© 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 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 Influenced by 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

© Cengage Learning 2016 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? Review