HD 3700 1st Edition Lecture 19 Outline of Last Lecture I Normal Anxiety and common ways of coping with it II Obsessive Compulsive Disorder and its neuro anatomical circuit III The range of anxiety disorders IV Hamlet and Horatio Outline of Current Lecture I Anxiety disorders II PTSD III Trauma and the self IV Psychotherapy V Medicating Anxiety Anxiolytics what they are how they work VI Approaching the play within the play Current Lecture I Anxiety Disorders all of these are fueled by anxiety Phobias specific severe spiders and snakes most common Generalized anxiety disorder the opposite of phobias general anxiety Panic disorder panic attacks are specific events that happen to people body in arousal state as if you re in danger Panic disorder with agoraphobia Social anxiety disorder not shyness fear of social situations OCD obsessive thoughts compulsive behaviors Eating disorders bulimia anorexia Body dysmorphic disorder PTSD inherently human leaves the person dysfunctional afterwards II PTSD Inherently human person faces severe stress and the stress leaves the person dysfunctional afterwards Common after WWI known as shell shock left soldiers impulsive depressed often self medicated with alcohol or opium because its if the trauma doesn t stop happening WWII less traumatizing because soldiers weren t sitting in trenches for months called it combat fatigue Vietnam vets also had awful PTSD but mental health professionals began to notice it Started being diagnosed in survivors from earthquakes women who had been raped Post traumatic stress disorder PTSD is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened Traumatic events that may trigger PTSD include violent personal assaults natural or human caused disasters accidents or military combat Among those who may experience PTSD are military troops who served in the Vietnam and Gulf Wars rescue workers involved in the aftermath of disasters like the terrorist attacks on New York City and Washington D C survivors of the Oklahoma City bombing survivors of accidents rape physical and sexual abuse and other crimes immigrants fleeing violence in their countries survivors of the 1994 California earthquake the 1997 North and South Dakota floods and hurricanes Hugo and Andrew and people who witness traumatic events Family members of victims also can develop the disorder PTSD can occur in people of any age including children and adolescents Many people with PTSD repeatedly re experience the ordeal in the form of flashback episodes memories nightmares or frightening thoughts especially when they are exposed to events or objects reminiscent of the trauma Anniversaries of the event can also trigger symptoms People with PTSD also experience emotional numbness and sleep disturbances depression anxiety and irritability or outbursts of anger Feelings of intense guilt are also common Most people with PTSD try to avoid any reminders or thoughts of the ordeal PTSD is diagnosed when symptoms last more than 1 month Physical symptoms such as headaches gastrointestinal distress immune system problems dizziness chest pain or discomfort in other parts of the body are common in people with PTSD Often doctors treat these symptoms without being aware that they stem from an anxiety disorder Diagnostic criteria o The person has been exposed to a traumatic event in which both of the following were present the person experienced witnessed or was confronted with an event or events that involved actual or threatened death or serious injury or a threat to the physical integrity of self or others the person s response involved intense fear helplessness or horror o The traumatic event is persistently re experienced in one or more of the following ways recurrent and intrusive distressing recollections of the event including images thoughts or perceptions recurrent distressing dreams of the event acting or feeling as if the traumatic event were recurring includes a sense of reliving the experience illusions hallucinations and dissociative flashback episodes including those that occur on awakening or when intoxicated intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event o Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness not present before the trauma as indicated by three or more of the following efforts to avoid thoughts feelings or conversations associated with the trauma efforts to avoid activities places or people that arouse recollections of the trauma inability to recall an important aspect of the trauma markedly diminished interest or participation in significant activities feeling of detachment or estrangement from others restricted range of affect e g unable to have loving feelings sense of a foreshortened future e g does not expect to have a career marriage children or a normal life span o Persistent symptoms of increased arousal not present before the trauma as indicated by two or more of the following difficulty falling or staying asleep irritability or outbursts of anger difficulty concentrating hypervigilance exaggerated startle response III Trauma and the self A few thoughts on trauma Predictive factors that make people more likely to get PTSD as a result of stress war o If you had an earlier trauma o Coping style men in Vietnam seal over internalize don t talk about it There is a spectrum of traumatic impact from devastating events death assault to more subtle repetitions a subtle rejecting parent The mind responds to trauma through the narrowing of associations This narrowing can range from isolation of affect to compete forgetting To know and not know that is the evolutionary challenge Human beings great strength was remembering and communicating yet traumatic events are too devastating for the individual to remember fully o Evolution we can still be traumatized but dissociate from it see mother get eaten by lion you can dissociate and run to safety o When we have a trauma the mind isolates the event so we don t associate to it fully perhaps we only associate to it visually o The event becomes quarantined in consciousness a wall of phobic associations around it o Once you remember something fully you can move on o See this