Trauma/Stressor-Related, Dissociative, and Somatic Symptom Disorders Flashcards
Reactive Attachment Disorder
symptom criteria
A. persistent pattern of inhibited and emotionally withdrawn beahvior toward adult caregivers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
Reactive Attachment Disorder
age-related onset criteria
- onset: before 5 years old
- developmental age of at least 9 months old
Disinhibited Social Engagement Disorder
symptom criteria
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
Disinhibited Social Engagement Disorder
duration criterion
developmental age of at least 9 months
Posttraumatic Stress Disorder
associated brain abnormalities
- hyperactive amygdala & anterior cingulate cortex
- hypoactive ventromedial PFC - reduces inhibitory top-down control of amygdala = exaggerated fear response
- reduced volume of the hippocampus
Posttraumatic Stress Disorder
associated neurotransmitter abnormalities
- increased levels and activity of dopamine, norepinephrine, & glutamate
- decreased levels and activity of serotonin & GABA
Posttraumatic Stress Disorder
first-line treatment
- CBT, CPT, cognitive therapy, & prolonged exposure
- electic therapy: EMDR (research inconsistently supports)
Posttraumatic Stress Disorder
research on critical incident stress debriefing and group psychological debriefing
- not effective
- may actually WORSEN symptoms
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
similary effective
Posttraumatic Stress Disorder
outcomes from research with veterans evaluating telepsychology for treating PTSD
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
Posttraumatic Stress Disorder
APA-recommended treatment for children and adolescents
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
Posttraumatic Stress Disorder
pharmacological treatment for adults
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
Prolonged Grief Disorder
symptom criteria
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
Prolonged Grief Disorder
duration and frequency criteria
- duration: at least 1 month
- frequency: nearly every day
Dissociative Disorders
characteristics of this class of disorders
A. disruption or discontinuity in normal integration of:
* consciousness
* memory
* identity
* emotion
* perception
* body representation
* motor control
* behavior
Dissociative Amnesia
symptom criteria
A. inability to recall important personal information
B. not attributed to ordinary forgetfulness
Dissociative Amnesia
types and descriptions
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
Dissociative Amnesia
a specifier is used to indicate…
if the disorder includes dissociative fugue (purposeful travel or purposeless wandering associated with memory loss)
Depersonalization/Derealization Disorder
symptom criteria
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
Somatic Symptom Disorder
symptom criteria
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
Somatic Symptom Disorder
duration criteria and specifiers
A. mild, moderate, or severe
* predominant pain
* persistent (severe, cause marked impairment, & lasted more than 6 month)
Functional Neurological Symptom Disorder
symptom criteria
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
Functional Neurological Symptom Disorder
use of specifiers
indicate symptom type, course of disorder (acute or persistent), & presence or absence of psychological stressor
Functional Neurological Symptom Disorder
can involve what type of seizures?
A. psychogenic non-epileptic seizures (PNES)
* behaviors resemble true epileptic seizures
* no brain electrical activity associated with true epileptic seizures
Factitious Disorder
symptom criteria
Gypsy Rose
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)
Factitious Disorder
important differentiations between factitious disorder and malingering
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
Malingering
suspect malingering when…
- 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
Malingering
method useful for detecting malingering
the TOMM assessment
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)
Factitious Disorder & Malingering
feigned memory loss associated with factitious disorder & malingering must be distinguished from…
genuine memory loss due to TBI or other condition
Factitious Disorder & Malingering
ways to distinguish feigned vs. genuine memory loss
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
