Trauma and Dissociation Flashcards
Experienced when our stress response systems
are overwhelmed or ill-equipped to handle events in our
lives and our bodies compensate/adjust to survive
Trauma
List the DSM-5 criteria (A-F) for post-traumatic stress disorder
A. Exposure to actual or threatened death, serious injury, or sexual violence
B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning
after the traumatic event(s) occurred
C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s)
occurred:
D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening
after the traumatic event(s) occurred
E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following
F. Symptoms have persisted for at least one month
List the five intrusion/cognitive re-experiencing symptoms associated with criterion B of the DSM-5 PTSD criteria
Intrusive thoughts
Nightmares
Flashbacks
Emotional reactivity
Physiological reactivity
List the five avoidance symptoms associated with criterion C of the DSM-5 PTSD criteria
Avoid thoughts of trauma
Avoid trauma reminders
Inability to recall trauma
List the four emotional numbing symptoms associated with criterion D of the DSM-5 criteria for PTSD
Loss of interest
Detachment
Restricted affect
Foreshortened future
List the five somatic hyperarousal symptoms associated with criterion E of the DSM-5 criteria for PTSD
Sleep disturbance
Increased irritability
Difficulty concentrating
Hypervigilance
Excessive startle response
Describe the first step of assessing for PTSD and the associated difficulty
The first step of PTSD assessment is determining Criterion A
(the “index trauma”) which can be a challenge
People often do not want (understandably) to discuss trauma
What are four challenges with PTSD assessment?
Many different types of traumatic events
What if there are multiple traumatic events?
How do you gather information without asking too many detailed questions?
What if someone describes an event as traumatic, but does not meet the criteria for Criterion A?
True or false: Most people who experience traumatic events develop PTSD
False
What is the prevalence rate of PTSD in the population?
8% lifetime
Describes the psycho-spiritual consequences of events that
seriously violate one’s core moral beliefs and expectations
Moral injury
What are the four core features of moral injury?
Guilt
Shame
Inner conflict or sense of loss relating to ones’ identity, spirituality, or sense of meaning
Loss of trust in self, others, institutions and/or transcendent beings
What are four options for treating PTSD?
Exposure-based methods
Rewriting the narrative of the traumatic event (e.g. cognitive
processing therapy)
SSRI medications
Eye movement desensitization and reprocessing (EMDR)
What does eye movement desensitization and reprocessing (EMDR) involve regarding PTSD treatment?
Involves moving the eyes quickly while discussing the trauma
What is the consequence of debriefing immediately after a traumatic event?
Debriefing traumatic events immediately after the event can be damaging (and cause PTSD symptoms)
What is the main distinction between acute stress disorder and PTSD?
Acute stress disorder can be diagnosed 3 days to 1 month after the traumatic event (for PTSD, symptoms need to be present at least one month after the event)
List the criteria (A-E) of adjustment disorders according to the DSM-5
A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).
B. Significant impairment evidenced by one or both: 1) Marked distress that is out of proportion to the severity or intensity of the stressor 2) Impairment in social, occupational, or other important functioning areas
C. The stress-related disturbance does not meet the criteria for another mental
disorder and is not merely an exacerbation of a preexisting mental disorder.
D. The symptoms do not represent normal bereavement.
E. Once the stressor or consequences have terminated, the symptoms do not persist for more than an additional 6 months
List the criteria (A-F) for prolonged grief disorder as outlined in the DSM-5-TR
A. The death, at least 1 year ago, of a person who was close to the bereaved individual
B. Since the death, the persistent grief response is characterized by one or both of the following (most days and to a clinically significant degree): Intense yearning/longing for the deceased person; preoccupation with thoughts/memories of the deceased person
C. Since the death, at least three symptoms (e.g., identity disruption, disbelief, avoidance, numbness) present most days to a clinically significant degree
D. Clinically significant distress/impairment in social, occupational, other important functioning areas
E. The duration and severity of bereavement reaction clearly exceed expected social, cultural, or religious norms for the individuals culture and context
F. Nor better explained by other disorders, substance, medical conditions
What are the two major attachment disorders?
Reactive attachment
disorder
Reactive attachment
disorder
What classifies an attachment disorder?
Symptoms emerge before the age of 5; unable to form healthy attachments with parental figures, often due to abusive early experiences
What are the three main types of dissociative disorders?
Depersonalization
/Derealization Disorder
Dissociative Identity Disorder
Dissociative amnesia
Disruption of and/or discontinuity in
the normal integration of consciousness, memory, identity, emotion, perception, body representation,
motor control, and behavior…frequently in the aftermath of trauma
Dissociation
Experiences of unreality or detachment with respect to surroundings
Derealization
Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions
Depersonalization
List the criteria (A-E) of Depersonalization/Derealization Disorder
A. The presence of persistent or recurrent experiences of
depersonalization, derealization, or both
B. During the depersonalization or derealization experiences,
reality testing remains intact.
C. The symptoms cause clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
D. The disturbance is not attributable to the physiological effects of
a substance
E. Not attributable to another disorder
List the criteria (A-D) of dissociative amnesia
A. An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting.
B. The symptoms cause clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
C. The disturbance is not attributable to the physiological effects of a
substance or a neurological or other medical condition
D. The disturbance is not better explained by another mental disorder
Apparently purposeful travel or bewildered wandering that is
associated with amnesia for identity or
for other important autobiographical
information.
Dissociative fugue
List the criteria (A-E) for dissociative identity disorder
A. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.
B. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The disturbance is not a normal part of a broadly accepted cultural or religious practice.
E. The symptoms are not attributable to the physiological effects of a substance or another medical condition
What is the relationship between DID and childhood trauma?
Almost everyone with DID (97%) has experienced significant childhood trauma; 68% reported incest
List the four main reasons why some mental health professionals question DID as a diagnosis
DID patients are highly suggestible and DID symptoms may be reinforced by therapists
How do you conclusively determine a separate personality?
Could they be faking? In lab experiments, 80% of participants (who do not have dissociative
symptoms) spontaneously faked DID to get out of a pretend murder charge
In an official position statement on recovered memories, the Canadian Psychiatric Association
warned that childhood memories later recovered in adulthood were of questionable
reliability and should never be accepted without corroboration
