© Cengage Learning 2016 Trauma- and Stressor-Related Disorders 6

© Cengage Learning 2016 © Cengage Learning 2016

Trauma- and Stressor-Related Disorders

6

© Cengage Learning 2016

• Stressors – External events or situations that place

physical or psychological demands on a person

• Stress – Internal psychological or physiological

response to a stressor

Stress Definitions


• Types of disorders covered in this chapter– Adjustment

– Acute stress

– Post-traumatic stress

• Childhood disorders are covered in chapter 16



• Difficulty coping with or adjusting to a specific life stressor

• DSM-5 diagnostic criteria– Exposure to an identifiable stressor that

results in onset of symptoms

– Symptoms are out of proportion to the severity of the stressor

– Symptoms persist no longer than six months after exposure to stressor has ended

Adjustment Disorders




• Typical outcomes after exposure to traumatic incidents– Resilience

– Recovery• Initial distress with symptom reduction over time

– Delayed symptoms• Few initial symptoms

• Increasing symptoms over time

– Chronic symptoms

Trauma-Related Disorders


Undergraduates’ Lifetime Exposure to Traumatic Events


• Requirements for diagnosis– Exposure to traumatic event

– Intrusion symptoms

– Avoidance

– Negative alterations in mood or cognition

– Arousal and changes in reactivity• Hypervigilance

Diagnosis of Acute and Post-Traumatic Stress Disorders


• Combat

• Sexual assaults

• Violent crime or domestic violence

• Sexual harassment

• Natural disasters

• Car accidents or work-related accidents

Traumatic Events Associated with ASD and PTSD


• Factors associated with increased risk– More severe physical injuries

– Stroke or injury to the head or extremities

– Major burn injuries

– Rape or sexual assault

– Intentional trauma

– Close relationship with the perpetrator of sexual assault

Etiology of ASD and PTSD


Lifetime Prevalence of Exposure to Stressors by Gender and PTSD Risk


• Body systems designed for homeostasis

• Fear extinction– Decline in fear responses associated with the

trauma

• SS genotype– Two short alleles of the serotonin transporter

gene

– More prone to heightened anxiety reactions associated with PTSD

Biological Dimension of ASD and PTSD


Multipath Model for Post-Traumatic Stress Disorder


• Risk factors– Preexisting conditions such as anxiety and

depression, hostility, and anger

– Specific cognitive styles or dysfunctional thoughts

• Interpret stressors in a catastrophic manner

• Social dimension– Social support can diminish PTSD symptoms

Psychological Dimension of ASD and PTSD


• Ethnic differences– Different exposure to previous trauma

– Cultural difference in responding to stress

• Women are twice as likely as men to suffer a trauma-related disorder

• Female police officers less likely than civilian women to have PTSD symptoms

Sociocultural Dimension of ASD and PTSD


• Certain antidepressants show some effect– Effective in fewer than 60 percent of

individuals• Only 20-30 percent show full recovery

• D-cycloserine– Mixed results

• Prazosin (hypertension medication)

• Propranolol (beta-blocker)– Under study; may offer little benefit

Medication Treatment for Trauma-Related Disorders


• Prolonged exposure therapy (PE)– Involves exposure to trauma-related cues

• Cognitive-behavioral therapy (CBT)– Involves identifying and challenging

dysfunctional cognitions

Psychotherapy for Trauma-Related Disorders


• Trauma-focused cognitive-behavioral therapy (TF-CBT)

• Eye movement desensitization and reprocessing (EMDR)– Nontraditional therapy

– Involves visualizing traumatic experience while following a therapist’s fingers moving side to side

Psychotherapy Methods (cont’d.)


• Stress– Causes a multitude of physiological,

psychological, and social changes that influence health

• Psychophysiological disorder– Physical disorder with a strong psychological

basis or component

Psychological Factors Affecting Medical Conditions


• Actual tissue damage

• Disease process

• Physiological dysfunction

• Relative contributions of physical and psychological factors vary greatly

• Both medical treatment and psychotherapy may be required

Medical Conditions Influencedby Psychological Factors


• Cardiac arteries narrow– Results in complete or partial blockage of flow

of blood and oxygen to heart

• Some risk factors for CHD– Poor eating habits

– Obesity and lack of physical activity

– Hypertension

– Stress

– Depression

Coronary Heart Disease


Atherosclerosis


• Normal blood pressure– Systolic pressure lower than 120

– Diastolic pressure lower than 80

• Hypertension– Systolic pressure at or above 140

– Diastolic pressure at or above 90

• Prehypertension– Blood pressure levels higher than normal but

not meeting hypertension levels

Hypertension


• Migraine headaches– Result from constriction of the cranial arteries

• Pressure on nearby nerves produces moderate to severe pain

• Often accompanied by nausea and vomiting

• Tension headaches– Stress creates a prolonged contraction of

scalp and neck muscles• Results in vascular constriction and steady pain

Types of Headaches


• Excruciating stabbing or burning sensations located in the eye or cheek– Pain so severe that 55 percent report suicidal

thoughts

• Attacks have a rapid onset– 15 minutes to three hours in duration

– End abruptly

• Headaches preceded by aura in about 20 percent of cases

Cluster Headaches


• Chronic inflammatory disease of the lungs

• Stress or other triggers cause excessive mucus secretion– Spasms and swelling of the airways, which

reduces the amount of air that can be inhaled

• Symptoms range from mild to severe

Asthma


An Asthma Attack


Asthma Prevalence


• Stress itself does not appear to cause infections– Appears to decrease immune system’s

efficiency• Results in more susceptibility to disease

• Stress response involves release of hormones (such as cortisol) that impair immune functioning

• Chronic stress accelerates disease progression

Stress and the Immune System


• Biological dimension– Stressors can dysregulate physiological

processes in the brain and body• Release of norepinephrine, epinephrine, and

cortisol

– Early environmental influences may produce changes in stress-response systems

– Brief exposure to stressors enhances immune functioning

Etiological Influences on Physical Disorders


• Psychological and personality characteristics can influence health status– Positive emotions help regulate stress

reactions

– Negative emotions accentuate the stress response

– Commitment, control, and openness to challenge associated with thriving through stressful situations

Psychological Dimension


• Risk factors for adverse health outcomes– Lack of social support

– Maltreatment in social relationships

• Good relationships moderate the link between hostility and poor health

Social Dimension


• Women are more likely to be impacted by stress– Due to care-giving role for children, parents,

and partners

– More likely to live in poverty

• Exposure to racism and discrimination– Coping skills, resources, and social support

mitigate vascular reactivity to racism

Sociocultural Dimension


• Relaxation training – Learn to relax muscles of the body under

almost any circumstances

• Biofeedback training – Learn to voluntarily control physiological

processes in order to improve physical or mental health

• Examples: heart rate, blood pressure

Treatment of Stress-Related Disorders


• Designed to improve coping skills and manage stress

• Shown to improve immune functioning in breast cancer patients

• Opportunities to talk about health situation help predict adjustment to cancer– Those who did not talk reported more

depressive symptoms

Cognitive-Behavioral Therapy


• Areas of research focus– How positive emotions affect stress

responses

– Role of psychological factors on disease progression and prevention

– Examining why gender and racial differences in stress response exist

Contemporary Trends and Future Directions


• What do we know about disorders caused by exposure to specific stressors or traumatic events?

• In what ways can stress affect our physical health?

Review

Documents

© Cengage Learning 2016 Trauma- and Stressor-Related Disorders 6