Stress, Adjustment Disorder, and PTSD

Question 1

Risk factor 
Variable risk factor 
Causal risk factor 
Fixed marker 
Variable marker (?)
Protective factor (?)

Answer 1

Risk factor: X correlated with Y and precedes Y
Variable risk factor: X can be changed
Causal risk factor: can change Y by manipulating X
Fixed marker: X cannot be changed
Variable marker: Y cannot be changed (?)
Protective factor: M that reduces correlation of X and Y, not just an absence of X

Question 2

Incidence (rate)
Point prevalence
Period prevalence
Lifetime prevalence

Answer 2

Incidence rate:
•a disorder’s number of new cases in a population over a period of time
Point prevalence:
•percentage of population that have disorder at a given time
Period prevalence:
•percentage of population that had disorder at some point over a period of time
Lifetime prevalence
•percentage of population that have had disorder at some point in their life

Question 3

Stress components

Answer 3

Stress:
•The psychological and physiological response evoked due to taxing internal or external conditions (organisms response)
•The organism is linked to environment (can’t be considered distinct)
Stressor:
•Internal/external stimulus that is evoking that stress
Coping strategy:
•Active behavioural or physiological change to adapt to the stressor
Coping with stress:
•Stress usually doesn’t overwhelm the ability to cope as the most common reaction is resilience
*Resilience: maintain healthy functioning after a stressor
•Correlations with higher resilience: male, older, higher education, more access to economic resources, ethnicity, high positive emotion/extraversion
*Men: different social contexts/status and hormones
*high emotion: can be too high
•Why these correlates may exist: adrenal glands release cortisol where male rats absorb into the cell while females stay outside

Question 4

Characteristics of stress and stressors

Answer 4

Stressors can be negative, positive, or neutral:
•Bad stress: distress
•Good stress: can also have negative effects that are just as prominent as bad stress (ex: getting married)
•Stress can built productivity and lead to resilience
Severity:
•Highly individual, but there are general trends for what stresses people out (losing job, relationships ending, $)
Duration:
•Acute (short term, single event) vs chronic (long term, something consistent in your environment)
•Chronic stress seen as more harmful (ex: bad long term health consequences)
Timing:
•Does the stress coincide with other stressors
Expectedness and preparedness:
•Are you prepared (police ready to handle the situation)
Controllability
•Do you feel in control (being stressed for exam but knowing you chose this program and want to do well)

Question 5

Homeostasis

Answer 5

Living organisms must stay at a distinct/stable internal environment that differs from external environment
•Ex: body temp is higher than outside temp
•Chemical reactions of biological systems occur in a narrow range of conditions (can’t get too hot/cold)
•Maintaining is an active process done through behaviour (animals migrating) or physiological responses (humans digesting)
•Amount of food/fluids consumed is in proportion with what you’re using
•Optimal conditions: dynamic equilibrium (perfect balance between internal and external)

Question 6

Allostasis

Answer 6

The process of maintaining homeostasis by an organism through behavioural and physiological changes
•Different stressors have different coping mechanisms (requires flexibility and metabolic energy) but maintaining flexibility consumes metabolic resources
•Need to balance trade-offs between different systems and functions (ex: when you’re sick, your white blood cells will work on that, but if a tiger comes, your body will stop fighting the cold to fight the tiger)

Question 7

Allostatic load

Answer 7

Physiological effects of coping with chronic stress result in “wear and tear” on body
•Overtime, hormonal stress does not go up nearly as high when it’s the same stressor (like clockwork), but different stressors everyday/pain stressors aren’t handled as well
•Worst: repeated unpredictable stress
Type 1: metabolic energy demand exceeded energy supply (to many things with not enough food/resources allocated)
Type 2: Unavoidable persistent social conflict/stressor with no net energy deficit (more relevant in western society)

Question 8

Sympathetic-adrenomedullary system (SAM)

Answer 8

A process where stress sends signals to the hypothalamus which is sent to your spinal cord that sends messages to the adrenal glands, releasing adrenaline and nora adrenaline leading to heavy breathing, increased blood flow, etc
•Hypothalamus: regulating psychological functions: fighting, fleeting, fucking, feeding and its response to stress
•Spinal cord (via pre-ganglia neurons)
•Adrenal medula (inner): epinephrine, norepinephrine (adrenaline)
•Fight or flight – increased HR, oxygen intake, blood flow to muscles, glucose metabolism decreased anabolic functions
SAM occurs immediately, increases the activity of the HPA axis

Question 9

Hypothalamic-Pitulitafy adrenal (HPA) axis

Answer 9

• Hypothalamus (fighting, fleeting, fucking, feeding response to stress): corticopin releasing hormone (CRH) to the anterior pituitary
• Anterior pituitary: adrenocorticotropin hormone (ACTH) to the adrenal cortex
• Adrenal cortex (outer): produces cortisol and other glucose
• Allocates resources towards fight or flight and away from feed and breed/rest and digest (medium to long term energy demands of flight to flight responses)

Question 10

HPA psychological effects

Answer 10

1) Immunosuppression (immune system gets worse)
2) Cell growth and tissue repair taxed (if chronic activated, can have long term negative health impacts)
3) Degradation of hippocampus cells (impairs memory formation)
•High cortisol levels are bad

Question 11

Stress-related disorders

Answer 11

Stress is important in almost all disorders
Some are specifically related to a response to a stressful event
Trauma and stressor related disorder

Question 12

Adjustment disorder

Answer 12

Psychological response to a common stressor that is
•Clinically significant (functional impairment) with emotional or behavioural symptoms
•Onset within 3 months after the stressor
•Often different diagnosis if symptoms last longer than 3 months (anxiety)

Question 13

Stressors in adjustment disorder and treatment (?)

Answer 13

Anything can be seen as a stressor as long as the individual finds it stressful enough to cause adjustment disorder
•Least stigmatizing of diagnosis’ because its the least severe/most related to daily life
•Usually major symptoms/features at the top, then some sort of exclusion (differential diagnosis) (?)
•Symptoms lessen when: stressor ends, or person learns to cope/habituate to stressor
Treatment
1)Psychotherapy for anxiety/depression
2)Coping strategies
3)Providing emotional support
4)Treat underlying vulnerability
5)Meds: antidepressant/anxiolytic

Question 14

Post traumatic stress disorder

Answer 14

PTSD: clinically significant distress following trauma
•Trauma: an experience that was extreme, terrifying, and stressful (natural disasters, major accidents that can be individual (attempted murder, sexual assault) or organized violence (war, ethnic cleansing))
*Witnessing an accident counts as trauma, but media does not except when forced to watch something traumatic (ex: your job as police to review tapes of child pornography)
PTSD history:
•Used to be classified under anxiety disorder due to the sense of fear
•DSM-5: more scientifically/administratively useful to classify PTSD into it’s own category

Question 15

PTSD symptoms

Answer 15

Following symptoms must be continuous for 1+ months following the trauma with clinically significant distress/impairment not resulting in other factors:
1) Direct exposure to traumatic event
2) Intrusive recollection of trauma
•Ex: nightmares, flashbacks where individual disassociates from reality
3) Avoidance of trauma related stimuli
•Ex: avoid going to intersection where accident happened
4) Poor mood and/or cognition:
•Ex: depression-like symptoms, negative/helpless outlooks on self/life, dissociative amnesia
5) Increased anxiety, arousal, and reactivity

Question 16

Traumatic memories (PTSD)

Answer 16

The memory is crucial to symptom presentation commonly experiencing:
•Fragmented memory of experience right before emotional event is common (memory right before is often most important in treatment)
•Dissociative amnesia: people may forget most important/traumatic parts of the event (could also just be refusal to think about it)
*May be present for only certain details of the memory (will remember generally what happened leading to collective memory)
•Intrusive recollections (due to the white bear phenomenon: trying to not think about event makes u think it more)

Question 17

Timing and onset (PTSD)

Answer 17

Onset of symptoms are usually present within first 3 weeks of exposure
•This can be delayed (ex: soldiers developing PTSD only after returning home)
•Can happen at any age, but children will display distress symptoms differently

Question 18

Prevalence of PTSD (US)

Answer 18

Lifetime: 8.7%//One year: 3.5%
Lifetime gender: M: 5-6%//F: 10-12%
•Women are about 2x more likely to develop lifetime because (theories):
•Men are more likely to experience traumatic stressors in general
•Women are more likely for some types of trauma (sexual assault)
•Men and women respond to stress differently (culturally and hormonally)

Question 19

Trauma related factors (PTSD)

Answer 19

PTSD is less common:
•In places with less natural disasters/ organized violence
PTSD is more common:
1) Following human-perpetrated trauma
•Ex: Shaley and Freedman looked at car accidents vs terrorist attacks in middle east, finding people were less likely to develop PTSD after accident because they aren’t calculated (results in a distrust of humanity)
2)With direct or intense exposure to traumatic events
•Ex: victims of natural disaster vs first responders to disasters

Question 20

Individual factors (PTSD) (?)

Answer 20

Risk of trauma associated with growing up in a bad area: male, less educated, conduct problems as a child, family history of psychiatric problems
•Family psychiatric: parents put child in more risk of disorganized environment
•Conduct disorder associated with antisocial personality disorder
•Males tend to respond to trauma with other types of presentation (alcoholism)

Risk of developing PTSD after trauma: high neuroticism, pre existing anxiety/depression, family history of psychiatric difficulties, lack of social support
•Social support: needed to avoid PTSD, but after trauma, it is common to withdrawal making it hard to have social support
•Negative beliefs about PTSD symptoms and environment (?)
•Cognitive ability: the higher the IQ, the less likely you’ll get PTSD
*No relationship to low IQ, but high IQ is a protective factor (make meaning/coping strategies in both adults and children)
•Concerns of future trauma: people who are worried about being traumatized have a correlation with developing PTSD

Question 21

Biological factors (PTSD) (?)

Answer 21

HPA-axis findings
1) Women with PTSD have greater baseline (higher cortisol) than women without it, with no difference found in men
2) People with PTSD have a more active stress-response system (cortisol/other HPA-axis activities) in response to stressors
*Other HPA factors: cortisol metabolism, receptor expression
3) Short form serotonin transporter gene (s/s) especially if low social support (related to interpersonal sensitivity)
4) Brain regions: hippocampus and PTSD
•Involved in forming of feared memory
•Impacted by HPA-axis activity
•Endocannabinoid system signalling implications as well

Question 22

Social factors (PTSD)

Answer 22

1) Ethnic minority groups are more likely develop PTSD/experience traumatic events
2) More access to education/healthcare and higher income, the less likely to develop PTSD/experience traumatic events
3) Good/supportive environment correlated with lower likelihood of PTSD development
4) Stigma/negative attitudes to PTSD increases vulnerability and symptoms
•Especially in military environments (not wanting to be seen as weak)
5) Beneficial to have: social support, opportunity to engage in stress coping behaviours, counselling soon after traumatic event (ex: comforts of home for soldiers)

Question 23

Treatment of PTSD

Answer 23

1) Safe environment: removal from stressor/traumatic context
2) Exposure to fearful memory:
•Prolonged imaginal exposure: elaboration of details overtime
•Take them back to site to discourage avoidance and examine underlying fears (requires support and encouragement)
3) Coping skills and strategies
4) Beliefs about self and the world: trying to shift negative beliefs
5) Meds for anxiety, depression, and sleep