Layout 1
67
C H A P T E R :5
Disorders of Trauma and
Stress
TO P I C OV E RV I E W
Stress and Arousal:The Fight-or-Flight Response
Acute and Posttraumatic Stress Disorders
What Triggers a Psychological Acute and Posttraumatic Stress Disorders?
Why Do People Develop Acute and Posttraumatic Stress Disorders?
How Do Clinicians Treat Acute and Posttraumatic Stress Disorders?
Dissociative Disorders
Dissociative Amnesia
Dissociative Fugue
Dissociative Identity Disorder (Multiple Personality Disorder)
How Do Theorists Explain Dissociative Amnesia and Dissociative Identity
Disorder?
How Are Dissociative Amnesia and Dissociative Identity Disorder? Treated?
Depersonalization-Derealization Disorde
Putting It Together: Getting a Handle on Trauma and Stress
L E C T U R E O U T L I N E
I. STRESS, COPING, AND THE ANXIETY RESPONSE
A. The state of stress has two components:
1. Stressor: Event creating demands
2. Stress response: The person’s reactions to the demands
a. Our stress response is influenced by how we judge (a) the events, and (b) ou
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
COMER_Fund7E_IR_CH05.QXP_Layout 1 5/1/13 4:05 PM Page 67
68 CHAPTER 5
3. When we view a stressor as threatening, the natural reaction is arousal and a sense
of fear.
a. The fear response is a “package” of responses—physical, emotional, and cognitive
B. Stress reactions, and the fear they produce, often are at play in psychological disorders
1. People who experience a large number of stressful events are particularly vulnerable
to the onset of GAD, social phobia, panic disorder, and OCD, as well as other psy-
chological problems
C. In addition, extraordinary stress and trauma play a more central role in certain psycholog-
ical disorders, including:
1. Acute stress disorde
2. Posttraumatic stress disorde
D. And, it plays a role in the “dissociative disorders”:
1. Dissociative amnesia
2. Dissociative identity disorde
3. Depersonalization-derealization disorde
E. The features of arousal and fear are set in motion by the hypothalamus
1. Two important systems are activated:
a. Autonomic nervous system (ANS)—an extensive network of nerve fibers that
connect the central nervous system (the
ain and spinal cord) to the body’s
other organs
. Endocrine system—a network of glands throughout the body that release hor-
mones
2. There are two pathways by which the ANS and the endocrine system produce
arousal and fear reactions—the first pathway is the sympathetic nervous system [See
Figure 5-1, text p. 141]
a. When we face a dangerous situation, the hypothalamus first activates the sympa-
thetic nervous system, which stimulates key organs either directly or indirectly
. When the perceived danger passes, the parasympathetic nervous system helps
eturn bodily processes to normal
3. The second pathway is the hypothalamic-pituitary-adrenal (HPA) pathway [See Fig-
ure 5-2, text p. 142]
a. When we are faced with stressors, the hypothalamus also signals the pituitary
gland, which signals the adrenal cortex to release corticosteroids—the stress
hormones—into the bloodstream
F. The reactions on display in these two pathways are refe
ed to as the fight-or-flight
response
1. People differ in their particular patterns of autonomic and endocrine functioning
and, therefore, in their particular ways of experiencing arousal and fea
2. The experience of fea
anxiety differs in two ways:
a. People differ in the general level of anxiety—called “trait anxiety”
(a) Some people always are tense, others always are relaxed
(b) Differences appear soon after birth
. People also differ in their sense of threat—called “state anxiety”
(a) Situation-based (e.g., fear of flying)
II. THE ACUTE AND POSTTRAUMATIC STRESS DISORDERS
A. During and immediately after trauma, we may temporarily experience high levels of
arousal and upset
1. For some, feelings will persist well after the upsetting situation is ove
a. These people may be experiencing:
(a) Acute stress disorde
(i) Symptoms begin immediately or soon after the traumatic event and
last for less than a month
(b) Posttraumatic stress disorder (PTSD) [See Table 5-1, text p. 144]
(i) Symptoms can begin at any time following the event but must last
for longer than 1 month
(ii) May develop from acute stress disorder (about 80 percent of all cases)
COMER_Fund7E_IR_CH05.QXP_Layout 1 5/1/13 4:05 PM Page 68
Disorders of Trauma and Stress 69
B. The situations that cause these disorders usually involves actual or threatened serious in-
jury to self or others and would be traumatic to anyone (unlike the anxiety disorders)
C. Aside from differences in onset and duration, symptoms of acute and posttraumatic stress
disorders (PTSDs) are almost identical:
1. Reexperiencing the traumatic event (flashbacks, nightmares)
2. Avoidance
3. Reduced responsiveness
4. Increased arousal, negative emotions, and guilt
D. These disorders can occur at any age and affect all aspects of life
1. They affect about 3.5 percent of U.S. population per year and about 7–9 percent of
U.S. population per lifetime
2. Approximately two-thirds of sufferers seek treatment at some point
3. Women are twice as likely as men to develop stress disorders; after trauma, 20 per-
cent of women vs. 8 percent of men develop disorders
4. In addition, people with low incomes are twice as likely as people with higher in-
comes to experience one of the stress disorders
E. What triggers acute and posttraumatic stress disorders?
1. Any traumatic event can trigger a stress disorder, however, some events are more likely
to cause disorders than others, including combat, disasters, abuse, and victimization:
a. Combat
(a) For years, clincians have recognized that many soldiers experience dis-
tress during combat (called “shell shock,” “combat fatigue”)
(b) Post–Vietnam War clinicians discovered that soldiers also experienced
distress after combat
(c) About 29 percent of Vietnam veterans suffered an acute or PTSD
(i) An additional 22 percent had at least some symptoms
(ii) About 10 percent are still experiencing problems
(d) A similar pattern is cu
ently unfolding among veterans of the wars in
Iraq and Afghanistan
(i) Individuals who have served multiple deployments have a signifi-
cantly heightened risk of developing PTSD
. Disasters
(a) Acute or posttraumatic stress disorders also may follow natural and acci-
dental disasters such as earthquakes, tornadoes, fires, airplane crashes,
and serious car accidents
(b) Civilian traumas have been implicated in stress disorders at least 10 times
as often as combat trauma (because they occur more often)
c. Victimization
(a) People who have been abused or victimized often experience lingering
stress symptoms
(i) More than one-third of all victims of physical of sexual assault de-
velop PTSD
(ii) As many as half of those directly exposed to te
orism or torture may
develop this disorde
(b) A common form of victimization is sexual assault
(i) One study found 94 percent of rape survivors developed an acute
stress disorder within 12 days after assault
(c) Ongoing victimization and abuse in the family also may lead to stress dis-
orders
d. Te
orism and torture
(a) The experience of te
orism often leads to posttraumatic stress symptoms,
as does the experience of torture
(i) Unfortunately, these sources of traumatic stress are on the rise in ou
society
F. Why do people develop acute and posttraumatic stress disorders?
1. Clearly, extraordinary trauma can cause a stress disorder; however, the event alone
may not be the entire explanation
COMER_Fund7E_IR_CH05.QXP_Layout 1 5/1/13 4:05 PM Page 69
70 CHAPTER 5
2. To understand the development of these disorders, researchers have looked to the
survivors’ biological processes, personalities, childhood experiences, social support
systems, and cultural backgrounds, as well as the severity of the traumas:
a. Biological and genetic factors
(a) Traumatic events trigger physical changes in the
ain and body that may
lead to severe stress reactions and, in some cases, to stress disorders
(b) Some research suggests abnormal neurotransmitter (NT) and hormone ac-
tivity (especially norepinephrine and cortisol)
(c) Evidence suggests that once a stress disorder sets in, further biochemical
arousal and damage may also occur (especially in the hippocampus and
amygdala)
(d) There may be a biological/genetic predisposition to such reactions
. Personality factors
(a) Some studies suggest that people with certain personalities, attitudes, and
coping styles are more likely to develop stress disorders, including:
(i) Preexisting high anxiety
(ii) Negative worldview
(b) Alternatively, a set of positive attitudes (called resiliency or hardiness) is
protective against developing stress disorders
c. Childhood experiences
(a) Researchers have found that certain childhood experiences increase risk
for later stress disorders, including:
(i) An impoverished childhood
(ii) Psychological disorders in the family
(iii) The experience of assault, abuse, or catastrophe at an early age
(iv) Being younger than 10 years of age when parents separated or di-
vorced
d. Social support
(a) People whose social support systems are weak are more likely to develop
a stress disorder after a traumatic event
e. Multicultural factors
(a) There is a growing suspicion among clinical researchers that the rates of
PTSD may differ among ethnic groups in the United States
(i) It seems that Hispanic Americans might be more vulnerable to PTSD
than other cultural groups
(ii) Possible explanations include cultural belief systems about trauma and
the cultural emphasis on social relationships and social support
f. Severity of the trauma
(a) Generally, the more severe trauma and the more direct one’s exposure to
it, the greater the likelihood of developing a stress disorde
(b) Especially risky: mutilation and severe injury; witnessing the injury o
death of others
3. How do clinicians treat acute and posttraumatic stress disorders?
a. About half of all cases of PTSD improve within 6 months; the remainder may
persist for years
. Treatment procedures vary depending on type of trauma
(a) General treatment goals include helping the client to:
(i) End lingering stress reactions
(ii) Gain perspective on the traumatic experience
(iii) Return to constructive living
d. Treatment for combat veterans
(a) Drug therapy
(i) Antianxiety and antidepressant medications are most common
(b) Behavioral exposure techniques
(i) Reduce specific symptoms, increase overall adjustment
(ii) Use of flooding and relaxation training
(iii) Use of eye movement desensitization and reprocessing (EMDR)
COMER_Fund7E_IR_CH05.QXP_Layout 1 5/1/13 4:05 PM Page 70
Disorders of Trauma and Stress 71
(c) Insight therapy
(i) Bring out deep-seated feelings, create acceptance, lessen guilt
(d) Often use couple, family, or group therapy formats such as rap groups
e. Psychological de
iefing
(a) A form of crisis intervention that has victims of trauma talk extensively
about their feelings and reactions within days of the critical incident
(b) Major components include:
(i) Normalizing responses to the disaste
(ii) Encouraging expressions of anxiety, anger, and frustration
(iii) Teaching self-helping skills
(iv) Providing refe
als
(c) The approach has come under careful scrutiny
(d) While many health professionals continue to believe in the approach de-
spite unsupportive research findings, the cu
ent climate is moving away
from outright acceptance
(i) It’s possible that certain high-risk individuals may profit from de
ief-
ing programs, but that others shouldn’t receive such interventions
III. DISSOCIATIVE DISORDERS
A. Although their conditions are also triggered by traumatic events, individuals with disso-
ciative disorders do