6.4 PUTTING IT...together

Getting a Handle on Trauma and Stress

The concepts of trauma and stress have been prominent in the field of abnormal psychology since its earliest days. Dating back to Sigmund Freud, for example, psychodynamic theorists have proposed that most forms of psychopathology—from depression to schizophrenia—begin with traumatic losses or events. Even theorists from the other clinical models agree that people under stress are particularly vulnerable to psychological disorders of various kinds, including anxiety disorders, depressive disorders, eating disorders, substance use disorders, and sexual dysfunctions.

But why and how do trauma and stress translate into psychopathology? That question has, in fact, eluded clinical theorists and researchers—until recent times. Due in part to the identification and study of acute and posttraumatic stress disorders, researchers now better understand the relationship between trauma, stress, and psychological dysfunction—viewing it as a complex interaction of many variables, including biological and genetic factors, personality traits, childhood experiences, social support, multicultural factors, and environmental events. Similarly, clinicians are now developing more effective treatment programs for people with acute and posttraumatic stress disorders—programs that combine biological, behavioral, cognitive, family, and social interventions.

CLINICAL CHOICES

Now that you’ve read about disorders of trauma and stress, try the interactive case study for this chapter. See if you are able to identify Michelle’s symptoms and suggest a diagnosis based on her symptoms. What kind of treatment would be most effective for Michelle? Go to LaunchPad to access Clinical Choices.

Insights and treatments for the dissociative disorders, the other group of trauma-triggered disorders discussed in this chapter, have not moved as quickly. Although these disorders were among the field’s earliest identified problems, the clinical field stopped paying much attention to them during the latter part of the twentieth century, with some clinicians even questioning the legitimacy of the diagnoses. However, the field’s focus on dissociative disorders has surged during the past two decades—partly because of intense clinical interest in posttraumatic stress reactions and partly because of the growing effort to understand physically rooted memory disorders such as Alzheimer’s disease. Researchers have begun to appreciate that dissociative disorders may be more common than clinical theorists had previously recognized. In fact, there is growing evidence that the disorders may be rooted in processes that are already well known from other areas of study, such as state-dependent learning and self-hypnosis.

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BETWEEN THE LINES

Job Stress

26

Percentage of adults completely satisfied with level of stress at their jobs

42

Percentage of adults somewhat satisfied with level of stress at their jobs

32

Percentage of adults dissatisfied with level of stress at their jobs

(Information from: Gallup Poll, 2010)

BETWEEN THE LINES

At the Movies: Recent Films about Memory Disturbances

Trance (2013)

The Vow (2012)

The Bourne series (2012, 2007, 2004, 2002)

Black Swan (2010)

Shutter Island (2010)

The Hangover (2009)

The Number 23 (2007)

Spider-Man 3 (2007)

Eternal Sunshine of the Spotless Mind (2004)

The Manchurian Candidate (2004, 1962)

Finding Nemo (2003)

Memento (2000)

Amidst the rapid developments in the realms of trauma and stress lies a cautionary tale. When problems are studied heavily, it is common for the public, as well as some researchers and clinicians, to draw conclusions that may be too bold. For example, many people—perhaps too many—are now receiving diagnoses of posttraumatic stress disorder, partly because the symptoms of PTSD are many and because PTSD has received so much attention (Holowka et al., 2014; Wakefield & Horwitz, 2010). Similarly, some of today’s clinicians worry that the resurging interest in dissociative disorders may be creating a false impression of their prevalence. We shall see such potential problems again when we look at other forms of pathology that are currently receiving great focus, such as bipolar disorder among children and attention-deficit/hyperactivity disorder. The line between enlightenment and overenthusiasm is often thin.

SUMMING UP

  • EFFECTS OF STRESS When we appraise a stressor as threatening, we often experience a stress response consisting of arousal and a sense of fear. The features of arousal and fear are set in motion by the hypothalamus, a brain area that activates the autonomic nervous system and the endocrine system. There are two pathways by which these systems produce arousal and fear—the sympathetic nervous system pathway and the hypothalamic-pituitary-adrenal pathway. pp. 177–180

  • ACUTE AND POSTTRAUMATIC STRESS DISORDERS People with acute stress disorder or posttraumatic stress disorder react with arousal, anxiety and mood problems, and other stress symptoms after a traumatic event, including reexperiencing the traumatic event, avoiding related events, being markedly less responsive than normal, and feeling guilt. Traumatic events may include combat experiences, disasters, or episodes of victimization. The symptoms of acute stress disorder begin soon after the trauma and last less than a month. Those of posttraumatic stress disorder may begin at any time (even years) after the trauma and may last for months or years.

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    In attempting to explain why some people develop a psychological stress disorder and others do not, researchers have focused on biological factors, personality, childhood experiences, social support, multicultural factors, and the severity of the traumatic event. Techniques used to treat the stress disorders include drug therapy, behavioral exposure, cognitive and other insight therapies, family therapy, and group therapy (including rap groups for combat veterans). Rapidly mobilized community interventions often follow the principles of critical incident stress debriefing. Such approaches initially appeared helpful after large-scale disasters; however, some recent studies have raised questions about their usefulness. pp. 181–196

  • DISSOCIATIVE DISORDERS People with dissociative disorders experience major changes in memory and identity that are not caused by clear physical factors—changes that often emerge after a traumatic event. Typically, one part of the memory or identity is dissociated, or separated, from the other parts. People with dissociative amnesia are unable to recall important personal information or past events in their lives. Those with dissociative fugue, an extreme form of dissociative amnesia, not only fail to remember personal information, but also flee to a different location and may establish a new identity. In another dissociative disorder, dissociative identity disorder (multiple personality disorder), a person develops two or more distinct sub-personalities. pp. 197–203

  • EXPLANATIONS AND TREATMENTS FOR DISSOCIATIVE AMNESIA AND DISSOCIATIVE IDENTITY DISORDER Dissociative amnesia and dissociative identity disorder are not well understood. Among the processes that have been cited to explain them are extreme repression, operant conditioning, state-dependent learning, and self-hypnosis. The latter two phenomena, in particular, have excited the interest of clinical scientists.

    Dissociative amnesia may end on its own or may require treatment. Dissociative identity disorder typically requires treatment. Approaches commonly used to help people with dissociative amnesia recover their lost memories are psychodynamic therapy, hypnotic therapy, and sodium amobarbital or sodium pentobarbital. Therapists who treat people with dissociative identity disorder use the same approaches and also try to help the clients recognize the nature and scope of their disorder, recover the gaps in their memory, and integrate their subpersonalities into one functional personality. pp. 203–209

  • DEPERSONALIZATION-DEREALIZATION DISORDER People with yet another kind of dissociative disorder, depersonalization-derealization disorder, feel as though they are detached from their own mental processes or body and are observing themselves from the outside, or feel as though the people or objects around them are unreal or detached. Transient depersonalization and derealization experiences seem to be relatively common, while depersonalization-derealization disorder is not. pp. 209–211

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