Abnormal Psych Chapter 5 Flashcards
What is stress?
A perception that environmental demands overwhelm one’s personal resources available to deal with them
What can responding constructively to stress involve?
Changing perceptions
Reducing, reframing, or renegotiating demands
Increasing personal resources to meet demands
Deploying personal resources more effectively
Characteristics of stressful events
Uncontrollable (natural disasters, many illnesses)
Unpredictable (earthquakes, some job layoffs, accidents)
Change/challenge capabilities or self concepts (exams, new relationships, a tough new job)
Stress response
Body must turn on, then turn off the stress response
Activate sympathetic nervous system, then activate the parasympathetic nervous system to restore homeostasis
Problems if homeostatic balance is not properly restored
Problems if stress response stays active long term
What happens in the brain when a threat is perceived?
Sensory input (e.g., see hear)
Amygdala: threat detected
Activates hypothalamus
Initiates the “fight or flight” response via two systems:
Sympathetic Nervous System
Pituitary -> Endocrine System
DSM-5 criteria for PTSD
The person has been exposed to a traumatic event in which they experienced, witnessed, or were confronted with an event involving actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others
Examples of traumatic events
Physical assault, sexual assault, sudden near-death experiences, military, natural disaster
Symptoms of PTSD per DSM-5
Re-experiencing the trauma
avoidance, Reduced responsiveness (detached, dissociation, derealization), Increased arousal, negative emotions, and reactivity
Re-experiencing the trauma
Recurrent, intrusive memories/dreams
“Flashbacks”
Intense response to cues to traumatic event
Avoidance
Avoiding thoughts, feelings, conversations, activities, places, or people reminiscent of trauma
Inability to recall aspects of the trauma
Reduced responsiveness
Feeling detached/ estranged from others
Restricted range of affect
Diminished interest in activities
Sense of foreshortened future
Increased arousal & negative emotions
Difficulty falling or staying asleep
Irritability or outbursts of anger
Difficulty concentrating
Hyper-vigilance
Exaggerated startle response
Acute stress disorder vs PTSD
Acute Stress Disorder: symptoms begin soon and last less than a month
Post Traumatic Stress Disorder: onset and duration of symptoms variable
What percent of men and women experience at least one traumatic event in their lifetime?
61% of men and 51% of women
What percent of the population aged 18-54 will experience symptoms of PTSD in a given year?
4%
Lifetime prevalence rates of PTSD
For Women is about 10%
For Men is about 5%
Course of PTSD
Onset: within 3 months or not until years later
Duration: varies
Some people recover within 6 months while others may suffer much longer. About half of all cases of PTSD improve within 6 months; the remainder may persist for years
Pattern:
Periods of acute symptoms followed by remissions are common.
Some individuals experience severe and unremitting symptoms.
Course and duration are very variable
Associated comorbid disorders with PTSD
Major depressive episodes
Alcohol/drug abuse/dependence
Simple and social phobias (more in women)
Conduct disorders (more in men)
In children: Anxiety disorders, Acting-out disorders
PTSD symptoms in children
Generalized fears
Sleep disturbances
Posttraumatic play and reenactment
Lose an acquired developmental skill
Omen formation
Pre-trauma risk factors for PTSD
poor coping skills
pre-existing mental-health problems
poor social support
Trauma-related risk factors for PTSD
the amount of physical injury
potential life-threat
loss of significant others
Post-trauma risk factors for PTSD
the rate of physical recovery
social support
involvement in work and social activities
Biological/genetic aspects of PTSD
Abnormal levels of cortisol and norepinephrine
System remains unstable, triggering symptoms, possible brain damage
Vulnerability may be passed on genetically
General clinical goals when treating PTSD
End lingering stress reactions
Gain perspective on painful experiences
Return to constructive living
Process goals when treating PTSD
Exposing the client to what they fear in order to extinguish that fear.
Challenging distorted cognition.
Helping reduce stress in daily lives.
Improving coping capacity.
Basic recommendations for those with PTSD
Reestablish Routines
Find Support Network
Avoid Major Life Decisions
Common treatments for combat veterans
Drug therapy:
Antianxiety and antidepressant medications
Behavioral exposure techniques:
Reduce specific symptoms, increase overall adjustment
Flooding and relaxation training
Eye movement desensitization and reprocessing (EMDR)
Insight therapy:
Bring out deep-seated feelings, create acceptance, lessen guilt
Often use family or group therapy formats; “rap groups”
Usually used in combinations
Which brain structure sets in motion the features of arousal?
The hypothalamus
What systems does the hypothalamus activate?
1) The autonomic nervous system: the extensive network of nerve fibers that connect the central nervous system (brain and spinal cord) to all other organs of the body, helping to control the involuntary activities of the organs
2) The endocrine system: the network of glands located throughout the body
When we face a dangerous situation, what does the hypothalamus excite?
The sympathetic nervous system: a group of ANS fibers that work to quicken our heartbeat and produce the other changes that we come to experience as fear or anxiety
What happens physically when perceived danger passes?
The parasympathetic nervous system helps return our heartbeat and other body processes to normal
Hypothalamic-pituitary-adrenal (HPA) axis
When we are faced by stressors, the hypothalamus signals the pituitary gland to secrete the adrenocorticotropic hormone (ACTH), sometimes called the body’s “major stress hormone”
ACTH in turn stimulates the outer layer of the adrenal glands, the adrenal cortex, triggering the release of a group of stress hormones called corticosteroids, including cortisol
Corticosteroids travel to various body organs, where they further produce arousal reactions
What are the reactions throughout the sympathetic nervous system and HPA axis collectively referred to as?
The fight-or-flight response, because they arouse our body and prepare us for a response to danger
Acute stress disorder
A disorder in which a person experiences fear and related symptoms soon after a trauma but for less than a month
Posttraumatic stress disorder
A disorder in which a person experiences fear and related symptoms long after a traumatic event
When could the symptoms of PTSD begin?
Either shortly after the traumatic event or months or years afterward
What fraction of acute stress disorder cases develop into PTSD?
At least half
Emotional dysregulation/Labile mood
Fluctuating anxiety, anger, or depression
Dissociation
Psychological separation
Depersonalization
Feeling that one’s conscious state or body is unreal
Derealization
Feeling that the environment is unreal or strange
What percent of people in North America have one of the stress disorders in any given year?
3.5 to 6 %
What percent of people in North America have one of the stress disorders at some point during their lifetimes?
7 to 12 %
Gender likelihood of stress disorders
Women are more likely than men to develop a stress disorder
What percent of people with life-threatening illnesses or severe chronic conditions develop PTSD?
25%
What percent of women who are raped develop PTSD?
46%
What happens in our body when we are stressed?
The brain’s hypothalamus activates two stress routes: the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis
These routes react to stress by producing a general state of arousal, the former through nerve cell firing and the latter through releasing hormones into the bloodstream
What does research suggest about people with PTSD and their stress routes?
They react to stress with especially heightened arousal in the routes
What hormones have researchers found abnormal activity in in PTSD victims?
Cortisol and norepinephrine, major players in the two stress routes
What have researchers found about the brain’s stress circuit in PTSD patients?
Dysfunctions within and between three structures in the circuit - the amygdala, prefrontal cortex, and hippocampus - play particularly key roles in PTSD
Activity by the amygdala is too high and activity by the prefrontal cortex is too low
Is there a genetic component to PTSD?
Yes-genetic studies have located several genes that might be involved in inherited susceptibility
What childhood experiences could make a person more likely to get PTSD?
Poverty, neglect, assault, abuse, a catastrophe, parental conflict, or living with family members suffering from psychological disorders
What are some cognitive factors that appear to play a key role in PTSD?
Individuals who develop PTSD often display significant memory difficulties prior to their exposure to trauma
Individuals who have a high intolerance of uncertainty (extreme discomfort with the fact that negative events can occur unpredictably in life) are susceptible to PTSD
Inflexible coping style and PTSD
Inflexible coping style may increase the likelihood of developing PTSD
Resilience
The process of adapting well in the face of adversity
Relationship between resilience and PTSD
People who are repeatedly resilient in life are less likely than other individuals to develop PTSD upon encountering traumatic events
Relationship between social support systems and PTSD
People whose social and family support systems are weak are more likely to develop PTSD after a traumatic event
Relationship between severity/nature of trauma and stress disorders
Generally, the more severe or prolonged the trauma and the more direct one’s exposure to it, the greater the likelihood of developing a stress disorder
Complex PTSD
Persons with complex PTSD experience normal PTSD symptoms as well as profound disturbances in their emotional control, self-concept, and relationships
Encounters with multiple or recurring traumas can lead to complex PTSD
What fraction of cases of PTSD improve within 12 months when treated?
1/3
Antidepressant drugs as treatment for PTSD
Helpful for the PTSD symptoms of increased arousal and negative emotions, less helpful for recurrent negative memories, dissociations, and avoidance behaviors
Cognitive-behavioral therapy as treatment for PTSD
Cognitive: guide veterans to examine and change the dysfunctional attitudes and styles of interpretation they have developed as a result of their traumatic experiences; veterans learn to deal with difficult memories and feelings, come to accept what they have experienced and done, become less judgmental of themselves, and begin to trust other people again; mindfulness techniques
Behavioral: exposure techniques, in which veterans are guided to confront trauma-related objects, events, and situations
Prolonged exposure
Therapists direct clients to confront not only trauma-related objects and situations but also their painful memories of traumatic experiences
Clients repeatedly recall and describe the memories in great detail for extended periods of time, holding on to them until becoming less aroused, anxious, and upset by them
Eye movement desensitization and reprocessing (EMDR)
Clients move their eyes in a rhythmic manner from side to side while flooding their minds with images of the objects and situations they ordinarily try to avoid
Psychological debriefing
Victims of trauma talk extensively about their feelings and reactions within days of the critical incident
The clinicians then clarify to the victims that their reactions are normal responses to a terrible event, offer stress management tips, and in some cases refer the victims to professionals for long-term counseling
Psychological first aid (PFA)
A disaster response intervention that seeks to reduce the initial distress of victims and foster their adaptive functioning, but without procedures that may be premature, intrusive, or inflexible
Dissociative disorders
Disorders marked by major changes in memory that do not have clear physical causes
Memory
The faculty for recalling past events and past learning
Dissociative amnesia
A disorder marked by an inability to recall important personal events and information
Localized amnesia
A person loses all memory of events that took place within a limited period of time, almost always beginning with some very disturbing occurrence
Amnestic episode
The forgotten period
Most common form of dissociative amnesia
Localized amnesia
Selective amnesia
People remember some, but not all, events that took place during a period of time
Second most common form of dissociative amnesia
Generalized amnesia
People forget events that occurred earlier in their life, not just trauma-linked events
Continuous amnesia
Forgetting continues into the present
What percent of all adults experience dissociative amnesia in a given year?
2%
Dissociative fugue
An extreme version of dissociative amnesia in which persons not only forget their personal identities and details of their past lives but also flee to an entirely different location
Dissociative identity disorder
A dissociative disorder in which a person develops two or more distinct personalities, often called subpersonalities or alternate personalities, each with a unique set of memories, behaviors, thoughts, and emotions
What percent of the population are reported to experience DID within a given year?
1%
Gender differences in DID?
Women receive this diagnosis at least 3 times as often as men
Mutually amnesic relationships
Subpersonalities have no awareness of one another
Mutually cognizant patterns
Each subpersonality is well aware of the rest
One-way amnesic relationships
Some subpersonalities are aware of others (coconscious subpersonalities), but the awareness is not mutual
Average number of subpersonalities per patient
15 for women and 8 for men
How do subpersonalities differ?
They may have their own names and different identifying features (age, gender, race, family history), abilities and preferences, and physiological responses (e.g., differences in blood pressure levels and allergies)
Iatrogenic
Unintentionally produced by practicioners
Psychodynamic view of dissociative disorders
Believe they are caused by repression, the most basic ego defense mechanism: people fight off anxiety by unconsciously preventing painful memories, thoughts, or impulses from reaching awareness
Amnesia is a single episode of massive repression, while DID is a lifetime of excessive repression
State-dependent learning
Learning that becomes associated with the condition under which it occurred, so that it is best remembered under the same conditions
Hypnotic amnesia
Hypnosis can make people forget facts, events, and even their personal identities
Self-hypnosis
People hypnotize themselves to forget unpleasant events
Psychodynamic treatment for dissociative amnesia
Therapists guide patients to search their unconscious in the hope of bringing forgotten experiences back to consciousness
Hypnotic therapy
Therapists hypnotize patients and then guide them to recall their forgotten events
What types of drugs can be useful for dissociative amnesia?
Barbiturates like amytal or pentothal, which calm people and free their inhibitions, thus helping them to recall anxiety-producing events
What do therapists do to treat patients with DID?
Help patients:
1) Recognize fully the nature of their disorder
2) Recover the gaps in their memory
3) Integrate their subpersonalities into one functional personality
Depersonalization-derealization disorder
A dissociative disorder marked by the presence of persistent and recurrent episodes of depersonalization, derealization, or both
Depersonalization
The sense that one’s own mental functioning or body is unreal or detached
Derealization
The sense that one’s surroundings are unreal or detached
Doubling
The sensation where one’s mind seems to be floating a few feet above them
What percent of the population experiences depersonalization-derealization disorder?
2%
