Exam 2: PTSD & Dissociation Flashcards
What are the 2 pathways through which arousal and fear are produced?
Sympathetic nervous system pathway and Hypothalamic-Pituitary-Adrenal (HPA) Pathway
Pathway 1: Sympathetic Nervous System
stressor activates sympathetic nervous system
- key organs are stimulated directly (e.g. heart) or indirectly (e.g. adrenal glands)
- when the perceived danger passes the parasympathetic nervous system helps return body processes to normal
pathway 2: Hypothalamic-Pituitary-Adrenal (HPA)
stressor activates hypothalamus
- pituitary gland releases adrenocorticotropic hormone (ACTH; major stress hormone)
- adrenal cortex releases corticosteroids (stress hormones) into bloodstream
what are corticosteroids?
stress hormone released into bloodstream by adrenal cortex as part of hypothalamic-pituitary-adrenal pathway
fight or flight response
the reactions on display in these 2 pathways (SNS & HPA) are collectively referred to as the fight or flight response
trait anxiety
a persons general level of arousal and anxiety
state or situation anxiety
persons sense of which situations are threatening
is stress the same as trauma?
NO!
trauma
a very difficult or unpleasant experience that causes someone to have mental or emotional problems for a long time…
APA - an emotional response to a terrible event…
what percentage of veterans report symptoms of PTSD?
20%
What is PTSD?
- Criterion A: exposure to trauma
- criterion B: Intrusion symptoms
- criterion C: persistent avoidance of stimuli associated w/ trauma
- criterion D: negative alterations in cognitions and mood associated w/ traumatic event
- criterion E: alterations in arousal and reactivity that began or worsened after traumatic event
- criterion F: significant impairment in functioning, w/ persistence of symptoms for more than 1 month
PTSD: Criterion A
- exposure to trauma
- direct exposure to death, threatened death, actual or threatened serious injury or violence
- may be indirect exposure (ex: learning a relative was exposed to trauma, vicarious traumatization)
vicarious traumatization
professionals repeatedly exposed to details of child abuse (or other trauma?)
PTSD: criterion B
intrusion symptoms such as:
- recurrent, involuntary, intrusive memories
- traumatic nightmares
- dissociative reactions (e.g. flashbacks) occurring on a continuum from brief episodes to complete loss of consciousness
- intense or prolonged distress - which may be emotional or physiological - after exposure to traumatic reminders
PTSD: criterion C
persistent avoidance of stimuli associated w/ trauma
- avoidance of trauma-related thoughts/feelings
- avoidance of trauma-related reminders (e.g. people, places)
PTSD: criterion D
negative alterations in cognitions and mood associated w/ traumatic event
- dissociative amnesia
- persistent (often distored) negative beliefs (e.g. self blame or global negative expectancies of others)
- persistent negative emotions (fear, horror)
- emotional numbing:
- diminished interest in pre-traumatic significant activities
- alienation (detachment or estrangement) from others
- constricted affect - inability to experience positive emotions
PTSD: Criterion E
alterations in arousal and reactivity that began or worsened after the traumatic event
- irritable or aggressive behavior
- self-destructive or reckless behavior
- hypervigilance
- exaggerated startle response
- problems in concentration
- sleep disturbance
PTSD: Criterion F
significant impairment in functioning, w/ persistence of symptoms for more than 1 month
Dissociative Disorders
- dissociative amnesia (and dissociative fugue)
- dissociative identity disorder (DID)
- depersonalization and derealization
Key symptoms of dissociative disorders
characterized by significant memory loss or identity disruption
in all types, memory for abstract or encyclopedic info usually remains intact
Dissociative amnesia
may be:
-localized: most common type; loss of all memory of events occurring w/in a limited period
- selective: loss of memory for some, but not all, events occurring w/in a period
- generalized: loss of memory beginning w/ an event, but extending back in time; may lose sense of identity; may fail to recognize family/friends
- continuous: forgetting continues into future; quite rare in cases of dissociative amnesia
Dissociative fugue
an extreme version of dissociative amnesia
- people w/ dissociative fugue not only forget their personal identities and details of their past, but also flee to an entirely different location
- for some the fugue is brief, a matter of hours or days, and ends suddenly
- for others, the fugue is more severe: people may travel far from home, take a new name and establish new relationships, and even a new line of work; some display new personality characteristics
dissociative fugue (continued)
- dissociative fugue disorders are rare: 0.2% of population (usually follows severely stressful event)
- fugues tend to end abruptly
- majority of people regain most/all of their memories and never have a recurrence
Dissociative Identity Disorder (DID)
- 2 or more distinct personalities (subpersonalities), each w/ unique set of memories, behaviors, thoughts, emotions
- at any given time, one of subpersonalities dominates the persons functioning
- usually one subpersonality - the primary or host - appears more often than the others
- the transition from one subpersonality to next (switching) is sudden and may be dramatic
Dissociative Identity disorder (cont.)
-most cases first diagnosed in late adolescence or early adulthood
- symptoms generally begin in childhood after episodes of abuse
- typical onset may be before age 5
-women receive diagnosis 3X as often as men
what relationships do subpersonalities of DID use to interact?
- mutually amnesic relationships: subpersonalities have no awareness of one another
- mutually cognizant patterns: each subpersonality is well aware of the others
- one-way amnesic relationships: most common pattern; some personalities aware of others, but awareness not mutual (those subpersonalities that are aware (co-conscious subpersonalities) are quiet observers)
How do subpersonalities of DID differ?
-often display dramatically different characteristics including identifying features (age, sex, race, family history), abilities and preferences (ability to drive, language, instruments), physiological features (autonomic nervous system activity, blood pressure levels)
how common is DID?
- # of diagnoses are increasing
- growing # of clinicians believe that the disorder does exist and are willing to diagnose it
- diagnostic procedures have become more accurate
Etiology of DID: psychodynamic view
- theorists believe that 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)
- most of the support for this model is drawn from case histories, which report brutal childhood experiences, yet some individuals w/ DID do not seem to have these experiences of abuse
Etiology of DID: behavioral view
behavioralists believe that dissociation grows from normal memory processes & is a response learned through operant conditioning:
- momentary forgetting of trauma leads to drop in anxiety, which increases likelihood of future forgetting
- like psychodynamic theorists, behaviorists see dissociation as COGNITIVE ESCAPE behavior
-also like psychodynamic theorists, behaviorists rely largely on case histories to support their view of dissociative disorders
Possible etiology of DID: state dependent learning
- people who are prone to develop dissociative disorders may have state to memory links that are unusually narrow/rigid
- each thought, memory, and skill is tied exclusively to a particular state of arousal
hence, they recall a given event only when they experience an arousal state almost identical to the state in which the memory was first acquired
possible etiology of DID: self-hypnosis
- although hypnosis can help people remember events that occurred & were forgotten years ago, it can also help people forget facts, events, and their personal identity
- called hypnotic amnesia, this phenomenon has been demonstrated in research studies w/ word lists
- self-hypnosis may be analogous (functionally equivalent) to the psychodynamic concept of repression
treatments for Dissociative disorders
- people w/ dissociative amnesia often recover on their own (only sometimes do their memory problems linger and require treatment)
- in contrast people w/ DID usually require treatment to regain their lost memories and develop an integrated personality (treatment for DID tends to be less successful than treatment for dissociative amnesia)
treatments for Dissociative disorders (cont)
-therapists try to help client by recognizing disorder, recovering memories, integrating subpersonalities into single identity, furthering therapy after to maintain complete personality and teach social/coping skills to prevent later dissociation
Portrayals of DID in film
-based on actual case: Voices within: the lives of truddi Chase
depersonalization-derealization disorder
depersonalization: individual feels as though they have become separated from their body and are observing themselves from outside
- in contrast to depersonalization, derealization is characterized by the feeling that the external world is unreal and strange
depersonalization-derealization disorder
depersonalization and derealization by themselves dont indicate a disorder
- transient depersonalization or derealization reactions are fairly common
- the symptoms of a depersonalization-derealization disorder are persistent or recurrent, cause considerable distress, and interfere w/ social relationships and job performance
