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© 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
© Cengage Learning 2016
• Types of disorders covered in this chapter– Adjustment
– Acute stress
– Post-traumatic stress
• Childhood disorders are covered in chapter 16
Trauma- and Stressor-Related Disorders
© Cengage Learning 2016
• 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
© Cengage Learning 2016
Trauma- and Stressor-Related Disorders
© Cengage Learning 2016
• 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
© Cengage Learning 2016
Undergraduates’ Lifetime Exposure to Traumatic Events
© Cengage Learning 2016
• 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
© Cengage Learning 2016
• 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
© Cengage Learning 2016
• 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
© Cengage Learning 2016
Lifetime Prevalence of Exposure to Stressors by Gender and PTSD Risk
© Cengage Learning 2016
• 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
© Cengage Learning 2016
Multipath Model for Post-Traumatic Stress Disorder
© Cengage Learning 2016
• 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
© Cengage Learning 2016
• 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
© Cengage Learning 2016
• 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
© Cengage Learning 2016
• 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
© Cengage Learning 2016
• 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.)
© Cengage Learning 2016
• 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
© Cengage Learning 2016
• 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
© Cengage Learning 2016
• 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
© Cengage Learning 2016
Atherosclerosis
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• 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
© Cengage Learning 2016
• 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
© Cengage Learning 2016
• 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
© Cengage Learning 2016
• 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
© Cengage Learning 2016
An Asthma Attack
© Cengage Learning 2016
Asthma Prevalence
© Cengage Learning 2016
• 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
© Cengage Learning 2016
• 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
© Cengage Learning 2016
• 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
© Cengage Learning 2016
• 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
© Cengage Learning 2016
• 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
© Cengage Learning 2016
• 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
© Cengage Learning 2016
• 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
© Cengage Learning 2016
• 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
© Cengage Learning 2016
• What do we know about disorders caused by exposure to specific stressors or traumatic events?
• In what ways can stress affect our physical health?
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