Chapter 5: Lecture notes
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Stress and Arousal Summary
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Post traumatic growth - being able to use that kind of trauma as something more positive change and growth for yourself and others.
Treatment to Stress Disorders: Therapy goals: ending the lingering stress reactions, acknowledging and giving a different perspective the traumas experienced, return to constructive living. Combat Stress Disorder Treamtent: drug therapy: antidepressant and anti-anxiety, reduce behavioral exposure techniques: flood & relaxation, EMDR, and reduce specific symptoms, and insight therapy.
People with different personalities are more likely to develop PTSD than others. Often the anxious types can contribute a chronic state of heightened anxiety or trauma aka trait anxiety, if someone has a negative worldview, not as resilient, or has some sort of childhood trauma, then PTSD is more likely to occur. Other factors include, rape/assault, war/violence, abuse/childhood abuse/catastrophe, personality disorders, biological/genetic predisposition, or experiencing your parents' divorce before the age of 10. Hispanic culture, and other cultural groups are at a higher risk than others, and a weak social support.
Abnormal neurotransmitter and hormone activity: cortisone and noprenprine. Once you develop a stress disorder, damage and shrink in the mind, especially in the amygdala and hippocampus. The trauma is greater than the physical symptoms, and it can also cause physical pain (somatic pain) that your body has enveloped from the trauma.
People have different fight or flight responses, which result from a generalized level of arousal and anxiety. It depends on the person on how events may be perceived as threatening, whereas for others it is not. Then there is situational-based, state anxiety like when you have a fear of flying while in the airplane.
When the fight or flight response is activated, the hypothalamus activates two systems: automated nervous system (ANS) and the endocrine system (hormones). In danger, the hypothalamus excites the sympathetic nervous system (SNS), which activates cortisol and nopreniprine, causing symptoms like pupils dilating and heart racing. Then the SNS kicks in to help calm the ANS and bring it back to a homeostasis state.
Terrorism and torture stress disorders usually result from survivors of war, or civilians.
Victimized and stress disorders: impact may be immediate and longterm, ongoing victimization and abuse.
Disasters and stress disorder occurs during natural disasters, airplane crashes, car accidents, etc. Most common and 10 times more at risk.
Combat Stress Disorders - "shell shock" and "combat fatigue."
Acute Stress Disorder has an onset of four weeks and usually disappears after 1 month. PSTD occurs when the precipitating event was very traumatic or stressful. It shows up weeks after the event or months or years even.
Stress triggers arousal and fear (flight or fight). Fear is a package of emotions that affect physical, emotional, and cognitive responses. Both arousal and fear play the central role in two psychological stress disorders: Acute Stress Disorder and PTSD.
Stress is the event that creates demands. It has two components: one's reaction, and how the event is judged. We have our own capacity to react to events, and it happens differently for everyone. When
Stress in the Brain
Treatment of stress disorder
specific to combat veterans
insight therapy
behavioral exposure techniques: reduce specific symptoms, flood & relaxation, EMDR
drug therapy
antidepressant / anti-anxiety
general goals
return to constructive living
gain perpsecitve on painful experiences
end lingering stress reactions
development of stress disorders
some cultural groups more vulnerable
latinos are more vulnerable - cultural beliefs and trauma and social relationships and social support.
weak social support
childhood experiences that increase risk
parent divorce before age 10
assault, abuse, catastrophe
psychological disorders
personality factors
resiliency
negative worldview
pre-existing high anxiety
trait anxiety
biological and genetic factors
biological/genetic predisposition
abnormal Neurotransmitter & hormone activity
once someone develops a stress disorder, it sets in forth further damage in the mind and body, esp in the amygdala and hippocampus
neuroprenipine and cortisol are related
trauma > physical changes
Stress & arousal: Fight or flight
fight or flight response: people differ
their perception of which situations are threatening
state anxiety, situation based: fear of flying when flying, you will have this feeling
general level of arousal and anxiety
Two pathways activated
hypothalamic-pituitary-adrenal
during stress, hypothalamus signals pituital gland which stimulates adrenal cortex to release
sympathetic nervous system (SNS)
hearts racing, pupils dilate
during danger, hypothalamus excites SNS
hypothalamus activates two systems
endocrine system (hormones)
automonimic nervous system (ans)
plays a central role in two psychological stress disorders
terrorism & torture
1/2 those exposed develop PTSD
victimization and stress disorders
ongoing victimization and abuse
impact may be immediate and long lasting
1 in 6 women is raped
1/3 of all victims of physical or sexual assault develop PTSD
disasters and stress disorders
10 times more at risk
natural disasters, airplane crashes, serious car accidents
combat and stress disorders
similar pattern for iraq and afganistan
29% of vietnam combat veterans
"shell shock", "combat fatigue"
symptoms of ASD and PTSD
hyperarousal: increased alertness and exaggerated startle reactions.
negative alterations in cognitions: enhanced negative emotional states, guilt, and shame
avoidance: steering clear of reminders of the trauma
re-experiencing: intrusive memories and flashbacks
PTSD
current prevalence: 3.5%; lifetime: 7-9%
associated with poverty
women > men (2:1)
begins either shortly after event or months or years afterward
precipitating event = actual or threatened serious injury to self or others
acute stress disorder
lasts for less than one month
4 weeks from the event
Stress has two components
arousal and fear when stressor is perceived as threatening
fear is a package of responses: physical, emotional, cognitive responses.
Key systems activated during stress include: ANS and endocrine system
endocrine system: releases hormones (cortisol) during stress response.
Autonomic nervous system (ANS): controls involuntarily bodily functions
stress responses: one's reaction
our capacity to react to event
how event is judged
stressors: event that creates demands
Part 1: Stress and Arousal
Why do stress disorders develop?
The hypothalamus acticates two systems: ANS and encocrine system (hormones), which creates arousal and fear into. It activates Sympathetic nervous system (SNS), which stimulates our key organs to whether or not do something. However when the stress and arousal subsides, the SNS kicks in to egulate us back to homeostasis.
Two pathways known as fight or flight response. People differ on trait anxieties and will face stress differently. (calm baby vs baby with intense emotions)
Describe what happens when we face perceived danger.
Dissosociative Disorders Summary
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Just because someone may experience some depersonalization or derealization, does not mean they have DDD. In order to be classified as having DDD, the person needs to have recurring events and it must be affecting their job and interpersonal relationships. This usually shows up in adolescents/young adults. It is long-lasting and sudden.
Depersonalization-derealization-disorder (DDD) is when someone is dissociative, they are experiencing an out-of-body experience, which is when the mind separates from the body, and the person sees them from the outside looking within (3rd POV). Unlike DID, DDD does not have any memory impairments. Instead clients with DDD experience a mental separation from their physical bodies. Their experience becomes unreal from the real world.
Treatment for DID can be complex and difficult. The ultimate goal is for the subpersonalities to merge into one. However, the first step is for the therapist to recognize the existence of subpersonalities. There, they will feel safe enough to explore the reasons why there was a split in the first place. It's a continuous treatment, but ultimately, the final merge deteremines the treatment was successful.
DID's subpersonalities interact in three ways: mutually amnesic personalities (all personalities are not aware that each other exist), cognizant amnesic personalities (all personalities are aware that each other exists), one-way amnesic personalities (some personalities are aware of each other, but it is not mutual.)
Dissociative Identity Disorder aka multipersonality disorder is when two or more distinct subpersonalities exist within a client as a form of protecting them after experiencing some kind of traumatic event. This is usually diagnosed before the age of 5, during late adolescent and early adulthood. The subpersonalities often switch from the primary and can have distinct personalities, emotions, and behaviors.
Treatment for DA: often resolves on their own. It can also be done through psychodynamic therapy guides the client to explore the unconscious mind and bring the event to the subconscious. Hypnotic therapy helps a client recall the memory. truth serum - drug therapy that calms the client's mind to free their inhibition. Often very successful.
Dissociative fugue - an extreme version of Dissociative amnesia. following an extreme traumatic event, a person may lose their identity and memory. Some may even leave and adopt a new identity without realizing it. When they do become aware of it, the dissociation will abruptly stop. This usually occurs when the patient's safety was extremely threatened.
Dissociative amnesia (DA) is when the patient is unable to recall any memory of an event. This can be localized (all memory is lost), selective (remembers beginning event, but may forget friends and family), and continuous (when future memory loss is regularly occurs). Continous is really rare.
When someone has a dissociative disorder, they have a major disruption in their memory affecting their identity and ability to make decisions.
Notes
Our memories make up who we are as a person and influences the decisions we make.
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Part 2: Dissociative Disorders
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dissaociative disorders
Depersonalization-Derealization Disorder
long-lasting
sudden onset
adolescents/young adults
must be persistent/recurrent, cause distress and interfere with relationships and job
experiences of depersonalization/derealization do not indicate a disorder
feel separated from their body, are observing themselves from the outside
reflected in some movies, out of body experience
derealization: surroundings are unreal or detached, external world is unreal
mental functioning or body feels unreal or detached and/or
episodes of depersonalization
dissaciative disorder in DSM-5 even though no memory difficulties
Dissociative Disorders Treatment
focus on
integrating subpersonalities
subpersonalities see goal as threat
continuous process
recovering memory
recognizing the disorder
therapist will educate the patient with the disorder and show them videos and involving family
bond with personalities and have them recognize
complex and difficult
Dissociative identity disorder (multipersonality)
behavior view
self hypnosis
perhaps DID sufferers undergo self-hypnosis
hypnotic amnesia looks like DID
can help people forget facts
state dependent learning
dissaociative disorders: have state to memory links that are rigid and narrow
each thought and skill is only triggered when they have the exact environment and element to trigger that htought or memory otherwise they forget
learning in a particular state makes it more likely ro remember when in same condition
case reports only
response learned through condition
dissociation as escape behavior
momentary forgetting is rewarded because it reduces anxiety
psychodynamic view
case history only
repression
DID: lifetime of repression remotivated by trauma
dissaociative amnesia & fuge: massive repression
fight off anxiety by preventing painful memories
how common?
# diagnosed is increasing
thousands cases in the US and canada
clinicians who believe disorder really exists
diagnostic procedures are more accurate
some (not all) cases may be iatrogenic
used to be thought to be rare
how they differ
physiloogical responses
ans activity, BP, allergies
abilities and preferences
encyclopedic info often disturbed
Key words
identifying features
age, sex, race, fam history
avg number of personalities
8 for men
15 for women
interaction between subpersonalities
generally three relationship
one-way amnesic relationshiops
some personalities are aware of others, but the awareness is not mutual
mutually cognizant pattern:
each subpersonality is well aware of the rest
mutually amnesic relationships -
they dont have any awareness of each other
diagnosed late adolescence/early adulthood
women 3x more than men
onset: before age 5
symptoms begin in childhood after abuse
features:
switching personality
primary personality
two or more distinct personalities with unique memories, behaviors, thoughts, emotions
dissociative fugue
tends to end abruptly.
0.2%
follows a severely stressful event
extreme version of dissociative amnesia
may be severe: person may take new identiy
forget personal identity and details about past
dissociative amnesia: inability to recall personal information, loss of memory extensive, not caused by physical factors, but often triggered by trauma.
Treatment
"truth serums"
often successful
drugs that calm people and free their inhibitions
hypnotic therapy
guide patients to recall the certain events
psychodynamic: use unconscious
guide patients to search their unconsciousness and bring their forgotten experiences to subconsciousness
often recover on their own
begins after a serious threat to a person's safety
memory loss interferes with person
may be localized or selective
continuous - forgetting continues into the future - super rare
selective - some loss of memory but not all in the series of event
loss of memory in the beginning of an event of the loss of time may fail to recognize friends or family or identity
localized - loss of all memory in the series of events within a period of time
memory seems "dissasociative" i.e. separates
major disruption of memory with no physical cause
Key thing: Memory
identity of who we are relies on memory, memory places a role in decision we make.
Disorders of Trauma and Stress
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PSY 341: Abnormal Psychology
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