Stress Disorders. Stress and coping. Stress and coping. Stress and coping. Parachute for sale: Only used once, never opened.

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Kristina Wiggins
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1 Stress Disorders Parachute for sale: Only used once, never opened. Stress and coping The state of stress has two components: Stressor: event creating demands Stress response: reactions to the demands Stress and coping Our stress response is influenced by how we (a) appraise the event (b) our capacity to react to the event effectively People who sense that they have the ability and resources to cope are more likely to take stressors in stride Stress and coping Stress reactions are often at play in psychological disorders People who experience a large number of stressful events are particularly vulnerable to anxiety-related difficulties, as well as other psychological problems, including depression

2 Extensive research indicates the following laws of stress Isolated, single stress experiences of stress (even with very traumatic stress), in which there is an opportunity for recovery, pose the least risk and often provide an opportunity for future stress resistance in increased resilience ( that which doesn t kill us can make us strong ) Extensive research indicates the following laws of stress People with premorbid vulnerability (esp. health and mental health problems) are at higher risk of stress-induced psychopathology Extensive research indicates the following laws of stress Repeated and chronic stress poses higher risk Stress experiences in which the victim was trapped, imprisoned, unable to effectively respond, and/or given a lasting injury pose higher risk The most common stress disorders are adjustment problems, anxiety, and depression (PTSD is less frequent) Stress and disease there is a well-established relationship between stress and illness People exposed to prolonged stress are at higher risk of a variety of diseases health psychology and behavioral medicine

3 Stress disorders Stress also plays a more central role in the DSM s and ICD s Trauma- and Stressor- Related and Severe Stress disorders, including: 1. Adjustment disorder the most common stress disorder 2. Acute stress disorder 3. Posttraumatic stress disorder Stress disorders Others that involve stress as a central symptom: Mental disorders that exacerbate disease & physical disorders called Psychological Factors Affecting Physical Condition These disorders are listed in the DSM-5 under somatic disorders - controversial) In children, Reactive Attachment Disorder and Disinhibited Social Engagement Disorder listed as stress disorders in the DSM - these are child reactions to neglect, loss, and severe attachment problems; ICD lists these as developmental disorders) Developmental Aspects of Stress Disorders Risk factors include: reactive personality problems preexisting high anxiety a history of psychological problems negative worldview accumulated stress with negative reaction is perhaps the most significant factor A set of positive attitudes ( resiliency or hardiness ) is protective against developing stress disorders Developmental Aspects of Stress Disorders Social support People whose social support systems are weak are more likely to develop a stress disorder after a negative event Severity of the stress The more severe, chronic (repeated), and entrapping the trauma, and the more direct one s exposure to it, the greater the likelihood of developing a stress disorder

4 Trauma and psychology when bad things happen... Trauma and psychology Psychological trauma involves actual or threatened serious injury to self or others psychological reactions to a lifethreatening event, serious injury or sexual violence Traumatic stress reactions follow events which would be extreme to anyone (unlike other stress/anxiety disorders) Trauma and psychology Most people have anxious distress, often with confusing Sx, after a traumatic event. Most people recover within 2-3 months. Most combat veterans, victims of rape, and survivors of sexual abuse recover and live normal lives but others do not... Trauma disorders If their symptoms persist, the most common reactions to trauma are anxiety depression depression and anxiety disorders are more common in trauma victims than PTSD. the two more difficult traumatic stress disorders are Acute stress disorder (ASD) Post-traumatic stress disorder (PTSD)

5 Traumatic Stress Symptom categories Intrusion: re-experiences of the traumatic event in dreams, memories, reactions, flashbacks Avoidance: of memories and reminders Negative mood: persistent difficulty experiencing positive emotion Arousal: sleep disturbance, hypervigilance, anxiety, startle reponse, difficulty concentrating Dissociation: Altered sense of reality, inability to remember important aspects of the trauma. Traumatic Stress Symptom categories some details on dissociation Dissociation is a loss or change in memory, consciousness, and/or identity, without physical causes, that results in dysfunction in normal/ongoing cognition, sensation and behavior. Usually temporary. Can be repetitive. often results in confusion, distress, hypersensitivity after trauma reactions minor forms: odd memory lapses, in STM severe forms: large absences in memory and cognition ( repression ) depersonalization and derealization Traumatic Stress Symptom categories some details on dissociation depersonalization experiences of unreality or detachment, or being an outside observer with respects to ones thoughts, feelings, emotions, behaviors... derealization experiences of unreality or detachment with respect to one s curroundings (foggy, unreal, lifeless..) DID (formerly MPD) is usually a traumatic stress disorder - see text and next lecture if we have time to get to this topic!) The trauma disorders Acute stress disorder: nine or more Sx from any of the five categories, that begin after the traumatic event and last no more than a month weeks of event and last for less than one month. Post-traumatic stress disorder (PTSD): Sx from each of the first four categories, often with dissociation, that begin at any time and last for longer than one month. Can have delayed onset.

6 ICD on Post-traumatic stress disorder: Arises as a delayed or protracted response to a stressful event or situation (of either brief or long duration) of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone. Predisposing factors, such as personality traits (e.g. compulsive, asthenic) or previous history of neurotic illness, may lower the threshold for the development of the syndrome or aggravate its course, but they are neither necessary nor sufficient to explain its occurrence. Typical features include episodes of repeated reliving of the trauma in intrusive memories ("flashbacks"), dreams or nightmares, occurring against the persisting background of a sense of "numbness" and emotional blunting, detachment from other people, unresponsiveness to surroundings, anhedonia, and avoidance of activities and situations reminiscent of the trauma. There is usually a state of autonomic hyperarousal with hypervigilance, an enhanced startle reaction, and insomnia. Anxiety and depression are commonly associated with the above symptoms and signs, and suicidal ideation is not infrequent. The onset follows the trauma with a latency period that may range from a few weeks to months. The course is fluctuating but recovery can be expected in the majority of cases. In a small proportion of cases the condition may follow a chronic course over many years, with eventual transition to an enduring personality change The big PTSD events: Combat ~30% of Vietnam combat veterans suffered acute or post-traumatic stress disorders An additional 22% had some stress symptoms ~ 10% still experiencing problems Disasters and violent accidents Victimization sexual assault/rape One study found that 94% of rape survivors developed an acute stress disorder within twelve days after assault Elements that make PTSD Sx worse: chronic harm being injured being trapped and unable to escape being overwhelmed, overcome, taken over so that control and coping were impossible Treatment the return to safety psychotherapy relaxation training biofeedback systematic desensitization psycho-education hypnosis/emdr problems in drug therapy with anxiolytics and sedatives

7 Conclusion: Trauma and society we all suffer from pre-traumatic Stress Disorder

ENTITLEMENT ELIGIBILITY GUIDELINE POSTTRAUMATIC STRESS DISORDER

ENTITLEMENT ELIGIBILITY GUIDELINE POSTTRAUMATIC STRESS DISORDER MPC 00620 ICD-9 309.81 ICD-10 43.1 DEFINITION Posttraumatic Stress Disorder (PTSD) is a condition in the Diagnostic and Statistical Manual