Chapter 6: Disorders Linked to Trauma and Stress

Question 1

Stress

Answer 1

The state of stress has 2 components: a stressor, the event that creates that demands, and a stress response, the person’s reactions to the demands. Our response to such stressors is influenced by the way we judge both the events and our capacity to react to them in an effective way. Stress can create fear which is a package of responses that are physical, emotional, and cognitive.

Question 2

Autonomic Nervous System (ANS)

Answer 2

• The network of nerve fibers that connect the central nervous system to all the other organs of the body
• The ANS is the extensive network of nerve fibers that connect the central nervous system (the brain and spinal cord) to all the other organs of the body. These fibers help control the involuntary activities of the organs – breathing, heartbeat, blood pressure, perspiration, and the like

Question 3

Sympathetic Nervous System

Answer 3

• The nerve fibers of the autonomic nervous system that quicken the heartbeat and produce other changes experienced or arousal
• When we face a dangerous situation, the hypothalamus first excites this system, then a group of ANS fibers that work to quicken the heartbeat and produce other changes that we come to experience as fear and anxiety (e.g., they may directly stimulate the heart and increase heart rate)

together the sympathetic and parasympathetic nervous systems help control our arousal reactions*

Question 4

Parasympathetic Nervous System

Answer 4

• The nerve fibers of the autonomic nervous system that help return bodily processes to normal
• When the perceived danger passes, a second group of autonomic nervous system fibers, called the Parasympathetic Nervous System, helps return our heartbeat and other processes to normal

together the sympathetic and parasympathetic nervous systems help control our arousal reactions

Question 5

Corticosteroids

Answer 5

• hormones, including cortisol, released by the adrenal glands at times of stress
• The hypothalamic-pituitary-adrenal (HPA) pathway, in turn, stimulates the outer layer of the adrenal glands, an area called the adrenal cortex, triggering the release of a group is hormones called corticosteroids, including the hormone, cortisol. These corticosteroids travel to various body organs, where they further produce arousal reactions

Question 6

Acute Stress Disorder

Answer 6

• a disorder in which a person experiences fear and related symptoms soon after a trauma but for less than a month
• Onset: Starts soon after the traumatic incident occurred. Patterns that arise in reaction to a psychologically traumatic event. A traumatic event is one in which a person is exposed to actual or threatened death, serious injury, or sexual violation
• Duration: 4 weeks or 1 month, but no longer than that, if symptoms last longer than it is considered PTSD

Question 7

Posttraumatic Stress Disorder (PTSD)

Answer 7

• a disorder in which a person experiences fear and related symptoms long after a traumatic event
• Onset: 25% of people with PTSD do not develop a full clinical syndrome until 6 months or more after their trauma. Patterns that arise in reaction to a psychologically traumatic event. A traumatic event is one in which a person is exposed to actual or threatened death, serious injury, or sexual violation
• Duration: may begin shortly after the traumatic event or months or years afterward. 25% of people with PTSD do not develop a full clinical syndrome until 6 months or more after their trauma

Question 8

Acute Stress Disorder & Posttraumatic Stress Disorder (PTSD) Symptoms

Answer 8

• repeated, uncontrolled, and distressing memories
• repeated and upsetting trauma-linked dreams
• dissociative experiences such as flashbacks, significant upset when exposed to trauma-linked cues
• pronounced physical reactions when reminded of the event(s)
• person avoids trauma-linked stimuli
• a person experiences negative changes in trauma-linked cognitions and moods, such as being unable to remember key features of the event(s) or experiencing repeated negative emotions
• a person displays conspicuous changes in arousal or reactivity, such as excessive alertness, extreme startle responses, or sleep disturbances
• person experiences significant distress or impairment,

Question 9

What are common triggers to a post-traumatic stress reaction?

Answer 9

• Combat (fighting in wars)
• Disasters (flood, earthquake, hurricane, Tsunami, etc.)
• Abuse, Victimization (sexual assault, terrorism, torture)

Question 10

Biology & Genetic Influence on Stress Disorders

Answer 10

• Biology and Genetics: brain-body stress pathways, the brain’s stress circuit, and inherited predispositions
• Brain-Body Stress Pathways: people who develop PTSD react with especially heightened arousal in the pathways (sympathetic nervous system pathway & hypothalamic-pituitary-adrenal (HPA) pathway). This persistent over-reactivity may lock in brain and body dysfunction and the continuing symptoms of PTSD
• Brain’s Stress Circuit: dysfunction in one such circuit, the stress circuit, apparently contributes to the symptoms of PTSD. The brain’s stress circuit includes such structures as the amygdala, prefrontal cortex, anterior cingulate cortex, insula, and hippocampus, among others.
• Inherited Predisposition: when individuals inherit a tendency for overly reactive brain-body stress pathways and a dysfunctional brain stress circuit

Question 11

Personality Influence on Stress Disorders

Answer 11

research suggests that people with certain personalities, attitudes, and coping styles are particularly likely to develop posttraumatic stress disorder. Research has also found that people who generally view life’s negative events are beyond their control tend to develop more severe stress symptoms after trauma. It has been found that people with a resilient style of personality are less likely than other individuals to develop PTSD after encountering traumatic events

Question 12

Childhood Experiences Influence on Stress Disorders

Answer 12

researchers believe that such a predisposition may be acquired during childhood rather than inherited at birth. Researchers have found that certain childhood experiences increase a person’s risk for later PTSD (e.g., people whose childhoods were marked by poverty appear more likely to develop the disorder in the face of later trauma)

Question 13

Social Support Influence on Stress Disorders

Answer 13

people whose social and family support systems are weak are also more likely to develop posttraumatic stress disorder after a traumatic event. Clinical reports have suggested that poor social support contributes to the development of PTSD in some combat veterans

Question 14

Severity of the Trauma Influence on Stress Disorders

Answer 14

the severity and nature of the traumatic event a person encounters help determine whether the individual will develop a stress disorder. Some events may override a favorable biological foundation, nurturing childhood, positive attitudes, and/or social support. 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. People who experience intentionally inflicted traumas are more likely to develop a stress disorder than persons who encounter unintentional traumas

Question 15

What are treatments for acute and post-traumatic stress disorders?

Answer 15

• All programs share basic goals: they try to help survivors put an end to their stress reactions, gain perspective on their painful experiences, and return to constructive living
• Antidepressant drugs, cognitive (therapists guide people to examine and change the dysfunctional attitudes) -behavioral (therapists typically apply exposure techniques) therapy, couple/family therapy, group therapy
• Prolonged Behavior: a treatment approach in which clients confront not only trauma-related objects and situations but also their painful memories of traumatic experiences
• Eye Movement Desensitization and Reprocessing (EMDR): an exposure treatment in which clients move their eyes in a rhythmic manner from side to side while flooding their minds with images of objects and situations they ordinarily avoid

Question 16

Psychological Debriefing

Answer 16

• a form of crisis intervention in which victims are helped to talk about their feelings and reactions to traumatic incidents. Also called critical incident stress debriefing
• Some clinicians believe that the early intervention programs may encourage victims to dwell too long on the traumatic events they have experienced. And a number worry that early disaster counseling may unintentionally “suggest” problems to certain victims, this helping to produce stress disorders. Given the unsupportive research findings of recent years, the current clinical climate is moving away from the ready application of this approach. A growing number of clinicians believe that certain high-risk individuals may profit from debriefing programs and that those people should receive debriefing techniques immediately after a traumatic event, but that other trauma victims should not necessarily receive such interventions

Question 17

Dissociative Disorders

Answer 17

• disorders marked by major changes in memory that do not have clear physical causes
• The memory difficulties and other dissociative symptoms found in these disorders are particularly intense, extensive, and disruptive. No clear physical factors at work in dissociative disorders. On part of a person’s memory or identity becomes dissociated, or separated, from other parts or his or her memory or identity

Question 18

Dissociative Amnesia

Answer 18

• a disorder marked by an inability to recall important personal events and information
• Person cannot recall important life-related information, typically traumatic or stressful information. The memory problem is more than simple forgetting. Significant distress or impairment. The symptoms are not caused by a substance or medical condition

Question 19

Dissociative Fugue

Answer 19

• a form of dissociative amnesia in which a person travels to a new location and may assume a new identity, simultaneously forgetting his or her past
• Their fugue may be brief (hours, days, etc.) and end suddenly. In other cases, however, the person may travel far from home, take a new name, and establish a new identity, new relationships, and even a new line of work. Such people may also display new personality characteristics; often they are more outgoing (e.g., Jason Bourne)

Question 20

Dissociative Identity Disorder

Answer 20

• a dissociative disorder in which a person develops 2 or more distinct personalities. Also known as multiple personality disorder
• Person experiences a disruption to his or her identity, as reflected by at least 2 separate personality states or experiences of possession. Person repeatedly experiences memory gaps regarding daily events, key personal information, or traumatic events, beyond ordinary forgetting. Significant distress or impairment. The symptoms are not caused by a substance or medical condition.

Question 21

Psychodynamic Explanations for the Dissociative Disorders

Answer 21

theorists believe that these dissociative disorders 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. Everyone uses repression to a degree but people with dissociative amnesia and dissociative identity disorder are thought to repress their memories excessively (e.g., theorists view dissociative amnesia is a single episode of massive repression)

Question 22

State-Dependent Learning

Answer 22

learning that becomes associated with the conditions under which it occurred, so that it is best remembered under the same conditions (e.g., research with human participants showed that state-dependent learning can be associated with mood states as well: material learned during a happy mood is recalled best when the participant is again happy, and sad-state learning is recalled best during sad states)

Question 23

What role does hypnosis play in treating dissociative disorders, and is it effective?

Answer 23

• Hypnotic Therapy: a treatment in which the patient undergoes hypnosis and is then guided to recall forgotten events or perform other therapeutic activities. Also known as hypnotherapy
• Because there has not been a lot of controlled investigations of hypnotic therapy and it is based more on case studies = seems effective enough for treating patients with this specific disorder but then again, there’s no research that proves it.

Question 24

How do therapists help people with dissociative amnesia?

Answer 24

• Psychodynamic Therapy: therapists guide patients to search their unconscious in the hope of bringing forgotten experiences back to consciousness. The focus of psychodynamic therapy seems particularly well suited to the needs of people with dissociative amnesia
• Hypnotic Therapy: a treatment in which the patient undergoes hypnosis and is then guided to recall forgotten events or perform other therapeutic activities (A.K.A., hypnotherapy). Therapists hypnotize patients and then guide them to recall their forgotten events.
• Drug Therapy: Sodium Amobarbital (Amytal) & Sodium Pentobarbital (Pentothal) injections of these barbiturates have been used to help patients with dissociative amnesia regain their lost memories. These drugs are often called “truth serums,” but actually their effect is to calm people and free their inhibitions, thus helping them to recall anxiety-producing events (don’t always work)

Question 25

How therapists help people with dissociative identity disorder

Answer 25

• Therapists usually try to help the clients (1) recognize fully the nature of their disorder (2) recover the gaps in their memory (3) integrate their subpersonalities into one functional personality
• Recognizing the Disorder: therapists usually try to bond with the primary personality and with each of the subpersonalities. As the bonds form, therapists try to educate patients and help them to recognize fully the nature of their disorder.
• Recovering Memories: to help patients recover the missing pieces of their past, therapists use psychodynamic therapy, hypnotherapy, and drug treatment
• Integrating the Subpersonalities: Therapists have used a range of approaches to help merge subpersonalities, including psychodynamic, supportive, cognitive, and drug therapies