Trauma + stress

Question 1

sympathetic NS pathway

Answer 1

hypothalamus excites the sympathetic NS that works to increase experience of anxiety. These may stimulate the adrenal glands & adrenal medulla – which releases epinephrine (adrenaline) & norepinephrine (noradrenaline) – produce fear & anxiety, parasympathetic NS relaxes it all again

Question 2

hypothalamic pathway

Answer 2

hypothalamus sends signals to pituitary gland which secretes Adrenocorticotropic Hormone (ACTH), This activates the outler layer of adrenal glands. THEN RELEASING corticosteroids (inc cortisol)

• cortisol – controls metabolism + inflammation

Question 3

What do ASD (acute stress disorder) and PTSD have in COMMON (4)

Answer 3

everything except duration and onset:

1) Re-experiencing traumatic event
2) Avoidance of things that remind people
3) Reduced responsiveness (i.e. loss of interest/feeling dazed)
4) Increased arousal, negative emotions and guilt (overly alert)

Question 4

What are some examples of What may induce acute & posttraumatic stress disorders?

Answer 4

• Combat
• Disasters
• Victimisation (sexual assult, terrorism, torture)

Question 5

What do ASD (acute stress disorder) and PTSD have DIFFERENTLY (2)

Answer 5

Onset + duration

• symptoms begin within 4 weeks of the traumatic event and last for less than a month = acute stress disorder
• if symptoms continue longer than a month = posttraumatic stress disorder. PTSD can begin even years after the event.

**Studies suggest that at least half of acute stress disorder cases become PTSD (Bryant et al. 2015) **

Question 6

BIOLOGICAL factors of ASD and PTSD (3)

Answer 6

1) Altered levels of cortisol levels/ other brain neurochemical changes
2) Damage to brain areas caused by abnormal levels of biochemicals
3) Passing on chemicals onto offspring when pregnant

Question 7

Evaluation of bio factors FOR

Answer 7

1) abnormal neurochemical levels –>
- higher cortisol levels in trauma survivors

2) Dysfunctional circuit
- pfc = dysfunction cant access it quick enough
- amygdala, hippocampus circuit damage
- hippocampus = plays a role in memory (reason for dysfunctional memories in PTSD
- amygdala = helps to regulate emotions. Works with hippoc to bind emotions + mems. SO strong emotional mems = dysfunctional. ALSO tells body to release cortisol
- smaller hippocampus - may also be genetic

3) Pregnancy passing on/genetics –
- Looked @ mothers from twin towers
- Found that the mum had higher cortisol levels + so did her children
- identical twin studies in the army: if one develops it then the identitcal twin is more likely to develop than the fraternal twin
- genetic influence on: dopamine receptors, hippocampus size, low serotonin transportation associated w ptsd

Question 8

Evaluation of bio factors AGAINST

Answer 8

1) some have found lower levels of cortisol in PTSD?
- It has been suggested that inconsistent findings may result from differences in the severity and timing (i.e. adolescence) of psychological trauma, the patterns of signs/symptoms, personality, and genetic makeup
- ALSO comorbid depression have been found to have lower cortisol levels than just PTSD alone
- ALSO history of previous trauma

***Microbiata also predisposes people

Question 9

Personality Factors for ASD and PTSD

Answer 9

• attitudes and coping styles affect ones likelihood of developing stress disorders
• feeling of no control over life helps contribute to the onset/struggle more after events
• those who find value in negative events = adjust easier after trauma – POSITIVE PSYCH

Question 10

Evaluation of personality factors FOR (3)

Answer 10

• avoidant coping strategies are related to more PTSD symptoms. MORE maladaptive strategies more PTSD symptoms
• those with PTSD experienced more intrusive
  thoughts, avoidant behaviors, and engaged in
  more distraction techniques than other psychiatric
  patients
• Resilience and PTSD: trauma survivors who have
  a capacity to mobilize and utilize protective
  factors, such as social and personal support
  mechanisms, have better outcomes.

Question 11

Evaluation of personality factors “AGAINST”/argument (2)

Answer 11

• the views on disclosure affect coping + control

a) positive social reactions to assault disclosure predicted greater perceived control over recovery AND more adaptive social and individual coping which in turn was related to less PTSD symptoms.
b) Negative social reactions to assault disclosure were related to greater PTSD symptoms both directly and indirectly through maladaptive coping and marginally through lower perceived control over recovery.

• Adaptive strategies put in place (E.G. cog restructuring), however, generally have a weaker influence on PTSD symptoms than maladaptive coping

Question 12

Childhood experiences

Answer 12

• poverty, abuse, assault –> more likely to develop
• divorced
• family members who suffered from psychological disorders

Question 13

Multicultural factors (who’s most prone + why?)

Answer 13

• Hispanics most prone
  WHY
  1) cultural views Hispanics tend to believe that traumatic events are inevitable and unalterable — a coping mechanism which may be making it worse (Perilla et al. 2002)

2) Hispanics rely a lot on their social support networks, so if the traumatic event deprives them of this network then this may cause symptoms to get worse (Escobar et al. 1983).

Question 14

Role of microbiota and PTSD

Answer 14

• suggests a reason why some are more prone to dev PTSD
• stress hormones are able to alter the composition of guts microbiota
• this then disrupts the gastrointestinal tract and causes systemic inflammation
• Inflammation = shown to link w risk of psychiatric disorders
• Levels of inflammation have been found to predict PTSD later on

Question 15

Treatment for PTSD (brief cos she probs wont ask about it if its my Q)

Answer 15

• anti anxiety drugs
• Behavioural exposure techniques (EMDR/3MDR)
• Cognitive therapies (framing thoughts + trusting others again)
• FAMILY therapies

Question 16

Dissociative disorders – link with PTSD/ASD? (2)

Answer 16

1) Those with acute and posttraumatic stress disorders may have symptoms of dissociation along with other symptoms : i.e. may feel dazed or forget things or have a sense of derealisation = also on display in dissociative disorders.
2) Dissociative disorders may also be triggered by traumatic events

Question 17

Dissociative Amnesia

- what

Answer 17

what? - Inability to recall important information, usually of a stressful nature, about their lives (APA, 2013) (factual + abstract knowledge remains)
CAN BE–
A) Localised (most common: where person loses memory for a particular time period. Almost always beginning with some very disturbing occurrence
b) Selective – can remember one but not all events that took place in a period of time
c) generalised – can extend back to even before the event
d) continuous – forgetting continues into the present
***dissociative fugue = personal identities are forgotten and details of their past lives

Question 18

Dissociative identity disorder

what + when does it occur?

Answer 18

• Aka multiple personality disorder; where a person can develop two + distinct personalities (sub-personalities) each with a unique set of memories, thoughts, behaviours & emotions.
• host personality and “switching”
• rare but more common than once thought
• More often than not symptoms occur in early childhood after abuse.
• Manifestations vary by cultures

Alternatively, a diathesis-stress model suggests that DID
could be a complex form of PTSD given that both are often conceptualized as responding to a
traumatic event (Gast, 2006)
—– would it be more beneficial to conceptualize dissociation as a dimension with DID being a more
extreme dimensional form of PTSD? maybs

Question 19

Behavioural view of Dissociative Amnesia & Dissociative identity disorder

Answer 19

• Drifting of mind
• dissociation stems from classical conditioning of these drifts; those who have trauma on their mind all the time find it rewarding when their mind drifts
• forgetting -> less anxiety -> learning
• But how do temporary escapes turn to disorders? Or why more people do not develop disorders?

Question 20

State-dependent learning + Dissociative Amnesia & Dissociative identity disorder

what + how?

Answer 20

• When people learn something when they are in a particular state of mind or situation, they are more likely to remember it best when they’re in that situation again.
  HOW?
• A particular level of arousal will have a set of mems attached to it (when that arousal is achieved again - more likely to remember that memory)
• Perhaps those who are prone to develop these disorders have state-to-memory links that are unusually rigid and narrow
• each of their memories, skills and thoughts is tied exclusively to a particular state of arousal
  E.G for MMP =different personalities for diff arousal levels + amnesia = forgetting @ diff levels of arousal

Question 21

Depersonalization-derealisation disorder

what?

Answer 21

• Persistent + impairing, reoccurring episodes of depersonalisation(sense that ones own mental functioning or body is unreal or detached), derealisation (surroundings feel unreal or detached), or both
• People feel they have been separated from their bodies and are observing themselves from the outside.
• Body parts feel foreign
• AWARE this is happening

Question 22

Theories for Depersonalization-derealisation disorder (3)

Answer 22

BIO: first study to consider (2016)
Cortical dysplasia in networks responsible for integration of sensory input and required to understand the significance of events and objects in the external environment.
Derangements in the HASC have produced non-modality specific neuropsychiatric deficits, and the component anatomy can account well for the aberrations in emotion, perception and memory characteristic of derealisation.
HASC serves to non-specifically integrate multimodal sensory
inputs correlates well with the peculiar phenomenology of derealisation, and forces a consideration of the exciting prospect of this being the (currently unrecognized) ‘common pathway’ of derealisation neurology that myriad etiologies function through.

Question 23

comorbidity

Answer 23

DID can be confused with a number of other mental disorders, including other dissociative
disorders, schizophrenia, borderline personality disorder and temporal lobe epilepsy (Osei,
2004).

These inconsistencies in diagnostic suggestions for DID illustrate that it is not completely
formed as a valid diagnosis, though it shows an obvious existence as a syndrome.