Exam 2 Flashcards
1
Q
4 Components of Depression
A
Emotional
Cognitive
Somatic
Behavioral
2
Q
Common Beliefs about Depression
A
Feeling sad
Weak personality
Personal flaw
Lazy
Selfish
3
Q
Emotional Components of Depression
A
Sad Mood and Anhedonia
4
Q
Anhedonia
A
Lack of pleasure and interest
5
Q
Cognitive Components of Depression
A
- Trouble concentrating / easily distracted
- Trouble making decisions
- Thoughts of death / Hopeless about the future
- Guilt – ruminating on things that you did that may barely be true and dwelling on that feeling
6
Q
Somatic Components of Depression
A
Fatigue / heavy feeling
Changes in appetite
Changes in sleep
7
Q
Behavioral Components of Depression
A
Psychomotor retardation:
Slow walking
Slow speech
Slumped posture
Avoiding eye contact
Difficulty with fine motor tasks
Psychomotor agitation:
Pacing
Fidgeting
Wringing hands
Uncontrolled tongue movement
Pulling off clothing and putting it back on
8
Q
DSM-5 Criteria for diagnosing MDD
A
5+ depressive symptoms, including sadness and/or anhedonia
Symptoms most of the day nearly every day, for 2+ weeks
Causing significant impairment / distress
9
Q
Depressive Additional Symptoms
A
Changes in sleep
Change in appetite or weight
Psychomotor agitation or retardation
Loss of energy
Feelings of worthlessness or excessive/inappropriate guilt
Difficulty concentrating, thinking, decision making
Recurrent thoughts of death or suicide
10
Q
DSM-5 Criteria for PDD
A
2 years of depressed mood and 2 or more other symptoms
11
Q
When is the avg age of onset for depression and is it changing?
A
Average age of onset is in early 30s, however this has decreased over past 50 years
12
Q
What age group had a significant increase in depression during covid?
A
Children and Teens
13
Q
What percent typically recover from depression within 6 months?
A
~50%
14
Q
Do people usually have one or multiple depressive episodes in their life?
A
Some experience a single depressive episode in their life, most have repeated episodes
15
Q
Depression accounts for ___% of disability worldwide
A
10%
16
Q
___% of population experiences depression
A
~16 - 20
17
Q
Which age group has the most depression and what percent?
A
30 - 44 yr olds and 19%
18
Q
Why is Dysthymia (PDD) so rare?
A
It’s underdiagnosed
19
Q
Why are women 2x more likely than men to have depression
A
Explanations: Women internalize their issues more than men OR Women have different hormones
20
Q
When does the gender difference in depression rates peak?
A
Adolescence
21
Q
What are the cross cultural differences in depression?
A
Depression is an universal experience however symptoms focus may be different
Ex. China the focus is on somatic symptoms whereas in Europe/NA the focus is on the feelings of guilt
However, this is changing and young generations in China are starting to focus on the emotions as well
22
Q
Social aspect of the Depression via the Biopsychosocial Model
A
Stressful life events predict depressive disorders
42-67% report stressful life event in year prior to depression
–> Poorer response to treatment (those with stressful life events respond worse to treatment partially because we have to help the event and the depression at the same time)
–> Longer time before remission
23
Q
Cogntitive aspect of the Depression via the Biopsychosocial Model
A
The way we think, perceive, and remember events influences how we feel and act
Automatic Negative Thoughts associated with depression
(If every time someone interprets an experience negatively, then they might get depressed)
24
Q
Psychological aspect of the Depression via the Biopsychosocial Model
A
Attributions Theory: Depression is associated with a tendency to view the causes of negative life events as being internal (“my fault”), stable (“always going to happen”) and global (“affects everything in my life”).
You can either attribute life to:
Internal, Stable, Global → Leads to Depression
External, Unstable, Specific
25
Biological aspect of the Depression via the Biopsychosocial Model
* Heritability ~50% --> Gene and Environment are important
* Serotonin
* Brain
26
How does Serotonin relate to Depression
one of the leading theories -> low levels of serotonin cause depression
Discovered when meds that increase serotonin were found to help mood
However, increasing serotonin via meds doesn’t always work, and it takes time
Research is mixed, unlikely to be the single cause
27
Besides serotonin which other neurotransmitters are related to depression?
Dopamine, norepinephrine and GABA are all likely involved
28
What does a variety of symptoms suggest in terms of depression?
Variety of symptoms may suggest different involvement via neurotransmitters
29
Dorsolateral prefrontal cortex
Function and Pattern in Depression
Function: Planning and executive functioning
Pattern: Decreased activity in some studies
30
Ventromedial prefrontal Cortex Function and Pattern in Depression
Function: Regulating Emotion
Pattern: Increased activity in some studies
31
Anterior Cingulate Cortex Function and Pattern in Depression
Function: motivation, emotion regulation
Pattern: Decreased activity
32
Amygdala Function and Pattern in Depression
Function: emotional salience
Pattern: increased activity in response to threat/negative stimuli
33
Can we use brain activity to diagnose depression?
No because it is not reliable!
34
3 Main Treatments for Depression
CBT
Mindfulness Based Cognitive Therapy
MDD Medications
35
Behavioral Activation
Increased activity with reinforcing events
36
Common cognitive distortions in depression
All or nothing thinking
Disqualifying the positive
Catastrophizing
Jumping to conclusions
37
Mindfulness-Based Cognitive Therapy
Thoughts are not facts; observe thoughts
Especially useful in reducing relapse of depression
Examples: Yoga, meditation, mindfulness-based practices, body scan exercises, and mindful stretching
38
SSRIs
Block reuptake of serotonin
Side effects common
Fairly effective
Take 4-6 weeks
Not effective for up to 1/3 people
39
SNRIs
More side effects
Can have brain zaps
Can have flu like symptoms when stopping
40
Combinations and Comparisons of Depression Treatment
Combining psychotherapy and antidepressant medications increases odds of recovery over either alone by 10–20%
--> Medications quicker, therapy longer-lasting effects
CBT is as effective as medication for severe depression
--> and CBT more effective than medication at preventing relapse
41
Other Treatments for Depression
Electroconvulsive Therapy (ECT)
Transcranial Magnetic Stimulation (TMS)
Exercise / Physical Activity
Ketamine
42
What is TMS and how does it work for depression?
Applies a magnetic pulse
Approved by FDA for treatment resistant depression
Targets the DLPFC
30-40% remission rates
43
What are characteristics of a Manic Episode?
Distinctly elevated or irritable mood
Abnormally increased activity or energy
AND 3 or more of Additional Symptoms
44
Additional Manic Episode Symptoms
Increased goal-directed activity or psychomotor agitation
Talkative; rapid speech
Flight of ideas or racing thoughts
Decreased need for sleep
Increased self-esteem / grandiosity
Distractibility
Excessive risky behavior (e.g., reckless spending/sexual behavior/driving)
45
How long do manic episodes have to last?
Lasts at least a week most of the day nearly every day, or requires hospitalization
46
Hypomanic episode
Last at least 4 days, clear changes in functioning but impairment isn’t as significant
47
Bipolar 1
Having one manic episode
48
Bipolar 2
Includes hypomanic episodes – not fully manic episode
49
What is the prevalence of Bipolar?
Prevalence - ~1% for Bipolar I; ~4% for Bipolar Disorders combined
50
What is the avg onset for Bipolar Disorder?
Onset occurs between 18-22 years of age
51
Are there gender differences for Bipolar?
No but women report more depressive episodes
52
Do people with bipolar have more depressive or manic episodes?
About 3x as many days depressed as manic/hypomanic
53
Do most people have one or more than one depressive/manic episode?
Most have more than one episode
More than ½ with the disorder have 4+ episodes across their life
54
What is the suicide rate for bipolar disorder?
~ 15% of people with diagnosis die by suicide
25% report suicide attempt, >50% report suicidal ideation in past 12mos
55
What are the causes of Bipolar Disorder?
Estimates of heritability range from 70 – 90% heritability
Shares genetic risk factors with schizophrenia and MDD
56
How does the brain relate to bipolar disorder?
Some evidence of reduced brain volume in prefrontal, limbic structures
Increased activation in amygdala and striatum – increased response to high rewards / goal achievement
Hypersensitivity to dopamine receptors mania
57
compare MDD and BD on: Activation of the striatum and amygdala in response to emotion stimuli
MDD - Diminished
BD - Elevated
58
What is the cortisol awakening response (CAR)?
The cortisol awakening response (CAR) is the change in cortisol concentration that occurs in the first hour after waking from sleep.
59
What is reward sensitivity?
how motivated/excited a person is to obtain a reward
60
How does reward sensitivity relate to BD?
Increase response to reward cues or pursuing rewards in those with BD and those at risk
Reward sensitivity predicts onset of disorder and more severe symptoms over time
61
How does goal striving relate to BD?
Improbable goal striving predicts future mania symptoms & onset of BD
Increase pursuit of extreme goals:
“You will have 100 million dollars or more.”
“Someone will write a book about your life.”
62
What is the first line of treatment for bipolar disorder?
Medication: Mood stabilizers, Anticonvulsants, and Antipsychotics common
63
How does lithium relate to bipolar disorder?
Mood stabilizer
Side effects may be severe (lithium toxicity)
1/3 show dramatic response to lithium; another 1/3 show some response
Protective effect against suicide
64
Are antidepressants good for BD?
They are a potential trigger for mania so they have to be paired with mood stabilizer to prevent triggering mania
65
What are 4 types of talk therapy that are good for BD?
Psychoeducation & Family-Focused
Social Rhythms Therapy
Goal Regulation
Behavioral activation – balancing act
66
Are suicide rates increasing or decreasing since 2019?
Decreasing -- went from 10th leading cause of death to 11th
67
What is the second leading cause of death for ppl 10-35 yrs of age?
Suicide
68
What are the gender differences in terms of suicide?
Men ~ 4x more likely to die by suicide than woman
Women more likely to attempt
69
What demographic has the highest suicide rate?
White men
70
What did the study of adolescents in Oregon show about suicide?
24% of high school girls and 15% boys have serious suicidal thoughts
Especially common in those who were depressed
71
What are the social influence risk factors for suicide?
Economic recessions
Media reports of suicide
Social Isolation
Access to means
72
What are the psychological influence risk factors for suicide?
Difficulty with problem-solving
Hopelessness
Impulsivity
73
What are the treatments for suicide?
Safety is the primary goal so....
Means restriction
Make highly lethal methods less available
Keep guns in locked cabinets
Restrict access to lethal drugs
Bridge design (incorporate suicide barriers)
BUT also DBT and CT-SP
74
What is Dialectical Behavior Therapy (DBT) for suicide?
3rd wave CBT
Consistent monitoring of suicidal ideation / behavior
Develop safety plan
Distress tolerance skills
24-hour access to therapist (for some ppl)
75
What is the difference btween DBT and CT?
CBT seeks to give patients the ability to recognize when their thoughts might become troublesome, and gives them techniques to redirect those thoughts. DBT helps patients find ways to accept themselves, feel safe, and manage their emotions to help regulate potentially destructive or harmful behaviors.
76
Difference between fear and anxiety
Fear:
Present focused: response to immediate danger / threat
Intensity builds quickly
Anxiety:
Future focused: anticipate and prepare
General diffuse emotional reaction
77
What does the Yerkes-Dodson Law say?
A moderate amount of anxiety leads to peak performance but there is worse performance if there is too much or too little anxiety
78
What makes anxiety disordered instead of normal?
Pervasive and persistent symptoms of anxiety and fear
Involves excessive avoidance
Causes significant distress and impairment
79
What is common to all core anxiety disorders?
> 50% of those with an anxiety disorder meet criteria for another anxiety disorder
75% meet criteria for another psychological disorder; 60% also have depression
Comorbidity is associated with greater severity and poorer outcomes of the anxiety disorders
80
What is the most common group of mental disorders?
Anxiety
81
What percent of ppl who qualify for an anxiety disorder actually seek treatment?
~25%
82
What are the most common anxiety disorders?
The most prevalent are social anxiety followed by specific phobias
83
What is a specific phobia?
Intense, persistent fear of a specific object or situation that is excessive or unreasonable and causes intense anxiety/distress
84
How long does fear, anxiety, and avoidance need to persist for speciifc phobias?
6+ months
85
Prevalence of Specific Phobias
~12% of general population
86
Gender differences for specific phobias
3x more common in women
87
Are specific phobias chronic?
Yes
88
when is age of onset for specific phobias?
onset varies widely
89
Etiology of Phobias
Evolutionary adaptation
90
Options for Treatment of Specific Phobias
Benzos
Beta Blockers
CBT
91
What method of treatment is most effecitvie for specific phobias and how does it work?
CBT is the most effective for specific phobias
- Exposure therapy
- In-vivo (real life) exposure
- Imaginal exposure
--> Sometimes really hard to do in vivo like for a fear of planes
--> Not as effective as in vivo
92
Definition of Social Anxiety
Fear or anxiety specific to social settings, in which the individual feels noticed, observed, or scrutinized
Fear that they others will notice their anxiety and experience social rejection
Social interaction consistently results in distress
Social interaction is avoided or endured with intense
anxiety/distress
The fear and anxiety are disproportionate to the situation
KEY COMPONENT: Fear of evaluation
93
Myths about Social Anxiety
People with social anxiety are happier alone
People with social anxiety just need to avoid the spotlight
People with social anxiety are just shy
94
Prevalence of Social Anxiety
~12% of the general population
95
Gender DIfferences in Social Anxiety
Slightly higher in women
96
Onset of Social Anxiety
Onset in adolescents – early adulthood
97
Is social anxiety chronic?
Yes
98
What does social anxiety have high comorbidity with?
High comorbidity with other anxiety disorders and depression
99
Social Anxiety Disorder Treatment Options
Medication (SSRIs)
CBT
Social Skills Traning
Attention Bias Modification Training
100
What treatment method is recommended for Social Anxiety Disorder
SSRIs are ok but high relapse rate when discontinued
CBT is best
101
Key Elements of CBT for Social Anxiety
Key elements: exposure, rehearsal, role-play in a group setting
102
Key elements of Social Skills Training for Social Anxiety
Key element: Extensive modeling of behaviors
103
Anxiety becomes GAD when
Frequency
Range of topics
Impairing
104
DSM-5: Generalized anxiety disorder (GAD)
Excessive worry at least 50% of the day about a number of events (e.g., health, school, finances)
Trouble controlling these worries
At least 3 of the following:
Restlessness or feeling “keyed up” or on edge
Easily fatigued
Difficulty concentrating or mind going “blank”
Irritability
Muscle tension
Sleep disturbance (falling asleep, restless sleep)
105
Difference between GAD and MDD
GAD: worry, trouble controlling worry
MDD: Sad mood, anhedonia
106
Prevalence of GAD
Lifetime prevalence ~ 6%
107
Gender Differences of GAD
Women outnumber men approximately 2:1
108
Heritability of GAD
33%
109
What is GAD comorbid with?
MDD
110
Is GAD anxiety chronic?
Yes
111
Are benzos good for GAD?
No
112
What is the treatment for GAD?
Mindfulness Based Cognitive Therapy:
Focus attention on present moment
When find mind wandering to ‘what ifs’ gently bring yourself back to present
Relaxation strategies
Identifying thoughts and emotions, reminding self they aren’t facts
Self-compassion
113
What is a panic attack?
A sudden onset of intense apprehension, terror, and/or feelings of impending doom, peaks quickly (10 minutes) with physical and psychological symptoms
114
Physical symptoms of panic attacks
Shortness of breath
Heart palpitations
Nausea
Upset stomach
Chest pain
Feelings of chocking/smothering
Dizziness, lightheadedness, faintness
Sweating
Chills
Heat sensations
Numbness or tingling
Trembling
115
Psychological symptoms of panic attacks
Depersonalization—feel like outside body
Derealization—feel like world isn’t real
Fear of losing control/going “crazy”
Fear of dying
116
When does first panic attack typically occur
First attack frequently experienced after high stress situation
117
do panic attacks mean you have panic disorder
Many adults who experience attack, never go on to develop Panic Disorder
~ 20% of college students have a panic attack. Most do not have more than one.
It is response to panic attack that dictates whether one develops the disorder
118
Criteria for agoraphobia
Fear or anxiety about being in situations difficult to escape or receive help
These situations are avoided or endured with intense fear/anxiety
119
Prevalence of Panic disorder
~3-4% of the population
120
Gender differences with panic disorder
2x as prevalent in women
121
Which disorder has a very common positive feedback loop and cycle?
Panic Disorder
122
What is the panic cycle?
Trigger Stimulus --> Apprehension or worry --> body sensations --> interpretation of sensation as catstrophic -->
123
DSM-5 Criteria for Panic Disorder
Recurrent, unexpected panic attacks
Persistent worry about having more attacks or the consequences of attacks (losing control, having heart attack, “going crazy,” etc.)
Significant change in behavior related to attacks (e.g., behaviors designed to avoid having panic attacks such as avoidance of exercise or unfamiliar situations
Panic Disorder can occur with or without Agoraphobia
124
Treatment for Panic Disorder
- often end up in ER
- Benzos (not recommended)
- during panic attack calming down
- eduction
- exposure
125
Types of Exposure for panic disorders
In Vivo (exposed to the fear in real life)
Imaginal (imaging a fear vividly)
Virtual Reality (being exposed to the fear via VR)
Interoceptive (triggering physical sensations to show they are not harmful)
126
Heritability across anxiety disorders
Heritability – modest ~30-50%
may elevate risk for several anxiety disorders
genetic vulnerability for anxiety and depression may overlap
127
Neurobiological correlates for anxiety disorders
Limbic system is key
Heightened activity in the amygdala / insula
Diminished activity of the prefrontal cortex in response to threatening stimuli
Post CBT treatment, show decrease activation in limbic system and prefrontal region
Neurotransmitters
Serotonin, GABA, norepinephrine implicated across anxiety disorders
Sympathetic Nervous system involved – physical symptoms (heart race, sweating) anxiety thoughts
128
Psychological factors about anxiety
People with anxiety tend to pay attention to threatening faces but we can do attention to threat therapy to help lower people’s attention to threatening faces
Tendency to notice negative environmental cues; selective attention to signs of threat
Sustained negative beliefs about future
129
Is exposure therapy helpful for anxiety generally
Effective for 70–90% of clients who do it
130
What is the preferred treatment for anxiety
Psychological treatments are considered the preferred treatment of most anxiety disorders but SSRIs are okay for long term
131
Misconceptions about OCD
Everyone is “a little bit OCD”
Being clean or organized
Just have to be strong and ignore the thoughts
132
DSM-5 Criteria of OCD
Obsessions:
Recurrent, persistent and unwanted thoughts, impulses or images
Experienced as intrusive and inappropriate and often nonsensical
Thoughts are not just excessive worries about real life problems
Attempt to suppress, ignore thoughts or try to neutralize with some other thought /action (i.e., compulsion)
Compulsions:
Repetitive behaviors or mental acts that person feels driven to perform in response to an obsession or according to rules that must be applied rigidly
133
Prevalence of OCD
Prevalence - about 1-2% of the population
Pretty uncommon
134
Gender Differences in OCD
Fairly equal between genders
Males more commonly affected in childhood, earlier onset, possibly more chronic course
135
Avg age of onset for OCD
Average age of onset = 19.5 years
25% of cases start by 14 years
136
Is OCD chronic?
Chronic condition, can be extremely severe and debilitating
137
What are the genetic influences of OCD?
Moderate genetic influences; concordance for MZ twins = .57, for DZ twins = .22
138
What is OCD comorbid with?
Comorbid with mood and substance use disorders
139
Treatment for OCD
Medication (SSRIs)
TMS
ERP
DBS
140
What treatments is best for OCD but what is the issue with it?
Exposure and response prevention
Very effective
BUT… 1/3 unwilling to begin ERP; among those enrolled, 1/3 drop out
most helpful when combined with SSRIs
141
Are SSRIs effective for OCD?
Antidepressants (SSRIs) – Benefit about 60%
Typically need higher doses than with depression so higher side effects as well
142
Etiology of OCD
Heritability in range of .40-.50
Frontal-striatal circuitry
Overactivity when shown stimuli that provoke obsessions
Successful treatment of OCD with ERP related to reduced activation of OFC and caudate
143
What is the only disorder that gives a cause to symptoms in the DSM-5?
PTSD
144
What are the symptom domains of PTSD?
Intrusive Memories
Avoidance symptoms
Negative changes in mood and thoughts
Changes in physical / emotional reactions
145
How does the DSM-5 define trauma?
Exposure to actual or threatened death, serious injury or sexual violence
146
What are the different ways one can experience trauma?
Happens to the person (direct experience)
Witnessing, in person, occur to others
Learning event occurred to close family or friend
Vicarious trauma: Repeated exposures to aversive details *can only be through media as long as it’s work related (e.g., firefighters, police)
147
What is no longer included in the trauma definition?
Unexpected death of family or a close friend due to natural causes is no longer included
148
How does the DSM-5 diagnose PTSD Intrusive memories?
- unwanted memories of traumatic events,
flashbacks or nightmares
- Individual feels or acts as if trauma is reoccurring
- intense or prolonged distress or physiological reactivity in response to reminders of trauma
149
How does the DSM-5 diagnose PTSD Avoidance symptoms?
avoids the reminder of the trauma
Internal: memories, thoughts, or feelings
External: People, places, activities
150
What are the DSM-5 negative changes in mood and thoughts?
1. Anhedonia
2. Difficulty remembering important aspects of the trauma
3. Persistent negative beliefs / expectations about self, others and world
4. Persistent blame of self or others about the traumas
5. Persistently negative emotional state (e.g., fear, anger)
6. Feeling disconnected from others
150
DSM-5 changes in physical and emotional reactions for PTSD
1. Irritable
2. Reckless or self-destructive behavior
3. Hypervigilance
4. Exaggerated startle response
5. Trouble concentrating
6. Sleep disturbance
151
What is acute stress disorder?
Like PTSD but symptoms only last 3 days to one month
152
What are the criticisms of acute stress disorder?
Are we pathologizing/stigmatizing a common, short-term response to serious trauma?
Not very predictive of development of PTSD (<50% of people); only 50% of people with PTSD first experienced acute stress disorder
153
Prevalence of PTSD
~7%
154
Gender differences in PTSD
Women are about twice as likely as men, but men more likely to be exposed to trauma
155
Most common traumas
Sexual assault
Accidents (man-made and natural)
Combat
156
What is the average age of onset for PTSD?
Average age of onset is early to mid-20s
157
What is PTSD comorbid with?
Commonly comorbid with other anxiety disorders, depression and substance abuse
158
How often do people experience PTSD from trauma?
~ 33% report symptoms 10 years later
159
Beyond trauma, what is the etiology of PTSD?
Genetic risk
Family history of mental illness
160
What are the psychosocial risks of PTSD?
Self-blame
Lack of social support
Conditioning / Learning -- flashbacks triggered by cues
Avoidance / Operant conditioning -- avoidance initially alleviates anxiety, but keeps it long term
161
What is the neurobiology of PTSD?
Neurobiology: the hippocampus
Blunted/diminished activation, smaller in size
Limbic system is also important
162
Are there reliable predictors/risk factors specific to PTSD?
No
163
What are some predictor factors of PTSD?
Cognitive Ability – problem solving, reasoning skills
Emotion Regulation Skills
Social Connectedness
Active coping instead of avoidant coping
164
What are the PTSD possible treatments?
Prolonged Exposure
Cognitive Processing Theory
EMDR
Psychedelics
Animal Therapy
165
PTSD Treatment: Prolonged Exposure
Build up resources – relaxation training
Imagery rehearsal – describing trauma in detail
Exposure – feared or avoided triggers
166
PTSD Treatment: Cognitive Processing Therapy
Identify problematic beliefs related to trauma experience
--> Ex. Self blame: I’m a failure for not stopping event, it’s all my fault
Challenge these ideas / beliefs about blame towards self
Write about impact trauma has had on life
Process emotions related to trauma
Imaginal: thinking about the incident
167
PTSD Treatment: EMDR
Eye-movement desensitization and reprocessing (EMDR)
EMDR = active ingredient may simply be the CBT-based component
Breathing, meditation
Recall past trauma
Skill building, challenging thoughts
Bilateral stimulation – eye movements, alternating taps from left to right
168
What is the takeaway about EMDR for PTSD?
No evidence that the mechanism (eye movement, bilateral tapping, etc) is driving the change
Active ingredient is likely things common in other therapies (e.g., exposure, relaxation, etc)
If it makes someone attend therapy and feel better it’s a win BUT don’t do self - EMDR
169
What are the potential mechanisms for psychadelics working?
Reduce fear, increase social engagement and compassion
170
What is animal assisted therapy?
Increase feelings of connectedness, and reduce loneliness
Decrease frequency of nightmares and sleep disturbances
Increased participation in life outside the home
Increased sense of purpose
171
What are good methods for PTSD Prevention?
Pre-trauma training for those with high-risk jobs --> teaching relaxation techniques, emotion coping, social support building, mindfulness to those at higher risk of seeing trauma
172
What are potential medications for PTSD?
Benzodiazepines – not effective, may also be related to higher rates of PTSD
Propranolol – lowers blood pressure – injected ~ 6 hrs after trauma - some evidence, but not very convincing
173
Dissociation Definition
Some aspect of emotion, memory, or experience being inaccessible consciously
174
What causes dissociation?
Sleep disturbance AND according to psychodynamic and behavioral theorists, an avoidance response that protects the person from consciously experiencing stressful events
175
3 Controversial Diagnosis
Dissosiative Amnesia
Dissociative Fugue
DID
176
Dissociative Amnesia
Sudden inability to recall important personal information
Usually selective – don’t lose all memory, just select things
Often follows a stressful event
Prevalence ~ 1.8% ?
177
Dissociative Fugue
Severe subtype, extensive memory loss
Person may disappear from home and work
Usually sudden, follows stressful / traumatic event
Very rare
178
What is important to rule out before diagnosing dissociation?
Substance abuse, brain injury, medication side effects, dementia
179
What is the stigma / misconceptions around DID?
People with DID are violent – there is no evidence that people with DID are more violent
Often showed in movies where one personality of the person makes them a mass murderer
DID = schizophrenia identities are not the same as voices in schizophrenia
180
DSM -5: DID
- Disruptions of identity characterized by 2 or more distinct personality states (alters)
- Recurrent gaps in memory for events or important personal information that are beyond ordinary forgetting
181
Host Definition
the identity that keeps other identities together
182
System Definition
Collection of alters
183
How long is treatment before diagnosis for DID
~7 years
184
How many alters do people with DID typically have?
Most commonly 2-4 alters identified when diagnosed
Average number of identities is ~ 10 – 15
185
What is DID comorbid with?
PTSD, depression, substance disorders
186
What is the etiology of DID?
Thought to be Trauma or sociocognitive model but very unclear
187
What is the evidence for the trauma model for DID
Very high number of people with DID report severe childhood trauma
188
What is the cause of DID according to the trauma model?
DID evolves as a defense mechanism to protect child – escape impact of trauma
189
What is the evidence against the trauma model for DID?
Almost no evidence of childhood DID diagnoses
Mixed findings whether childhood abuse predicts tendency for adults to dissociate
190
What is the cause of DID according to the sociocognitive model?
After severe abuse in childhood people seek explanations for symptoms and distress
Alters appear in response to suggestions by therapists, exposure to media reports of DID, other cultural influences
191
What is the evidence in support of the sociocognitive model for DID?
The symptoms of DID can be role-played
Those with DID more prone to suggestibility / fantasy
Experts in DID tend to be responsible for large % of diagnoses/treatment
192
How is DID related to media?
Before Sybil there were only 79 known cases worldwide, a number that increased to thousands post-release
TikTok & Youtube increase in interest and diagnoses last few years
Increase self diagnosis of DID (i.e., going to therapist for DID treatment)
193
How do therapists reinforce DID symptoms?
Use of hypnosis, urging clients to unbury unremembered abuse experiences, naming different alters
Most clients are unaware of having alters before treatment
Rapid increase in the number of alters as treatment progresses
194
What is the etiology of DID?
Hippocampal / amygdala volume differences
195
DID Treatment
No well-validated treatments available
Medications to help with comorbid symptoms (e.g., depression, etc)
maybe hypnosis but could worsen symptoms
Could do a psychodynamic or a phase approach
