Anxiety Disorders- Erica (PTSD): o PTSD developed after being on an Amtrak that derailed o Treatment:  Give validation that the trauma was horrible to the victim, but explain that it could be worse Treat trauma/thoughts/memories like toxic emotion inside a jar, teach the victim how to control the cap Gradual exposure/CBT (imagine performing the feared activity)- PTSD (more than one month  DSM-5)o Exposure to actual or threatened death, injury or sexual violence (1+) Direct experience Witness Learn about trauma from a close friend (*) Experience or exposure to details (*) (*) = vicarious trauma, new to DSM-5o Intrusion symptoms (1+) Memories Dreams/nightmares Dissociative reactions (flashbacks) Distress at exposure to internal/external cues  Physiological reactions to internal/external cueso Avoidance (1+) Avoid memories or feelings Avoid reminderso Negative changes in cognition/mood (2+) Inability to remember aspects of trauma Negative beliefs about self, others, world Distorted cognitions about cause or consequences of trauma Negative emotional state (fear, horror, anger) Diminished interest (Erica  athletics) Detachment, estrangement (Erica  daughter, husband) Inability to experience positive emotionso Changes in arousal/reactivity (2+) Irritability, outbursts, Reckless, self-destructive Hyper vigilance (always expecting danger) Startle Concentration problems Sleep disturbance - Shattered Assumptionso Trauma changes you  shatters your assumptions about the worldo Assumptions: The world is benevolent  the world is a good place The world is meaningful  things happen for good reasons (perceived invulnerability = it won’t happen to me) The self is worthy  I am a good personDissociative & Somatic Disorders- Fred (dissociative identity disorder):o Psychologically abused by his mom as a child, hid under bed with cato Animals = object relationso Develop characteristics of DID so victim can fight off the potential “predator” of their trauma (when I am a bear, I’m strong enough to fight)o Treatment: bring all animals into a coherent personality- Dissociative Identity Disorder: individual develops more than one personality associated with sense of selfo Identity disruption 2+ personality states Discontinuity in sense of self with changes in:- Affect (emotional expressiveness)- Behavior (how I act)- Consciousness (what I think)- Memory- Perception- Cognition- Sensory-motor functioningo Gaps in recall of events, personal information, and/or traumatic eventso Distress or impairment- Iatrogenic: induced in a patient by a clinician’s activity, manner or therapyo Dr. in a fractured mind; make you believe traumatic events happened when they did not, or that you have a certain diagnosis - False memory: “lost in the mall” effect; tell little brother he once got lost in the mall, he now believes the implanted memory- Malingering: making up a story for an ulterior motive- Facticitious Disorder: making up, or purposely creating symptoms for attentionParaphilia, Sexual dysfunctions, & Gender Dysphoria (1)-Don (paraphilic disorder):o Came in banged up, stopping by “to see someone before my death”o First thing he says in Halgin’s office – “this place feels warm”o “I’m about to be killed”  offers sex to truck drivers, gets beat up and brought into ER by police every nighto Raised by psychologically disturbed mom and sexually abusive step fathero Did not want to change this behavior – found an ad for sado-masochistic bonding group,wanted to be their slave and total subordinate -Paraphilia vs. paraphilic disordero Paraphilia: intense and persistent sexual interest, other than genital stimulation or fondling with mature consenting partnero Paraphilic disorder: distress, impairment, or harm (at least six months)Pain: sexual masochism and sexual sadism disordersCourtship: -Voyeuristic – observing others naked-Exhibitionistic – exposing genitals to a stranger-Frotteuristic – rub up against those in a large crowd-Anomalous target preferences:o Fetishistic disorder – body part or non-living objecto Transvestic disorder – with fetishism or autogynephilia (aroused by the thought that one is a woman)o Pedophilic disorder – adult engages in sexual activity with a child (pedophilia in DSM-4)Some pedophiles express great relief when caughtPedophiles are known to childPedophiles are not marriedPedophiles are involved in activities granting access to childrenPedophiles are ingratiating to child’s parents so they like himSuspicion arises  denial sets ino We have a perimeter that we do not want violatedo Once exploited  trust is fragmented -Jeffrey Dahmer:o Wanted total and complete control over someone for as long as he wantedo Compulsive  overcome by violent urgeso Dissociative state  didn’t remember beating and killing the man who started his kill sprees againo Cannibalism gave sexual satisfaction  victims were a part of him Paraphilia, Sexual dysfunctions, & Gender Dysphoria (2)- Mary  Max (gender dysphoria):o One year minimum of psychotherapy before gender reassignmento Accepted in high school but suicidally depressed in college- Gender Identity Disorder (DSM-4): transition body to match identity- Gender dysphoria (adults)o Incongruence between experience/expressed gender and assigned gender (6 months) 2+ Incongruence with primary or secondary sex characteristics Desire to be rid of these characteristics  Desire for characteristics of other gender Desire to be the other gender (or alternative gender other than one’s assigned) Desire to be treated as the other/alternate gender Conviction that one has typical feelings and reactions of other/alternate gendero Distress or impairment- Gender dysphoria (children)o Incongruence between experienced/expressed gender and assigned gender (6 months) 6+ Desire or insistence to be the other gender Boys: cross dressing, girls: prefer boy’s clothes and resist girl’s clothes Preference for cross gender roles in play Preference for toys, games etc stereotypical of the other gender Preference for playmates of the other gender Rejection of games/toys/play associated with one’s gender Dislike/disdain one’s sexual anatomy Desire for sexual characteristics of other gendero