Abnormal Psychology 3018 Trauma and Stressor Related Disorders

• Reactive Attachment Disorder;

• Disinhibited Social Engagement Disorder;

• Post-Traumatic Stress Disorder;

• Acute Stress Disorder;

• Adjustment Disorder.

The explicit criterion for this chapter is ‘exposure to trauma or stress’.

A. Exposure to actual or threatened death, serious injury, or sexual violence.
B. Intrusion symptoms (1+).
C. Persistent avoidance of stimuli (1+).
D. Negative changes in cognition, mood (2+).
E. Changes in arousal, reactivity (2+).

A. Exposure to actual or threatened death, serious injury, or sexual violence.

• Directly experiencing event;

• Witnessing event;

• Learning of the event (of a friend family member);

• Exposure to adverse events (police, ambulance).

B. Intrusion symptoms (1+).

• Distressing memories;

• Distressing dreams;

• Dissociative reactions (flashbacks);

• Distress at exposure to reminders of the event;

• Physiological reactions to reminders of the event.

C. Persistent avoidance of stimuli (1+).

• Avoidance of distressing memories, thoughts, feelings associated with event.

• Avoidance of external reminders related to the event.

D. Negative changes in cognition, mood (2+).

• Inability to remember important aspects of event (dissociative amnesia).

• Negative beliefs about oneself, others, or world.

• Distorted ideas about the causes/consequences of event (leading to blame of oneself/others).

• Persistent negative emotions.

• Diminished interest or participation in activities.

• Feeling detachment or estrangement from others.

• Inability to experience positive emotions.

E. Changes in arousal, reactivity (2+).

• Irritable behaviour and angry outbursts (verbal or physical aggression).

• Reckless or self-destructive behaviour.

• Hyper-vigilance.

• Exaggerated startle response.

• Problems with concentration.

• Sleep disturbance.

F. Duration of symptoms longer than 1 month.

G. Symptoms cause significant distress of impairment.

To have been violent, accidental or occurring suddenly.

They are flashbacks, whereby the person feels as though the traumatic event is reoccurring.

The inability to remember an important aspect of the event.

1. Dissociative symptoms.

2. Delayed onset.
   They indicate a negative prognosis.

They cannot be diagnosed with PTSD.

They are really frightening, so in order to not experience them, the person performs avoidance behaviours.

They may see the world and themselves differently, that the world is unsafe or that they can’t trust anyone.

Seek out dangerous activities.

Complex PTSD or Developmental Trauma Disorder.

It is a disorder caused by chronic, long-term trauma (often abuse or neglect).

A severe inability to regulate emotions.
It occurs because an abused child does not have the skills to process the trauma, leading to emotional dysregulation later in life.

• Very low self-worth.

• Emotional avoidance.

• Substance use.

• Abusive relationships.

• Self-destructive.

1. 1. Helping patient deal with emotions (distress tolerance treatment therapy).

2. 2. Help person develop a sense of self-worth and self-care.

It occurs within 3 days - 1 month after a traumatic event and has very similar symptoms to PTSD. If symptoms are not resolved after 1 month, diagnosis changes to PTSD.

Dissociative symptoms.

1. Intrusion symptoms.

• memories, dreams, etc.

1. Dissociative symptoms

• depersonalisation, derealisation.

1. Avoidance symptoms.

2. Arousal symptoms.

Depersonalisation is feeling detached and often unable to feel emotion.
Derealisation is feeling detached from your surroundings (like in a movie), and those you love - as though there is a glass wall between you and them.

60-70% untreated will develop PTSD.
14% who are treated will develop PTSD.
This indicates that the treatment of ASD is extremely important in the prognosis and onset of PTSD.

A tendency to have difficulty with attachments due to prolonged exposure to abuse in childhood (often neglect).

Troubled internal attachment models cause excessive attachment, due to childhood abuse (often neglect).

An Adjustment Disorder is caused by exposure to a common stressful life event. The person cannot process event normally and has abnormal symptoms considering the event. Not as extreme as PTSD.

6-7 months after the stressful event.

60%.

12-month prevalence: 1-4%.
Lifetime prevalence: 6-7%.
60% of the population have experienced a traumatic event, so 6-7% of that means that on the flip side, 80-90% of those who experience a traumatic event, DO NOT develop PTSD.

10-20% of women will develop PTSD after a traumatic event.

| 6-8% of men will develop PTSD after a traumatic event.

Distress is a normal reaction to a traumatic event and within 75% of people, distress will drop within 3 months.
Allowing a person to process the trauma on their own, have time to heal is normally all that is needed.

Not necessarily, talking excessively can make the event seem even more heightened. People tend to have their own coping mechanisms to deal with stress.

If someone doesn't start to recover, it must be identified as soon as possible to immediately assist with PSTD development.

What was the person like before?
Psychiatric problems?
Childhood trauma? Family instability?

How impactful traumatic event was;
severity of exposure.
Location of exposure (home vs. elsewhere).
Role in the event (victim, observer, helper).

Social support? Coping style? Other stressors?

If someone is psychologically vulnerable, lacks social support, is at a social/economic disadvantage.

Car accident: 10-12%.
Natural disaster: 10-12%.
Combat: 30-40%.
Rape: 55%.

Benzodiazepines, antidepressants (SSRIs).

| Can be quite effective, not as effective as CBT.

1. Assess suitability.

2. Psychoeducation (about PTSD & therapy).

3. Anxiety management techniques.

4. Cognitive restructuring (shift the meaning person gave to event/to themselves).

5. Prolonged exposure.

It involves the person detailing the event in first person, from start to finish. They do this multiple times until anxiety is reduced and they can then process the memories and event.

The dropout rate is high.