ABNORMAL PSYCHOLOGY PSYCH 460
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Somatoform and Dissociative Disorders In addition to disorders covered earlier two other kinds of disorders are comnonly associated with stress and anxiety Somatoform disorders Dissociative disorders Somatoform and Dissociative Disorders Somatoform disorders are problems that appear to be medical but are due to psychosocial factors Unlike psychophysiological disorders in which psychosocial factors interact with physical ailments somatoform disorders are psychological disorders masquerading as physical problems Somatoform and Dissociative Disorders Dissociative disorders are patterns of memory loss and identity change that are caused almost entirely by psychosocial factors rather than physical ones Somatoform and Dissociative Disorders The somatoform and dissociative disorders have much in common Both may occur in response to severe stress Both have traditionally been viewed as forms of escape from stress A number of individuals suffer from both a somatoform and a dissociative disorder Theorists and clinicians often explain and treat the two groups of disorders in similar ways Somatoform Disorders When a physical ailment has no apparent medical cause physicians may suspect a somatoform disorder People with a somatoform disorder do not consciously want or purposely produce their symptoms They believe their problems are genuinely medical There are two main types of somatoform disorders Hysterical somatoform disorders Preoccupation somatoform disorders What Are Hysterical Somatoform Disorders People with hysterical somatoform disorders suffer actual changes in their physical functioning These disorders are often hard to distinguish from genuine medical problems It is always possible that a diagnosis of hysterical disorder is a mistake and that the patient s problem has an undetected organic cause What Are Hysterical Somatoform Disorders DSM IV TR lists three hysterical somatoform disorders Conversion disorder Somatization disorder Pain disorder associated with psychological factors What Are Hysterical Somatoform Disorders Conversion disorder In this disorder a psychosocial conflict or need is converted into dramatic physical symptoms that affect voluntary or sensory functioning Symptoms often seem neurological such as paralysis blindness or loss of feeling May be called pseudoneurological Most conversion disorders begin between late childhood and young adulthood They are diagnosed in women twice as often as in men At times of extreme stress and last a matter of weeks They usually appear suddenly and are thought to be rare What Are Hysterical Somatoform Disorders Somatization disorder People with somatization disorder have many long lasting physical ailments that have little or no organic basis Also known as Briquet s syndrome To receive a diagnosis a patient must have a range of ailments including several pain symptoms gastrointestinal symptoms a sexual symptom and a neurological symptom Patients usually go from doctor to doctor in search of relief What Are Hysterical Somatoform Disorders Somatization disorder Patients often describe their symptoms in dramatic and exaggerated terms Most also feel anxious and depressed Between 02 and 2 of all women in the US experience a somatization disorder in any given year compared with less than 02 of men The disorder often runs in families and begins between adolescence and young adulthood What Are Hysterical Somatoform Disorders Somatization disorder This disorder lasts much longer than a conversion disorder typically for many years Symptoms may fluctuate over time but rarely disappear completely without psychotherapy 23 of individuals with this disorder in the US receive treatment for their physical ailments from a medical or mental health professional in any given year What Are Hysterical Somatoform Disorders Pain disorder associated with psychological factors Patients may receive this diagnosis when psychosocial factors play a central role in the onset severity or continuation of pain Patients with a conversion or somatization disorder may also experience pain but it is the key symptom in this disorder Although the precise prevalence has not been determined it appears to be fairly comnon The disorder often develops after an accident or illness that has caused genuine pain Which then takes on a life of its own The disorder may begin at any age and more women than men seem to experience it What Are Hysterical Somatoform Disorders Hysterical vs medical symptoms It can be difficult to distinguish hysterical disorders from true medical conditions Studies across the world suggest that as many as one fifth of all patients who seek medical care may actually suffer from somatoform disorders Physicians sometimes rely on oddities in the patient s medical picture to help distinguish the two For example hysterical symptoms may be at odds with the known functioning of the nervous system as in cases of glove anesthesia Glove anesthesia in this conversion symptom the entire hand extending f rom the fingertips to the wrist becomes numb Actual physical damage to the ulnar nerve in contrast causes anesthesia in the ring finger and little finger and beyond the wrist partway up the arm Damage to the radial nerve causes loss of feeling only in parts of the ring middle and index fingers and the thumb and partway up the arm What Are Hysterical Somatoform Disorders Hysterical vs factitious symptoms Hysterical somatoform disorders are different from patterns in which individuals are purposefully producing or faking medical symptoms Patients may be malingerng intentionally faking illness to achieve external gain eg financial compensation military deferment Patients may be manifesting a factitious disorder intentionally producing or faking symptoms simply out of a wish to be a patient Factitious Disorder People with a factitious disorder often go to extremes to create the appearance of illness Many give themselves medications to produce symptoms Patients often research their supposed ailments and are impressively knowledgeable about medicine Factitious Disorder Factitious disorder seems to be most common among people who As children received extensive medical treatment for a true physical disorder Experienced family disruptions or physical or emotional abuse in childhood Carry a grudge against the medical profession Have worked as nurses laboratory technicians or medical aides Have an underlying personality problem such as extreme dependence They often have limited social support few enduring social relationships and little family life Factitious Disorder Munchausen syndrome is the extreme and long term form of factitious disorder In Munchausen syndrome by proxy a related disorder parents make up or produce physical illnesses in their children What Are Preoccupation Somatoform Disorders Preoccupation somatoform disorders include hypochondriasis and body dysmorphic disorder People with these problems misinterpret and overreact to bodily symptoms or features Although these disorders also cause great distress their impact on one s life differs from that of hysterical disorders What Are Preoccupation Somatoform Disorders Hypochondriasis People with hypochondriasis unrealistically interpret bodily symptoms as signs of serious illness Often their symptoms are merely normal bodily changes such as occasional coughing sores or sweating Although some patients recognize that their concerns are excessive many do not What Are Preoccupation Somatoform Disorders Hypochondriasis Patients with this disorder can present a picture very similar to that of somatization disorder If the anxiety is great and the bodily symptoms are relatively minor a diagnosis of hypochondriasis is probably in order If the symptoms overshadow the anxiety they may indicate somatization disorder What Are Preoccupation Somatoform Disorders Hypochondriasis Although this disorder can begin at any age it starts most often in early adulthood among men and women in equal numbers Between 1 and 5 of all people experience the disorder For most patients symptoms rise and fall over the years What Are Preoccupation Somatoform Disorders Body dysmorphic disorder BDD People with this disorder also known as dysmorphophobia become deeply concerned over some imagined or minor defect in their appearance Most often they focus on wrinkles spots facial hair swelling or misshapen facial features nose jaw or eyebrows Most cases of the disorder begin in adolescence but are often not revealed until adulthood Up to 5 of people in the US experience BDD and it appears to be equally common among women and men Sufferers may severely limit contact with other people be unable to look others in the eye or go to great lengths to conceal their defects As many as half of people with this disorder seek plastic surgery or dermatology treatment and often they feel worse rather than better afterward One study found that 30 of participants with this disorder were housebound and 17 had attempted suicide They are also more likely to be unemployed and to have limited academic success What Causes Somatoform Disorders Theorists typically explain the preoccupation somatoform disorders much as they do the anxiety disorders Behaviorists classical conditioning or modeling Cognitive theorists oversensitivity to bodily cues people with the disorders are so sensitive to and threatened by bodily cues that they come to misinterpret them In contrast the hysterical somatoform disorders are widely considered unique and in need of special explanation No explanation has received much research support and the disorders are still poorly understood in the late nineteenth century thought that psychosocial factors cause hysterical disorders What Causes Somatoform Disorders The psychodynamic view Freud believed that hysterical disorders represented a conversion of underlying emotional conflicts into physical symptoms Because most of his patients were women Freud centered his explanation on the psychosexual development of girls and focused on the phallic stage ages 3 to 5 What Causes Somatoform Disorders The psychodynamic view During this stage girls develop a pattern of sexual desires for their fathers the Electra complex and recognize that they must compete with their mothers for his attention Because of the mother s more powerful position however girls repress these sexual feelings Freud believed that if parents overreact to such feelings the Electra complex would remain unresolved and the child might re experience sexual anxiety throughout her life Freud concluded that some women hide their sexual feelings in adulthood by converting them into physical symptoms What Causes Somatoform Disorders The psychodynamic view Today s psychodynamic theorists take issues with Freud s explanation of the Electra conflict They continue to believe that sufferers of these disorders have unconscious conflicts carried from childhood What Causes Somatoform Disorders The psychodynamic view Psychodynamic theorists propose that two mechanisms are at work in the hysterical disorders Primary gain hysterical symptoms keep internal conflicts out of conscious awareness Secondary gain hysterical symptoms further enable people to avoid unpleasant activities or receive sympathy from others What Causes Somatoform Disorders The behavioral view Behavioral theorists propose that the physical symptoms of hysterical disorders bring rewards to sufferers May remove individual from an unpleasant situation May bring attention from other people In response to such rewards people learn to display symptoms more and more This focus on rewards is similar to the psychodynamic idea of secondary gain but behaviorists view the gains as the primary cause of the development of the disorder What Causes Somatoform Disorders The cognitive view Some cognitive theorists propose that hysterical disorders are a form of comnunication providing a means for people to express difficult emotions Like psychodynamic theorists cognitive theorists hold that emotions are being converted into physical symptoms This conversion is not to defend against anxiety but to comnunicate extreme feelings What Causes Somatoform Disorders The multicultural view Some theorists believe that Western clinicians hold a bias that sees somatic symptoms as an inferior way of dealing with emotions The transformation of personal distress into somatic complaints is the norm is many non Western cultures As we saw in Chapter 6 reactions to life s stressors are often influenced by one s culture What Causes Somatoform Disorders A possible role for biology The impact of biological processes on somatoform disorders can be understood through research on placebos and the placebo effect Placebos substances with no known medicinal value Treatment with placebos has been shown to bring improvement to many possibly through the power of suggestion or through the release of endogenous chemicals Perhaps traumatic events and related concerns or needs can also trigger our inner pharmaciesquot and set in motion the bodily symptoms of hysterical somatoform disorders How Are Somatoform Disorders Treated People with somatoform disorders usually seek psychotherapy only as a last resort Individuals with preoccupation disorders typically receive the kinds of treatments applied to anxiety disorders particularly OCD Antidepressant medication Exposure and response prevention ERP The behavioral approach that often helps people with 000 clients are reminded of their perceived physical defects and at the same time prevented from doing anything to help reduce their discomfort How Are Somatoform Disorders Treated Treatments for hysterical disorders often focus on the cause of the disorder and apply the same kind of techniques used in cases of PTSD particularly Insight often psychodynamically oriented Exposure client thinks about traumatic events that triggered the physical symptoms Drug therapy especially antidepressant medication How Are Somatoform Disorders Treated Other therapists try to address the physical symptoms of the hysterical disorders applying techniques such as Suggestion usually an offering of emotional support that may include hypnosis Reinforcement a behavioral attempt to change reward structures Confrontation an overt attempt to force patients out of the sick role Researchers have not fully evaluated the effects of these particular approaches on hysterical disorders Dissociative Disorders The key to one s identity the sense of who we are and where we fit in our environment is memory Our recall of the past helps us to react to present events and guides us in making decisions about the future People sometimes experience a major disruption of their memory identity or consciousness They may not remember new information They may not remember old information Dissociative Disorders When such changes in memory lack a clear physical cause they are called dissociative disorders In such disorders one part of the person s memory typically seems to be dissociated or separated from the rest Dissociative Disorders There are several kinds of dissociative disorders including Dissociative amnesia Dissociative fugue Dissociative identity disorder multiple personality disorder These disorders are often memorably portrayed in books movies and television programs DSM IV TR also lists depersonalization disorder as a dissociative disorder Dissociative Disorders Keep in mind that dissociative symptoms are often found in cases of acute or posttraumatic stress disorders When such symptoms occur as part of a stress disorder they do not necessarily indicate a dissociative disorder a pattern in which dissociative symptoms dominate 0n the other hand research suggests that people with one of these disorders also develop the other as well Dissociative Amnesia People with dissociative amnesia are unable to recall important information usually of an upsetting nature about their lives The loss of memory is much more extensive than normal forgetting and is not caused by organic factors Often an episode of amnesia is directly triggered by a specific upsetting event Dissociative Amnesia Dissociative amnesia may be Localized circumscribed most comnon type loss of all memory of events occurring within a limited period Selective loss of memory for some but not all events occurring within a period Generalized loss of memory beginning with an event but extending back in time may lose sense of identity may fail to recognize family and friends Continuous forgetting of both old and new information and events quite rare in cases of dissociative amnesia Dissociative Amnesia All forms of the disorder are similar in that the amnesia interferes primarily with episodic memory one s autobiographical memory of personal material Semantic memory memory for abstract or encyclopedic information usually remains intact Clinicians do not known how common dissociative amnesia is but many cases seem to begin during times of serious threat to health and safety Dissociative Fugue People with dissociative fugue not only forget their personal identities and details of their past but also flee to an entirely different location For some the fugue is brief a matter of hours or days and ends suddenly For others the fugue is more severe people may travel far from home take a new name and establish new relationships and even a new line of work some display new personality characteristics Dissociative Fugue 02 of the population experience dissociative fugue It usually follows a severely stressful event Fugues tend to end abruptly When people are found before their fugue has ended therapists may find it necessary to continually remind them of their own identity The majority of people regain most or all of their memories and never have a recurrence Dissociative Identity Disorder Multiple Personality Disorder A person with dissociative identity disorder DID formerly multiple personality disorder develops two or more distinct personalities subpersonalities each with a unique set of memories behaviors thoughts and emotions Dissociative Identity Disorder Multiple Personality Disorder At any given time one of the subpersonalities dominates the person s functioning Usually one of these subpersonalities called the primary or host personality appears more often than the others The transition from one subpersonality to the next switching is usually sudden and may be dramatic Dissociative Identity Disorder Multiple Personality Disorder Cases of this disorder were first reported almost three centuries ago Many clinicians consider the disorder to be rare but some reports suggest that it may be more comnon than once thought Dissociative Identity Disorder Multiple Personality Disorder Most cases are first diagnosed in late adolescence or early adulthood Symptoms generally begin in childhood after episodes of abuse Typical onset is before age 5 Women receive the diagnosis three times as often as men Dissociative Identity Disorder Multiple Personality Disorder How do subpersonalities interact The relationship between or among subpersonalities varies from case to case Generally there are three kinds of relationships Mutually amnesic relationships subpersonalities have no awareness of one another Mutually cognizant patterns each subpersonality is well aware of the rest One way amnesic relationships most common pattern some personalities are aware of others but the awareness Is not mutual Those who are aware co conscious subpersonalitiesquot are quiet observersquot Dissociative Identity Disorder Multiple Personality Disorder How do subpersonalities interact Investigators used to believe that most cases of the disorder involved two or three subpersonalities Studies now suggest that the average number is much higher 15 for women 8 for men There have been cases of more than 100 Dissociative Identity Disorder Multiple Personality Disorder How do subpersonalities differ Subpersonalities often display dramatically different characteristics including Vital statistics Subpersonalities may differ in features as basic as age sex race and family history Abilities and preferences Although encyclopedic knowledge is unaffected by dissociative amnesia or fugue in DID it is often disturbed It is not uncomnon for different subpersonalities to have different abilities including being able to drive speak a foreign language or play an instrument Dissociative Identity Disorder Multiple Personality Disorder How do subpersonalities differ Subpersonalities often display dramatically different characteristics including Physiological responses Researchers have discovered that subpersonalities may have physiological differences such as differences in autonomic nervous system activity blood pressure levels and allergies Dissociative Identity Disorder Multiple Personality Disorder How common is DID Traditionally DID was believed to be rare Some researchers even argue that many or all cases are iatrogenic that is unintentionally produced by practitioners These arguments are supported by the fact that many cases of DID first come to attention only after a person is already in treatment Not true of all cases Dissociative Identity Disorder Multiple Personality Disorder How common is DID The number of people diagnosed with the disorder has been increasing Although the disorder is still uncomnon thousands of cases have been documented in the US and Canada alone Two factors may account for this increase A growing number of clinicians believe that the disorder does exist and are willing to diagnose it Diagnostic procedures have become more accurate Despite changes many clinicians continue to question the legitimacy of the category How Do Theorists Explain Dissociative Disorders A variety of theories have been proposed to explain dissociative disorders Older explanations have not received much investigation Newer viewpoints which combine cognitive behavioral and biological principles have captured the interest of clinical scientists How Do Theorists Explain Dissociative Disorders The psychodynamic view Psychodynamic theorists believe that dissociative disorders are caused by repression the most basic ego defense mechanism People fight off anxiety by unconsciously preventing painful memories thoughts or impulses from reaching awareness How Do Theorists Explain Dissociative Disorders The psychodynamic view In this view dissociative amnesia and fugue are single episodes of massive repression DID is thought to result from a lifetime of excessive repression motivated by very traumatic childhood events How Do Theorists Explain Dissociative Disorders The psychodynamic view Most of the support for this model is drawn from case histories which report brutal childhood experiences yet Some individuals with DID do not seem to have these experiences of abuse Why might only a small fraction of abused children develop this disorder How Do Theorists Explain Dissociative Disorders The behavioral view Behaviorists believe that dissociation grows from normal memory processes and is a response learned through operant conditioning Momentary forgetting of trauma leads to a drop in anxiety which increases the likelihood of future forgetting Like psychodynamic theorists behaviorists see dissociation as escape behavior Also like psychodynamic theorists behaviorists rely largely on case histories to support their view of dissociative disorders While the case histories support this model they are also consistent with other explanationsquot How Do Theorists Explain Dissociative Disorders State dependent learning If people learn something when they are in a particular state of mind they are likely to remember it best when they are in the same condition This link between state and recall is called state dependent learning This model has been demonstrated with substances and mood and may be linked to arousal levels It has been theorized that people who are prone to develop dissociative disorders have state to memory links that are unusually rigid and narrow each thought memory and skill is tied exclusively to a particular state of arousal so that they recall a given event only when they experience an arousal state almost identical to the state in which the memory was first acquired How Do Theorists Explain Dissociative Disorders Self hypnosis Although hypnosis can help people remember events that occurred and were forgotten years ago it can also help people forget facts events and their personal identity Called hypnotic amnesiaquot this phenomenon has been demonstrated in research studies with word lists The parallels between hypnotic amnesia and dissociative disorders are striking and have led researchers to conclude that dissociative disorders may be a form of self hypnosis How Are Dissociative Disorders Treated People with dissociative amnesia and fugue often recover on their own Only sometimes do their memory problems linger and require treatment In contrast people with DID usually require treatment to regain their lost memories and develop an integrated personality Treatment for dissociative amnesia and fugue tends to be more successful than treatment for DID How Are Dissociative Disorders Treated How do therapists help people with dissociative amnesia and fugue The leading treatments for these disorders are psychodynamic therapy hypnotic therapy and drug therapy Psychodynamic therapists guide patients to search their unconscious and bring forgotten experiences into consciousness In hypnotic therapy patients are hypnotized and guided to recall forgotten events Sometimes intravenous injections of barbiturates are used to help patients regain lost memories Often called truth serumsquot the key to the drugs success is their ability to sedate people and free their inhibitions How Are Dissociative Disorders Treated How do therapists help individuals with DID Unlike victims of dissociative amnesia or fugue people with DID do not typically recover without treatment Treatment for this pattern like the disorder itself is complex and difficult How Are Dissociative Disorders Treated How do therapists help individuals with DID Therapists usually try to help the client by Recognizing the disorder Once a diagnosis of DID has been made therapists try to bond with the primary personality and with each of the subpersonalities As bonds are forged therapists try to educate the patients and help them recognize the nature of the disorder Some use hypnosis or video as a means of presenting other subpersonalities Many therapists recomnend group therapy How Are Dissociative Disorders Treated How do therapists help individuals with DID Therapists usually try to help the client by Recovering memories To help patients recover missing memories therapists use many of the approaches applied in other dissociative disorders including psychodynamic therapy hypnotherapy and drug treatment These techniques tend to work slowly in cases of DID How Are Dissociative Disorders Treated How do therapists help individuals with DID Therapists usually try to help the client by Integrating the subpersonalities The final goal of therapy is to merge the different subpersonalities into a single integrated entity Integration is a continuous process fusion is the final merging Many patients distrust this final treatment goal and many subpersonalities see integration as a form of death Once the subpersonalities are integrated further therapy is typically needed to maintain the complete personality and to teach social and coping skills to prevent later dissociations Depersonalization Disorder DSM IV TR categorizes depersonalization disorder as a dissociative disorder even though it is different from the other dissociative patterns The central symptom is persistent and recurrent episodes of depersonalization which is a change in one s experience of the self in which one s mental functioning or body feels unreal or foreign Depersonalization Disorder People with depersonalization disorder feel as though they have become separated from their body and are observing themselves from outside This sense of unreality can extend to other sensory experiences and behavior Depersonalization is often accompanied by derealization the feeling that the external world too is unreal and strange Depersonalization Disorder Depersonalization experiences by themselves do not indicate a depersonalization disorder Transient depersonalization reactions are fairly common The symptoms of a depersonalization disorder in contrast are persistent or recurrent cause considerable distress and interfere with social relationships and job performance Depersonalization Disorder The disorder occurs most frequently in adolescents and young adults hardly ever in people older than 40 The disorder comes on suddenly and tends to be long lasting Relatively few theories have been offered to explain depersonalization disorder and little research has been conducted on the problem Stress Coping and the Anxiety Response The state of stress has two components Stressor event that creates demands Stress response person s reactions to the demands Our response to such stressors in influenced by the way we appraise both the events and our capacity to react to them Influenced by how we appraise both the event and our capacity to react to the event effectively When we appraise a stressor as threatening a natural reaction is arousal and a sense of fear People who sense that they have the ability and resources to cope are more likely to take stressors in stride and respond constructively Stress Coping and the Anxiety Response When we appraise a stressor as threatening the natural reaction is fear Fear is a package of responses that are physical emotional and cognitive Stress reactions and the fear they produce are often at play in psychological disorders People who experience a large number of stressful events are particularly vulnerable to the onset of anxiety and other psychological disorders Stress Coping and the Anxiety Response Stress also plays a more central role in certain psychological disorders including Acute stress disorder Posttraumatic stress disorder PTSD Technically DSM IV TR lists these patterns as anxiety disorders quotas well as certain physical disorders called psychophysiological disorders These disorders are listed in the DSM IV TR under psychological factors affecting medical conditionquot Stress and Arousal The FightorFlight Response The features of arousal and fear are set in motion by the hypothalamus When our brain interprets a situation as dangerous neurotransmitters in the hypothalamus are released triggering the firing of neurons throughout the Two important systems are activated Autonomic nervous system ANS An extensive network of nerve fibers that connect the central nervous system the brain and spinal cord to all other organs of the body These fibers help regulate the involuntary activities of the organs breathing heartbeat blood pressure perspiration etc Endocrine system A network of glands throughout the body that release hormones Glands release hormones into the bloodstream and on to various body organs The ANS and endocrine system often overlap in their responsibilities and activities Stress and Arousal The FightorFlight Response There are two pathways or routes by which the ANS and the endocrine system produce arousal and fear reactions Sympathetic nervous system pathway Hypothalamic pituitary adrenal pathway Stress and Arousal The FightorFlight Response When we face a dangerous situation the hypothalamus first excites the sympathetic nervous system which stimulates key organs either directly or indirectly Directly Stimulate the heart and increase heart rate Indirectly stimulating the adrenal glandsin particular the adrenal medulla which is the inner layer When these glands are stimulated the chemicals epinephrine and When the perceived danger passes the parasympathetic nervous system helps return body processes to normal Together the sympathetic and parasympathetic nervous systems help control Stress and Arousal The Fightor Flight Response The second pathway is the hypothalamic pituitary adrenal HPA pathway When confronted by stressors the hypothalamus signals the pituitary gland which stimulates the adrenal cortex to release corticosteroids stress hormones into the bloodstream This includes the hormone cortisol The corticosteroids travel to various body organs including emotional memories and the hippocampus helps turn off the body39s arousaL Stress and Arousal The FightorFlight Response The reactions on display in these two pathways are collectively referred to as the fight or fYght response Each person has a particular pattern of autonomic and endocrine functioning and so a particular way of experiencing arousal and fear Some people are almost always relaxed while others typically feel tension even when no threat is apparent A person s general level of arousal and a differences in trait anxiety appear soon after birth Stress and Arousal The FightorFlight Response People differ in Their general level of arousal and anxiety Called trait anxietyquot Some people are usually somewhat tense others are usually relaxed Differences appear soon after birth Their sense of which situations are threatening Called state anxietyquot 0r situation anxiety Situation based example fear of flying The Psychological Stress Disorders During and immediately after trauma we may temporarily experience levels of arousal anXIety and depressIon For some symptoms persist well after the trauma These people may be suffering from Acute stress disorder Posttraumatic stress disorder PTSD The precipitating event usually involves actual or threatened serious injury to self or others The situations that cause these disorders would be traumatic to anyone unlike other anxiety disorders The Psychological Stress Disorders Acute stress disorder Symptoms begin within four weeks of event and last for less than one month Posttraumatic stress disorder PTSD Symptoms may begin either shortly after the event or months or years afterward As many as 80 of all cases of acute stress disorder develop into PTSD The symptoms of acute stress disorder and PTSD are almost identical The re experience the traumatic event avoiding activities that remind them of the event and related thoughts feelings or conversations they have reduced responsiveness feeling detached from others people and lose interest in activities that once brought enjoyment derealization and dissociation and depersonalization and they feel increased arousal and anxiety and guilt What Triggers a Psychological Stress Disorder Can occur at any age and affect all aspects of life People with these stress disorders may also experience depression another At least 35 of people in the US are affected each year 79 of people in the US are affected sometime during their lifetime Around two thirds seek treatment at some point but only 7 do so when they first develop the disorder Ratio of women to men is 221 After trauma around 20 of women and 8 of men develop disorders Some events including combat disasters abuse and victimization are more likely to cause disorders than others What Triggers a Psychological Stress Disorder Combat and stress disorders For years clinicians have recognized that soldiers experience distress during combat Called shell shockquot or combat fatiguequot Post Vietnam War clinicians discovered that soldiers also experienced psychological distress AFTER combat As many as 29 of Vietnam combat veterans suffered acute or posttraumatic stress disorders An additional 22 had some stress symptoms 10 still experiencing problems A similar pattern is currently unfolding among veterans of wars in Iraq and Afghanistan What Triggers a Psychological Stress Disorder Disasters and stress disorders Acute or posttraumatic stress disorders may also follow natural and accidental disasters Types of disasters include earthquakes floods tornadoes fires airplane crashes and serious car accidents Civilian traumas have been implicated in stress disorders at least 10 times as often as combat traumas What Triggers a Psychological Stress Disorder Victimization and stress disorders People who have been abused or victimized often experience lingering stress symptoms Research suggests that more than one third of all victims of physical or sexual assault develop PTSD A common form of victimization is sexual assaultrape Around 1 in 6 women is raped at some time during her life Psychological impact is immediate and may be long lasting One study found that 94 of rape survivors developed an acute stress disorder within 12 days after assault Although most rape victims improve psychologically within 3 or 4 months t he effects may persist for up to 18 months or longer What Triggers a Psychological Stress Disorder Victimization and stress disorders Between 4 and 30 percent of victims develop a sexually transmitted disease Ongoing victimization and abuse in the family may also lead to stress disorders The experience of terrorism or the threat of terrorism often leads to posttraumatic stress symptoms as does the experience of torture Why Do People Develop a Psychological Stress Disorder Clearly extraordinary trauma can cause a stress disorder However the event alone may not be the entire explanation To understand the development of these disorders researchers have looked to the Survivors biological processes Personalities Childhood experiences Social support systemscultural backgrounds Severity of the traumas Why Do People Develop a Psychological Stress Disorder Biological and genetic factors Traumatic events trigger physical changes in the brain and body that may lead to severe stress reactions and in some cases to stress disorders Some research suggests abnormal neurotransmitter and hormone activity especially norepinephrine and cortisol Evidence suggests that other biological changes and damage may also occur especially in the hippocampus and amygdala as a stress disorder sets in Normally the hippocampus plays a major role in both memory and the regulation of the body39s stress hormones A dysfunctional hippocampus may help produce the intrusive memories and ongoing arousal that characterize posttraumatic stress disorder Similarly the amygdala helps control emotional responses including anxiety and panic responses The amygdala also works with the hippocampus to produce the emotional components of memory dysfunctional amygdala may help produce the repeated emotional symptoms and intense emotional memories experienced by persons with posttraumatic stress disorder The excessive arousal generated by extraordinary traumatic events may gt lead to stress disorders in some people And the stress disorders ay produce yet further brain abnormalities locking in the disorders all the more firmly There may be a biologicalgenetic predisposition to such reactions Why Do People Develop a Psychological Stress Disorder Personality factors Some studies suggest that people with certain personality profiles attitudes and coping styles are particularly likely to develop stress disorders Risk factors include Preexisting high anxiety A history of psychological problems Negative worldview A set of positive attitudes called resiliency or hardiness is protective against developing stress disorders Why Do People Develop a Psychological Stress Disorder Childhood experiences Researchers have found that certain childhood experiences increase risk for later stress disorders Risk factors include An impoverished childhood Psychological disorders in the family The experience of assault abuse or catastrophe at an early age Being younger than 10 years old when parents separated or divorced Teach the child that the world is an unpredictable and dangerous place Why Do People Develop a Psychological Stress Disorder Social support People whose social support systems are weak are more likely to develop a stress disorder after a traumatic event Multicultural factors A careful look at research literature suggests that there may be important cultural differences in the occurrence of PTSD It seems that Hispanic Americans might be more vulnerable to PTSD than other racial or ethnic groups Possible explanations include early dissociative reactions to trauma cultural beliefs systems and the cultural emphasis on social relationships Believe that traumatic events are inevitable and unalterable this coping response may heighten their risk for posttraumatic stress disorder Also their culture emphasizes social relationships and social support traumatic experiences may deprive them of that for a while or permanently Why Do People Develop a Psychological Stress Disorder Severity of the trauma The more severe the trauma and the more direct one s exposure to it the greater the likelihood of developing a stress disorder Especially risky Mutilation and severe injury witnessing the injury or death of others How Do Clinicians Treat the Psychological Stress Disorders About half of all cases of PTSD improve within 6 months the remainder may persist for years Symptoms have been found to last an average of 3 years with treatment and 5 years without treatment Treatment procedures vary depending on type of trauma General goals End lingering stress reactions Gain perspective on painful experiences Return to constructive living How Do Clinicians Treat the Psychological Stress Disorders Treatment for combat veterans Drug therapy Antianxiety and antidepressant medications are most common May reduce the occurrence of nightmares panic attacks flashbacks and feelings of depression Behavioral exposure techniques Reduce specific symptoms increase overall adjustment Use flooding and relaxation training Some studies have found that exposure treatment is the single most helpful intervention for persons with stress disorders irrespective of the precipitating trauma exposure of one kind of another should always be part of the treatment picture Use eye movement desensitization and reprocessing EMDR Clients move their eyes in a saccadic or rhythmic manner freom side to side while flooding their minds with images of the objects and situation they ordinarily try to avoid Insight therapy Bring out deep seated feelings create acceptance lessen guilt Talking or writing about traumatic experiences can reduce lingering anxiety and tension Often use family or group therapy formats rap groups Rap group where individuals meet with others like themselves to share experiences and feelings develop insights and give mutual support The major issue they deal with is guilt Usually used in combinations How Do Clinicians Treat the Psychological Stress Disorders Psychological debriefing A form of crisis intervention that has victims of trauma talk extensively about their feelings and reactions within days of the critical incident They have not yet manifested any symptoms at all as well as those who have Counselors guide the individuals to describe the details of the recent trauma and the thoughts that had accompanied the unfolding event vividly to vent and relive the emotions provoked at the time of the event and to express their lingering reactions Four stage approach Normalize responses to the disaster Encourage expressions of anxiety anger and frustration Teach self help skills Provide referrals Relief workers themselves may become overwhelmed Research on this type of intervention continues to call into question its effectiveness In a study of 63 british soldiers whose job was to handle and identify the bodies of individuals who had been killed Half of them developed PTSD
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