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Chapter 7
Acute and Posttraumatic Stress
Disorders, Dissociative Disorders, and
Somatoform Disorders
Copyright © 2006 Pearson Education Canada Inc.
Quote of the Day
Remembrance has a Rear and Front,
'Tis something like a HouseIt has a Garret also
For Refuse and the Mouse.
-- Emily Dickinson
Copyright © 2006 Pearson Education Canada Inc.
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Overview



Focus: normal vs. pathological reactions to
trauma
Dissociation – disruption of the normally
integrated processes of memory
consciousness, identity, or perception
Anxiety, dissociation, and stress are linked
–
much disagreement about the link
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Acute and Posttraumatic Stress
Disorders
Stress: normal aspect of everyday life
(Ch. 8)
 Traumatic stress:

–
–
event that involves actual or threatened
death/serious injury to self or others
Creates intense feelings of fear or horror
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Acute stress disorder (ASD)
within 4 weeks after exposure to
trauma
 characterized by

–
–
–
dissociative symptoms
re-experiencing of the event
marked anxiety/arousal
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Posttraumatic stress disorder (PTSD)

like ASD, characterized by
–
–
–

dissociative symptoms
re-experiencing of the event
marked anxiety/arousal
Unlike ASD, symptoms long-lasting
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Case Study:
Lt.-Gen. Roméo Dallaire
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
PTSD due to trauma during Rwandan conflict
(1993-1994)
Largely helpless during the genocide
Fired upon, received death threats,
witnessed massacre of staff
Now prominent advocate for treatment of
PTSD in Canadian military
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ASD & PTSD: Typical Symptoms
1.
2.
3.

Re-experiencing trauma
Avoidance of associated stimuli
Persistent arousal/anxiety
ASD not PTSD: dissociative
symptoms
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1. Re-experiencing Trauma


Persistent, horrific images (e.g.,
nightmares)
Flashbacks – spontaneous memories
of trauma
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2. Avoidance



thoughts or feelings about the event
associated people, places, or
activities
numbing of responsiveness
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3. Arousal/Anxiety

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hypervigilance
sleep/concentration difficulties
irritability
heightened startle response
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ASD:
dissociative symptoms

Depersonalization
–

feeling outside of oneself or one’s environment
Derealization
–
marked sense of unreality of oneself or one’s
environment
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Historical Perspective
neurosis”
 “shell shock”
 interest in PTSD amplifies following
Vietnam War

“combat
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DSM IV-TR: Defining Trauma
event: actual/threatened death or
serious injury to self or others
 response: intense fear, helplessness, &
horror

 emphasizes
subjective response
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Etiology

Social factors
–
–

Biological factors
–
–

level of exposure
post-trauma social support
genetic
amygdala
Psychological factors
–
–
two-factor theory
Edna Foa: emotional processing
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Prevention/Treatment
critical incident stress debriefing
(CISD)
 anti-depressants (but not anxiolytics)
 CBT

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Dissociative Disorders
persistent problems in the integration
of memory, consciousness, or identity
 perhaps best interpreted from a
psychoanalytic perspective

–
Unconscious processes
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Typical Symptoms

Dissociative Identity Disorder (DID)
–
–

Depersonalization Disorder
–

formally called Multiple Personality Disorder
2+ personalities in the same individual
out-of-body experiences
Dissociative Amnesia
–
impaired memory of psychogenic origin
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DID Controversies

problem of self-report

reliability of recovered memories
–
–
infantile amnesia
scientific evidence for false memories
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Quote of the Day

“Well, this has been kind of fun, but I really
must go. I’m conducting a seminar for
multiple personality disorders, and it takes
me forever to fill out the name tags.”
Dr. Niles Crane
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Skepticism regarding DID



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most diagnoses by a small number of
advocates
increased diagnoses following release of
Sybil
increasing number of personalities in DID
cases
why only in North America?
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Etiology

Psychological factors
–
–
–

Biological factors
–

recurring childhood trauma
self-hypnosis
state dependant learning
genetic (conflicting research findings)
Social factors
–
Social role theory
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Spanos’ Theory of DID

not a true “disorder”

patients are role-playing
–
symptoms are iatrogenic
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Treatment of Dissociative Disorders

Psychological approach
–
recovery of traumatic memories

–

hypnosis
main objective: integration of personalities
Medical approach
–
distress reduction
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Somatoform Disorders
 Problems
featuring physical
symptoms with no organic basis
 perhaps best interpreted from a
psychoanalytic perspective
symptoms not faked
– unconscious factors
–
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Typical Symptoms: 3 Variations
single impairment of somatic system
(e.g., paralysis, blindness)
 multiple physical symptoms (e.g., pain
& gastrointestinal symptoms)
 Preoccupation with a single disease
(e.g., cancer)

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5 types of somatoform disorders
1) Conversion Disorder
 psychological conflicts converted into
physical symptoms
 symptoms mimic common neurological
conditions
 often inconsistent with accurate anatomical
functioning
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Research on Conversion Blindness
• What happens if a researcher asks a
person with conversion blindness to
“guess” in a recognition task? (e.g., is
the bear on the right or left?)
• the person responds at a level
significantly above chance.
• malingerers respond at a level below
chance.
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5 types of somatoform disorders
2) Somatization


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Disorder
referred to at Briquet’s syndrome
patient complains of at least 8 symptoms
clinical presentation
–
–
histrionic
la belle indifference
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5 types of somatoform disorders
3) Hypochondriasis

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belief that one has a serious disease (e.g.,
brain cancer)
minimum 6 month duration
“doctor shopping”
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5 types of somatoform disorders
4) Pain

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Disorder
preoccupation with pain symptoms
complaints seem obsessive
no known biological origin
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5 types of somatoform disorders
5) Body
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
preoccupation with an imagined physical
defect
common complaints:
–

Dysmorphic Disorder
nose, mouth, ears
common result:
–
unnecessary plastic surgeries
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Diagnosing Somatoform Disorders

First rule out intentional deception
–
Malingering
 Feigning
–
condition for external gain
Factitious Disorder
 Intentionally
feigning condition
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False Symptoms Can Be Intentional:
Factitious Disorders
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also called Munchausen’s Syndrome
motivation is conscious and to assume
the sick role
no other incentives (money, attention,
etc.) present
Munchausen’s by proxy: intentionally
induce sickness in one’s child to assume
the sick role!
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Etiology

Biological factors
–

Psychological factors
–
–
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possibility of misdiagnosis
imagined or real trauma
secondary gain
Social factors
–
culturally-specific anxiety
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Treatment of Somatoform Disorders


Traditionally, little empirical testing
Cognitive-behavioural approach
–

Pain Disorder: reward successful coping
Medical approach
–
antidepressants
need for physician empathy
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