1. DISORDERS OF TRAUMA AND STRESS Chapter 5 Lichtman, Fundamentals of Abnormal Psychology, 7e.

2. 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 Influenced by how we judge both the events and our capacity to react to them effectively People who sense that they have the ability and resources to cope are more likely to take stressors in stride and respond well Lichtman, Fundamentals of Abnormal Psychology, 7e 2

3. Stress and Arousal: The Fight-or-Flight 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 Lichtman, Fundamentals of Abnormal Psychology, 7e 3

4. The Autonomic Nervous System Lichtman, Fundamentals of Abnormal Psychology, 7e 4

5. The Endocrine System Lichtman, Fundamentals of Abnormal Psychology, 7e 5

6. Stress, Coping, and the Anxiety Response Stress psychological disorders: Acute stress disorder Posttraumatic stress disorder (PTSD) …as well as the “dissociative disorders”: Dissociative amnesia Dissociative identity disorder Depersonalization-derealization disorder Lichtman, Fundamentals of Abnormal Psychology, 7e 6

7. Acute and Posttraumatic Stress Disorders Acute stress disorder Symptoms begin immediately or soon after the traumatic 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 Lichtman, Fundamentals of Abnormal Psychology, 7e 7

8. Acute and Posttraumatic Stress Disorders Symptoms of acute stress disorders and PTSD are almost identical: Reexperiencing the traumatic event Avoidance Reduced responsiveness Increased arousal, negative emotions, and guilt Lichtman, Fundamentals of Abnormal Psychology, 7e 8

9. What Triggers Acute and Posttraumatic Stress Disorders? Ratio of women to men is 2:1 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 Lichtman, Fundamentals of Abnormal Psychology, 7e 9

10. What Triggers Acute and Posttraumatic Stress Disorders? Victimization A common form of victimization is sexual assault/rape Ongoing victimization and abuse in the family may also lead to stress disorders Lichtman, Fundamentals of Abnormal Psychology, 7e 10

11. What Triggers Acute and Posttraumatic Stress Disorders? Terrorism and torture The experience of terrorism or the threat of terrorism often leads to posttraumatic stress symptoms, as does the experience of torture Unfortunately, these sources of traumatic stress are on the rise in our society Lichtman, Fundamentals of Abnormal Psychology, 7e 11

12. Why Do People Develop Acute and Posttraumatic Stress Disorders? Biological and genetic factors Abnormal neurotransmitter and hormone activity (especially norepinephrine and cortisol) Evidence suggests that once a stress disorder sets in, further biochemical arousal and damage may also occur (especially in the hippocampus and amygdala) There may be a biological/genetic predisposition to such reactions Lichtman, Fundamentals of Abnormal Psychology, 7e 12

13. Why Do People Develop Acute and Posttraumatic Stress Disorders? Personality factors Some studies suggest that people with certain personalities, attitudes, and coping styles are particularly likely to develop stress disorders Risk factors include: Preexisting high anxiety Negative worldview A set of positive attitudes (called resiliency or hardiness) is protective against developing stress disorders Lichtman, Fundamentals of Abnormal Psychology, 7e 13

14. Why Do People Develop Acute and Posttraumatic Stress Disorders? 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 Lichtman, Fundamentals of Abnormal Psychology, 7e 14

15. Why Do People Develop Acute and Posttraumatic Stress Disorders? Social support People whose social support systems are weak are more likely to develop a stress disorder after a traumatic event Lichtman, Fundamentals of Abnormal Psychology, 7e 15

16. Why Do People Develop Acute and Posttraumatic Stress Disorders? Multicultural factors It seems that Hispanic Americans might be more vulnerable to PTSD than other cultural groups Lichtman, Fundamentals of Abnormal Psychology, 7e 16

17. How Do Clinicians Treat Acute and Posttraumatic Stress Disorders? About half of all cases of PTSD improve within 6 months; the remainder may persist for years Lichtman, Fundamentals of Abnormal Psychology, 7e 17

18. How Do Clinicians Treat Acute and Posttraumatic Stress Disorders? Treatment for combat veterans Drug therapy Antianxiety and antidepressant medications are most common Behavioral exposure techniques Reduce specific symptoms, increase overall adjustment Use flooding and relaxation training Use eye movement desensitization and reprocessing (EMDR) Insight therapy Bring out deep-seated feelings, create acceptance, lessen guilt Often use couple, family, or group therapy formats; rap groups Lichtman, Fundamentals of Abnormal Psychology, 7e 18

19. How Do Clinicians Treat Acute and Posttraumatic Stress Disorders? Psychological debriefing Crisis intervention. Major components include: Encouraging expressions of anxiety, anger, and frustration Teaching self-help skills **While many health professionals continue to believe in the approach despite unsupportive research findings, the current climate is moving away from outright acceptance Lichtman, Fundamentals of Abnormal Psychology, 7e 19

20. Dissociative Disorders In dissociative disorders, one part of the person’s memory typically seems to be dissociated, or separated, from the rest Dissociative amnesia Dissociative identity disorder (multiple personality disorder) Depersonalization-derealization disorder These disorders are often memorably portrayed in books, movies, and television programs Lichtman, Fundamentals of Abnormal Psychology, 7e 20

21. Dissociative Amnesia People with dissociative amnesia are unable to recall important information, usually of a stressful nature, about their lives The loss of memory is much more extensive than normal forgetting and is not caused by physical factors Often an episode of amnesia is directly triggered by a specific upsetting event Lichtman, Fundamentals of Abnormal Psychology, 7e 21

22. Dissociative Amnesia Amnesia interferes mostly with a person’s memory for personal material Memory for abstract or encyclopedic information – usually remains intact Lichtman, Fundamentals of Abnormal Psychology, 7e 22

23. Dissociative Amnesia An extreme version of dissociative amnesia is called dissociative fugue Here persons 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 Lichtman, Fundamentals of Abnormal Psychology, 7e 23

24. Dissociative Amnesia 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 Lichtman, Fundamentals of Abnormal Psychology, 7e 24

25. Dissociative Identity Disorder (Multiple Personality Disorder) A person with dissociative identity disorder (DID, or multiple personality disorder) develops two or more distinct personalities, called “subpersonalities”, each with a unique set of memories, behaviors, thoughts, and emotions Lichtman, Fundamentals of Abnormal Psychology, 7e 25

26. 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 Lichtman, Fundamentals of Abnormal Psychology, 7e 26

27. 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 common than once thought Lichtman, Fundamentals of Abnormal Psychology, 7e 27

28. 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 Women receive the diagnosis three times as often as men Lichtman, Fundamentals of Abnormal Psychology, 7e 28

29. 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 Not encylopedic differences Lichtman, Fundamentals of Abnormal Psychology, 7e 29

30. How Do Theorists Explain Dissociative Amnesia and DID? The psychodynamic view DID is thought to result from a lifetime of excessive repression, motivated by very traumatic childhood events Lichtman, Fundamentals of Abnormal Psychology, 7e 30

31. How Do Theorists Explain Dissociative Amnesia and DID? 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 Lichtman, Fundamentals of Abnormal Psychology, 7e 31

32. How Do Theorists Explain Dissociative Amnesia and DID? 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 Lichtman, Fundamentals of Abnormal Psychology, 7e 32

33. How Do Theorists Explain Dissociative Amnesia and DID? 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 Lichtman, Fundamentals of Abnormal Psychology, 7e 33

34. How Are Dissociative Amnesia and DID Treated? People with dissociative amnesia often recover on their own In contrast, people with DID usually require treatment to regain their lost memories and develop an integrated personality Treatment for dissociative amnesia tends to be more successful than treatment for DID Lichtman, Fundamentals of Abnormal Psychology, 7e 34

35. How Are Dissociative Amnesia and DID Treated? How do therapists help people with dissociative amnesia? The leading treatments for these disorders are psychodynamic therapy, hypnotic therapy, and drug therapy Sometimes intravenous injections of barbiturates are used to help patients regain lost memories Often called “truth serums,” the key to the drugs’ success is their ability to calm people and free their inhibitions Lichtman, Fundamentals of Abnormal Psychology, 7e 35

36. How Are Dissociative Amnesia and DID Treated? 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 identity Integration is a continuous process; fusion is the final merging Lichtman, Fundamentals of Abnormal Psychology, 7e 36

37. Depersonalization-Derealization Disorder Depersonalization-derealization disorder is a dissociative disorder, even though it is not characterized by memory difficulties. Lichtman, Fundamentals of Abnormal Psychology, 7e 37

38. Depersonalization-Derealization Disorder The central symptom is persistent and recurrent episodes of depersonalization, which is the sense that one’s own mental functioning or body are unreal or detached, and/or derealization, which is the sense that one’s surroundings are unreal or detached Lichtman, Fundamentals of Abnormal Psychology, 7e 38

39. Depersonalization-Derealization 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 Few theories have been offered to explain this disorder Lichtman, Fundamentals of Abnormal Psychology, 7e 39