Module- 2
Somatic, Dissociative and Stress
disorders
Somatic Symptom Disorder: Severe concern about physical symptoms leading to
significant distress or impairment.
Dissociative Disorder: Persistent and recurrent feelings of being "out of it" leading to
profound and unusual memory deficits.
Somatic Symptom and Related Disorders:
Involves physical symptoms along with abnormal thoughts, feelings, and behaviors in response
to those symptoms (APA, 2013).
"Soma" means "body."
People with somatic symptom disorders experience bodily symptoms
Patients with somatic symptom disorders are more commonly found in medical settings
than in mental health clinics.
The affected patients have no control over their symptoms.
Four disorders in the somatic symptom and related disorders category are -
1. Somatic symptom disorder
2. Illness anxiety disorder
3. Conversion disorder
4. Factitious disorder
1. Somatic symptom disorder
Focus on chronic somatic symptoms causing distress and dysfunctional thoughts, feelings,
and/or behaviors.
Symptoms seen as defense mechanisms against unresolved or unacceptable unconscious
conflicts.
Patients with somatic symptom disorder are usually seen in medical clinics.
Patients with somatic symptom disorder frequently engage in illness behavior that is
dysfunctional.
High levels of functional impairment are common, as is comorbid psychopathology—
especially depression and anxiety.
Experience these bodily sensations as intense, disturbing, and highly aversive.
DSM 5 Criteria:
A. One or more somatic symptoms that are distressing or result in significant disruption of
daily life.
B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated
health concerns as manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of oneÕs symptoms.
2. Persistently high level of anxiety about health or symptoms.
3. Excessive time and energy devoted to these symptoms or health concerns.
C. Although any one somatic symptom may not be continuously present, the state of being
symptomatic is persistent (typically more than 6 months).
The three sub categories are : Hypochondiasis, Somatization Disorder and Pain Disorder.
a) Hypochondriasis
The person is preoccupied either with fears of contracting a serious disease or with the idea
that of having that disease even though they do not.
Individuals with hypochondriasis tend to be highly preoccupied with bodily functions or
with minor physical abnormalities or with vague and ambiguous physical sensations.
They attribute these symptoms to a particular disease and often have intrusive
thoughts about it.
They are not malingering—consciously faking symptoms to achieve a specific goals such
as winning a personal injury lawsuit in other words, they are sincere in their conviction
that the symptoms they detect represent real illness.
Causal Factors
Cognitive-behavioral views of hypochondriasis are perhaps most widely accepted.
An individualÕs past experiences with illnesses lead to the development of a set of
dysfunctional assumptions about symptoms and diseases that may predispose a person
to developing hypochondriasis.
They tend to have an excessive amount of illness in their families while growing up,
which may lead to strong memories of being sick or in pain and perhaps also of having
observed some of the secondary benefits that sick people sometimes reap
Treatment
Cognitive-behavioral treatment
The treatment is relatively brief (6 to 16 sessions) and can be delivered in a group format
b) Somatization Disorder
Somatization disorder is characterized by many different physical complaints. To qualify for
the diagnosis, these had to begin before age 30, last for several years, and not be
adequately explained by independent findings of physical illness or injury.
Three to ten times more common among women than among men.
Somatization disorder very commonly co-occurred with several other disorders
including major depression, panic disorder, phobic disorders, and generalized anxiety
disorder.
Causal Factors
Evidence is there that somatization disorder runs in families and that there is a familial
linkage between antisocial personality disorder in men and somatization disorder in women.
Treatment
➔ Certain type of medical management along with cognitive-behavioral treatments.
➔ Identifying suitable physicians and attending to the client on a daily basis and
providing physical exams based on new problems
➔ Minimising unnecessary diagnostic testing, medications and therapy.
c) Pain Disorder
Characterized by persistent and severe pain in one or more areas of the body that is not
intentionally produced or stimulated.
Medical condition may contribute to the pain but psychological factors are judged to
play an important role.
Acute (less than 6 months) and Chronic (over 6 months)
Pain that is experienced is very real and can hurt as much as pain that comes from
other sources.
Pain cannot be objectively identified by others.
More prevalent among women than men
Comorbid with anxiety or mood disorders
Hindrance to daily activities
Inactivity and social isolation may lead to depression and to a loss of physical strength
and endurance.
Behavioral component of pain is that it can increase when it is reinforced by attention,
sympathy, or avoidance of unwanted activities.
Treatment
Relaxation training, support and validation that the pain is real, scheduling of daily
activities, cognitive restructuring, and reinforcement of “no-pain” behaviors.
Antidepressant medications (especially the tricyclic antidepressants) and certain
SSRIs(Selective Serotonin Reuptake Inhibitors) have been shown to reduce pain
intensity.
2. Illness anxiety disorder
- Characterized by high anxiety about having or developing a serious illness.
- Anxiety is distressing and/or disruptive but there are very few (mild) somatic symptoms.
Patients with illness anxiety disorder (IAD) emanate their distress and anxiety not primarily
from the physical complaint itself but rather from their anxiety about the meaning,
significance, and cause of the complaint, they remain unsatisfied with the reassurance of the
physicians.
DSM 5 Criteria :
A. Preoccupation with having or acquiring a serious illness.
B. Somatic symptoms are not present or, if present, are only mild in intensity.
If another medical condition is present or there is a high risk for developing a medical
condition (e.g., strong family history is present), the preoccupation is clearly excessive or
disproportionate.
C. There is a high level of anxiety about health, and the individual is easily alarmed about
personal health status
D. The individual performs excessive health-related behaviors (e.g., repeatedly checks his or
her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor
appointments and hospitals).
E. Illness preoccupation has been present for at least 6 months, but the specific illness that
is feared may change over that period of time.
F. The illness-related preoccupation is not better explained by another mental disorder,
such as somatic symptom disorder, panic disorder, generalized anxiety disorder, body
dysmorphic disorder, obsessive-compulsive disorder, or delusional disorder, somatic type.
3. Conversion disorder
A pattern in which symptoms or deficits affecting the senses or motor behavior strongly
suggest that the patient has a medical or neurological condition.
Examples include partial paralysis, blindness, deafness, and pseudoseizures.
- Diagnosis requires a comprehensive medical and neurological workup.
- Emphasizes that symptoms are not intentionally produced or faked.
- Historically this was termed as Hysteria. Freud used the term conversion hysteria for
these disorders.
- The primary gain for conversion symptoms is continued escape or avoidance of a stressful
situation.
- The secondary gain is used to refer to any “external” circumstance, such as attention
from loved ones or financial compensation, that would tend to reinforce the maintenance
of disability
- Conversion disorders are found in approximately 50 percent of people referred for
treatment at neurology clinics.
- It generally has a rapid onset after a significant stressor and often resolves within 2
weeks if the stressor is removed, although it commonly recurs.
- Diverse Range of Conversion Disorder Symptoms: Four categories of symptoms:
1. Sensory (visual system, auditory system, sensitivity to feeling),
2. Motor (conversion paralysis)
3. Seizures (pseudoseizures),
4. a mixed presentation of the first three categories
DSM 5 Criteria:
A. One or more symptoms of altered voluntary motor or sensory function.
B. Clinical findings provide evidence of incompatibility between the symptom and recognized
neurological or medical conditions.
C. The symptom or deficit is not better explained by another medical or mental disorder.
D. The symptom or deficit causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning or warrants medical evaluation.
Treatment
Behavioral approach in which specific exercises are prescribed in order to increase
movement or walking, and then reinforcements (e.g., praise and gaining privileges) are
provided when patients show improvements. Adding hypnosis to other therapeutic
techniques, can also be useful.
4. Factitious disorder
Deliberate and conscious feigning of disability or illness.
Intentional production of psychological or physical symptoms for benefits of playing the
"sick role."
Benefits include attention and concern from family and medical personnel.
Malingering involves intentionally producing or exaggerating physical symptoms for
external incentives like avoiding work or military service, or evading criminal prosecution.
Patients may alter their own physiology, e.g., taking drugs, to simulate real illnesses.
At risk for serious injury or death, may need institutionalization.
More common in women than men.
DSM 5 Criteria:
A. Falsification of physical or psychological signs or symptoms, or induction of injury or
disease, associated with identified deception.
B. The individual presents himself or herself to others as ill, impaired, or injured.
C. The deceptive behavior is evident even in the absence of obvious external rewards.
D. The behavior is not better explained by another mental disorder, such as delusional
disorder or another psychotic disorder.
Dissociative disorders
Dissociative disorders involve disruptions in a person's normally integrated functions
of consciousness, memory, identity, or perception.
Some of the phenomena in dissociative disorders include individuals who cannot recall
their identity or origin and those with multiple distinct identities or personality
states.
Dissociation is defined as a disruption or discontinuity in the normal, subjective integration
of one or more aspects of psychological functioning, including memory, identity,
consciousness, perception, and motor control. Everyday examples of mild dissociation include
daydreaming, losing track of surroundings, and missing parts of a conversation.
Pathological dissociation serves as a way to escape from autobiographical memory or
personal identity.
DSM-5 recognizes several types of pathological dissociation:
depersonalization/derealization disorder, dissociative amnesia, and dissociative
identity disorder.
Depersonalization/ Derealization Disorder
Derealization: Temporary loss of sense of the reality of the outside world.
Depersonalization: Temporary loss of sense of one's own self and reality.
Persistent or recurrent experiences of feeling detached from one's own body and
mental processes.
Depersonalization symptoms include:
● feeling like youÕre outside your body, sometimes as if youÕre looking down on yourself
from above
● feeling detached from yourself, as if you have no actual self
● numbness in your mind or body, as if your senses are turned off
● feeling as if you canÕt control what you do or say
● feeling as if parts of your body are the wrong size
● difficulty attaching emotion to memories
Derealization symptoms include:
● having trouble recognizing surroundings or finding your surroundings hazy and almost
dreamlike
● feeling like a glass wall separates you from the world — you can see whatÕs beyond but
canÕt connect
● feeling like your surroundings arenÕt real or seem flat, blurry, too far, too close, too
big, or too small
● experiencing a distorted sense of time — the past may feel very recent, while recent
events feel as if they happened long ago
DSM V Criteria:
A. The presence of persistent or recurrent experiences of depersonalization,
derealization, or both:
1. Depersonalization: Experiences of unreality, detachment, or being an outside observer
with respect to oneÕs thoughts, feelings, sensations, body, or actions (e.g., perceptual
alterations, distorted sense of time, unreal or absent self, emotional and/or physical
numbing).
2. Derealization: Experiences of unreality or detachment with respect to surroundings
(e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or
visually distorted).
B. During the depersonalization or derealization experiences, reality testing remains
intact.
C. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
D. The disturbance is not attributable to the physiological effects of a substance (e.g.,
a drug of abuse, medication) or another medical condition (e.g., seizures).
E. The disturbance is not better explained by another mental disorder, such as
schizophrenia, panic disorder, major depressive disorder, acute stress disorder,
posttraumatic stress disorder, or another dissociative disorder.
Treatment and Outcomes
- Limited systematic, controlled research on treatment.
- Generally resistant to treatment, with some effectiveness in managing associated
problems like anxiety and depression.
- Hypnosis, including self-hypnosis training, may help patients gain control over their
experiences.
- Antidepressants, antianxiety, and antipsychotic drugs have shown modest effects, but
not consistently.
- Repetitive Transcranial Magnetic Stimulation (rTMS) to the temporoparietal junction has
shown promise in reducing depersonalization symptoms.
Dissociative Amnesia and Dissociative Fugue
Types of Amnesia:
Retrograde Amnesia: Inability to recall previously acquired information or past
experiences.
Anterograde Amnesia: Inability to retain new information.
Dissociative Amnesia: Failure to recall previously stored personal information (retrograde
amnesia) not accounted for by ordinary forgetting.
Causes and Characteristics of Dissociative Amnesia:
Often occurs following intolerably stressful circumstances, such as combat conditions,
serious accidents, suicide attempts, or traumatic experiences.
Gaps in memory may be revealed under hypnosis, narcosis, or when amnesia spontaneously
clears up.
Episodes last from a few days to a few years, with some individuals experiencing multiple
episodes.
Only episodic or autobiographical memory is affected; semantic, procedural, and short-
term storage usually remain intact.
No difficulty encoding new information.
DSM V Criteria:
A. An inability to recall important autobiographical information, usually of a traumatic or
stressful nature, that is inconsistent with ordinary forgetting.
Note: Dissociative amnesia most often consists of localized or selective amnesia for a
specific event or events; or generalized amnesia for identity and life history.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
C. The disturbance is not attributable to the physiological effects of a substance (e.g.,
alcohol or other drug of abuse, a medication) or a neurological or other medical condition
(e.g., partial complex seizures, transient global amnesia, sequelae of a closed head
injury/traumatic brain injury, other neurological condition).
D. The disturbance is not better explained by dissociative identity disorder, posttraumatic
stress disorder, acute stress disorder, somatic symptom disorder, or major or mild
neurocognitive disorder.
Dissociative Fugue:
A subtype of dissociative amnesia in which a person not only experiences amnesia for
aspects of their past but also departs from home surroundings.
May assume a new identity and be unaware of memory loss during the fugue state.
Behavior during the fugue state is usually normal, reflecting a different lifestyle.
Recovery from the fugue state may occur suddenly or after repeated questioning.
- Individuals facing extremely unpleasant situations suppress large segments of their
personalities and memory of stressful situations to escape stress.
- Similar to conversion symptoms, but instead of becoming physically dysfunctional,
individuals avoid thoughts about the situation or leave the scene.
- Semantic knowledge generally intact; primary deficit is compromised episodic or
autobiographical memory.
- Implicit memory often remains intact, suggesting knowledge without conscious awareness.
Treatment and Outcomes
- Safe environment crucial for individuals with dissociative amnesia.
- Removing the person from perceived threatening situations may lead to spontaneous
memory recovery.
- Hypnosis and drugs like benzodiazepines are used to facilitate recall of repressed
memories.
- After memory recall, working through memories with a therapist is essential.
- Independent corroboration of memories is necessary due to the risk of false memories.
Dissociative Identity Disorder (DID):
Formerly known as multiple personality disorder is a dramatic dissociative disorder in which a
patient manifests two or more distinct identities that alternate in some way in taking control
of behavior.
Each identity may appear to have a different personal history, self-image, and name,
although there are some identities that are only partially distinct and independent from
other identities.
❏ Host identity : Frequently encountered, carrying the personÕs real name.
❏ Alter identities : Differ in striking ways involving gender, age, handedness,
handwriting, sexual orientation, prescription for eyeglasses, predominant affect,
foreign languages spoken, and general knowledge.
Additional symptoms are depression, self-mutilation, frequent suicidal ideation and attempts,
erratic behavior, headaches, hallucinations, posttraumatic symptoms, and other amnesic and
fugue symptoms.
- DID usually starts in childhood, although most patients are in their teens, 20s, or 30s at
the time of diagnosis.
- Females tend to have a larger number of alters than do males.
- DSM III clearly specified for the first time the diagnostic criteria of DID.
- Increase in prevalence of DID
DSM V Criteria :
A. Disruption of identity characterized by two or more distinct personality states, which
may be described in some cultures as an experience of possession.
The disruption in identity involves marked discontinuity in sense of self and sense of agency,
accompanied by related alterations in affect, behavior, consciousness, memory, perception,
cognition, and/or sensory-motor functioning.
These signs and symptoms may be observed by others or reported by the individual.
B. Recurrent gaps in the recall of everyday events, important personal information, and/ or
traumatic events that are inconsistent with ordinary forgetting.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
D. The disturbance is not a normal part of a broadly accepted cultural or religious practice.
Note: In children, the symptoms are not better explained by imaginary playmates or other
fantasy play.
E. The symptoms are not attributable to the physiological effects of a substance (e.g.,
blackouts or chaotic behavior during alcohol intoxication) or another medical condition
(e.g., complex partial seizures).
Causal Factors and Controversies about DID:
1. Whether DID is a real disorder or is faked, and whether, even if it is
real, it can be faked.
- Controversy over whether DID is a genuine disorder or can be faked.
- Some cases, like the Hillside Strangler (Kenneth Bianchi), have involved claims of DID to
avoid legal consequences.
- Instances of factitious and malingering cases of DID are relatively rare, but they exist.
- Skepticism exists about the authenticity of DID in legal contexts.
2. How DID develops: early childhood trauma or social enactment of multiple
different roles that have been accidentally encouraged by careless
clinicians.
Disagreement on how DID develops.
Post-traumatic theory suggests childhood trauma is the primary cause.
DID starts from the childÕs attempt to cope with an overwhelming sense of hopelessness and
powerlessness in the face of repeated traumatic abuse dissociating and escaping into a
fantasy, becoming someone else. Self-hypnosis helps to alleviate some of the pain caused by
the abuse, it will be reinforced and occur again in the future
A diathesis-stress model proposes that those prone to fantasy or easily hypnotizable
may have a diathesis for developing DID when severe abuse occurs.
A complex and chronic variant of posttraumatic stress disorder, which by definition is
caused by exposure to some kind of highly traumatic event(s), including abuse .
Sociocognitive theory suggests DID develops through suggestion and reinforcement by
clinicians.
this is not done intentionally or consciously by the afflicted individual but, rather, occurs
spontaneously with little or no awareness. The suspicion is that clinicians, through fascination
with the clinical phenomenon of DID and unwise use of such techniques as hypnosis, are
themselves largely responsible for eliciting this disorder in highly suggestible, fantasy-prone
patients
3. Are these memories related childhood trauma of early abuse real or false
- Controversy over the accuracy of memories of widespread childhood abuse reported by
individuals with DID.
- Sociocognitive theory proponents argue that some memories may be the result of false
memories induced by suggestive techniques.
- Cases of innocent family members being falsely accused.
- Difficulty in distinguishing between real and false memories.
- Controversy extends to therapeutic techniques and leading questions used by clinicians.
4. Is abuse the only causal role or is there any correlation with the abuse &
Other causes.
- Assuming abuse has occurred, the debate focuses on its causal role.
- Challenges in determining causation due to the complexity of family environments and
correlated sources of adversity.
- Difficulty in isolating abuse as the sole causal factor, as individuals with DID and abuse
may seek treatment more often.
- Childhood abuse associated with various psychopathologies, making it challenging to
establish a specific role in DID development.
Treatment and Outcomes
- Therapeutic approaches often based on the assumption of posttraumatic theory (caused
by abuse).
- Integration of alters into the host personality is a common treatment goal.
- Resistance to integration is common among patients who view dissociation as a protective
mechanism.
- Successful integration may lead to a unified personality, but partial integration is not
uncommon.
- Improvement in symptoms and associated disorders is more likely than full integration.
- Psychodynamic and insight-oriented therapy, often involving hypnosis, is typical for DID.
- Hypnosis helps patients recover and process traumatic memories, though caution is
needed due to suggestibility.
- Therapy requires highly skilled professionals; successful negotiation of treatment phases
crucial.
- Most reports are single-case summaries; caution needed due to publication bias.
- DID does not spontaneously remit, requiring prolonged treatment, often lasting many
years.
- Long-term follow-up studies show marked improvements in various aspects of life, but full
integration is achieved by a minority.
Stress
Stress is a psychological condition that arises when individuals experience or perceive
challenges to their physical or emotional well-being that surpass their coping resources and
abilities.
★ Stressors: any event, force, or condition internally or externally that results in
physical or emotional stress.
★ Stress: The effects within the organism resulting from the challenges posed by
stressors.
★ Coping Strategies: Efforts made by individuals to deal with stress and manage its
impact.
Characteristics of Stressors
Question posed about why some stressors are less stressful than others, using the example
of misplacing keys versus major life events like an unhappy marriage or job loss.The key
factors determining stress severity include:
- the severity of the stressor
Events involving significant aspects of a personÕs life, such as death of a loved one, divorce,
job loss, serious illness, or negative social exchanges, tend to be highly stressful.
Longer-operating stressors, like abuse or living in poverty, have more severe effects.
- its chronicity (duration),
frustrated in a boring and unrewarding job, suffer for years in an unhappy and conflict-filled
marriage, or be severely frustrated by a physical limitation or a long-term health problem.
- its timing,
If a man loses his job, learns that his wife is seriously ill, and receives news that his son has
been arrested for selling drugs, all at the same time.
- proximity to one's life,
Learning that the uncle of a close friend was injured in a car accident is not as stressful as
being in an accident oneself
- expectation of the stressor,
- controllability of the stressor.
Unpredictable and unanticipated stressors, without established coping strategies, lead to
severe stress.
Lack of control and predictability in stressors increases their impact.
Example of a study showing reduced anxiety and need for pain medication when patients
were given realistic expectations before hip replacement surgery.
Factors Predisposing a Person to Stress
Individual Variation in Stress Perception:
- People face unique patterns of demands and interpret similar situations differently.
- No two individuals have the exact same pattern of stressors.
Vulnerability in Specific Groups:
- Children are particularly vulnerable to severe stressors like war and terrorism.
- Adolescents with depressed parents are more sensitive to stressful events and more
likely to experience depression after such events.
Protective Factors:
Coping skills, presence or absence of resources, higher levels of optimism, greater
psychological control, increased self-esteem, and better social support improve a personÕs
ability to handle life stress. These factors are linked to reduced distress and more favorable
health outcomes.
Genetic Influence on Stress Sensitivity:
- Genetic makeup can make individuals more or less "stress-sensitive."
- Research explores genes influencing how reactive a person is to stress.
- Specific gene (5HTTLPR gene) linked to the likelihood of developing depression in
response to life stress.
Early Life Stress Impact:
- Stress experienced early in life may make individuals more sensitive to stress later on.
- Cumulative effects of stress may sensitize the biological system, enhancing reactivity to
later stressors.
Stress Tolerance:
Stress tolerance refers to a personÕs ability to withstand stress without becoming seriously
impaired.
Cognitive Impact of Stress:
- Stressful experiences may create a self-perpetuating cycle by changing how individuals
think about or appraise events.
- People with a history of depression tend to perceive negative events as more stressful.
If feeling depressed or anxious, a friend canceling plans might be perceived as a personal
rejection rather than a scheduling conflict.
Biological responses
Understanding the link between stress and physical/psychological problems requires
knowledge of the body's response to stress. Two systems involved:
1) Sympathetic-adrenomedullary (SAM) system, mobilizing resources for fight-or-flight.
2) Hypothalamus pituitary-adrenal (HPA) system, releasing stress hormones like cortisol.
Sympathetic-Adrenomedullary (SAM) System [fight-or-flight response]
stress response - hypothalamus - stimulates - sympathetic nervous system (SNS).
This, in turn, causes the inner portion of the adrenal glands (the adrenal medulla) to secrete
adrenaline and noradrenaline, cause an increase in heart rate and metabolises more glucose.
Hypothalamus-pituitary-adrenal (HPA) system
Sympathetic nervous system (SNS) stimulation leads to the release of adrenaline and
noradrenaline.
HPA system involves the release of corticotropin-releasing hormone (CRH), stimulating the
pituitary gland to release adrenocorticotropic hormone (ACTH), inducing the adrenal cortex
to produce cortisol.
Cortisol's Functions:
- Cortisol is beneficial in emergencies, preparing the body for fight or flight.
- Inhibits the innate immune response, delaying the inflammatory response to injuries.
- Survival priority over healing in emergency situations.
Downside of Cortisol:
- If cortisol response is not shut off, it can damage brain cells, especially in the
hippocampus.
- Stress is detrimental to the brain, and cortisol may even stunt growth.
- Brain has receptors to detect cortisol, activating a feedback mechanism to dampen the
stress response.
- Chronic overactivity of the HPA axis, with high cortisol levels, may pose problems.
Psychoneuroimmunology:
Psychoneuroimmunology is the study of interactions between the nervous system and the
immune system.
- Stress is linked to physical illnesses, including diseases not directly related to nervous
system activity (e.g., colds).
- Suggests stress may compromise immune functioning, leading to overall vulnerability to
diseases.
Bi-Directional Communication:
- Nervous system and immune system communicate bidirectionally.
- Growing evidence that the brain influences the immune system, and vice versa.
- Behavior and psychological states can affect immune functioning, and immune system
status influences mental states and behavioral dispositions.
Impact on Neurochemicals:
- Immune system status affects blood levels of circulating neurochemicals.
- These neurochemicals modify brain states.
The mind-body connection is evident, with behavior, psychological state, and stress
influencing immune functioning, and the immune system influencing mental states and
behavior.
Trauma and Stress related Disorders- Adjustment disorder
❏ Is a psychological response to a common stressor (e.g., divorce, death of a loved one,
loss of a job) that results in clinically significant behavioral or emotional symptoms.
❏ Stressor can be a single event or involve multiple stressors.
❏ For the diagnosis to be given, symptoms must begin within 3 months of the onset of
the stressor.
❏ The person must experience more distress than would be expected given the
circumstances or be unable to function as usual.
❏ The personÕs symptoms lessen or disappear when the stressor ends or when the person
learns to adapt to the stressor.
❏ If symptoms continue beyond 6 months, the diagnosis is usually changed to some other
mental disorder.
❏ Work-related problems can produce great stress in employees, being unemployed can
be stressful too.
❏ One of the most disturbing findings is that unemployment, especially if it is prolonged,
increases the risk of suicide.
❏ Managing the stress associated with unemployment requires great coping strength,
especially for people who have previously earned an adequate living.
Causal factors
● Women with PTSD do seem to have higher levels of baseline cortisol than women
without PTSD. This is not so for men with and without PTSD.
● Type of trauma is an important factor , eg: levels of cortisol tend to be lower in people
with PTSD who have experienced physical or sexual abuse.
● Gene–environment interactions, having the s/s form of the serotonin-transporter gene
makes a bad situation worse. People with this genotype may be especially susceptible
to the effects of traumatic stress, particularly if they also have low levels of social
support.
● Returning to a negative and unsupportive social environment can also increase
vulnerability to posttraumatic stress.
● Being a member of a minority group seems to place people at higher risk for developing
PTSD.
Prevention and Treatment of Stress Disorders
➔ Reduce the frequency of traumatic events.
➔ Prevent maladaptive responses to stress by preparing people in advance and providing
them with information and coping skills.
➔ Adequate training and preparation for extreme stressors may also help soldiers,
firefighters, and others for whom exposure to traumatic events is highly likely.
➔ Cognitive-Behavioral Techniques to help people manage potentially stressful situations
or difficult events.
➔ Stress-inoculation training, prepares people to tolerate an anticipated threat by
changing the things they say to themselves before or during a stressful event.
Treatments
❏ Telephone Hotlines : National and local telephone hotlines provide help for people
under severe stress and for people who are suicidal, victims of rape and sexual assault.
❏ Crisis Intervention : focuses on the immediate problem with which an individual or
family is having difficulty.A central assumption in crisis-oriented therapy is that the
individual was functioning well psychologically before the trauma. Thus therapy is
focused only on helping the person through the immediate crisis, not on “remaking” her
or his personality
❏ Medications: Antidepressants and antipsychotic medications.
❏ Cognitive-Behavioral Treatment
❏ Prolonged exposure
