Chapter 7 Dissociation Traumatic stress Acute and posttraumatic stress disorders dissociative disorders and somatic symptom disorders Traumatic stress dissociative disorders and somatoform disorders look different but share similarities The disruption of the normally integrated mental process involved in memory consciousness identity or perception Dsm definition an event that involves injury or threatened death sexual violence new to the definition witnessing others experience trauma learning that loved ones have been traumatized or repeatedly being exposed to trauma An example of trauma being in a car that is hanging off a bridge Acute Stress Disorder Occurs within a month after exposure to traumatic stress Posttraumatic Stress Disorder PTSD Lasts longer that one month sometimes has a delayed onset Symptoms of ASD and PTSD 1 Intrusive re experiencing repeated distressing images and thoughts intrusive flashbacks horrifying dreams dissociative state 2 Avoidance 3 Increased arousal or reactivity predicts a worse prognosis hypervigilance restlessness agitation irritability exaggerated startle response 4 Negative mood or thoughts range of negative feelings inability to experience positive emotions persistent fear anger guilt or feeling of detachment numbing of responsiveness emotional anesthesia 5 Dissociative symptoms Dazed and act spaced out de personalizaiton feeling like a robot De realization dissociative amnesia DSM 5 groups ASD and PTSD in a new diagnostic grouping Trauma and stress related disorders This new category includes adjustment disorders Dissociation is involved in many PTSD symptoms not just the explicit dissociative symptoms Brief historical perspective Vietnam war prompted much interest in PTSD due to delayed reactions to combat being very common Disaster and Emergency Workers Not immune to traumas aftereffects Emergency workers are less than half as likely to develop PTSD as victims Training preparation and sense of purpose appear to be protective Hardiness sense of commitment control challenge in facing stress Frequency of trauma PTSD and ASD 6 8 OF PEOPLE LIVING IN US have PTSD 90 of people living in Detroit have experienced a trauma with 9 developing PTSD Unexpected death of loved one is most common cause of PTSD 20 40 of children develop PTSD Frequency of trauma in ptsd and asd Many traumas do not occur at random due to risky behaviors People who are anxious or who have a family history of mental illness also experience more traumas Course and outcome people with ASD are likely to develop PTSD Three symptoms best predict future PTSD Numbing depersonalization a sense of reliving the experience Causes of PTSD and ASD Social factors Victims of trauma are more likely to develop PTSD when the trauma is more intense With less severe stressors social support after a trauma can play a crucial role in alleviating long term psychological damage Psychological factors The risk for PTSD depends on cognitive factors Preparedness purpose and absence of blame The role of dissociation is debated may not be adaptive may be related to PTSD Posttraumatic growth positive changes resulting from trauma linked with depression and more positive wellbeing but also with more intrusive and avoidant thoughts The most effective treatment for PTSD is re exposure to trauma Treatment Cognitive behavior therapy for PTSD Prolonged exposure Imagery rehearsal therapy Cognitive restructuring Antidepressant medication Antidepressants and therapeutic re exposure are first line therapies for PTSD Effectiveness of SSRIS and likely due to the high comorbidity levels Symptoms characterized by persistent maladaptive disruption in the integration of memory Dissociative disorders identity Hypnosis Psychologically produced amnesia Confused travel of long distances from home Debated as being a true state of dissociation Some say works mostly on highly susceptible participants Dissociative identity disorder DID Depersonalization 2 or more personalities coexist within a single individual doesn t exists out of US People feel detached from themselves Derealization Dissociative amnesia emotional distress can be a cause Frequency of Dissociative Disorders Symptoms involves feelings of unreality detachment from the environment Partial or complete loss of recall for particular events or for a particular period of time most cases of dissociative disorders are diagnosed by a handful of arfent advocates The frequency of the diagnosis pf dissociative disorders in general and DID in particular increased rapidly after release of the very popular book and movie Sybil Most frequent disorders found among elderly psychiatric patients A gradual worsening loss of memory and related cognitive functioning A confusional state that develops over a short period of time Memory impairments that are more limited than those seen in dementia or delirium Dementia and delirium are listed as cognitive disorders in DSM 5 Chapter 14 Neurocognitive disorders Dementia Delirium Amnestic disorders Cognitive processes Perception and attention Memory Reasoning and decision making Neurologists Neuropsychologists Assess for cognitive impairments Physicians who deal with disease of the brain and nervous system Delirium Primary symptom A clouding of consciousness in association with a reduced ability to maintain and shift attention Symptoms of delirium follow a rapid onset from a few hours to several days Symptoms usually worse at night Sleep wake cycle is often disturbed Coma may occur if symptoms allowed to progress Neurocognitive Symptoms Memory and Learning Memory loss is diagnostic hallmark Retrograde amnesia Anterograde amnesia Neurocognitive Symptoms Verbal Communication Aphasia Apraxia Inability to learn or remember new information Most obvious problem during the beginning stages of dementia is Loss or impairment in language Difficulty performing purposeful movements in response to verbal commands Personality and Emotion Changes and disturbances frequently associated with dementia Hallucinations and delusions are seen in at least 20 of dementia cases More common during the later stages of the disorder Personality and Emotion Emotional consequences are varied Apathetic or emotionally flat Exaggerated and unpredictable May become agitated pacing restlessly or wandering away from familiar places Motor Behaviors Muscular rigidity Dyskinesia Dementia Versus Depression Tic tremors and jerky movements of the face and limbs called chorea
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