Trauma/stressor-related And Dissociated Disorders Flashcards
What are the trauma and stress disorders?
- Posttraumatic Stress Disorder
- Acute Stress Disorder
- Adjustment Disorder
- Reactive Attachment Disorder
- Disinhibited Social Engagement Disorder
What are the types of stressors?
Psychological distress in response to a stressful event – “overwhelmed” coping mechanisms
• Traumatic stressor: Involves actual/threatened death or serious injury
• Non-traumatic stressor: Perception that environmental demands exceed one’s resources to cope
Psychological distress can manifest in many forms (e.g., anxiety, dysphoria, anger, dissociation)
What is the PTSD diagnosis?
Exposure to a traumatic stressor:
- Actual or threatened death or serious injury or sexual violence
- Exposure may include direct experience of event, witnessing event, or learning about event that happened to a close family member/friend
As a result, 1+ symptom from each of the 4 categories of symptoms must develop:
What are the characteristics of PTSD symptoms?
1) Intrusive Symptoms • Dreams • Automatic Recollections • Feeling like the event is re-occurring • Psychological or physiological distress when encountering symbols that remind of the event
2) Avoidance Symptoms
• The individual avoids thoughts, places, or conversations that remind him/her of the event
3) Negative Alterations in Cognition and Mood
• Negative beliefs/expectations
• Negative emotional states
• Inability to experience positive emotion
• Diminished interest/participation in activities
• Detachment/estrangement from others
• Inability to remember an important aspect of the traumatic event
4) Alterations in Arousal and Reactivity
• Sleep disturbance
• Irritable and angry outbursts
• Reckless or self-destructive behavior • Concentration problems
• Hypervigilance
• Exaggerated startle response
• DSM Diagnostic Note: Specify if with dissociative symptoms
(i.e., depersonalization and/or derealization)
Describe the onset of PTSD
Duration: Symptoms must last >1 month
- Onset: Symptoms usually begin within 3 months of the trauma but can begin any time
- Vulnerable Populations: Often occurs in young adults but can happen to anyone; Patients with sudden-onset, life- threatening medical emergencies can experience PTSD
Describe the onset of ASD
Exposure to a traumatic stressor
• Numerous PTSD-like symptoms must develop from the four PTSD symptom categories or an additional category: Dissociative Symptoms
• Altered sense of the reality of one’s surroundings or oneself
• Inability to remember an important aspect of the traumatic event(s)
typically due to dissociative amnesia
• Duration of the disorder is 3 days to 1 month after trauma exposure
What is adjustment disorder?
Significant and disproportional emotional/behavioral symptoms in direct response to a stressor
• Stressor can be “ordinary” psychosocial (i.e., divorce) or traumatic
• Acute onset (symptoms develop within a few months of stressor onset)
• Brief duration (symptoms expected to resolve within a few months after stressor termination)
Symptoms aren’t explained by another disorder
Contrast ASD and PTSD
Key to differentiating ASD from PTSD is the time frame:
- ASD: Symptoms start and resolve within the first 30 days after the trauma and last 3+ days
- PTSD: Symptoms start anytime after the trauma and last more than 30 days
What are the subtypes of adjustment disorder?
Adjustment Subtypes
• with depressed mood
• with anxiety
• with disturbance of conduct (i.e., externalizing misbehavior such as vandalism)
• with mixed anxiety and depressed mood
• with mixed disturbances of emotion & conduct
• unspecified
What is the key differentiating adjustment disorder?
Key to differentiating Adjustment Disorder is process of elimination
- If sufficient symptoms (following a stressor) to match other diagnostic criteria – that is the diagnosis (e.g., Major Depressive Disorder)
- Adjustment Disorder diagnosed ONLY if there is a causal stressor AND no other disorder explains the symptoms
What can lead to RAD ?
In relation to adult caregivers: 1. 2. 3. 4. Consistent pattern of inhibited, emotionally withdrawn behavior
• Child rarely (i) seeks comfort; (ii) responds to comfort when distressed
At least 2 persistent social and emotional disturbances:
Minimal social and emotional responsiveness to others
Limited positive affect
Unexplained irritability, sadness, or fearfulness during nonthreatening interactions
At least 1 extreme of insufficient childcare:
Persistent lack of emotional needs for comfort, stimulation, and affection Repeated changes of primary caregivers
Rearing in unusual settings that limits attachment
Insufficient childcare precedes withdrawn behavior
What is Disinhibited Social Engagement Didorder?
Same as RAD diagnosis except #1 and #2: Externalizing versus internalizing behaviors
Child approaches and interacts with unfamiliar adults in 2+ ways:
- Reduced or absent reticence in interacting with unfamiliar adults
- Age and culturally inappropriate verbal or physical behavior
- Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings
- Willingness to go off with an unfamiliar adult
Explain the etiology of PTSD and ASD
Hyperresponsive amygdala (fear)
• Under-responsive prefrontal cortex
(failure to inhibit fear)
- Reduced volume and dysfunction of hippocampus (impaired memory consolidation – dissociation?)
- Likely underlies the intrusive symptoms, alterations in arousal and reactivity, and impaired executive function seen in these disorders
Explain RAD and DSED etiology
• A direct result of pathogenic care in early childhood (under 5 years old):
– Social emotional neglect
– Repeated changes in adult caregiver
• Health and well-being of caregivers impacts child well-being:
– Current caregiver stressors, such as economic challenges
• Low SES = increased risk of emotional-behavioral problems in children
– Caregiving paradigm shaped by past experiences
• Abused caregivers more likely to have children who are abused/neglected
How do we treat PTSD and ASD?
Psychotherapy:
• Supportive therapy offering safe environment to express feelings
• Behavioral therapy to address specific problematic behaviors (e.g., avoidance behavior)
Medications:
• Antidepressants (SSRI first-choice, e.g., Sertraline)
