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 5 o Intrusion symptoms 1 Memories Dreams nightmares Dissociative reactions flashbacks Distress at exposure to internal external cues Physiological reactions to internal external cues o Avoidance 1 Avoid memories or feelings Avoid reminders o 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 emotions o Changes in arousal reactivity 2 Irritability outbursts Reckless self destructive Hyper vigilance always expecting danger Startle Concentration problems Sleep disturbance Shattered Assumptions o Trauma changes you shatters your assumptions about the world o 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 person Dissociative Somatic Disorders Fred dissociative identity disorder o Psychologically abused by his mom as a child hid under bed with cat o Animals object relations o 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 self o 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 functioning o Gaps in recall of events personal information and or traumatic events o Distress or impairment Iatrogenic induced in a patient by a clinician s activity manner or therapy o 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 attention Paraphilia 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 night o Raised by psychologically disturbed mom and sexually abusive step father o 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 disorder o Paraphilia intense and persistent sexual interest other than genital stimulation or fondling with mature consenting partner o 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 object o 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 DSM4 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 in o We have a perimeter that we do not want violated o Once exploited trust is fragmented Jeffrey Dahmer o Wanted total and complete control over someone for as long as he wanted o Compulsive overcome by violent urges o Dissociative state didn t remember beating and killing the man who started his kill sprees again o 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 reassignment o 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 gender o 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 gender o Significant distress or impairment World Professional Association for Transgender Health WPATH standards of care o Instruct individual to live his her life as the other gender before surgery dress name presentation in society o Mary Max o Suppress breasts with bandages o Take hormones testosterone o Issue legal statement for a name change and change info at RMV Sex reassignment procedures o Mastectomy breast removal o Hysterectomy remove uterus ovaries o 12 hour reconstruction of genital