatic event and last for less than one month
  • Posttraumatic stress disorder (PTSD)
  • Symptoms may begin either shortly after the
    event, or months or years afterward
  • As many as 80 of all cases of acute stress
    disorder develop into PTSD

10
ACUTE AND POSTRAUMATIC STRESS DISORDERS
  • Re-experiencing
  • Avoidance
  • Repeated, distressing images or thoughts
  • Intrusive flashbacks
  • Horrifying dreams
  • Attempts of avoid thoughts, feelings related to
    the event
  • Avoid people, places, or activities that remind
    them of the event
  • Numbing of responsiveness

11
ACUTE AND POSTRAUMATIC STRESS DISORDERS
  • Arousal or anxiety
  • Dissociative symptoms
  • Predicts a worse prognosis
  • Hypervigilance
  • Restlessness, agitation, and irritability
  • Exaggerated startle response
  • Dazed and act spaced out
  • Depersonalization
  • Derealization
  • Dissociative amnesia

12
What Triggers Acute and Posttraumatic Stress
Disorders?
  • Can occur at any age and affect all aspects of
    life
  • At least 3.5 of people in the U.S. are affected
    each year
  • 79 of people in the U.S. are affected sometime
    during their lifetime
  • Around two-thirds seek treatment at some point

13
What Triggers Acute and Posttraumatic Stress
Disorders?
  • Ratio of women to men is 21
  • Low incomes 2x as likely
  • Victimization, Combat, Disasters, Abuse

14
Why Do People Develop Acute and Posttraumatic
Stress Disorders?
  • Biological and genetic factors
  • Traumatic events trigger physical changes in the
    brain and body that may lead to severe stress
    reactions and, in some cases, to stress disorders
  • Some research suggests abnormal especially
    norepinephrine and cortisol levels
  • Evidence suggests that once a stress disorder
    sets in, further biochemical arousal and damage
    may also occur (especially in the hippocampus and
    amygdala)

15
Why Do People Develop Acute and Posttraumatic
Stress Disorders?
  • Personality factors
  • Preexisting high anxiety
  • Negative worldview
  • A set of positive attitudes (called resiliency or
    hardiness) protective

16
Why Do People Develop Acute and Posttraumatic
Stress Disorders?
  • Childhood experiences
  • An impoverished childhood
  • Psychological disorders in the family
  • The experience of assault, abuse, or catastrophe
    at an early age
  • Being younger than 10 years old when parents
    separated or divorced

17
Why Do People Develop Acute and Posttraumatic
Stress Disorders?
  • Social support
  • People whose social support systems are weak are
    more likely to develop a stress disorder after a
    traumatic event
  • Severity of the trauma
  • Generally, the more severe the trauma and more
    direct ones exposure to it, greater likelihood
    of developing stress disorder
  • Especially risky Mutilation and severe injury
    witnessing the injury or death of others

18
ACUTE AND POSTRAUMATIC STRESS DISORDERS
  • Psychological Factors in ASD and PTSD
  • Two-factor theory
  • Classical conditioning creates fear when the
    terror of trauma is paired with the cues
    associated with it.
  • Operant conditioning maintains avoidance by
    reducing fear (negative reinforcement).
    Avoidance prevents the extinction of anxiety
    through exposure.

19
How Do Clinicians Treat Acute and Posttraumatic
Stress Disorders?
  • About half of all cases of PTSD improve within 6
    months the remainder may persist for years
  • Treatment procedures vary depending on type of
    trauma
  • General goals
  • End lingering stress reactions
  • Gain perspective on painful experiences
  • Return to constructive living

20
How Do Clinicians Treat Acute and Posttraumatic
Stress Disorders?
  • Treatment
  • Drug therapy
  • Anti-anxiety and antidepressant medications are
    most common
  • Behavioral exposure techniques
  • Reduce specific symptoms, increase overall
    adjustment
  • Use flooding and relaxation training
  • Use eye movement desensitization and reprocessing
    (EMDR)
  • Insight therapy
  • Bring out deep-seated feelings, create
    acceptance, lessen guilt
  • Often use couple, family, or group therapy
    formats

21
Dissociative Disorders
  • Although their conditions are also triggered by
    traumatic events, individuals do not typically
    experience the significant arousal, negative
    emotions and other symptoms associated with the
    stress disorders
  • Instead, their symptoms are characterized by
    patterns of memory loss and identity change

22
Dissociative Disorders
  • The key to our identity the sense of who we
    are and where we fit in our environment is
    memory
  • In dissociative disorders, one part of the
    persons memory typically seems to be
    dissociated, or separated, from the rest

23
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24
Amnesia
  • Retrograde Amnesia
  • Anterograde Amnesia
  • Is the amnesia biologically-based or psychogenic?
  • Organic amnesia usually involves personal and
    general information also may involve anterograde
    amnesia.
  • Psychogenic amnesia usually involves only
    personal information also may involve retrograde
    amnesia.

25
Dissociative Disorders
  • There are several kinds of dissociative
    disorders, including
  • Dissociative amnesia
  • Dissociative fugue
  • Dissociative identity disorder (multiple
    personality disorder)
  • Depersonalization-derealization disorder

26
Dissociative Amnesia
  • People with dissociative amnesia are unable to
    recall important information, usually of a
    stressful nature, about their lives
  • The loss of memory is much more extensive than
    normal forgetting and is not caused by physical
    factors
  • Often an episode of amnesia is directly triggered
    by a specific upsetting event

27
Dissociative Amnesia
  • Dissociative amnesia may be
  • Localized
  • Selective
  • Generalized
  • Continuous

28
Dissociative Fugue
  • Persons not only forget their personal identities
    and details of their past, but also flee to an
    entirely different location.

29
Dissociative Identity Disorder
  • A person with dissociative identity disorder
    develops two or more distinct personalities,
    called subpersonalities, each with a unique set
    of memories, behaviors, thoughts, and emotions

30
Dissociative Identity Disorder
  • At any given time, one of sub-personalities
    dominates persons functioning
  • Usually one of these sub-personalities called
    the primary, or host, personality appears more
    often than others
  • Transition from one sub-personality to next
    (switching) is usually sudden and may be
    dramatic

31
Dissociative Identity Disorder
  • How do sub-personalities interact?
  • The relationship between or among
    sub-personalities varies from case to case
  • Generally there are three kinds of relationships
  • Mutually amnesic relationships
  • Mutually cognizant patterns
  • One-way amnesic relationships

32
Dissociative Identity Disorder
  • Sub-personalities often display dramatically
    different characteristics, including
  • Identifying features
  • Sub-personalities may differ in features as basic
    as age, sex, race, and family history
  • Abilities and preferences
  • It is not uncommon for different subpersonalities
    to have different abilities, including being able
    to drive, speak a foreign language, or play an
    instrument

33
Dissociative Identity Disorder
  • Subpersonalities often display dramatically
    different physiological responses
  • Differences in autonomic nervous system activity,
    blood pressure levels, and allergies

34
Dissociative Identity Disorder
  • Traditionally, DID was believed to be rare
  • Some researchers even argue that many or all
    cases are iatrogenic that is, unintentionally
    produced by practitioners

35
Dissociative Identity Disorder
  • The number of people diagnosed with the disorder
    has been increasing
  • Although the disorder is still uncommon,
    thousands of cases have been documented in the
    U.S. and Canada alone
  • Two factors may account for this increase
  • A growing number of clinicians believe that the
    disorder does exist and are willing to diagnose
    it
  • Diagnostic procedures have become more accurate
  • Despite changes, many clinicians continue to
    question the legitimacy of this category

36
Why should you doubt claims that dissociative
identity disorder is common?
  • 1. Most cases of dissociative disorders are
    diagnosed by a handful of ardent advocates.
  • 2. The frequency of the diagnosis of dissociative
    disorders in general and DID in particular
    increased rapidly after release of the very
    popular book and movie Sybil.
  • 3. The number of personalities claimed to exist
    in cases of DID has grown rapidly, from a handful
    to 100 or more.
  • 4. Dissociative disorders are rarely diagnosed
    outside of the United States and Canada for
    example, only one unequivocal case of DID has
    been reported in Great Britain in the last 25
    years).

37
DISSOCIATIVE DISORDERS
  • Causes of Dissociative Disorders
  • Psychological Factors in Dissociative Disorders
  • Little controversy that dissociative amnesia and
    fugues can be precipitated by trauma.
  • Trauma is suspected in DID, but much of the
    data is retrospective.
  • The vast majority of trauma victims do not
    develop a dissociative disorder.

38
PSYCHODYNAMIC PERSPECTIVES
  • Freuds model
  • Topographic model
  • conscious
  • preconscious
  • unconscious

39
How Do Theorists Explain Dissociative Amnesia and
DID?
  • State-dependent learning
  • If people learn something when they are in a
    particular state of mind, they are likely to
    remember it best when they are in the same
    condition
  • This link between state and recall is called
    state-dependent learning
  • This model has been demonstrated with substances
    and mood and may be linked to arousal levels

40
How Are Dissociative Amnesia and DID Treated?
  • Therapists usually try to help the client by
  • Recognizing the disorder
  • Recovering memories
  • Integrating the subpersonalities
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