TRAUMA RELATED DISORDERS

1
TRAUMA RELATED DISORDERS
2
Acute Stress Disorder

• A. The person has been exposed to a traumatic
  event in which both of the following were
  present 
• (1) the person experienced, witnessed, or was
  confronted with an event or events that involved
  actual or threatened death or serious injury, or
  a threat to the physical integrity of self or
  others 
• (2) the person's response involved intense fear,
  helplessness, or horror 
• B. Either while experiencing or after
  experiencing the distressing event, the
  individual has three (or more) of the following
  dissociative symptoms 
• (1) a subjective sense of numbing, detachment,
  or absence of emotional responsiveness (2) a
  reduction in awareness of his or her surroundings
  (e.g., "being in a daze") (3) derealization (4) 
  depersonalization (5) dissociative amnesia (i.e.,
  inability to recall an important aspect of the
  trauma) 
• C. The traumatic event is persistently
  re-experienced in at least one of the following
  ways recurrent images, thoughts,
  dreams, illusions, flashback episodes, or a sense
  of reliving the experience or distress on
  exposure to reminders of the traumatic event. 

3

• D. Marked avoidance of stimuli that arouse
  recollections of the trauma (e.g., thoughts,
  feelings, conversations, activities, places,
  people). 
• E. Marked symptoms of anxiety or increased
  arousal (e.g., difficulty sleeping, irritability,
  poor concentration, hypervigilance,
  exaggerated startle response, motor
  restlessness). 
• F. The disturbance causes clinically significant
  distress or impairment in social, occupational,
  or other important areas of functioning or
  impairs the individual's ability to pursue some
  necessary task, such as obtaining necessary
  assistance or mobilizing personal resources by
  telling family members about the traumatic
  experience. 
• G. The disturbance lasts for a minimum of 2 days
  and a maximum of 4 weeks and occurs within 4
  weeks of the traumatic event. 
• H. The disturbance is not due to the direct
  physiological effects of a substance(e.g., a drug
  of abuse, a medication) or a general medical
  condition, is not better accounted for by Brief
  Psychotic Disorder, and is not merely an
  exacerbation of a preexisting Axis I or Axis
  II disorder.

4
POST TRAUMATIC STRESS DISORDERLifetime
Prevalence Rate 8

• A. The person has been exposed to a traumatic
  event in which both of the following were
  present 
• (1) the person experienced, witnessed, or was
  confronted with an event or events that involved
  actual or threatened death or serious injury, or
  a threat to the physical integrity of self or
  others (2) the person's response involved
  intense fear, helplessness, or horror. Note In
  children, this may be expressed instead by
  disorganized or agitated behavior 
• B. The traumatic event is persistently
  re-experienced in one (or more) of the following
  ways 
• (1) recurrent and intrusive distressing
  recollections of the event, including images,
  thoughts, or perceptions. Note In young
  children, repetitive play may occur in which
  themes or aspects of the trauma are
  expressed. (2) recurrent distressing dreams of
  the event. Note In children, there may be
  frightening dreams without recognizable
  content. (3) acting or feeling as if the
  traumatic event were recurring (includes a sense
  of reliving the experience, illusions, hallucinati
  ons, and dissociative flashback episodes,
  including those that occur on awakening or
  when intoxicated). Note In young children,
  trauma-specific reenactment may occur. (4)
  intense psychological distress at exposure to
  internal or external cues that symbolize or
  resemble an aspect of the traumatic event (5)
  physiological reactivity on exposure to internal
  or external cues that symbolize or resemble an
  aspect of the traumatic event 

5

• C. Persistent avoidance of stimuli associated
  with the trauma and numbing of general
  responsiveness (not present before the Ctrauma),
  as indicated by three (or more) of the
  following 
• (1) efforts to avoid thoughts, feelings, or
  conversations associated with the trauma (2)
  efforts to avoid activities, places, or people
  that arouse recollections of the trauma (3)
  inability to recall an important aspect of the
  trauma (4) markedly diminished interest or
  participation in significant activities (5)
  feeling of detachment or estrangement from
  others (6) restricted range of affect (e.g.,
  unable to have loving feelings) (7) sense of a
  foreshortened future (e.g., does not expect to
  have a career, marriage, children, or a normal
  life span) 
• D. Persistent symptoms of increased arousal (not
  present before the trauma), as indicated by two
  (or more) of the following 
• (1) difficulty falling or staying
  asleep (2) irritability or outbursts of
  anger (3) difficulty concentrating (4) hypervigi
  lance(5) exaggerated startle response

6

• E. Duration of the disturbance (symptoms in
  Criteria B, C, and D) is more than 1 month. 
• F. The disturbance causes clinically significant
  distress or impairment in social, occupational,
  or other important areas of functioning. 
• Specify if 
• Acute if duration of symptoms is less than 3
  months Chronic if duration of symptoms is 3
  months or more 
• Specify if 
• With Delayed Onset if onset of symptoms is at
  least 6 months after the stressor
• Symptoms fall in two clusters
• Intrusions/Avoidance intrusive thoughts,
  flashbacks, recurrent dreams, hyperactivity to
  cues of the trauma, and avoidance of
  thoughts/reminders
• Hyperarousal and numbing detachment, loss of
  interest in everyday activities, sleep
  disturbance, irritability, and a sense of a
  foreshortened future

7

• PTSD and Combat
• Studies found that Vietnam Veterans whom had
  access to social support and assistance when they
  returned had lower rates of PTSD
• 6.2 of soldiers returning from Afghanistan and
  12.9 of those returning from Iraq suffer from it
• Seligman Can building resilience inoculate
  soldiers from PTSD?
• Etiology/Treatment (Keane, et al, 2006)
• PTSD Risk factors can be grouped into the
  following 3 categories
• A) Pre-existing factors specific to the
  individual men are more likely to be exposed to
  trauma although women are more likely to develop
  PTSD
• - People who have experienced prior trauma or
  adversities in life may be more vulnerable to the
  development of PTSD

8

• B) Factors related to the traumatic event
  there is a direct relationship between the
  severity of the trauma and the risk of PTSD. Of
  specific relevance is bodily injury. Rape is
  another specific factor which increases the risk
  of PTSD.
• C) Events following the experience trauma
  survivors who receive social support and
  understanding following the event have a
  decreased chance of PTSD.
• - Psychological treatment monitor individuals
  response to medical treatments
• - Covering supportive therapy/stress
  management- help client seal over the pain of
  the trauma- overall increase their ability to
  handle stress
• - Uncovering reliving the trauma, include
  imaginal flooding and systematic desensitization
  
• - Benefit finding some studies have found
  that those who find benefit in the experience of
  trauma are less depressed and tend to have a more
  positive sense of well-being
• - Biological approaches a traumatic experience
  primes the CNS to be hypersensitive about
  danger in the future changes in the
  hippocampus/amygdala have been noted
• Medications are used to target specific symptoms
  (i.e. anti-anxiety, anti-depressant)

9
DISSOCIATIVE DISORDERS

• Dissociative Amnesia
• A. The predominant disturbance is one or more
  episodes of inability to recall important
  personal information, usually of a traumatic or
  stressful nature, that is too extensive to be
  explained by ordinary forgetfulness. 
• B. The disturbance does not occur exclusively
  during the course of Dissociative Identity
  Disorder, Dissociative Fugue, Posttraumatic
  Stress Disorder, Acute Stress Disorder,
  or Somatization Disorder and is not due to the
  direct physiological effects of
  a substance (e.g., a drug of abuse, a medication)
  or a neurological or other general medical
  condition (e.g., Amnestic Disorder Due to Head
  Trauma). 
• C. The symptoms cause clinically significant
  distress or impairment in social, occupational,
  or other important areas of functioning

10

• Depersonalization Disorder
• A. Persistent or recurrent experiences of
  feeling detached from, and as if one is an
  outside observer of, one's mental processes or
  body (e.g., feeling like one is in a dream). 
• B. During the depersonalization experience, reali
  ty testing remains intact. 
• C. The depersonalization causes clinically
  significant distress or impairment in social,
  occupational, or other important areas of
  functioning. 
• D. The depersonalization experience does not
  occur exclusively during the course of
  another mental disorder, such as Schizophrenia, Pa
  nic Disorder,Acute Stress Disorder, or
  another Dissociative Disorder, and is not due to
  the direct physiological effects of
  a substance (e.g., a drug of abuse, a medication)
  or a general medical condition (e.g., temporal
  lobe epilepsy).

11

• Dissociative Fugue
• A. The predominant disturbance is sudden,
  unexpected travel away from home or one's
  customary place of work, with inability to recall
  one's past. 
• B. Confusion about personal identity or
  assumption of a new identity (partial or
  complete). 
• C. The disturbance does not occur exclusively
  during the course of Dissociative Identity
  Disorder and is not due to the direct
  physiological effects of asubstance (e.g., a drug
  of abuse, a medication) or a general medical
  condition (e.g., temporal lobe epilepsy). 
• D. The symptoms cause clinically significant
  distress or impairment in social, occupational,
  or other important areas of functioning.

12

• Dissociative Identity Disorder
• A. The presence of two or more distinct
  identities or personality states (each with its
  own relatively enduring pattern of perceiving,
  relating to, and thinking about the environment
  and self). 
• B. At least two of these identities or
  personality states recurrently take control of
  the person's behavior. 
• C. Inability to recall important personal
  information that is too extensive to be explained
  by ordinary forgetfulness. 
• D. The disturbance is not due to the direct
  physiological effects of a substance(e.g.,
  blackouts or chaotic behavior during Alcohol
  Intoxication) or a general medical condition
  (e.g., complex partial seizures). Note In
  children, thesymptoms are not attributable to
  imaginary playmates or other fantasy play.

13

• The core personality is called the host, which
  typically is passive, dependent, and possibly
  depressed and guilty and the others alters
• Alters reflect a failure to integrate aspects of
  a persons identities, consciousness, and
  memories
• Gaps in memory are a common symptom
• Depression, self-mutilation, frequent suicidal
  ideation/attempts, erratic behavior, PTSD,
  hallucinations and other amnestic/fugue symptoms
  often occur
• Rodelwald (2011) Average number of co-morbid
  disorders is 5-PTSD most common substance abuse,
  depression, and borderline personality disorder
• Most cases involve fewer than 10 personalities

14
The controversy about the validity of DID

• Before 1979, only 200 cases were known, by 1999,
  30,000 were reported in North America alone
• Number of cases began to rise after the release
  of Sybil (1973)
• Clarification of diagnostic criterion as well as
  that for Schizophrenia also contributed
• Etiology
• Factitious Disorder feigning of symptoms to
  maintain the personal benefits that a sick role
  may provide (i.e. attention, concern of medical
  personnel, family members)
• Malingering consciously faking symptoms to
  achieve some non-medical objective (i.e. legal
  system)

15

• - Post-traumatic theory 95 of people with DID
  report memories of severe/horrific abuse as
  children- stems from childs attempts to cope
  with an overwhelming sense of hopelessness/powerle
  ssness in the face of repeated traumtic abuse
• - lacking other resources they dissociate and
  escape into a fantasy , becoming someone else
• - those that are prone to fantasy/hypnosis are
  at greatest risk for developing DID
• - Sociocognitive theory DID develops when a
  highly suggestible person learns to adopt and
  enact the roles of multiple identities, mostly
  because clinicians have inadvertently suggested,
  legitimized, and reinforced them

16

• The controversy of recovered memories of sexual
  abuse
• Loftus (1995) 25 of adults 18-53 recalled a
  memory of being lost in a mall that never
  happened!
• It is important to note that while there are
  times recovered memories are false there are also
  times they are true- the real difficulty is
  telling the difference
• Treatment
• Depersonalization disorder resistant to
  treatment- focused on co-morbid disorders (i.e.
  anxiety, depression). Help a person reassociate
  gaining some sense of control over their
  depersonalization/derealization

17

• Dissociative amnesia/fugue a safe environment
  often allows for spontaneous recovery of
  memories. Hypnosis can be used but the risk of
  false memories has to be considered
• Dissociative Identity Disorder most therapists
  set integration of the previously separate alters
  together with their merging into the host
  personality, as the ultiamte goal of treatment
• Resistance is great because dissociation is
  viewed as a protection
• Coping with current stressors is an essential
  part of treatment as well