Week 6 Flashcards
What is the role of anxiety in the Egos management of conflict between the ID and the super ego?
The anxiety is the signal and symptom, to call the defense mechanism in conflict in action
How would a white gay male and a Latino gay male experience the privilege of sexism differently?
We experience multiple social identities are experienced simultaneously (4 cultural principles by Dadlani, overtree & Perry Jenkins)
Cognitive behavioral approach to case formulation
Focused on developing “patient story” that describes the emergence and maintenance of symptoms
Cannons flight or flight theory (1914)
Sympathetic nervous system activates and down regulates body’s “fight, flee, or freeze response”
With adjustment disorder what about the stressor?
We always know what the stressor is to diagnose it
Adjustment disorder
Associated with increased risk of suicide attempts and completed suicides, diagnosis is not used if symptoms meet criteria for another mental disorder
Adjustment disorder: diagnostic criteria
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. These symptoms or behaviors are clinically significant, as evidenced by one or both of the following:
1 Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.
2 Significant impairment in social, occupational, or other important areas of functioning.
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 and are not better explained by prolonged grief disorder.
E. Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.
Specifiers: acute vs chronic reflects the difference of the duration of the stressor, not the symptoms
Adjustment disorder subtypes
F43.21 with depressed mood
F43.22 with anxiety
F43.23 with mixed anxiety and depressed mood
F43.21 Adjustment disorder with depressed mood
predominant manifestations are symptoms such as depressed mood, tearfulness or feelings of hopelessness
F43.22 adjustment disorder with anxiety
Symptoms such as nervousness, worry or jitteriness or in children, fears of separation from major attachment figures
F43.23 adjustment with mixed anxiety and depressed mood
Combination of anxiety and depressed mood
More subtypes of adjustment disorder
F43.24 with disturbance of conduct
F43.25 with mixed disturbance of emotions and conduct
F43.20 unspecified
Diathesis-Stress model
Predisposition+stress=increased risk
-diathesis=vulnerability
-a psychological theory that attempts to explain a disorder as the result of an interaction between a predispositional vulnerability and a stress caused by life experiences
McWilliams levels of character structure
a psychodynamic stress/diathesis model composed of 3 schemas: neurotic, borderline and psychotic
In the McWilliams character structure
the levels of schemas contribute to the vulnerability of different types of stressors
Neurotic level of personality structure (everyone is neurotic)
rely primarily on the more mature or second-order defenses, integrated sense of identity, good reality testing and engage in a therapeutic split
In good reality testing symptoms are
ego dystonic (they feel wrong, they feel bad, these symptoms hurt me, they are a sign that I am not doing well)
Psychotic level of personality structure
defenses are primitive and preverbal (not a response you will expect) the primitive defenses prevents them from being realistic about reality
Borderline level of personality structure
sometimes difficult to distinguish from psychotic level when regressed, they look the same, when they feel close to another person, they panic because they fear total control
When do trauma and stressor related disorders occur
it can happen to anyone, whenever, and the context of the trauma comes along with us, it is always complicated when introducing trauma
Acute Stress Disorder
diagnosed when symptoms occurred at least two days after stressor, but no more than 4 weeks
What happens if a symptoms from a acute stress disorder last more than 4 weeks?
consider PTSD, if not acute stress may dissolve
When can an individual not meet criteria for Acute stress disorder
when the stress exposure is from electronic media, games, tv, movies
How do children experience traumatic events?
They reenact the trauma with their toys, or have nightmares and do not speak about them.
Therapeutic Split
having an observing ego and splitting to see there’s a person here acting this way and being able to reflect about why they are the way they are. Being able to take a step and look at yourself- this is the best type of client because therapist can sit back
F43.0 Acute stress disorder criteria
Criterion A: one (or more) of the following ways:
• Directly experiencing the traumatic event(s).
• Witnessing, in person, the event(s) as it occurred to others
• Learning that the event (s) occurred to a close family member or close friend.
• Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains, police officers repeatedly exposed to details of child abuse).
Criterion B: Presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred:
Intrusion Symptoms
• Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
• Recurrent distressing dreams in which the content and/or affect of the dream are related to the even(s). Note: In children, there may be frightening dreams without recognizable content.
• Dissociative reactions (e.g. flashbacks) in which the individual feels or acts as if the traumatic even(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings). Note: In Children, Trauma specific reenactment may occur in play
• Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic event
• Negative Mood
• Persistent Inability to experience positive emotions (e.g. inability to experience happiness, satisfaction or loving feelings)
Dissociative Symptoms
• An altered sense of the reality of one’s surroundings or oneself (e.g. seeing oneself from another’s perspective, being in a daze, time slowing)
• Inability to remember an important aspect of the traumatic event (typically due to dissociative amnesia and not other factors such as head injury, alcohol or drugs)
Avoidance Symptoms
• Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
• Efforts to avoid external remindersa (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts or feelings about or closely associated with the traumatic event(s)
Arousal Symptoms
• Sleep disturbance (e.g. difficulty falling or staying asleep, restless sleep).
• Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.
• Hypervigilance
• Problems with concentration
• Exaggerated startle response
Criterion C: Duration of the disturbance (symptoms described in Criterion B) occurs for 3 or more days and less than 1 month after the traumatic event. Note: Symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria
Criterion D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
Criterion E. The disturbance is not due to the direct physiological effects of a substance (e.g., medication or alcohol) or a general medical condition (e.g., traumatic brain injury, coma), and is not better accounted for by brief psychotic disorder
Sexualization (Higher)
Endowing an object with sexual significance to turn a negative experience into an exciting and stimulating one
Isolation of affect (Higher)
Separating an idea from the associated affect state
Police officer describes a murder scene without emotion (to survive how it would feel)
Intellectualization (Higher)
Excessive use of abstraction to avoid unpleasant feelings e.g. not dealing with a break up by intellectualizing it
Schizoid fantasy (primitive)
Retreating into one’s private external world to avoid anxiety about interpersonal situations (like Benedict Cumberbatch’s Sherlock Holmes. Acts like he doesn’t need people and can live in his own mind).
Somatization (primitive)
Converting emotional pain and other affect states into physical symptoms and focusing on somatic rather than intrapsychic, concerns. The body helps avoid confronting what is going on. Emotionally /psychologically driven.
Acting out (Primitive)
Enacting an unconscious wish or fantasy impulsively as a way of avoiding painful affect
Splitting (the first defense that makes you “you”) (Primitive)
Compartmentalizing experiences of self and other such that integration is not possible
Comes from Object-relations theory (theorist called Klein): the fist way an infant separates itself from another. Psychological birth. Having split off elements, away from awareness, because it’s complicated to have multiple feelings.
Idealization (primitive)
Attributing perfect or near perfect qualities to others as way of avoiding anxiety or negative feelings, such as contempt, envy, or anger
Identification (higher)
Internalizing the qualities of another person by becoming like that person
