Trauma and Stress

• Stressor


  Event that creates demands, can be perceived as threatening
• Stress Response


  Person's reactions to demands, involving physiological and emotional changes
• Stress and Psychological Disorders

  • Acute Stress Disorder
  • Posttraumatic Stress Disorder (PTSD)
• Stress and Physical Disorders

  • Listed in DSM-5 under "Psychological Factors Affecting Medical Condition"
• Hypothalamus


  Key area in the brain involved in arousal and fear
• Activated Systems


  • Autonomic Nervous System (ANS)
  • Endocrine System
• Sympathetic Nervous System


  "Fight-or-flight" response
• Parasympathetic Nervous System


  "Rest-and-digest" response
• Acute Stress Disorder


  Symptoms begin within 4 weeks of a traumatic event and last less than one month
• Posttraumatic Stress Disorder (PTSD)


  Symptoms may begin shortly after or months/years after trauma
• 80% of acute stress disorder cases develop into PTSD
• Similar Symptoms


  • Increased arousal
  • Anxiety
  • Guilt
  • Re-experiencing the event
  • Avoidance
  • Reduced responsiveness
  • Dissociation
• DSM-5 Checklist for PTSD/Acute Stress Disorder

  • Exposure to Traumatic Event
  • Intrusive Symptoms
  • Avoidance
  • Negative Changes in Cognitions/Mood
  • Arousal/Reactivity
  • Duration
• Exposure to Traumatic Event

  • Death or threatened death
  • Serious injury
  • Sexual violence
• Intrusive Symptoms


  • Uncontrolled memories
  • Upsetting trauma-linked dreams
  • Flashbacks
  • Distress when exposed to trauma-linked cues
  • Physical reactions when reminded of the event
• Symptoms lasting more than one month for PTSD
• Prevalence and Triggers


  • Affects 3.5% of US population annually
  • More common in women and people with low incomes
  • Most common triggers: Combat, disasters, abuse, victimization (sexual assault, terrorism, torture)
• Causes of PTSD/Acute Stress Disorder

  • Biological Factors
  • Childhood Experiences
  • Cognitive Factors/Coping Styles
  • Social Support Systems
  • Trauma Severity and Nature
• Biological Factors


  • Brain-body stress pathways
  • Brain's stress circuit
  • Inherited predisposition
• Childhood Experiences


  • Chronic neglect or abuse
  • Poverty
  • Parental separation/divorce
  • Catastrophes
  • Family history of mental disorders
• Cognitive Factors/Coping Styles


  • Pre-trauma memory difficulties
  • Intolerance of uncertainty
  • Inflexible coping styles
  • Resilience
• Social Support Systems


  Weak family and social support
• Trauma Severity and Nature

  • More severe or prolonged trauma
  • Direct exposure to trauma
  • Intentionally inflicted trauma
  • Mutilation, severe injury, sexual assault
• Treatment Goals


  • End lingering stress reactions
  • Gain perspective on traumatic experiences
  • Return to constructive living
• Treatment Procedures for Combat Veterans

  • Antidepressant drugs
  • Cognitive-behavioral therapy (CPT, mindfulness, exposure, EMDR)
  • Couple/family therapy, group therapy
• Virtual Reality Therapy


  Increasingly used for exposure-based treatments
• Psychological Debriefing (Critical Incident Stress Debriefing)

  Talking about trauma within days of the event, research does not support its effectiveness
• Dissociation


  Changes in memory, consciousness, or identity that lack a physical cause
• Types of Dissociative Disorders

  • Dissociative Amnesia
  • Dissociative Fugue
  • Dissociative Identity Disorder (DID)
• Dissociative Amnesia


  Inability to recall important personal information, typically traumatic or stressful
• Types of Dissociative Amnesia

  • Localized
  • Selective
  • Generalized
  • Continuous
• Dissociative Fugue


  People forget personal identities and flee to a new location
• Dissociative Identity Disorder (DID)


  Two or more distinct personalities (subpersonalities) with unique memories, behaviors, thoughts, and emotions
• Switching


  Sudden transitions between subpersonalities triggered by stress
• Subpersonality Interactions


  • Mutually amnesic relationships
  • Mutually cognizant relationships
  • One-way amnesic relationships
• Subpersonality Differences


  • Identifying features
  • Abilities and preferences
  • Physiological responses
• Traditionally considered rare, but diagnoses have increased. Still uncommon, but thousands of cases documented. Many clinicians question the legitimacy of this category.
• Theories of Dissociative Disorders

  • Psychodynamic Perspective
  • Cognitive-Behavioral Perspective
  • State-Dependent Learning
  • Self-Hypnosis
• Treatment for Dissociative Amnesia

  • Psychodynamic therapy: Uncover repressed memories
  • Hypnotic therapy: Guided recall of forgotten events
  • Drug therapy: Barbiturates sometimes used to help recall memories
• Treatment for Dissociative Identity Disorder

  Goal: Recognize the disorder, recover memories, integrate subpersonalities. Complex and challenging treatment.