1. Comer, Fundamentals of Abnormal Psychology, 3e
Slides & Handouts by Karen Clay Rhines, Ph.D.
Seton Hall University
Chapter 6
Stress Disorders
Comer, Fundamentals of Abnormal Psychology, 3e

2. Stress, Coping, and the Anxiety Response
The state of stress has two components:
Stressor: event creating demands
Stress response: reactions to the demands
Influenced by how we appraise (a) the event, and (b) our capacity to react to the event effectively
People who sense that they have the ability and resources to cope are more likely to take stressors in stride
Comer, Fundamentals of Abnormal Psychology, 3e

3. Stress, Coping, and the Anxiety Response
When we appraise a stressor as threatening, the natural reaction is fear
Fear is a “package” of physical, emotional, and cognitive responses
Stress reactions, and the fear they produce, are often at play in psychological disorders
People who experience a large number of stressful events are particularly vulnerable to the onset of GAD, social phobia, panic disorder, and OCD, as well as other psychological problems
Comer, Fundamentals of Abnormal Psychology, 3e

4. Stress, Coping, and the Anxiety Response
Stress also plays a more central role in certain psychological disorders, including:
Acute stress disorder
Posttraumatic stress disorder
Technically, DSM-IV-TR lists these patterns as anxiety disorders
…as well as certain physical disorders called psychophysiological disorders
These disorders are listed in the DSM-IV-TR under “psychological factors affecting medical condition”
Comer, Fundamentals of Abnormal Psychology, 3e

5. Stress and Arousal: The Fight-or-Flight Response
The features of arousal and fear are set in motion by the hypothalamus
Two important systems are activated:
Autonomic nervous system (ANS)
An extensive network of nerve fibers that connect the central nervous system (the brain and spinal cord) to the body’s other organs
Contains two systems: sympathetic and parasympathetic
Endocrine system
A network of glands throughout the body that release hormones
Comer, Fundamentals of Abnormal Psychology, 3e

6. Stress and Arousal: The Fight-or-Flight Response
When confronting a dangerous situation, the hypothalamus first activates the sympathetic nervous system, which stimulates key organs either directly or indirectly
When the perceived danger passes, the parasympathetic nervous system helps return bodily systems to normal
Comer, Fundamentals of Abnormal Psychology, 3e

7. Stress and Arousal: The Fight-or-Flight Response
The reactions displayed by these two pathways are referred to as the fight-or-flight response
People differ in their particular patterns of autonomic and endocrine functioning and therefore also in their particular ways of experiencing arousal and fear…
Comer, Fundamentals of Abnormal Psychology, 3e

8. Stress and Arousal: The Fight-or-Flight Response
People differ in:
Their general level of anxiety
Called “trait anxiety”
Some people are usually somewhat tense; others are usually relaxed
Differences appear soon after birth
Their sense of threat
Called “state anxiety”
Situation-based (example: fear of flying)
Comer, Fundamentals of Abnormal Psychology, 3e

9. The Psychological Stress Disorders
During and immediately after trauma, many people become highly anxious and depressed
For some, feelings persist well after the trauma
These people may be experiencing:
Acute stress disorder
Posttraumatic stress disorder (PTSD)
The precipitating event usually involves actual or threatened serious injury to self or others
Occurs following an event which would be traumatic to anyone (unlike other anxiety disorders)
Comer, Fundamentals of Abnormal Psychology, 3e

10. The Psychological Stress Disorders
Acute stress disorder
Symptoms begin within four weeks of event and last for less than one month
Posttraumatic stress disorder (PTSD)
Symptoms can begin at any time following the event but must last for longer than one month
May develop from acute stress disorder
Comer, Fundamentals of Abnormal Psychology, 3e

11. Comer, Fundamentals of Abnormal Psychology, 3e

12. What Triggers a Psychological Stress Disorder?
Can occur at any age and affect all aspects of life
~4% of U.S. population affected each year
~7% of U.S. population affected sometime during life
Approximately 2/3 seek treatment at some point
Ratio of women to men is 2:1
After trauma, 20% of women and 8% of men develop disorders
Some events – including combat, disasters, abuse, and victimization – are more likely to cause disorders than others
Comer, Fundamentals of Abnormal Psychology, 3e

13. What Triggers a Psychological Stress Disorder?
Combat and stress disorders
It has long been recognized that soldiers experience distress during combat
Called “shell shock,” “combat fatigue”
Post-Vietnam War clinicians discovered that soldiers also experienced psychological distress after combat
~30% of Vietnam combat veterans suffered acute or posttraumatic stress disorders
An additional 22% had some stress symptoms
10% still experiencing problems
Comer, Fundamentals of Abnormal Psychology, 3e

14. What Triggers a Psychological Stress Disorder?
Disasters and stress disorders
Acute or posttraumatic stress disorders may also follow natural and accidental disasters
Civilian traumas have been implicated in stress disorders at least 10 times as often as combat trauma
Types of disasters include traffic accidents, weather, earthquakes, and airplane crashes
Comer, Fundamentals of Abnormal Psychology, 3e

15. What Triggers a Psychological Stress Disorder?
Victimization and stress disorders
People who have been abused, victimized, or terrorized often experience lingering stress symptoms
Common victimization is sexual assault/rape
~1 in 7 women is raped at some time during her life
Psychological impact is immediate and may be long-lasting
One study found that 94% of rape survivors developed an acute stress disorder within 12 days after assault
Comer, Fundamentals of Abnormal Psychology, 3e

16. Why Do People Develop a Psychological Stress Disorder?
Biological and genetic factors
Traumatic events trigger physical changes in the brain and body that may lead to severe stress reactions, and, possibly, stress disorders
Some research suggests abnormal NT and hormone activity (especially norepinephrine and cortisol)
There may be a biological/genetic predisposition to such reactions
Evidence suggests that other biological changes and damage may also occur as a stress disorder sets in
Comer, Fundamentals of Abnormal Psychology, 3e

17. Why Do People Develop a Psychological Stress Disorder?
Personality factors
Some studies suggest that people with certain personality profiles, attitudes, and coping styles are more likely to develop stress disorders
Risk factors include:
Preexisting high anxiety
A history of psychological problems
Negative worldview
A set of positive attitudes (called resiliency or hardiness) is protective against developing stress disorders
Comer, Fundamentals of Abnormal Psychology, 3e

18. Why Do People Develop a Psychological Stress Disorder?
Negative childhood experiences
A wave of studies has found that certain childhood experiences increase risk for later stress disorders
Risk factors include:
An impoverished childhood
Psychological disorders in the family
The experience of assault, abuse, or catastrophe at an early age
Being younger than 10 years old when parents separated or divorced
Comer, Fundamentals of Abnormal Psychology, 3e

19. Why Do People Develop a Psychological Stress Disorder?
Social support
People whose social support systems are weak are more likely to develop a stress disorder after a negative event
Severity of the trauma
The more severe the trauma and the more direct one’s exposure to it, the greater the likelihood of developing a stress disorder
Especially risky: mutilation and severe injury; witnessing the injury or death of others
Comer, Fundamentals of Abnormal Psychology, 3e

20. How Do Clinicians Treat the Psychological Stress Disorders?
Psychological debriefing
A form of crisis intervention that has victims of trauma talk extensively about their feelings and reactions within days of the critical incident
Four-stage approach:
Normalize responses to the disaster
Encourage expressions of anxiety, anger, and frustration
Teach self-help skills
Provide referrals
Relief workers themselves may become overwhelmed
Research on this type of intervention has called into question its effectiveness
Comer, Fundamentals of Abnormal Psychology, 3e