Trauma and Dissociation

Question 1

Experienced when our stress response systems
are overwhelmed or ill-equipped to handle events in our
lives and our bodies compensate/adjust to survive

Answer 1

Trauma

Question 2

List the DSM-5 criteria (A-F) for post-traumatic stress disorder

Answer 2

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

Question 3

List the five intrusion/cognitive re-experiencing symptoms associated with criterion B of the DSM-5 PTSD criteria

Answer 3

Intrusive thoughts

Nightmares

Flashbacks

Emotional reactivity

Physiological reactivity

Question 4

List the five avoidance symptoms associated with criterion C of the DSM-5 PTSD criteria

Answer 4

Avoid thoughts of trauma

Avoid trauma reminders

Inability to recall trauma

Question 5

List the four emotional numbing symptoms associated with criterion D of the DSM-5 criteria for PTSD

Answer 5

Loss of interest

Detachment

Restricted affect

Foreshortened future

Question 6

List the five somatic hyperarousal symptoms associated with criterion E of the DSM-5 criteria for PTSD

Answer 6

Sleep disturbance

Increased irritability

Difficulty concentrating

Hypervigilance

Excessive startle response

Question 7

Describe the first step of assessing for PTSD and the associated difficulty

Answer 7

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

Question 8

What are four challenges with PTSD assessment?

Answer 8

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?

Question 9

True or false: Most people who experience traumatic events develop PTSD

Answer 9

False

Question 10

What is the prevalence rate of PTSD in the population?

Answer 10

8% lifetime

Question 11

Describes the psycho-spiritual consequences of events that
seriously violate one’s core moral beliefs and expectations

Answer 11

Moral injury

Question 12

What are the four core features of moral injury?

Answer 12

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

Question 13

What are four options for treating PTSD?

Answer 13

Exposure-based methods

Rewriting the narrative of the traumatic event (e.g. cognitive
processing therapy)

SSRI medications

Eye movement desensitization and reprocessing (EMDR)

Question 14

What does eye movement desensitization and reprocessing (EMDR) involve regarding PTSD treatment?

Answer 14

Involves moving the eyes quickly while discussing the trauma

Question 15

What is the consequence of debriefing immediately after a traumatic event?

Answer 15

Debriefing traumatic events immediately after the event can be damaging (and cause PTSD symptoms)

Question 16

What is the main distinction between acute stress disorder and PTSD?

Answer 16

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)

Question 17

List the criteria (A-E) of adjustment disorders according to the DSM-5

Answer 17

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

Question 18

List the criteria (A-F) for prolonged grief disorder as outlined in the DSM-5-TR

Answer 18

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

Question 19

What are the two major attachment disorders?

Answer 19

Reactive attachment
disorder

Reactive attachment
disorder

Question 20

What classifies an attachment disorder?

Answer 20

Symptoms emerge before the age of 5; unable to form healthy attachments with parental figures, often due to abusive early experiences

Question 21

What are the three main types of dissociative disorders?

Answer 21

Depersonalization
/Derealization Disorder

Dissociative Identity Disorder

Dissociative amnesia

Question 22

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

Answer 22

Dissociation

Question 23

Experiences of unreality or detachment with respect to surroundings

Answer 23

Derealization

Question 24

Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions

Answer 24

Depersonalization

Question 25

List the criteria (A-E) of Depersonalization/Derealization Disorder

Answer 25

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

Question 26

List the criteria (A-D) of dissociative amnesia

Answer 26

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

Question 27

Apparently purposeful travel or bewildered wandering that is
associated with amnesia for identity or
for other important autobiographical
information.

Answer 27

Dissociative fugue

Question 28

List the criteria (A-E) for dissociative identity disorder

Answer 28

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

Question 29

What is the relationship between DID and childhood trauma?

Answer 29

Almost everyone with DID (97%) has experienced significant childhood trauma; 68% reported incest

Question 30

List the four main reasons why some mental health professionals question DID as a diagnosis

Answer 30

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