Exam 3 Flashcards
DSM criteria for PTSD
Symptom duration for at least 1 months posts-trauma
includes re-experiencing (e.g., flashbacks, intrusive thoughts), avoidance (e.g., avoiding reminders of the trauma), negative alterations in cognition and mood (e.g., persistent negative beliefs, emotional numbness), and hyper-arousal (e.g., irritability, difficulty sleeping)
Key symptoms of PTSD
dissociation (feeling detached from reality) - derealization & depersonalization
- flashbacks (reliving the trauma)
- hyper-arousal (heightened state of alertness)
- nightmares (disturbing dreams related to trauma)
- avoidance (avoiding places, people, activities that remind of the trauma)
- negative thoughts (persistent negative beliefs about oneself or the world)
- mood changes (e.g., depression, anxiety)
Shattering of schemas
Persistent feeling of being unsafe, disrupted beliefs about the world and self, difficulty trusting others, feeling vulnerable and exposed
Biological factors in PTSD
Role of cortisol (stress hormone), heritability (genetic predisposition), brain impact of early trauma (e.g., changes in hippocampus, amygdala, prefrontal cortex)
Prevalence rate of PTSD
Only about 10% of those who experience trauma develop full PTSD; varies based on type and severity of trauma, individual resilience, and support systems
What are some predictors of PTSD?
- Genetic vulnerability (explains about 30% of variance in some studies
- Neurological vulnerability (link with early trauma history)
- Lack of social support
- Perceived severity of trauma
- Use of physical violence in trauma
- DSM co-morbidity (e.g., depression, anxiety, eating disorder)
Adverse Childhood Experiences (ACEs)
ACEs increase vulnerability to PTSD; includes abuse (physical, emotional, sexual), neglect (physical, emotional), household dysfunction (e.g., substance abuse, domestic violence, mental illness)
Complex PTSD (c-PTSD)
not in DSM, added to ICD-11
- repeated childhood trauma
- PTSD symptoms + disordered emotion regulation (difficulty managing emotions), identity (unstable sense of self), relationships (difficulty forming and maintaining relationships)
- very similar to borderline personality disorder
- Treatment is way different and takes more time to treat someone with c-PTSD than with PTSD
Treatments of PTSD
- Medication (antidepressant & antianxiety)
- Cognitive-behavioral therapies (graded exposure to traumatic memories, processing trauma & modifying core beliefs)
- EMDR (Eye Movement Desensitization & Reprocessing)
- Theory: something about getting both hemispheres of the brain processing the traumatic event by invoking somatosensory bilateral stimulation by doing exposure and the recall of the trauma. It leads to a deeper type of exposure that allows the exposure to be more effective
- Trauma has a physical imprint, and EMDR gets the person in touch with how their body is being encoded in their sensory memories - Psychodynamic Therapy
- CISD (Critical Incident Stress Debriefing)
- meeting in a group of strangers who went through traumatic events, everyone is encouraged to share their stories, not helpful if it’s a group of complete strangers. People will open up before they’re ready
Concept Creep for “Trauma” in Pop Culture
Many upsetting events are labeled as trauma, but not all meet clinical criteria for genuine trauma; genuine trauma involves threat to life or physical integrity, intense fear, helplessness, or horror
Traumatic repression of memories
Scientific evidence does not fully support the concept of traumatic memory repression; memories of trauma are often fragmented and can be influenced by suggestive questioning
Definition of obsession
Recurrent, persistent thoughts, urges, or images that are intrusive and unwanted, causing significant anxiety or distress. Common themes include aggression, contamination, sexuality, and harm
Compulsions/Rituals
Repetitive behaviors or mental acts performed to reduce anxiety triggered by obsessions
Ex. hand washing, checking, counting, and repeating actions
OCD vs OCPD
OCD:
- involves unwanted, distressing obsessions and complusions
OCPD (obsessive-complusive personality disorder) involves a chronic preoccupation with orderliness, perfectionism, and control, often described as having an “anal” personality
Role of Anterior Cingulate Cortex
“error detection”
Involved in error detection and emotional regulation. Dsyfunction in this area, along with serotonin imbalances, is linked to OCD
- CSTC circuit “brain lock”
- Their attention gets fixated on their obsession, begin to do a ritual to get rid of it, ritual doesn’t work, and there ends up being too much activity in CSTC circuit and keeps the brain hyperfixating
DSM Criteria for OCD
Presence of obsessions, compulsions, or both. There must be time-consuming (e.g., more than 1 hour per day) and cause significant distress or impairment in social, occupational, or other important areas of functioning
Risk factors for OCD
Heritability (genetic predisposition), head trauma, and strep infections (PANDAS)
Role of CSTC Circuit
CSTC circuit regulates information flow to the cortex. In OCD, this circuit gets “stuck” in a loop, leading to repetitive thoughts and behaviors. Serotonin circuits help inhibit this “brain lock” pattern
Treatment for OCD
- Exposure and Ritual Preventions (ERP) therapy (86% response)
- ERP involves gradual exposure to feared situations and prevention of compulsive responses - Anafranil (48% response)
- SSRI/SNRI (40-50% response rate)
OCD Spectrum Disorders
Includes hoarding disorder, trichotillomania (hair-pulling disorder), excoriation disorder (skin-picking disorder), and body dysmorphic disorder
Hoarding disorder vs OCD
Hoarding disorder involves ego-syntonic obsessions (consistent with one’s self-image)
OCD involves ego-dystonic obsessions (inconsistent with one’s self-image and causing distress
Ego-syntonic obsessions vs ego-dystonic obsessions
Ego-syntonic obsessions - consistent with one’s self-image
ego-dystonic obsessions - inconsistent with one’s self-image and causing distress
Core symptoms of Major Depressive Disorder (MDD)
DSM requires 5 or more of the below for multiple times a day ≥ 2 weeks (one of them MUST include symptoms 1 or 2)
- Depressed Mood
- Loss of interest/pleasure in activities (anhedonia)
- Change in sleep (insomnia/hypersomnia)
- Change in weight/appetite
- Loss of energy
- Psychomotor retardation/agitation
- Excessive guilt or worthlessness
- Concentration difficulty/difficulty making decisions
- Suicidality/thoughts of death
Depression Subtypes
Severe or Melancholic (motor retardation, anhedonia, diurnal mood variation, cognitive impairment)
- Have all or nearly all 9 DSM core symptoms at a very, very high level of severity
- Diurnal mood variation - mood goes up and down throughout a 24-hr cycle. Wake up very tearful and mood brightens throughout day
Seasonal Onset or Atypical (hypersomnia, weight gain, sluggishness, anxiety)
- December thru February (1/4 people in US)
- vitamin C and D deficiency (D is created in skin when adequately strong UV rays from sun hit our skin)
Psychotic (delusions or hallucinations - only present during depressive episode)
