Chapter 7: Trauma and Dissociation

Question 1

Trauma- and stressor-related disorders

Answer 1

1. Post traumatic stress disorder
2. Adjustment disorders
3. Attachment disorders

Question 2

Post traumatic stress disorder (PTSD)

Answer 2

Enduring, distressing emotional disorder that follows exposure to a severe helplessness or fear inducing threat. The victim re-experiences the trauma, avoids stimuli associated with it, and develops a numbing of responsiveness and an increased vigilance and arousal.

• Diagnosis cannot be made until at least one month after the occurrence of the traumatic event.
• When PTSD continues longer than three months, it is considered chronic.

Question 3

PTSD with a disassociative subtype

Answer 3

A subgroup of individuals with PTSD may also experience dissociative symptoms. Individuals with PTSD respond differently to treatment if they meet the criteria for dissociative subtype.

Question 4

PTSD and the DSM-III

Answer 4

PTSD was first named in 1980 in the DSM-III

Question 5

Samuel Pepys

Answer 5

In 1666 Samuel witnessed the Great Fire of London and later describe symptoms of PTSD in his diary

Question 6

Acute stress disorder

Answer 6

Similar to PTSD occurring within the first month after the trauma.

• According to a recent study approximately 50% of individuals with acute stress disorder going to develop PTSD.
• Acute stress disorder was included in the DSM-IV because many people with very severe early reactions to trauma could not otherwise diagnosed

Question 7

PTSD and suicide

Answer 7

A diagnosis of PTSD predicts suicide attempts independently of any other problem, such as alcohol abuse.

Question 8

Statistics

Answer 8

• One study found that 32% of rape survivors meet the criteria for PTSD at some point in their lives
• Looking at all types of trauma in a large sample of US adult women it was found at 18% experience PTSD.
• 15 to 20% of Canadian adult experiencing severe auto accidents developed PTSD.
• 11% of members of the Canadian Armed Forces reported experiencing PTSD during their lifetime.
• 19% of Vietnam war veterans developed PTSD.
• 67% of prisoners of war in Vietnam developed PTSD.
• 20% of individuals living close to the World Trade Centre developed PTSD compared to 8% of people that lived further away further away
• 10.5% of children in grades four through 12 suffered PTSD after September 11
• In 2012 1.7% of the Canadian population 15 years or older had a current diagnosis of PTSD

Question 9

Adjustment disorders

Answer 9

Anxious or depressive reactions to life stress that are generally milder than one would see in acute stress disorder or PTSD but are nevertheless impairing in terms of interfering with work or school performance, interpersonal relationships, or other areas of living.

• doesn’t meet criteria for other anxiety or mood disorders
• If the symptoms persist more than six months after the removal of the stress or its consequences, they just met disorder would be considered chronic.

Question 10

Attachment disorders

Answer 10

Refer to the disturbed and developmentally inappropriate behaviours in children, emerging before five years of age, in which the child is unable or unwilling to form normal attachment relationships with caregiving adults.

• Due to inadequate or abusive child rearing practices.
• Considered to be pathological reactions to early extreme stress.
• Two separate attachment disorders are reactive attachment disorder and disinhibited social engagement disorder. (Separated in the DSM-5, Because of the markedly different presentations of an adequate detachment behaviour.)

Question 11

Reactive attachment disorder

Answer 11

The child will very seldom seek out a caregiver for protection, support, and nurturance and will seldom respond to offers from caregivers to provide this kind of care.
-lack of responsiveness, limited positive affect, and additional heightened emotionality, such as fearfulness an intense sadness.

Question 12

Disinhibited social engagement disorder

Answer 12

A similar set of child-rearing circumstances (as reactive attachment) perhaps including early persistent harsh punishment would result in a pattern of behaviour in which the child shows no inhibition whatsoever to approaching adults.
-Such a child might engage in inappropriately intimate behaviour by showing a willingness to immediately accompany an unfamiliar adult figure somewhere without first checking back with the caregiver.

Question 13

Dissociative disorders

Answer 13

Disorders in which individuals feel detached from themselves or their surroundings, and reality, experience, and identity may disintegrate.

1. Depersonalization-derealization disorder
2. Dissociative amnesia
3. Dissociative identity disorder (DID)
4. Dissociative trance disorder (DTD)

Question 14

Depersonalization

Answer 14

Perception alters so that you temporary lose a sense of your own reality.

Question 15

Derealization

Answer 15

Sense of the reality of the external world is lost.

Question 16

Depersonalization–derealization Disorder

Answer 16

A disassociative disorder in which feelings of depersonalization or so severe they dominate the client’s life and prevent normal functioning.

• very rare.
• Not the same as psychosis as the person experiencing episodes remains in good contact with reality.
• Majority of cases, onset occurred following a traumatic life event, after sexual abuse, or after giving birth.
• mean age onset 16
• chronic, lasting an average of 15.7 years
• 50% had comorbid mood and anxiety disorders
• deficits in perception, attention, emotional responding
• psychological treatments haven’t been studied
• evaluation of Prozac did not show any treatment effect

Question 17

Disassociative amnesia

Answer 17

Disassociative disorder future in the inability to recall personal information, usually have a stressful a traumatic nature.

1. Generalized amnesia: unable to remember anything. May be lifelong or extend from a period in the more recent past, such as six months or a year previously. (Identity, life history)
2. Localized amnesia (selective amnesia): failure to recall specific events, usually traumatic, that occur during a specific period. Far more common than generalized. (Events)
   - common during war

Question 18

Disassociative fugue

Answer 18

• Fugue literally means flight
• Memory loss revolves around a specific incident-an unexpected trip.
• individuals leave and later find themselves in a new place, unable to remember why or how they got there.
• Usually they have left behind and intolerable situation.

Question 19

Disassociative identity disorder (DID)

Answer 19

Formally known as multiple personality disorder, disorder in which as many as 100 personalities or fragments of personalities coexist within one body and mind.

• Average number of alters is 15
• How much more common in females
• The onset is almost always in childhood, often as young as four years of age, although it is usually approximately seven years after the appearance of symptoms before the disorder is identified.
• last a lifetime in the absence of treatment
• Almost all patients presenting with this disorder report horrible, often unspeakable, abuse as a child

Question 20

Nicholas Spanos

Answer 20

Leading expert worldwide on Hipnosis, dissociative disorders, and false memories.