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Chapter 5

chapter 5.docx

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Richard B Day

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Psych 2AP3: Abnormal Psychology – Major Disorders Chapter 5: Stress and Adjustment Disorders Posttraumatic Stress Disorder: Reactions to Catastrophic Events - Result from sudden, unexpected environmental crises - Symptoms include:  The traumatic event is persistently re-experienced by the person through intrusive, recurring thoughts or nightmares  The person avoids stimuli associated with the trauma  The person may experience chronic tension or irritability, often accompanied by insomnia and the inability to tolerate noise  The person may have impaired concentration and memory  The person may be unable to experience positive emotions and may feel distant or alienated from other people - PTSD includes elements of anxiety but bears close relationship to the experience of major stress - Prevalence of PTSD in the general population:  7-12% of Canadian and U.S adults are affected by PTSD at some point in their lives  Exposure to trauma is quite common in the general population  PTSD only develops in a minority of traumatized individuals  The risk of being traumatized and developing PTSD is higher for people living in war-torn countries and for those engaging in hazardous activities and occupations  Men are more likely to be exposed to trauma, women are more likely to develop PTSD  Women are more likely to experience particular stressors such as sexual assault, a particularly potent stressor for causing PTSD  Often follows a chronic course, although the frequency and severity of a symptom typically fluctuate over time  PTSD comorbidity: anxiety disorders, mood disorders, personality disorders, and substance-use disorders - Distinguishing between acute stress disorder and posttraumatic stress:  For both of these disorders, the stressor is unusually severe  Where the disorders differ is in timing and duration of symptoms  Acute stress disorder: occurs within four weeks of the traumatic event and lasts for a minimum of two days and a maximum of four weeks.  If the symptoms last longer, the appropriate diagnosis is PTSD  If PTSD persists for less than three months, then the disorder is acute; if PTSD persists for longer than three months, the disorder is chronic  If symptoms begin more than 6 months after the traumatic event, PTSD is considered to have a delayed onset  Research shows that most cases of PTSD are immediate rather than delayed in their onset  Two forms of delayed-onset PTSD: person had little or no psychopathology after the trauma until the PTSD appears (truly delayed-onset); posttraumatic symptoms that gradually increase in severity (slowly developing PTSD)  Victim’s initial responses following a disaster typically involve three stages:  Shock stage: victim is stunned, dazed, and apathetic  Suggestible stage: victim tends to be passive, suggestible, and willing to take directions from rescue workers or others  Recovery stage: victim may be tense and apprehensive and show generalized anxiety but gradually regains psychological equilibrium, often with a need to repeatedly describe the catastrophic event  It is in the third stage that PTSD may develop  Recurrent nightmares and need to retell the same story about the disaster appear to be mechanisms for reducing anxiety and desensitizing the self to the traumatic experience  Tension, apprehensiveness, and hypersensitivity appear to be residual effects of the shock reaction and to reflect the person’s realization that the world can become overwhelmingly dangerous and threatening  Intense grief, depression and guilt further complicate the disorder  Guilt of survivors  Person’s traumatic reaction state may be more complicated in cases of severe loss - The trauma of rape:  In our society rape occurs with alarming frequency  Rape is the most frequent cause of PTSD in women  In stranger rape, the victim is likely to experience strong fear of physical harm and death  In acquaintance rape, the victim may feel not only fear but also betrayal by someone she had trusted. May feel more responsible for what happened and experience greater guilt. May be more hesitant to seek help or report the rape out of fear that she will be held responsible for it  Age and life circumstances of a victim may also influence her reaction  Husbands and boyfriends, if unsympathetic to what a woman is undergoing after being raped, can negatively influence a rape victim’s adjustment  Affects women in five areas of functioning:  Physical disturbances: hyperarousal or anxiousness  Emotional problems: anxiety, depressed mood, and low self- esteem  Cognitive dysfunction: disturbed concentration and the experience of intrusive thoughts, negative beliefs about other people and concerns for their own safety even a year later  Atypical behaviour: aggressive, antisocial actions and substance abuse  Interference with social relationships: sexual problems, intimacy problems, and further victimization  Coping with rape:  Anticipatory phase: period that occurs before an actual rape, when an offender “sets up” a victim and the victim begins to perceive a dangerous situation. Defence mechanisms applied.  Impact phase: phase begins with victim’s recognition that she’s actually going to be raped and ends when the rape is over. Intense fear for life.  Posttraumatic recoil phase: following rape, many women experience symptoms of hyperarousal and numbing along with continuing intrusive symptoms and avoidance behaviour. Expressed and controlled styles. Self-blame.  Reconstitution phase: begins as victim starts to make plans for leaving the emergency room and ends when the stress of the rape has been assimilated. Self-protective activities, frightening nightmares, and phobias.  Long-term effects:  Whether a rape victim will experience serious psychological problems depends on past coping skills, resiliency with dealing with problems, and level of psychological functioning.  Victim’s perceptions of whether they can control future circumstances influence the recovery process  When problems do continue, they are likely to involve anxiety, depression, withdrawal, and difficulties in heterosexual relationships  Counselling rape victims:  Women who participate in disclosure about the rape tend to have more positive and fewer negative outcomes  Specific trauma intervention programs have proved effective in treating rape victims - The trauma of military combat:  Combat exhaustion caused the single greatest loss of personnel during WW2  Clinical picture in combat-related stress:  Vary depending on the type of duty, severity and nature of the traumatic experience, and the personality of the individual  Dose –response relationship between the amount of combat exposure and risk of developing disorders  Study which compared three groups of Vietnam veterans according to three levels of experienced stress: exposed to combat, exposed to abusive violence in combat, and participated in abusive violence in combat. Posttraumatic symptoms including intrusive imagery, hyperarousal, numbing, and cognitive disruption were associated with exposure to combat violence. Participation in abusive violence was most highly associated with more severe pathologies marked by cognitive disruptions. Soldiers involved in graves registration duties had high rates of PTSD symptoms.  General clinical picture is uniform for soldiers who developed combat stress in different wars: increased irritability and sensitivity, sleep disturbances, and recurrent nightmares. Anger and anger control problems.  Most physically wounded soldiers have shown less combat exhaustion symptoms than soldiers not physically wounded except in cases of permanent mutilation  Prisoners of war and holocaust survivors:  Many survivors of Nazi concentration maps sustained residual organic and psychological damage, along with a lowered tolerance to stress of any kind  Severity of symptoms varied with the experiences of the holocaust survivors  Survivors who had been in concentration camps had more severe OTDS than those who had not been in camps  Symptoms of camp survivors: anxiety, insomnia, headaches, irritability, depression, nightmares, impaired sexual potency, and functional diarrhea  Symptoms were att
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