Trauma/Stressor-Related, Dissociative, and Somatic Symptom Disorders

Question 1

Reactive Attachment Disorder

symptom criteria

Answer 1

A. persistent pattern of inhibited and emotionally withdrawn beahvior toward adult caregivers

B. persistent social and emotional disturbances including at least 2 of 5 of the following:
* minimal social & emotional responsiveness to others
* limited positive affect
* unexplained irritability, sadness, or fearfulness when interacting with caregivers

C. history of extreme insufficient care

Question 2

Reactive Attachment Disorder

age-related onset criteria

Answer 2

• onset: before 5 years old
• developmental age of at least 9 months old

Question 3

Disinhibited Social Engagement Disorder

symptom criteria

Answer 3

A. inappropriate interactions with unfamiliar adults as demonstrated by at least 2 of 4 symptoms:
* reduced or absent reticence in approaching or interacting with strangers
* overly familiar behavior with strangers
* diminished or absent checking with adult caregivers after being separated from them
* willingness to accompany a stranger with little to no hesitation

B. history of extreme insufficient care

Question 4

Disinhibited Social Engagement Disorder

duration criterion

Answer 4

developmental age of at least 9 months

Question 5

Posttraumatic Stress Disorder

associated brain abnormalities

Answer 5

• hyperactive amygdala & anterior cingulate cortex
• hypoactive ventromedial PFC - reduces inhibitory top-down control of amygdala = exaggerated fear response
• reduced volume of the hippocampus

Question 6

Posttraumatic Stress Disorder

associated neurotransmitter abnormalities

Answer 6

• increased levels and activity of dopamine, norepinephrine, & glutamate
• decreased levels and activity of serotonin & GABA

Question 7

Posttraumatic Stress Disorder

first-line treatment

Answer 7

1. CBT, CPT, cognitive therapy, & prolonged exposure
2. electic therapy: EMDR (research inconsistently supports)

Question 8

Posttraumatic Stress Disorder

research on critical incident stress debriefing and group psychological debriefing

Answer 8

• not effective
• may actually WORSEN symptoms

Question 9

Posttraumatic Stress Disorder

research on telepsychology for treating PTSD has found it to be (more effective, the same, or less effective) than face-to-face interventions

Answer 9

similary effective

Question 10

Posttraumatic Stress Disorder

outcomes from research with veterans evaluating telepsychology for treating PTSD

Answer 10

telepsychology & face-to-face interventions yielded similar outcomes in the following:
* reduction of symptoms
* attendance & dropout rates
* client satisfaction
* therapist fidelity to treatment protocols

yielded difference in: therapeutic alliance
* noted some barriers due to inability to detect nonverbal communication

Question 11

Posttraumatic Stress Disorder

APA-recommended treatment for children and adolescents

Answer 11

A. not addressed by APA guidelines
B. TF-CBT originally designed for children & adolescents ages 3 to 18 years old who have experienced sexual abuse
* now used for variety of trauma
* incorporates family therapy, parenting skills training ,& conjoint parent-child therapy

Question 12

Posttraumatic Stress Disorder

pharmacological treatment for adults

Answer 12

A. SSRIs:
* fluoxetine
* paroxetine
* sertraline

B. SNRIs:
* venlafaxine

useful for treating depression that accompanies PTSD & may alleviate core symptoms of re-experiencing, avoidance/numbing, and hyperarousal

Question 13

Prolonged Grief Disorder

symptom criteria

Answer 13

A. death of a person close to the patient
B. grief response must include:
* intense yearning for the deceased person and/or
* preoccupation with thoughts about that person
C. at least 3 of 8 symptoms:
* marked sense of disbelief
* avoidance of reminders of deceased person
* emotional numbness
* intense loneliness

Question 14

Prolonged Grief Disorder

duration and frequency criteria

Answer 14

• duration: at least 1 month
• frequency: nearly every day

Question 15

Dissociative Disorders

characteristics of this class of disorders

Answer 15

A. disruption or discontinuity in normal integration of:
* consciousness
* memory
* identity
* emotion
* perception
* body representation
* motor control
* behavior

Question 16

Dissociative Amnesia

symptom criteria

Answer 16

A. inability to recall important personal information
B. not attributed to ordinary forgetfulness

Question 17

Dissociative Amnesia

types and descriptions

Answer 17

A. localized amnesia (most common): inability to recall all events
B. selective amnesia: inability to recall some events
C. generalized amnesia: complete loss of memory of one’s entire life
D. systematized amnesia: loss of memory for specific category of information
E. continuous amnesia: inability to remember new events as they happen

Question 18

Dissociative Amnesia

a specifier is used to indicate…

Answer 18

if the disorder includes dissociative fugue (purposeful travel or purposeless wandering associated with memory loss)

Question 19

Depersonalization/Derealization Disorder

symptom criteria

Answer 19

A. persistent or reccurent episodes of depersonalization (a sense of unreality, detachment, or being an outside observer of one’s thoughts, actions, etc.) OR derealization (a sense of unreality or detachment to one’s surroundings)
B. intact reality testing
C. significant distress or impaired functioning

Question 20

Somatic Symptom Disorder

symptom criteria

Answer 20

A. one or more somatic symptoms cause distress or significant disruption to daily life
B. accompanied by excessive thoughts, emotions, or behaviors related to symptoms or associated health concerns as indicated by at least 1 of the following:
* disproportionate or persistent thoughts about seriousness of symptoms
* persistently high level of anxiety about health or symptoms
* excessive time & energy spent on health concerns or symptoms

Question 21

Somatic Symptom Disorder

duration criteria and specifiers

Answer 21

A. mild, moderate, or severe
* predominant pain
* persistent (severe, cause marked impairment, & lasted more than 6 month)

Question 22

Functional Neurological Symptom Disorder

symptom criteria

Answer 22

A. one or more symptoms involve disturbance in voluntary motor or sensory functioning (e.g., paralysis, blindness)
B. symptoms must be incompatible with any known neurological or medical condition

B. video EEG required for diagnosis

Question 23

Functional Neurological Symptom Disorder

use of specifiers

Answer 23

indicate symptom type, course of disorder (acute or persistent), & presence or absence of psychological stressor

Question 24

Functional Neurological Symptom Disorder

can involve what type of seizures?

Answer 24

A. psychogenic non-epileptic seizures (PNES)
* behaviors resemble true epileptic seizures
* no brain electrical activity associated with true epileptic seizures

Question 26

# **Factitious Disorder** **symptom** criteria ## Footnote Gypsy Rose

Answer 26

distinguish between **imposed on self** or **imposed on another** A. falsify or induce physical or psychological symptoms associated with a deception (e.g., ingestion of a drug to produce abnormal lab results) B. present self to others as being ill or impaired AND engage in the deception even when there's no obvious external reward for doing so *imposed on another - same symptoms excpet they are induced in another person (e.g., often in a child by their mother)

Question 27

# **Factitious Disorder** important **differentiations** between *factitious disorder* and *malingering*

Answer 27

*malingering* * intentional reporting of symptoms **for personal gain** A. intentional production of physical or psychological symptoms for purpose of obtaining a drug, financial compensation, or other external reward *factitious disorder* * illness falsification is **not** fully accounted for by external rewards

Question 27

# **Malingering** suspect malingering when...

Answer 27

* a person seeks medical evaluation for legal reasons * marked **discrepancy** between symptoms & objective findings * person is **uncooperative** with evaluation or treatment * person exhibits **excessive impairment** or unexpected pattern of responding on neuropsych tests * person has **antisocial personality disorder**

Question 28

# **Malingering** **method** useful for detecting malingering ## Footnote the TOMM assessment

Answer 28

forced-choice * presenting test items that require the person to choose the correct answer from 2 or more alternatives **people malingering will choose the incorrect option at a higher rate than would be expected by chance alone** *(ex. true or false options - person answers more than 50% of items incorrectly)*

Question 29

# **Factitious Disorder & Malingering** **feigned memory** loss associated with factitious disorder & malingering must be distinguished from...

Answer 29

genuine memory loss due to TBI or other condition

Question 30

# **Factitious Disorder & Malingering** ways to distinguish feigned vs. genuine memory loss

Answer 30

A. genuine: * start & end of amnestic period is gradual & hazy * often remember fragments of some events that occurred during that period * often believe that hints or clues will help recall B. feigned: * onset & termination of amnestic period often sudden * do not remember any events that occurred during this time period